Conservative physiotherapy interventions for subacromial pain syndrome: a systematic review of current evidence

Introduction Subacromial pain syndrome (SAPS) is one of the most common causes of shoulder pain and functional limitation in adults. Conservative physiotherapy management includes exercise therapy, manual therapy, patient education, and electrotherapy. This systematic review aimed to summarise and evaluate current evidence on conservative physiotherapy-based treatment approaches for SAPS, with particular focus on pain reduction and functional improvement. Methods A comprehensive search of PubMed, Web of Science, and Google Scholar was performed for studies published between 2020 and 2025. The last database search was conducted on January 15, 2026. Eligible studies included randomised controlled trials, systematic reviews, meta-analyses, and study protocols investigating conservative, non-surgical physiotherapy interventions in adults with SAPS. Primary outcomes included pain, shoulder function, disability, and range of motion. Results Twenty-two studies met the inclusion criteria, including 14 randomised controlled trials, 7 systematic reviews/meta-analyses, and 1 randomised study protocol. Exercise-based treatment consistently showed significant improvements in pain and functional outcomes. Methodological quality of randomised controlled trials ranged from 6 to 8 out of 10 on the PEDro (Physiotherapy Evidence Database) scale. According to AMSTAR-2 (A Measurement Tool to Assess systematic Reviews), two systematic reviews were rated as of high quality, four as of moderate quality, and one as of low quality. Progressive exercise protocols that targeted the rotator cuff and scapular muscles were associated with superior clinical improvements compared to generalised exercise programmes. Scapular stabilisation and motor control exercises demonstrated moderate effectiveness in improving shoulder pain and disability index (SPADI) and range of motion outcomes. Manual therapy provided short-term benefits when combined with exercise. Conclusions Current evidence supports exercise-based physiotherapy for SAPS, with individualised loading and education improving outcomes.