A systematic review and meta-analysis of the efficacy of exercise therapy for the rehabilitation of rotator cuff-related shoulder pain: a subgroup analysis of racquet sport athletes

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Objective: Rotator Cuff Related Shoulder Pain (RCRSP) is a common musculoskeletal disorder in both clinical and athletic populations, with a particularly high prevalence among racquet sport athletes. This study aimed to systematically evaluate the overall effectiveness of exercise therapy in the rehabilitation of RCRSP and to further explore its therapeutic effects among racquet sport athletes, providing evidence-based guidance for clinical practice and individualized rehabilitation programs. Methods: Following the PRISMA guidelines, a systematic search was conducted across PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, and Wanfang databases. Randomized controlled trials (RCTs) investigating the effects of exercise therapy on RCRSP were included. Meta-analysis was performed using Stata 18 software with a random-effects model for pooled analysis. Subgroup and sensitivity analyses were conducted to explore potential influencing factors. Results: = 96.5%; Cochran's Q p < 0.001). Sensitivity analysis indicated that the pooled effect size remained stable after removing individual studies (range: -1.24 to 1.13). Subgroup analysis revealed significant differences in treatment efficacy across different athlete populations (between-group difference test p < 0.001). Among racquet sport athletes, exercise therapy significantly reduced pain (SMD = -0.94, 95% CI: -1.38 to -0.50, p < 0.001). In the non-racket sports athletes subgroup, the pooled effect size was SMD = 0.35 (95% CI: 0.09 to 0.61, p < 0.001), with inconsistent effect direction. The overall pooled effect was non-significant (SMD = 0.01, 95% CI: -0.21-0.24). The funnel plot does not show clear symmetry, suggesting possible small-study effects or publication bias. Conclusion: This study suggested that exercise therapy may be associated with greater pain reduction among racquet sport athletes. Given the substantial heterogeneity, limited number of included studies, and potential publication bias, these findings should be interpreted with caution. Future high-quality randomized controlled trials are needed to confirm the effectiveness of exercise therapy in sport-specific populations.