Chronic Shoulder Pain - Clinically Reasoned Using An Integrated Physiotherapy Approach

My client was referred to me by his GP with a 6 month history of ‘rotator cuff’, vague yes, but a starting point perhaps.

Indeed he showed and arc of pain raising the shoulder into abduction. He had a positive Jobes empty can test, but as we know this type of test lacks validity and reliability. Nonetheless the test indicated that some shoulder structure or other did not like to be stressed in this way. But did Jobe's test reproduce my clients pain? - no, and neither did the other impingement tests which appeared positive. So was the possible impingement a secondary issue?

My client's shoulder was ‘stiff’ and generally restricted in all directions. His pain was more accurately reproduced when he actively raised his arm into about 90 degrees of abduction and then outwardly rotated at the shoulder. This reproduced ‘his pain’ which was located at the upper long head of biceps brachii region. The biceps muscle, possibly tendon is the problem? No, only mildly tender to palpate and the biceps provocations tests were negative. However when I applied a gentle anteroposterior glide to the head of the humerus his pain eased immediately and he was able to move without pain further into range.

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‘Hands Off’ Physiotherapy - Is This The Best Way Forward?

Handsoff 300Physiotherapy, like most professions is subject to trends and fads. Big names in research will on occasion hit upon an idea that starts to gain traction in research circles and then may filter down to clinical practice.

Most of us in clinical practice want to get better and what we do so that we can help our clients get better more quickly. Others get bored with using the same techniques and love an opportunity to do it differently. For this reason physiotherapists seem ever open to new approaches and techniques.

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How I Use Medical Acupuncture In My Integrated Physiotherapy Approach

Medical acupuncture which may include dry needling often gets criticised by other healthcare practitioners as being too ‘passive’. The concern seems to be that you as clients will develop a reliance when the emphasis should be on self management, exercise, movement and lifestyle modification etc.

I fully understand the concern and the importance promoting active involvement on the part of the client. We as physiotherapists know that some of the best evidence for the long term management of pain is with exercise. Lifestyle adjustments as well as an understanding of how thoughts, attitudes and beliefs towards pain is now better understood and should also be addressed by your physiotherapist if needed.

My view if that medical acupuncture is most effective when combined with exercise and lifestyle adjustments and this is how I practice. No session with me would be complete without getting you moving afterwards. My aim is to facilitate movement and function which is free and easy, comfortable and relaxed, I want you to trust your body and let it work for you without fear and concern. The type of movement and exercises I will recommend will be tailored to your needs and based on what I find on assessment.

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Patients may Be denied effective treatment for low back pain in the UK

The National Institute for Health and Care Excellence (NICE) are an advisory body which advise medical practitioners in the UK. NICE issue so called evidence based guidelines which advise on treatment protocols for most medical conditions including low back pain. Although UK based, practitioners including physiotherapists in other countries consult the guidelines.

The guideline on the treatment of low back pain (CG88) published in 2009 included medical acupuncture for persistent non specific low back pain. This meant that medical acupuncture could be offered by the NHS and as a result many patients would have benefited from this effective and safe form of treatment.

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Why RCT’s Are Not Fair To Medical Acupuncture?

The randomised control trial (RCT) was designed mainly for use within the pharmaceutical research. Simplified, an active pill and a dummy or ‘inert’ pill are compared for effectiveness. The active pill has to perform significantly better than the dummy pill for the effect not to be considered a placebo.

RCT Acu

This RCT model suits the pharmaceutical industry because it’s easy to create a dummy pill. But when the RCT is applied to medical acupuncture, how do you create a credible dummy needle?

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