Abstract
Background:
Subacromial impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. Modified posterior shoulder stretching exercises have been proposed as a treatment method aimed at improving shoulder function and reducing pain in patients with SIS. However, the efficacy of these exercises remains controversial, necessitating a systematic meta-analysis to comprehensively evaluate their effectiveness.
Methods:
A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials (RCTs) and observational studies evaluating the efficacy of modified posterior shoulder stretching exercises in patients with SIS. Inclusion criteria required that participants be diagnosed with SIS, the intervention be modified posterior shoulder stretching exercises, and key outcomes such as shoulder function improvement and pain relief be reported. Meta-analysis was performed using RevMan 5.3 software, calculating standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity and bias risk were assessed.
Results:
A total of 10 RCTs with 628 patients were included. The modified posterior shoulder stretching exercises demonstrated significant effects in reducing pain at rest (SMD = –1.00, 95% CI: −1.85 to −0.15, P = .02) and during activity (SMD = –1.45, 95% CI: −2.49 to −0.41, P = .006). Additionally, the exercises showed positive effects in improving internal rotation (SMD = 0.49, 95% CI: 0.22–0.75, P = .0003) and external rotation range of motion (SMD = 0.29, 95% CI: 0.00–0.58, P = .05), as well as enhancing shoulder function (CMS score: SMD = 0.95, 95% CI: 0.64–1.25, P < .00001) and reducing disability (quick DASH score: SMD = –0.85, 95% CI: −1.12 to −0.58, P < .00001). Sensitivity analysis indicated high robustness of the results, and Egger test did not reveal significant publication bias (P > .05).
Conclusion:
Modified posterior shoulder stretching exercises are significantly effective in improving shoulder function and reducing pain in patients with SIS, with the study results showing high robustness and low risk of bias. However, further high-quality research is needed to validate these findings.
Keywords: meta-analysis, modified posterior shoulder stretching exercises, pain relief, shoulder function, subacromial impingement syndrome
1. Introduction
Subacromial Impingement Syndrome (SIS) is 1 of the primary causes of shoulder pain and functional impairment, commonly observed in individuals with repetitive overhead activities or structural abnormalities of the shoulder.[1,2] SIS typically results from the compression or friction of soft tissues, such as the supraspinatus tendon and subacromial bursa, within the subacromial space, leading to local inflammation and pain.[3,4] As the condition progresses, patients may experience restricted shoulder mobility, increased pain during the night, and a significant decline in daily living activities.[5] SIS is particularly prevalent among athletes, manual laborers, and the elderly,[6] whose professions or lifestyles predispose them to the risk factors associated with the syndrome.
Current treatment approaches for SIS include both nonsurgical and surgical options. Nonsurgical treatments are typically the first line of intervention and include physical therapy, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management, and corticosteroid injections to reduce local inflammation.[7–9] While these methods often yield favorable outcomes in early cases, they may be less effective for some patients, especially those with a longer disease course or more severe symptoms.[10] For these patients, surgical interventions such as subacromial decompression may become necessary. Surgery aims to relieve the pressure on subacromial structures by removing the impinging factors, thereby directly alleviating symptoms.[11,12] However, surgery is not suitable for all patients due to potential risks, the complexity of postoperative rehabilitation, and some patients’ reluctance to undergo surgery, prompting clinicians and patients to seek effective nonsurgical alternatives.
Posterior shoulder stretching exercises have garnered attention in recent years as a nonsurgical treatment modality for SIS.[13] These exercises aim to increase shoulder joint mobility, reduce tension in the joint capsule and soft tissues, and subsequently relieve pressure on the subacromial structures.[14] However, while these exercises have shown some effectiveness in certain patients, they may have limitations in practice. Specifically, traditional stretching exercises may not adequately target specific muscle groups or shoulder structures, potentially limiting their efficacy in some cases.[15] In response to these challenges, researchers have developed modified posterior shoulder stretching exercises. These modifications integrate the latest biomechanical theories with modern rehabilitation techniques, specifically targeting the pathophysiological mechanisms of SIS.[16–18] The modified exercises not only retain the advantages of traditional stretching but also include precise adjustments in movement and muscle activation designed to more effectively alleviate pressure on the subacromial structures and improve shoulder function.[19] Despite promising preliminary results, the efficacy of these modified stretching exercises remains controversial in the existing literature.[17–19] Some studies have been limited by small sample sizes, suboptimal study designs, or a lack of long-term follow-up data, making it difficult to generalize their findings and assess their clinical relevance fully.[13,20–22] Therefore, a systematic meta-analysis is necessary to comprehensively evaluate the impact of these modified exercises on shoulder function in SIS patients.
Traditional treatments for SIS, such as conventional stretching and physical therapy, often lack specificity in targeting the posterior shoulder structures associated with impingement. This study systematically evaluated the efficacy of modified posterior shoulder stretching exercises, which incorporate the latest biomechanical principles and specifically target the pathophysiological mechanisms of SIS, through a meta-analysis to provide more comprehensive evidence for their effectiveness in reducing subacromial pressure, alleviating pain, and improving shoulder function. By synthesizing and analyzing existing clinical research data, this study aims to provide a more comprehensive evidence base to help clinicians better understand and implement these modified stretching exercises, ultimately improving patient outcomes and quality of life.
2. Methods
2.1. Databases and literature search strategy
To retrieve relevant research literature, a systematic search was conducted across several authoritative databases, including PubMed, Cochrane Library, Embase, and Web of Science. The selection of search keywords was based on the core concepts and related terms pertinent to the research topic. The primary search terms included “SIS,” “posterior shoulder stretching,” “shoulder function,” and “modified exercises.” Additionally, Boolean operators (such as AND and OR) were employed to combine these keywords, The specific search strategies used were as follows: (“SIS”[MeSH terms] OR “SIS”[all fields]) AND (“posterior shoulder stretching”[all fields] OR “shoulder function”[all fields] OR “modified exercises”[all fields]), The literature search covered the period from the inception of each database to August 2024, ensuring the inclusion of the most up-to-date relevant studies.
2.2. Inclusion and exclusion criteria
To ensure the scientific rigor and reliability of this study’s results, strict inclusion and exclusion criteria were established. The inclusion criteria are as follows: the study must be a RCT or an observational study (such as cohort studies or case-control studies) aimed at evaluating the efficacy of modified posterior shoulder stretching exercises in patients with SIS; the study population must consist of patients who have been definitively diagnosed with SIS, with clearly defined diagnostic criteria; the study must include modified posterior shoulder stretching exercises as the primary intervention, either alone or in combination with other treatment modalities; the study must report key outcomes such as shoulder function improvement and pain relief, using scientifically valid measurement methods. The exclusion criteria include non-original research (e.g., review articles, case reports), studies in which patients were not clearly diagnosed with SIS or where the diagnostic criteria were unclear, studies that did not include modified posterior shoulder stretching exercises as an intervention or where the effects of this intervention could not be separately evaluated, and studies where the outcome measures did not involve shoulder function improvement or pain relief, or where the evaluation methods were significantly limited.
2.3. Data extraction and quality assessment
Following the selection of studies, the research team systematically extracted data and assessed the quality of the included studies. The extracted variables encompassed both basic study information and outcome data. Specifically, the extracted information included the author’s name, publication year, sample size, detailed description of the intervention, and specific data on key outcomes such as shoulder function improvement and pain relief.
To evaluate the quality of the included studies, the Cochrane risk of bias tool was employed. This tool systematically assesses the internal validity of each study across several dimensions, including randomization process, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential sources of bias. Based on the assessment results, the risk of bias for each study was categorized as “low risk,” “unclear risk,” or “high risk,” ensuring that these factors are adequately considered in the subsequent analysis.
2.4. Statistical methods
In this study, statistical methods were employed to conduct a meta-analysis of the data from the included studies. For continuous variables, such as shoulder function scores and pain scores, standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to assess the effect of modified posterior shoulder stretching exercises on patients with SIS. For dichotomous variables, risk ratios with 95% CIs were computed. To assess heterogeneity among the studies, the I2 statistic and Q test were used. The I2 value ranges from 0% to 100%, with higher values indicating greater heterogeneity among studies. If the I2 value exceeds 50% or the P-value of the Q test is <.1, significant heterogeneity is indicated, and a random-effects model will be applied; otherwise, a fixed-effects model will be used. Additionally, to evaluate potential publication bias, Egger test was performed for quantitative assessment. All statistical analyses were conducted using RevMan 5.3 software (Oxford, UK) with a P-value of <.05 considered statistically significant.
3. Result
3.1. Literature screening process and characteristics of included studies
This study utilized a preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart to illustrate the literature screening process. The initial search identified 1320 relevant studies. After removing duplicates (n = 196), 1124 records were screened. Following the abstract screening, 1048 records were excluded for not meeting the inclusion criteria. Subsequently, 76 reports were sought for full-text assessment, with none excluded due to unavailability. Out of the 76 reports, 66 were excluded for the following reasons: missing key outcome measures (n = 26), data could not be extracted (n = 31), or they were reviews, meta-analyses, case reports, etc (n = 9). Finally, 10 studies met the inclusion criteria and were included in the meta-analysis (Fig. 1). The 10 included studies were all randomized controlled trials (RCTs), with study populations drawn from various countries and regions, including Turkey (4 studies), the USA, Sweden, Korea, Iran, and Japan. Sample sizes varied, with the experimental group sizes ranging from 10 to 51 participants, and control group sizes ranging from 10 to 46 participants. The average age of participants ranged from 21.4 to 59.13 years, with some studies reporting BMI data, ranging from 23.7 kg/m² to 29.69 kg/m² (Table 1).
Figure 1.
PRISMA flow diagram of the literature screening process. PRISMA = preferred reporting items for systematic reviews and meta-analyses.
Table 1.
Characteristics of included studies.
| Author | Year | Study design | Country/region | Sample size | Age (yr) | BMI (kg/m2) | Female; n (%) | Follow-up | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Experimental | Control | Experimental | Control | Experimental | Control | Experimental | Control | |||||
| Başkurt et al[23] | 2011 | RCT | Turkey | 20 | 20 | 51.25 (11.55) | 51.50 (8.40) | 26.22 (3.10) | 25.46 (3.02) | / | / | 10 mo |
| Gharisia et al[16] | 2021 | RCT | USA | 20 | 22 | 26.0 (2.5) | 25.9 (2.6) | 27.3 (4.5) | 25.1 (3.5) | 11 (55) | 11 (50) | 1 mo |
| Holmgren et al[17] | 2012 | RCT | Sweden | 51 | 46 | 52 (9) | 52 (8) | / | / | 14 (27.45) | 22 (47.8) | 3 mo |
| Özlü et al[18] | 2024 | RCT | Turkey | 24 | 24 | 53.42 (14.45) | 59.13 (12.67) | 25.92 (4.22) | 29.0 (6.19) | 12 (50) | 17 (70.8) | 3 mo |
| Park et al[19] | 2020 | RCT | Korea | 10 | 10 | 49.20 (9.48) | 50.90 (9.10) | / | / | 7 (70) | 7 (70) | 3 mo |
| Shariat et al[20] | 2018 | RCT | Iran | 43 | 28 | 29.41 (1.16) | 28.74 (0.82) | / | / | / | / | 6 mo |
| Tahran et al[13] | 2020 | RCT | Turkey | 22 | 23 | 51.64 (13.15) | 55 (9.7) | 29.69 (4.83) | 28.94 (4.81) | 8 (36.4) | 5 (21.73) | 1 mo |
| Turgut et al[21] | 2017 | RCT | Turkey | 15 | 15 | 33.4 (9.3) | 39.5 (8.2) | 23.7 (2.19) | 25.8 (3.66) | 7 (46.6) | 7 (46.6) | 4 mo |
| Türksan et al[22] | 2024 | RCT | Turkey | 24 | 23 | 50.9 (10.1) | 48.4 (13.2) | 25.2 (4.0) | 28.1 (5.8) | 14 (58.3) | 11 (47.8) | 1 mo |
| Yamauchi et al[24] | 2016 | RCT | Japan | 12 | 11 | 21.4 (1.2) | 20.3 (0.9) | / | / | / | / | 3 mo |
3.2. Quality assessment of included studies
Figure 2 presents the risk of bias assessment results for the 10 RCTs, evaluated using the Cochrane risk of bias tool across several dimensions. The results show that most studies had a low risk of bias in “random sequence generation” and “allocation concealment,” though some studies exhibited unclear risk in allocation concealment. “Blinding of participants and personnel” displayed a higher risk of bias, primarily due to the difficulty of fully implementing blinding in physical therapy interventions. “Blinding of outcome assessment” was mostly rated as low risk, although a few studies showed unclear risk in this aspect. “completeness of outcome data” was generally good, with a low risk of bias, while some studies had unclear risk in “selective reporting.” Despite some bias in blinding, the overall quality of the included studies was high, providing a reliable foundation for the meta-analysis.
Figure 2.
Risk of bias of 10 RCTs. RCTs = randomized controlled trials.
3.3. Meta-analysis of pain
3.3.1. Pain at rest
As shown in Figure 3, the meta-analysis of pain at rest included 3 studies that compared the effects of modified posterior shoulder stretching exercises on pain reduction in patients with SIS. Due to the moderate heterogeneity among the studies (I2 = 78%, P = .01), a random-effects model was used to calculate the standardized mean difference (SMD). The pooled results showed a significant reduction in pain at rest in the experimental group compared to the control group, with an overall SMD of −1.00 (95% CI: −1.85 to −0.15, P = .02) (Fig. 2). These findings indicate that modified posterior shoulder stretching exercises are effective in reducing pain at rest in patients with SIS, with a significant overall effect favoring the experimental intervention over the control. The observed heterogeneity may be attributed to differences in exercise protocols among the studies, including variations in the duration, frequency, and intensity of the stretching exercises. Additionally, differences in patient characteristics, such as baseline pain levels and disease severity, might have influenced individual responses to the intervention. Despite these sources of variability, the overall effect suggests that modified posterior shoulder stretching exercises are effective in reducing pain at rest in patients with SIS, with a significant advantage for the experimental intervention over the control.
Figure 3.
Meta-analysis of pain at rest in patients with SIS. SIS = subacromial impingement syndrome.
3.3.2. Pain at activity
The meta-analysis of pain during activity included 3 studies, as shown in Figure 4. These studies compared the effects of modified posterior shoulder stretching exercises on pain reduction during activity in patients with SIS. Due to the high heterogeneity observed among the studies (I2 = 83%, P = .003), a random-effects model was used to calculate the SMD. The pooled results indicated a significant reduction in pain during activity in the experimental group compared to the control group, with an overall SMD of −1.45 (95% CI: −2.49 to −0.41, P = .006). These findings suggest that modified posterior shoulder stretching exercises are effective in reducing pain during activity for patients with SIS, with a significant overall effect favoring the experimental intervention. The high heterogeneity may be due to several factors. First, variations in exercise protocols across studies – such as differences in duration, frequency, intensity, and specific techniques – likely affected the effectiveness of the interventions. Second, differences in patient characteristics (e.g., baseline pain severity, disease duration, physical activity levels) may have influenced individual responses to the exercises. Lastly, the use of different scales and tools to assess pain during activity could have introduced inconsistencies when pooling data. Despite these sources of variability, the overall findings indicate that modified posterior shoulder stretching exercises significantly reduce pain during activity in patients with SIS, favoring the experimental intervention.
Figure 4.
Meta-analysis of pain during activity in patients with SIS. SIS = subacromial impingement syndrome.
3.4. Meta-analysis of shoulder rotation
3.4.1. Internal rotation range of motion
The meta-analysis of internal rotation (IR) range of motion (ROM) included 6 studies, as shown in Figure 5. These studies evaluated the effect of modified posterior shoulder stretching exercises on the improvement of shoulder IR ROM in patients with SIS. A fixed-effects model was applied due to moderate heterogeneity among the studies (I2 = 38%, P = .15).The combined results demonstrated a statistically significant improvement in IR ROM in the experimental group compared to the control group, with an overall SMD of 0.49 (95% CI: 0.22–0.75, P = .0003). These findings imply that modified posterior shoulder stretching exercises are effective in enhancing IR ROM in patients with SIS. The moderate effect size favors the experimental intervention, indicating that these targeted exercises may play a beneficial role in restoring shoulder mobility and potentially alleviating the functional limitations associated with SIS.
Figure 5.
Meta-analysis of IR ROM in patients with SIS. IR = internal rotation, ROM = range of motion, SIS = subacromial impingement syndrome.
3.4.2. External rotation ROM
The meta-analysis of external rotation (ER) ROM included 5 studies, as shown in Figure 6. These studies assessed the impact of modified posterior shoulder stretching exercises on shoulder ER ROM in patients with SIS. A fixed-effects model was used due to the low heterogeneity among the studies (I2 = 29%, P = .23).The combined results showed a small but statistically significant improvement in ER ROM in the experimental group compared to the control group, with an overall standardized mean difference (SMD) of 0.29 (95% CI: 0.00–0.58, P = .05). These findings imply that modified posterior shoulder stretching exercises may provide a modest benefit in enhancing ER ROM in patients with SIS. However, the small effect size suggests that this improvement may vary depending on factors such as individual patient characteristics and specific study protocols. While the intervention appears to positively impact ER ROM, the clinical significance of this effect may be limited and could require further investigation in diverse patient populations and with standardized exercise protocols to confirm its applicability.
Figure 6.
Meta-analysis of external rotation range of motion in patients with SIS. SIS = subacromial impingement syndrome.
3.5. Meta-analysis of shoulder function and disability
3.5.1. Constant-Murley score
The meta-analysis of shoulder function and disability using the constant-Murley score (CMS) included 3 studies, as shown in Figure 7. These studies assessed the impact of modified posterior shoulder stretching exercises on shoulder function and disability in patients with SIS. A fixed-effects model was used due to the low heterogeneity among the studies (I2 = 0%, P = .73).The pooled results demonstrated a statistically significant improvement in CMS in the experimental group compared to the control group, with an overall standardized mean difference (SMD) of 0.95 (95% CI: 0.64–1.25, P < .00001). These findings indicate that modified posterior shoulder stretching exercises are highly effective in enhancing shoulder function and reducing disability associated with SIS. The strong effect size supports the clinical relevance of this intervention, suggesting that these exercises may offer meaningful improvements in daily function and quality of life for patients. The consistency across studies further reinforces the potential value of incorporating these targeted stretching exercises into the nonsurgical management of SIS.
Figure 7.
Meta-analysis of shoulder function and disability using the constant-Murley score in patients with SIS. SIS = subacromial impingement syndrome.
3.5.2. Quick DASH score
The meta-analysis of shoulder function and disability using the quick disabilities of the arm, shoulder, and hand (quick DASH) score included 4 studies, as shown in Figure 8. These studies evaluated the impact of modified posterior shoulder stretching exercises on reducing disability in patients with SIS. A fixed-effects model was applied due to the low heterogeneity among the studies (I2 = 0%, P = .86).The pooled results showed a statistically significant reduction in the quick DASH score in the experimental group compared to the control group, with an overall standardized mean difference (SMD) of −0.85 (95% CI: −1.12 to −0.58, P < .00001). These findings suggest that modified posterior shoulder stretching exercises are highly effective in reducing shoulder-related disability in SIS patients, as measured by the quick DASH score. The strong effect size highlights the clinical relevance of these exercises, suggesting that they can lead to meaningful improvements in daily activities and overall quality of life for patients with SIS. Furthermore, the consistency of the effect across studies reinforces the potential utility of incorporating these modified exercises into nonsurgical treatment protocols for SIS.
Figure 8.
Meta-analysis of shoulder disability using the quick DASH Score in patients with SIS. Quick DASH = quick disabilities of the arm, shoulder, and hand score, SIS = subacromial impingement syndrome.
3.6. Sensitivity analysis and bias risk assessment
To assess the robustness of the study results and potential bias, sensitivity analysis and Egger test were conducted. Sensitivity analysis, which involved sequentially excluding individual studies and recalculating the overall effect size, indicated that the effect size remained consistent, suggesting high stability of the results. Additionally, Egger test did not reveal significant publication bias (P > .05), indicating a low risk of bias and supporting the reliability of the study’s conclusions.
4. Discussion
4.1. Main findings
This study systematically evaluated the efficacy of modified posterior shoulder stretching exercises in patients with SIS through a meta-analysis. The key findings include significant improvements in shoulder function, reductions in pain at rest and during activity, and enhancements in shoulder internal and external rotation ROM due to the modified exercises. Specifically, the SMD for pain reduction at rest and during activity were –1.00 and −1.45, respectively, indicating significant pain relief. Additionally, the SMDs for improvements in internal and external rotation ROM were 0.49 and 0.29, respectively, showing effective enhancement of shoulder mobility. The modified exercises also demonstrated significant benefits in increasing CMSs (SMD = 0.95) and reducing quick DASH scores (SMD = –0.85), indicating positive effects in reducing shoulder disability associated with SIS.
4.2. Comparison with existing research
Compared to traditional treatments, such as conventional stretching exercises and pharmacological therapies, the modified posterior shoulder stretching exercises showed more significant efficacy in improving shoulder function and alleviating pain in SIS patients.[21–23] While conventional treatments, including regular physical therapy and medications, are effective, they often require longer treatment durations and may not achieve the same level of improvement as the modified exercises. For example, conventional physical therapy typically involves stretching, strengthening, and posture correction, which, while beneficial for shoulder function, may not alleviate pain as effectively as the modified exercises.[24,25] Similarly, pharmacological treatments, such as NSAIDs and corticosteroid injections, offer quick pain relief but often have short-term effects and potential side effects.[26]
In comparison with other similar studies, this research further confirms the effectiveness of modified posterior shoulder stretching exercises in relieving SIS symptoms. Although some previous studies also suggested that posterior shoulder stretching exercises are effective for SIS patients, their conclusions have sometimes been inconsistent due to small sample sizes or inadequate study designs.[13,19,20] This study, by including a larger sample and employing rigorous meta-analytic methods, provides more reliable evidence supporting the clinical value of these modified exercises.
4.3. Mechanisms of action
The modified posterior shoulder stretching exercises likely exert their effects through multiple mechanisms. Firstly, by specifically targeting the muscles and soft tissues at the posterior aspect of the shoulder joint, these exercises reduce pressure within the subacromial space, relieving compression on the rotator cuff muscles, thereby reducing pain and functional impairment.[27,28] This targeted stretching enhances the flexibility of the shoulder capsule, reducing friction and impingement within the subacromial structures.[29] Additionally, the modified exercises may improve shoulder joint stability, reducing the frequency of subacromial impingement, which is crucial for long-term symptom relief.[30] Finally, these exercises may enhance shoulder muscle coordination, improving shoulder mobility and overall function, which contributes to better quality of life.[31,32]
4.4. Study limitations
Despite the positive findings from this meta-analysis, there are several limitations. Firstly, the included trials exhibited differences in study protocols, such as variations in intervention frequency, duration, and specific implementation details. These protocol differences could affect the consistency of the results and contribute to variability in effect sizes across studies. Additionally, the varying follow-up durations may have influenced the assessment of long-term effects, as studies with shorter follow-up periods might not capture sustained benefits. Secondly, differences in study environments, including healthcare settings, patient demographics, and regional rehabilitation practices, may have impacted outcomes. Variations in clinical practice standards and patient access to resources across different sites could influence both patient adherence and their response to the intervention, potentially limiting the generalizability of the findings. Lastly, while the meta-analysis demonstrated overall robust results, the small sample sizes and heterogeneity among studies might limit the broader applicability of these conclusions. Additionally, some studies showed a risk of bias in blinding and outcome reporting, which could impact the reliability of the results. To address these limitations, future studies should aim to standardize protocols and conduct trials across diverse settings to improve the robustness and applicability of the findings.
4.5. Future research directions
To further validate the efficacy of modified posterior shoulder stretching exercises, future research should consider conducting more large-scale RCTs to enhance the reliability and generalizability of the results. It is particularly important to focus on standardizing the implementation of interventions to reduce heterogeneity across studies. Moreover, future research should explore the differential responses to these exercises among various patient subgroups (e.g., different ages, genders, or stages of disease), which could help in developing more personalized treatment protocols. Finally, studies should investigate the optimal frequency, duration of intervention, and whether these exercises should be combined with other treatment modalities to maximize therapeutic outcomes and prolong the duration of benefits. These studies will further refine our understanding of the modified posterior shoulder stretching exercises and facilitate their broader application in clinical practice.
Author contributions
Conceptualization: Rui Guo.
Formal analysis: Rui Guo.
Funding acquisition: Rui Guo.
Investigation: Yang Xu.
Methodology: Yang Xu.
Project administration: Yujun Luo, Yang Xu, Kang Lan.
Resources: Yujun Luo, Kang Lan.
Software: Yujun Luo, Kang Lan.
Supervision: Yan Zhao.
Validation: Yan Zhao.
Visualization: Yan Zhao.
Writing – original draft: Rui Guo, Yujun Luo, Yang Xu, Kang Lan.
Writing – review & editing: Yan Zhao.
Abbreviations:
- CHEERS
- consolidated health economic evaluation reporting standards
- CI
- confidence interval
- CMS
- constant-Murley score
- CONSORT
- consolidated standards of reporting trials
- I2 =
- I-squared (statistic for heterogeneity in meta-analysis)
- NSAIDs
- nonsteroidal anti-inflammatory drugs
- PRISMA
- preferred reporting items for systematic reviews and meta-analyses
- P-value
- probability value (for statistical significance)
- Quick DASH
- quick disabilities of the arm, shoulder, and hand score
- RCT
- randomized controlled trial
- ROM
- range of motion
- SIS
- subacromial impingement syndrome
- SMD
- standardized mean difference
- STROBE
- strengthening the reporting of observational studies in epidemiology
Clinical efficacy and mechanism of skeletal muscle repair in patients with amyotrophic lateral sclerosis with different syndrome types treated by Tai Chi massage and kneading (2023AFD165).
This paper has been reviewed and approved by relevant departments of our hospital, such as the Science and Education Department, Medical Department and Ethics Committee of Affiliated Hospital of Hubei University of Chinese Medicine. The research content involved in this research meets the requirements of medical ethics and academic morality of our hospital, and the research content is reasonable, the risks are controllable, and there are no violations. The relevant research carried out is in line with the safe, standardized and true scientific research guiding principles, and in line with the requirements of the clinical research ethics code.
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Guo R, Luo Y, Xu Y, Lan K, Zhao Y. Efficacy of modified posterior shoulder stretching exercises on shoulder function in subacromial impingement syndrome: A comprehensive meta-analysis. Medicine 2025;104:2(e41117).
RG and YL contributed to this article equally.
Contributor Information
Rui Guo, Email: 1540374238@qq.com.
Yujun Luo, Email: luoyujun@hbhtcm.com.
Yang Xu, Email: 16065986@qq.com.
Kang Lan, Email: 380070454@qq.com.
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