BACKGROUND: Disorders related to shoulder impingement are consistently classified as the most common diagnostic subgroup of shoulder pain. A variety of interventions for shoulder impingement have been proposed, including manual therapy and exercises. Despite a growing body of evidence on these interventions, their effectiveness has not yet been conclusively established. OBJECTIVES: To establish the current state of evidence on the effectiveness of manual therapy and exercises to improve patient-centered outcomes in adults with shoulder impingement. METHODS: This systematic review updates a previous systematic review by the same authors. It includes evidence from randomized controlled trials published between October 2008 and September 2012. Comprehensive searches were made of seven relevant electronic databases including Medline, Cochrane CENTRAL, CINAHL, and PEDro, supplemented by further sources. Methodological quality was assessed with the PEDro scale. RESULTS: Nine randomized controlled trials were included and synthesized narratively. The trials varied considerably in methodological quality and reporting quality, as well as in terms of the interventions and comparisons considered, and in the outcome measures used. Clinical heterogeneity precluded meta-analysis. The trials provide limited evidence to support the effectiveness of a diversity of manual therapy and exercise approaches for treating shoulder impingement. CONCLUSIONS: This systematic review update provides some further evidence supporting the effectiveness of manual therapy and exercises for shoulder impingement, but methodological deficits/risk of bias warrant cautious interpretation. Further research is needed to establish the optimal manual therapy and exercise techniques and parameters.

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