Painful Shoulders giving you sleepless nights:o(

Painful Shoulders???

Why though??? Treatment is here...

Painful shoulders, one of the most chronic and debilitating conditions that people present to the clinic with. It happens to be the third most common presenting musculoskeletal condition seen in primary care (Parsons, 2007). Imagine over 54% of people have ongoing symptoms after 3years!!! (McFarlane et el, 1998).

More specifically, rotator cuff pathology is the most common cause of shoulder pain with the problem increasing with age.

What’s the Rotator Cuff?

The rotator cuff is a small group of muscles and tendons that act to stabilize the shoulder. They are deep to you big shoulder muscle the deltoid but have huge importance in stabilizing and accommodating full pain-free movement of the shoulder.

How do I know what problem I have in my shoulder?

There are over 150 specific tests prescribed for identifying shoulder conditions. Many of these are unreliable as Hegedus et al, 2013 confirmed, “Physical test of the shoulder are consistently found to be unreliable and poor predictors of structural pathology”. Unfortunately a lot of unqualified therapists out there try to use many non - specific tests leading to misdiagnosis and delayed healing etc.

However, with an excellent understanding of the anatomy of the shoulder and its biomechanics, your chartered physiotherapist has a number of specific pain provocation and movement tests that can be performed to identify the source of your pain. One of the biggest indicators of rotator cuff pathology is age.

How did I damage them?

Damage can of course arise from trauma to the shoulder but in the older patient, in the main, the rotator cuff is damaged through wear and tear. There are differing thoughts on why the various tendons deteriorate and especially as medical science has improved, previously held views on the mechanisms of injury are been questioned with justification e.g. shoulder impingent.

What to do?

Well there are three options:

                1) Conservative, i.e. physiotherapy, injections

                2) Surgery

                3) Do nothing and live in pain with disturbed sleep and all the other undesirable effects.

Surgery v Physio!!!

Effects of surgery, when compared to supervised physiotherapy are consistently unconvincing. Studies show that surgical intervention results are no better than conservative treatment for Shoulder Impingement Syndrome (SIS) (Dorrestijn et al 2009).

This is the case even considering the dramatic difference in costs. Surgical interventions roughly cost double that of a full course of supervised physiotherapy for the same shoulder condition. All the while results are similar or better (Ketola et al, 2009).

The results of surgery for SIS remain inconclusive with the best results being shown in younger patients.

Additionally, while preparing for surgery a patient may firstly rest. Then surgery is performed after which rest is again prescribed. This is followed by supervised physiotherapy with activity modification in the short term.

The question can be asked, which part of the process is responsible for the improvement in the shoulder condition?

The rest? The surgery? The activity modification? The physiotherapy? Is surgery providing relative rest? (Lewis, 2011)

What’s involved in Physiotherapy for my painful shoulder?

There are generally four stages of a physiotherapy programme for rotator cuff pathology. Your rehabilitation will be matched to the stage of the shoulder problem.

Physiotherapy will involve a multi-modal approach and could include the following:

1) Manual therapy: joint mobilisations, trigger point therapy, dry-needling, soft tissue mobilisation.

2) Exercise: strength, flexibility, endurance of the shoulder. Core stability work,

3) Posture, exercise to correct structural anomalies

4) Scapular control, altering the position/orientation of the scapula to allow for movement

5) Proprioceptive and neuromuscular control – towards end stage

How long will all this take?

The severity, nature and stage of the condition will ultimately dictate the duration of a successful programme, as will patient adherence to the programme.

Even severe conditions given the right rehabilitation should see resumption of normal activities after 12weeks.

Don’t live in pain. Call in and see your Chartered Physiotherapist today.

Physio Central

Ardan Rd,

Ardan Surgery,

Tullamore,

Co. Offaly

E:info@physiocentral.ie

T: (057)9322720

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