Current Evidence and Future Directions in Exercise –Based Management of Subacromial Impingement Syndrome: A Narrative Review

Background: Subacromial Impingement Syndrome (SAIS) is a leading cause of shoulder pain and functional limitation, primarily managed through conservative, exercise-based interventions. Over the past few years a growing research proved the role of various exercise interventions in modulating symptoms and restoring function. However, inconsistencies in clinical approaches and variability in outcomes warrant a critical evaluation of the current evidence and identification of future directions. Objective: This narrative review aims to summarize and appraise the existing literature on exercise-based management of SAIS, including the effectiveness of specific exercise types such as motor control, neuromuscular training, and strength-based protocols. Methods:Anarrative review approach was used to synthesize findings from peer-reviewed articles, clinical guidelines, and systematic reviews published in literature. Sources were identified through searches in PubMed, Scopus, and Google Scholar, focusing on exercise-based interventions for SAIS. Results: Current evidence supports exercise therapy as the mainstay of SAIS management, mainly the protocols that focus on scapular stabilization, rotator cuff strengthening, and proprioceptive training. Although there is evidence to suggest exercise interventions can reduce shoulder impingement symptoms, there is minimal evidence of these interventions changing movement patterns of the shoulder complex. There are many varieties of exercises with different rationale and techniques. Many of the exercise programs do not provide adequate information of what and why interventions are used. Conclusion: Future research should prioritize high-quality trials with standardized protocols, long-term follow-up, and structured exercise programs tailored to treat patient-specific structural impairments leading to functional impairments to improve functional performance.