International Orthopaedics

, Volume 39, Issue 4, pp 715–720 | Cite as

Consensus for physiotherapy for shoulder pain

  • Ingrid Hultenheim KlintbergEmail author
  • Ann M. J. Cools
  • Theresa M. Holmgren
  • Ann-Christine Gunnarsson Holzhausen
  • Kajsa Johansson
  • Annelies G. Maenhout
  • Jane S. Moser
  • Valentina Spunton
  • Karen Ginn
Original Paper



Shoulder pain is a common disorder. Despite growing evidence of the importance of physiotherapy, in particular active exercise therapy, little data is available to guide treatment. The aim of this project was to contribute to the development of an internationally accepted assessment and treatment algorithm for patients with shoulder pain.


Nine physiotherapists with expertise in the treatment of shoulder dysfunction met in Sweden 2012 to begin the process of developing a treatment algorithm. A questionnaire was completed prior to the meeting to guide discussions. Virtual conferences were thereafter the platform to reach consensus.


Consensus was achieved on a clinical reasoning algorithm to guide the assessment and treatment for patients presenting with local shoulder pain, without significant passive range of motion deficits and no symptoms or signs of instability. The algorithm emphasises that physiotherapy treatment decisions should be based on physical assessment findings and not structural pathology, that active exercises should be the primary treatment approach, and that regular re-assessment is performed to ensure that all clinical features contributing to the presenting shoulder pain are addressed. Consensus was also achieved on a set of guiding principles for implementing exercise therapy for shoulder pain, namely, a limited number of exercises, performed with appropriate scapulo-humeral coordination and humeral head alignment, in a graduated manner without provoking the presenting shoulder pain.


The assessment and treatment algorithm presented could contribute to a more formal, extensive process aimed at achieving international agreement on an algorithm to guide physiotherapy treatment for shoulder pain.


Shoulder pain Physiotherapy Exercise therapy Treatment algorithm Clinical reasoning 


Conflict of interest



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Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Ingrid Hultenheim Klintberg
    • 1
    • 7
    Email author
  • Ann M. J. Cools
    • 2
  • Theresa M. Holmgren
    • 3
  • Ann-Christine Gunnarsson Holzhausen
    • 1
  • Kajsa Johansson
    • 3
  • Annelies G. Maenhout
    • 2
  • Jane S. Moser
    • 4
  • Valentina Spunton
    • 5
  • Karen Ginn
    • 6
  1. 1.Institution Neuroscience and Physiology/PhysiotherapyUniversity of Gothenburg and Physiotherapy Department Sahlgrenska University HospitalGothenburgSweden
  2. 2.Department of Rehabilitation Sciences & Physiotherapy, Faculty of Medicine and Health SciencesGhent UniversityGentBelgium
  3. 3.Division of Physiotherapy, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  4. 4.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesOxford University Hospitals TrustOxfordUK
  5. 5.University of GenoaGenoaItaly
  6. 6.Discipline of Biomedical Science, School of Medical Sciences, Sydney Medical SchoolThe University of SydneySydneyAustralia
  7. 7.Department of PhysiotherapySahlgrenska University Hospital/MölndalMölndalSweden

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