Exercise Therapy Is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis

  • Michel G. Mertens
    Research Group Move Antwerp (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium

    Pain in Motion International Research Group, Belgium
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  • Lotte Meert
    Research Group Move Antwerp (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium

    Pain in Motion International Research Group, Belgium
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  • Filip Struyf
    Research Group Move Antwerp (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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  • Ariane Schwank
    Research Group Move Antwerp (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium

    Pain in Motion International Research Group, Belgium

    Department of Physiotherapy, Canton Hospital Winterthur, Winterthur, Switzerland
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  • Mira Meeus
    Corresponding author Mira Meeus, PhD, Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, Wilrijk 2610, Belgium.
    Research Group Move Antwerp (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium

    Pain in Motion International Research Group, Belgium

    Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Published:August 20, 2021DOI:


      • Exercise therapy is effective in improving range of motion, function and pain
      • The effect of adding stretches to a program with exercises is uncertain
      • Adding physical modalities is to a program with exercises not beneficial
      • The effect of exercise therapy in the long term is unknown
      • There is large heterogeneity in exercise therapy and physical therapy programs



      To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective.

      Data Sources

      PubMed, Web of Science and Cochrane Central Register of Controlled Trials.

      Study Selection

      Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched.

      Data Extraction

      Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template.

      Data Synthesis

      Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure.


      ROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.


      List of abbreviations:

      AROM (active range of motion), CPM (continuous passive motion), CMS (Constant Murley Score), FS (frozen shoulder), GRADE (Grading of Recommendations Assessment, Development and Evaluation), MD (mean difference), PROM (passive range of motion), ROM (range of motion), SMD (standardized mean difference), SPADI (Shoulder Pain and Disability Index), RC (rotator cuff)
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