SHOULDER PAIN: WHY PHYSIO IS FIRST LINE TREATMENT
Shoulder pain is the third highest MSK condition in terms of years lived with disability (1). Up to 40% of those who experience shoulder pain will continue to have symptoms a year later. A thorough assessment by a Physiotherapist and progressive rehabilitation is recommended as a first line treatment in reducing pain and disability.
A progressive active rehabilitation has been recommended as a first line treatment for shoulder pain. It has been found effective in reducing surgical waiting lists by 80%, and is as effective as surgery for non-traumatic rotator cuff tears (2). 12 weeks is recommended as a minimum period of active rehabilitation before considering invasive options.
SURGERY & IMAGING
Shoulder pain is complex, and multi-factorial in nature. In many cases imaging is unable to identify where the symptoms are coming from. Up to 50% of people over 60 with no shoulder pain, will have abnormal findings on imaging (3).
Surgery should only be considered a last line of defence in many cases. A large study in the UK found that arthroscopic decompression surgery showed no greater results than a placebo surgery (4).
HOW PHYSIO CAN REDUCE PAIN
Physiotherapists are experts in ensuring a progressive active rehabilitation, as well reducing pain levels.
Various techniques including symptom modification procedures, taping and manual therapy are used to reduce pain, which improves adherence and the ability to perform a rehab programme.
Studies have found a reduction in pain levels of up to 65% within the first session using symptom modification procedures for shoulder pain (5). This is short term however, with long term gains achieved with a more active approach.
This blog was written by our Senior Musculoskeletal Physiotherapist Paul Atkinson.
1) Vos 2018, Global Burden of Disease. Lancet 2018.
2) Holmgren 2012, Effect of specific exercises strategy on need for surgery.
3) Sher 1995. Abnormal MRI findings in asymptomatic shoulders.
4) Beard 2016. Arthroscopic subacromial decompression RCT. Lancet.
4) Meakins 2018. Reliability of Shoulder Symptom Modification Procedure.