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Physical Therapy & Steroid Shots May Both Benefit For Shoulder Pain

Nearly 85% of shoulder conditions involve the rotator cuff, and among the most common of these is shoulder impingement syndrome (SIS). SIS results from the rotator cuff tendons becoming compressed—or “impinged”—as they pass through a small bone on top of the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, which eventually leads to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement, and pain.

SIS is most common in individuals that regularly perform lots of overhead activities, especially golfers, swimmers, and baseball and tennis players, as well as painters and construction workers. The condition can also result from an injury that compresses the structures of the shoulder—like a fall—or from frequently sleeping on your side regularly, which can strain the shoulder and cause impingement over time.

SIS is closely related to rotator cuff tendinitis and subacromial pain, and in some cases, the terms are used interchangeably. When any of these conditions develop, the best course of action is a comprehensive physical therapy program, which utilizes movement–based treatments to alleviate pain and increase strength, flexibility, and physical function. However, many patients with SIS go to a primary care physician or some other healthcare provider rather than a physical therapist, and while these providers typically do what they think is best for patients, in some cases they prescribe interventions that are costly and/or ineffective for alleviating shoulder pain.
Researchers review three studies comparing injections to physical therapy

One of these interventions is steroid injections, which some healthcare providers use to provide short–term pain relief for conditions like SIS. However, research analyzing the differences between physical therapy and steroid injections is limited, and this led a team of researchers to conduct a study called a systematic review to compare these two interventions.

For the systematic review, investigators searched a major medical database for studies that compared physical therapy to steroid injections for patients with shoulder pain caused by SIS. This search led to three high–quality studies called randomized–controlled trials being included in the review, which featured data on 452 patients.

Results from these three studies revealed that both physical therapy and steroid injections led to improvements in pain, shoulder range of motion (ROM), and shoulder function in the short term (1–3 months), medium term (6 months), and long term (12 months). Although steroid injections were more effective than physical therapy for improving shoulder function in the short term at 6–7 weeks, there were no significant differences between these interventions in pain, shoulder ROM, or shoulder function at the medium–term or long–term follow–ups.

Based on these findings, it appears that both physical therapy and steroid injections provide similar benefits for patients with shoulder pain caused by SIS, with neither intervention found to be superior to the other. Therefore, researchers recommend that patients should be educated on the risks versus benefits of each intervention and given the choice between interventions based on their preference. As a part of this discussion, patients should be informed that physical therapy is generally regarded as a lower–risk treatment option, as evidence on the long–term risks of steroid injections is limited and some studies have found that injections can lead to a compromised immune system and cartilage toxicity over time.

If you’re currently dealing with SIS, we encourage you to explore all treatment options available to you before making a decision. And if you decide that physical therapy is right for you, we’d be more than happy to get you started on a comprehensive treatment program right away.

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