Recovery rate is low for many of those with condition

Chronic shoulder pain-meaning it has lasted for at least three months-is a very common condition, with a prevalence of up to 67% in some populations. It is also a complex syndrome that features many unanswered questions, which is one reason the recovery rate from it is so low. Statistics show that about 60% of patients with chronic shoulder pain continue to deal with symptoms one year after first noticing it, and this highlights the need for better treatments to address the condition. Current treatments like physical therapy generally help patients in the initial stages of shoulder pain, but are less effective when it progresses into the chronic phase after several months. One reason for this is that psychological factors like depression, anxiety and fear of pain may actually impact the way in which the patient perceives pain and disability. The connection between psychological factors and chronic shoulder pain has been evaluated, but there is still a great deal that needs to be understood. For this reason, a powerful study called a systematic review was conducted to determine the extent that these factors can have on the perception of shoulder pain and what can be done to correct them.

Twenty-seven studies fit the necessary criteria

Researchers performed a search of five major medical databases for studies that investigated patients who had shoulder pain for at least three months. They were particularly interested in studies focusing on the psychological state of these patients and how it affected their pain and/or disability. This search process led to 128 studies being evaluated, and 27 of these fit the necessary criteria to be accepted into the review. Once collected, the findings from these studies were analyzed and compared to one another in order to establish a clearer idea of the connection between psychological factors and chronic shoulder pain.

Patients with positive attitudes about their condition have less pain and disability

The results clearly showed that patients’ attitudes and perceptions had a significant impact on their levels of pain and disability related to their condition. In particular, a strong relationship was identified between high levels of resiliency, confidence and positive expectations regarding recovery with low levels of pain intensity and disability. On the flip side, it was found that high levels of emotional distress, depressive symptoms, anxiety, concerns about surgery and fear of pain were associated with high levels of pain intensity and disability. The reason for these associations is not completely understood, but is believed to result from patients with negative beliefs perceiving their shoulder pain as a threat. In turn, this may lead them to stop using their shoulder and become less physically active, which begins a vicious cycle that only makes their condition and symptoms worse.

How physical therapists can educate and help these patients

These findings suggest that when treating shoulder pain, psychological factors must be taken into consideration and addressed in addition to physical symptoms. Physical therapists can help by identifying these negative factors in patients early on in treatment, and then work to educate and help patients overcome any barriers to success. In doing so, patients will understand their condition more clearly and increase their chances of experiencing a full recovery from shoulder pain. Patients with shoulder pain are therefore encouraged to consult a physical therapist at the earliest signs of shoulder pain for a full-scale evaluation and appropriate treatment program that takes all their physical and psychological symptoms into consideration.

-As reported in the April ’18 issue of BMJ Open

Rates of shoulder surgery are increasing, and it may be partially due to MRI results

The labrum is a piece of cartilage shaped like a cup that’s attached to the rim of the shoulder socket. Its function is to secure the shoulder socket and keep the ball of the joint in place during movement, but this cartilage can tear either from an injury or due to the aging process. The result is called a labral tear, which may or may not cause symptoms depending on how severe it is. Labral tears are difficult to diagnose, and the methods used for evaluation like physical exams and MRIs are not very consistent at identifying the injury. Statistics also show that the rate of surgery for labral tears has been increasing over the past decade-especially in middle-aged patients-and that some of them are not experiencing positive outcomes. While it’s not completely clear why this has been occurring, one possible explanation is that more patients are being diagnosed with labral tears on their MRI and then being told to consider surgery. To investigate this matter and develop a better understanding of the connection between MRI results and shoulder symptoms, a study was conducted.

Patients with no shoulder pain undergo MRIs

Middle-aged individuals between ages 45-60 without any shoulder pain were recruited and invited to participate in the study, which led to 53 of them being accepted. All participants underwent a physical examination and were asked a series of questions regarding the use of their shoulder in work or sports. Then, each participant had an MRI of their shoulder and two radiologists evaluated the results. A radiologist is a medical professional trained to interpret the findings of imaging tests like MRIs and X-rays, and in this case, they were not given any information about the study subjects to increase the reliability of their evaluations.

Both radiologists find labral tears in at least half of patients

On the whole, results showed that labral tears were fairly common. The first radiologist interpreted 38 (72%) of the MRIs as containing a labral tear, while the second radiologist found labral tears in 29 patients (55%). Further analysis revealed that the two radiologists had a moderate level of reliability between them, and that there was only one area in which their reliability was poor.

Avoid having an MRI and see a physical therapist instead

These findings show that even in middle-aged patients that have no signs of shoulder pain, labral tears are commonly found on MRIs. The unfortunate result of this fact is that a patient with shoulder pain can be told they have a labral tear and then go on to have surgery to repair it, even though their pain may not be related to the tear. One way to avoid this predicament is to see a physical therapist first for any type of shoulder pain. Physical therapists will usually treat the pain immediately with a comprehensive treatment program and will only prescribe tests like MRIs if they find it to be completely necessary. Following this course will help you work towards getting better right away regardless of what’s causing your shoulder pain and by keeping you out of the operating room for a labral tear that may not be related to your pain.

-As reported in the January ’16 issue of The Orthopaedic Journal of Sports Medicine

Long-term computer use can lead to muscle dysfunction and disorder

Approximately 90% of white-collar workers use computers for more than four hours per day. Over time, sitting and working at a computer can lead to a dysfunction of muscle stability and other disorders of the region, which may result in shoulder and neck pain, as well as a decreased threshold for pain. One of the main reasons for shoulder pain is hyperactivity of an upper back muscle called the upper trapezius, which results in decreased control of two other muscles and instability. To treat this muscle instability, several physical therapy interventions may be used, including manual therapy. In manual therapy, the physical therapist performs various manipulations and mobilizations on the painful area in order to bring about tissue changes that will lead to less pain. Manual therapy may, therefore, be helpful for office workers with shoulder pain, and to evaluate this possibility, a study was conducted.

Middle-aged office workers with pain serve as the study group

Individuals between the ages of 30-40 who had shoulder pain and worked on a computer for more than eight hours a day were invited to participate in the study and screened to determine if they were eligible. This process led to 38 individuals who were accepted, and then randomly assigned to either the manual therapy group or the shoulder stabilization exercise group. Both groups underwent treatment during two 40-minute sessions per week for six weeks. In the manual therapy group, the therapist applied manipulations and mobilizations to various muscles in the back, chest, and neck for three minutes each. In the shoulder stabilization group, patients were instructed to perform a series of stretching and strengthening exercises for muscles in the same area. All patients were assessed before and after undergoing treatment for pressure pain threshold (PPT) of certain muscles, which measures the minimum force applied that causes pain.

Manual therapy leads to greater improvements

After completing treatment, participants in both groups experienced significant improvements with an increased PPT of several muscles of the upper back; however, the manual therapy group showed greater PPT improvements in these muscles than the shoulder stabilization group. This is likely due to the pain-relieving properties of manual therapy, as it increases blood flow and decreases the activity of muscles in such a way that it changes the length of tissues and results in less pain. These results show that while both shoulder strengthening exercises and manual therapy appear to be effective for office workers with shoulder pain, manual therapy is even more beneficial for improving their threshold for pain. Individuals currently dealing with this type of pain should, therefore, seek out the services of a physical therapist for appropriate treatment.

-As reported in the September ’16 issue of The Journal of Physical Therapy Science

Persistence of symptoms results from both physical and psychological factors

Approximately 50% of people with whiplash-associated disorders (WADs) continue to report neck pain one year after injury, yet despite this prevalence, there is no clear evidence regarding the most effective treatment. Though exercise is considered safe and effective for neck pain, it’s efficacy for WADs specifically is unclear, and the same is true for prescribed physical activity (PPA). In addition, since the persistence of symptoms in WAD patients is due to both physical and psychological factors, a behavioral approach may also be beneficial, but this is not clear either. Based on these shortcomings, a randomized-controlled trial (RCT) was conducted to evaluate the long-term effects of neck-specific exercise on WADs.

Two-year follow-up performed on earlier RCT

The current study was a one- and two-year follow-up on a 2014 RCT. Initially, 216 individuals with grade 2 or 3 whiplash injury were recruited and randomized to the neck-specific exercise (NSE) group, the neck-specific exercise with behavioral approach (NSEB) group or the PPA group, and all interventions spanned 12 weeks. Patients in the NSE group followed a supervised neck-specific exercise program twice a week. At first, this focused on deep cervical muscles, and eventually, more progressive head resistance training was incorporated gradually. The NSEB group received the same treatments plus physical therapist-led behavioral interventions. The PPA group was prescribed general physical activity to be performed independently without any neck-specific exercises. Patients were assessed for pain, disability, functioning and other variables at baseline and then one and two years later.

Positive long-term outcomes reached with neck-specific exercises

In total, 170 patients (79%) completed the one-year follow-up and 123 (57%) completed the two-year-follow-up. At one year, both neck-specific groups displayed more clinically important improvements in pain, disability, and functioning than the PPA group. At two years, the same was true for disability, and there were also clear trends towards greater improvements in all other outcomes as well. The addition of the behavioral approach did not produce any significant differences. This follow-up RCT suggests that neck-specific exercises can lead to improvements in patients with WADs for one or two years, but additional research is needed to confirm these findings with a different study population, longer follow-up and higher retention rates.

-As reported in the March ’16 issue of the Journal of Rehabilitation Medicine

Understanding these costs may help patients spend less on treatment

Low back pain (LBP) is one of the most common of all painful conditions, as up to 36% of the population will experience it at least once every year. For most of these individuals, the first episode of LBP is not the last, and in some cases, the pain can become a long-term problem. This shows just how important it is to utilize effective treatments for LBP. There are numerous treatments available for patients with LBP, but not all lead to the same benefits and some will cost significantly more than others. This means that some patients can be instructed to receive treatments for their LBP that aren’t necessarily the best for them and cost more, simply because that’s what their doctor recommended. In some cases, this could even wind up costing patients more in the process. To develop a clearer idea of the general costs associated with physical therapy and other treatments for LBP, a study was conducted using Medicare data.

Researchers analyze Medicare data over three years

To conduct the study, researchers gathered Medicare data on patients who were diagnosed with LBP for the first time from 2013-2015. They labeled these patients “beneficiaries” and tracked the treatments they received for their first episode of LBP over this period of time, especially focusing on physical therapy, injections, back-related surgery and no treatment. The Medicare costs associated with the treatments these beneficiaries received was then analyzed and compared to determine how expensive each of them was overall.

Medicare spending for patients who received physical therapy is significantly less than it is for surgery

The data showed that in the three years analyzed, 472,000 patients were diagnosed with LBP. Of these beneficiaries, 60,000 (12.7%) received physical therapy as their first line of treatment, while 53,000 (11.3%) were treated with injections, 8,000 (1.6%) had surgery and 351,000 (74.4%) did not receive any of these treatments in the one year following their diagnosis. The analysis revealed that for the beneficiaries that received physical therapy first, the total Medicare spending was about 19% less than it was for injections and about 75% less than spending for patients who had surgery. In addition, within one year after the LBP diagnosis, the difference in average spending was 18% between the therapy first group and injection first group and about 54% between the therapy first group and surgery first group. Finally, beneficiaries who received physical therapy within the first 15 days after being diagnosed with LBP had costs that were about 27% lower down the line than those who received therapy 45-90 days after their diagnosis.

These results show that physical therapy has the lowest Medicare costs of the three treatments analyzed for LBP and that these costs are even lower if patients begin treatment within the first 15 days of being diagnosed. In some cases, this can wind up saving patients money in the long run if they are treated with physical therapy instead of a much more expensive option like surgery. Patients should, therefore, keep this information in mind when deciding if they should seek out treatment for LBP and when considering surgery if a doctor recommends it.

-Summarized from an April ’17 study published by theAlliance for Physical Therapy Quality and Innovation

This particular treatment is commonly used to address a prevalent condition

Joints are the area where two bones come together, and the end of each joint is surrounded by a protective layer called articular cartilage, which cushions your bones and protects them from rubbing against one another. When this cartilage diminishes, the condition that results is called osteoarthritis. Osteoarthritis is the most common form of arthritis and the leading cause of disability and pain in middle-aged and elderly people throughout the world. It can occur in any joint in the body, but it is most common in the knees and hips. Of the many treatments available for knee osteoarthritis, manual therapy is one of the more popular used today. Manual therapy means that the therapist uses only their hands to apply various movements and techniques to the joint in order to reduce pain and other symptoms. Although manual therapy is a frequently used treatment for knee osteoarthritis, it’s not completely clear just how effective it is for reducing patients’ symptoms. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted on all the available research on this topic.

14 studies are accepted for the review

To conduct the study, researchers performed a search of seven medical databases using terms related to manual therapy and knee osteoarthritis. They only accepted randomized-controlled trials (RCTs), which are high-quality studies considered to be the gold standard for evaluating whether a treatment is effective or not. This search led to 99 studies being screened to determine if they were eligible, and of these, 14 RCTs fit the necessary criteria and were accepted for the systematic review and meta-analysis. The findings of each of these RCTs were compared to one another and researchers also assessed their quality.

Manual therapy found to significantly reduce pain, alleviate stiffness and improve function

Results showed that manual therapy was found to significantly reduce pain, alleviate stiffness and improve the physical function in patients with knee osteoarthritis. These positive effects of manual therapy occurred with less than four weeks of treatment, but a treatment course lasting longer than four weeks led to even greater benefits. In addition, only one patient experienced increased discomfort from manual therapy, while no other negative effects were found in any of the other studies. Unfortunately, the quality of the studies included in this systematic review and meta-analysis was not very high due to certain flaws in their design. Nonetheless, these findings indicate that manual therapy is a beneficial treatment for knee osteoarthritis and should be used in treatment programs for patients with this condition. Due to the poor quality of the studies included, additional high-quality RCTs are needed with better design and a longer follow-up to further confirm these findings.

-As reported in the May ’17 issue of Pain Physician

Results from previous studies are inconsistent on effectiveness of treatment

Temporamindibular joint disorder (TMJ) is an umbrella term used to describe several conditions that involve a dysfunction of the jaw. The most common symptoms of TMJs are pain and decreased mobility of the jaw, both of which have a negative impact on patients’ quality of life. There are a number of conservative (non-surgical) treatments available for TMJs, including physical therapy interventions such as exercise-based therapy, massage, stretching and a combination of these techniques. Exercise therapy programs are commonly used to treat TMJs and may include aerobic, stretching, balance and strengthening exercises, but the available studies on this intervention have produced results that are inconsistent. For this reason a powerful pair of studies called a systematic review and meta-analysis was conducted on the effectiveness of exercise therapy for patients with a TMJ. A systematic review collects all the available evidence on a topic, and in the meta-analysis, researchers pool the data from these studies to tease out common trends.

Two medical databases are searched for relevant studies

Researchers performed a search of two major medical databases for high-quality studies that evaluated exercise therapies for TMJ. They only accepted randomized-controlled trials (RCTs), which are considered the gold standard of individual studies used to determine if a treatment is effective. The search identified 37 studies to be screened, and of these, six RCTs fit the necessary criteria and were used for the systematic review and meta-analysis. All included studies were then analyzed and their findings were compared to one another to determine if exercise therapy was in fact effective for TMJs, and their quality was also ranked to gauge their reliability.

Exercise therapy leads to several benefits for patients

After completing the systematic review and meta-analysis, researchers found that exercise therapy reduced pain and improved the range of motion (flexibility) of patients with TMJs. The improvements in flexibility came primarily from programs that emphasized mobility exercises and a mixed treatment programs, and it appeared that twice weekly was the most effective treatment method for reducing pain. However, it’s not clear what the most appropriate type, intensity and duration of exercise therapy should be for the best results. Therefore, more research is needed to investigate these factors in more detail. Nonetheless, these studies clearly show that exercise therapy is an effective treatment for reducing pain and improving flexibility in patients with a TMJ. Individuals with this condition should therefore be encouraged to seek out the treatment of a physical therapist for an appropriate treatment program that will help them improve.

-As reported in the October ’16 issue of Clinical Rehabilitation

Delaying surgery can lead to complications after the procedure

Hip fractures are the most common fractures in older adults, and their frequency is growing as a result of an aging population. Rehabilitation methods like physical therapy are recommended after hip fractures to prevent the loss of patients’ independence, but many patients also require surgery to help them recover. Occasionally, surgery for these patients needs to be delayed, mainly because of acute medical problems and lack of operating room availability. Delayed surgery can lead to complications like pneumonia, a decline in physical function, and delayed discharge from the hospital, which is why it’s important to identify ways to reduce these complications. One possible solution is to provide physical therapy before surgery-or preoperative physical therapy-but research on this topic is limited. For this reason, a study was conducted to determine if preoperative physical therapy is effective for improving outcomes and reducing complications in older adults who have hip surgery.

Data on 681 older patients analyzed

To conduct the study, researchers sought out data on older patients who had underwent surgery for a hip fracture from 34 hospitals. A total of 681 patients fit the necessary criteria to be included in the study, half of which were treated with preoperative physical therapy. The preoperative physical therapy program consisted of muscle-strengthening exercises that targeted the lower limbs and trunk, stretching exercises, sitting exercises and ankle movements intended to prevent a condition called deep vein thrombosis. Most programs consisted of about 20-30 minutes of physical therapy every weekday prior to surgery, and whether or not patients received it was determined based on the doctor’s personal opinion. Once these patients were identified, data regarding their outcomes after surgery was collected and analyzed. In particular, researchers were interested in patients’ Functional Independence Measure (FIM) scores, which assessed their independence in common daily activities.

Preoperative physical therapy leads to a number of benefits for patients

Results indicated that patients who underwent preoperative physical therapy experienced a number of benefits and better outcomes compared to those who did not. In particular, preoperative physical therapy patients reported significantly greater gains in motor FIM scores, motor FIM effectiveness and motor FIM score at discharge than the other patients. This means that these patients became significantly more independent while functioning in their daily lives due to the treatment they received. These patients were also discharged from the hospital at a faster rate compared to those who did not receive the therapy. Based on these findings, it appears that preoperative physical therapy can lead to better overall outcomes for older patients who have surgery for a hip fracture. Patients who need hip surgery should therefore be aware that physical therapy before their procedure is an option that will likely help them recover faster, and they should ask their doctor about what is available to them during this time.

– As reported in the March ’18 issue of Geriatrics & Gerontology International

Physical therapy is consistently supported as an effective treatment for low back pain

Low back pain (LBP) is estimated to affect up to 80% of all Americans at some point in their lives, and it is one of the leading causes of disability and reasons for visiting a doctor throughout the world. On top of this, studies suggest that this problem will only continue to grow in the future as more people become affected by the condition. National and international guidelines recommend a number of treatments for LBP, which include education, exercise, massage and manual therapy, particularly because they have been deemed effective and safe. Physical therapy for LBP typically includes these and many other commonly recommended interventions, which are brought together in a personalized way for each patient. Studies have consistently shown that physical therapy is an effective treatment for LBP, and the earlier a patient is referred to a physical therapist, the sooner they return to work and the better their outcomes are. This is why many national guidelines specifically recommend physical therapy for LBP. Yet despite this evidence and support, it doesn’t appear that the referral rates for physical therapy have actually increased over the years. To get a clearer idea of how the referral rates of physical therapy to treat LBP have changed in recent times, a study was conducted.

National surveys used to establish patterns in referral rates

To perform the study, researchers collected data from two national surveys on medical care services and another survey from emergency departments from 1997 to 2010. They focused only on visits for patients between 16-90 years of age, and classified patients into four groups based on their age: 16-39, 30-44, 45-59 and 60-90. In addition to data on physical therapy referral rates, researchers also analyzed data on the rates for opioid prescriptions over the same period of time.

Measures are needed to educate doctors and patients about the benefits of physical therapy

Based on the surveys analyzed, approximately 170 million patients visited a doctor for complaints related to LBP. From these visits, 17.1 million patients were referred to physical therapy, which equated to a referral rate of 10.1%. From 1997 to 2010, this referral rate for physical therapy remained stable at this low percentage, while the rate for opioid prescriptions increased in these patients over the same time period. Further analysis showed that patients who were not referred to physical therapy were more likely to receive an opioid prescription. This highlights a major problem occurring in the country today, as rising rates of opioid prescriptions are largely to blame for addiction and abuse of these drugs. Physical therapy, on the other hand, is a safe and effective method for treating LBP that is not associated with any of these types of problems. This is why patients with LBP must be educated on the importance of seeking out the services of a physical therapist for their condition, and doctors must also recognize its value and make the appropriate decision of referring patients to physical therapy to improve the chances of a positive outcome.

-As reported in the May ’17 issue of Spine

Association between the two has not been clearly evaluated

Knee osteoarthritis (OA) is a condition in which cartilage that normally protects the knee gradually wears down over the course of time. It is one of the leading causes of pain and disability throughout the world, affecting about 10% of men and 13% of women over the age of 60 in the U.S. The patellofemoral joint connects the kneecap (patella) with the upper leg bone (femur), and symptoms of knee OA frequently occur in this area. This joint also plays a critical role in the function of the knee, as it allows individuals to complete many daily activities like squatting and climbing or descending stairs. Due to its role, though, the patellofemoral joint may be negatively affected by forces that are too strong, such as excessive weight. Overweight or obese individuals with a high body mass index (BMI) put lots of stress on their knees, which may increase the risk for pain in the patellofemoral joint and knee OA, but this association has not yet been clearly evaluated. For this reason, a powerful pairing of studies called a systematic review and meta-analysis were conducted to determine if high BMI is a risk factor for patellofemoral pain and knee OA.

52 studies are accepted into the review

Researchers performed a search of six major medical databases for studies that included information on the associated between BMI and patellofemoral pain or knee OA. This search led to a total of 7,894 studies being evaluated, and from these, 52 met the necessary criteria and were accepted into the review. The findings of each of these studies were then evaluated and compared to one another, and the quality was ranked to determine how reliable their data was. Studies were given a rating from 1 (strong evidence) to 5 (conflicting evidence).

Adults—but not adolescents—with patellofemoral pain and knee OA have a higher BMI

The results of this systematic review and meta-analysis showed that the BMI of adults with patellofemoral pain and knee OA was generally higher than the BMI of healthy individuals without knee pain that they were compared to. When it came to adolescents with patellofemoral pain, however, the same type of association was not found. As for why this association was found it, adults, it likely has to do with the fact that individuals with a higher BMI generally reduce their activity levels due to the persistent pain that is brought on by their condition. In turn, reduced activity levels can actually lead to more weight gain and more stress on the knees, which can create a vicious cycle that makes their condition even worse. This study, therefore, shows how important it is for those with a high BMI to reduce their weight, as doing so may also lower their chances of developing knee pain due to the involvement of the kneecap. Physical therapists can help in their pursuit by prescribing specific exercises and offering advice on how to increase physical activity levels, and those with patellofemoral pain are encouraged to seek out their services for additional guidance.

-As reported in the May ’17 issue of the British Journal of Sports Medicine