Proprioceptive Neuromuscular Facilitation for Shoulder Pain: An Updated Systematic Review and Evidence Synthesis of Controlled Trials on Pain, Disability, and Range of Motion

Abstract

Background: Shoulder pain is a common musculoskeletal problem for which exercise-based rehabilitation is frequently prescribed. Proprioceptive neuromuscular facilitation (PNF) is used to address pain, range of motion, neuromuscular control, and shoulder function, but trials differ substantially in diagnosis, technique, comparator, and outcome measurement.
Objective: To update the evidence on the effects of PNF-based rehabilitation on pain, shoulder-related disability, and range of motion in adults with symptomatic shoulder disorders.
Methods: PubMed-indexed literature, PEDro records, clinical-trial information, publisher pages, and prior systematic reviews were searched and cross-checked through 2 October 2026. Randomized or controlled clinical studies evaluating PNF as a shoulder rehabilitation intervention were considered. Because the published literature contains clinically heterogeneous populations and several reports do not provide sufficient numerical data for independent effect-size calculation, quantitative findings that could be verified were synthesized separately from narrative evidence rather than manufacturing a new pooled estimate.
Results: A 2025 meta-analysis identified nine English-language studies involving 158 participants receiving PNF and reported a pooled VAS improvement of −3.26 (95% CI −4.33 to −2.20), while the pooled SPADI estimate was not statistically significant (−20.57, 95% CI −47.92 to 6.78). A separate 2025 review of scapulohumeral periarthritis identified 12 randomized trials involving 885 participants and reported improvements in pain, shoulder function, and activities of daily living, but substantial heterogeneity and methodological concerns were present. Newer evidence includes an 80-participant assessor-blinded adhesive-capsulitis trial, a 2026 56-participant trial examining neural mobilization added to PNF, a 2026 chronic subacromial-bursitis trial after corticosteroid injection, and a 2025 rotator-cuff-syndrome trial.
Conclusion: PNF is associated with improvements in several shoulder outcomes in the existing evidence base, but the certainty of a generalizable treatment effect is limited by diagnostic heterogeneity, small samples, short follow-up in many trials, co-interventions, and inconsistent reporting. A publication-quality updated meta-analysis should use the complete database exports and full texts to independently extract all eligible studies before a new pooled effect is claimed