WALDRON’S PEAK PHYSICAL THERAPY P.C. …€¦ · · 2012-12-18acromial impingement syndrome...
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WALDRON’S PEAK PHYSICAL THERAPY P.C. DECEMBER 2012 PAGE 1 This is the monthly newsletter for Waldron’s Peak PT. The newsletters will be a way for us to let you know what is new with the clinic, and also keep you up to date on relevant and recent research regarding physical therapy and your health. NEWSLETTER Shoulder pain is a common source of peripheral joint pain occurring at a prevalence rate of 47% and is the second most common cause of musculoskeletal pain 7,9 . Symptoms associated with shoulder disorders account for 1/3 of all physician visits and are most frequently associated with sub acromial impingement syndrome (SIS) 13 . The diagnosis of SIS represents a wide range of pathology in the shoulder including rotator cuff tendinopathies, bursitis, and rotator cuff tears. SIS occurs when the soft tissue structures of the shoulder are compressed between the humeral head of the arm and the acromion and ligaments of the shoulder blade. The etiology behind SIS is likely multifactorial including spinal or extremity joint loss of motion, upper quarter weakness, motor control impairments, and postural deviations. Unfortunately the natural history of shoulder pain is not favorable with only 50% of new shoulder problems demonstrating resolution of symptoms at 6 months 12 . -.$/01"#’)0% )’!)*3&’&*+ -4*5"#’& 6-0)-7 Connect With Us @WaldronsPeakPT /WaldronsPeakPT Problem:
Transcript of WALDRON’S PEAK PHYSICAL THERAPY P.C. …€¦ · · 2012-12-18acromial impingement syndrome...
WALDRON’S PEAK PHYSICAL THERAPY P.C. DECEMBER 2012
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ThisisthemonthlynewsletterforWaldron’sPeakPT.Thenewsletterswillbeawayforustoletyouknowwhatisnewwiththeclinic,andalsokeepyouuptodateonrelevantandrecentresearchregardingphysicaltherapyand
yourhealth.
NEWSLETTER
Shoulder pain is a common source of peripheral joint pain occurring at a prevalence rate of 47% and is the second most common cause of musculoskeletal pain7,9. Symptoms associated with shoulder disorders account for 1/3 of all physician visits and are most frequently associated with sub acromial impingement syndrome (SIS)13. The diagnosis of SIS represents a wide range of pathology in the shoulder including rotator cuff tendinopathies, bursitis, and rotator cuff tears. SIS occurs when the soft tissue structures of the shoulder are compressed between the humeral head of the arm and the acromion and ligaments of the shoulder blade. The etiology behind SIS is likely multifactorial including spinal or extremity joint loss of motion, upper quarter weakness, motor
control impairments, and postural deviations. Unfortunately the natural history of shoulder pain is not favorable with only 50% of new shoulder problems demonstrating resolution of symptoms at 6 months12.
Shoulder pain is a common source of peripheral joint pain occurring at a prevalence rate of up to 47% across all age groups and is second most common cause of musculoskeletal pain.7, 9
Symptoms of shoulder pain account for 33.2% of physician visits in the U.S. and are most frequently associated with SAIS.13
Only 50% of new shoulder problems show resolution of patient symptoms at 6 months.12
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Evidence in the medical literature supports the utilization of manual therapy to the spine and shoulder girdle in the management of shoulder pain disorders.1, 2, 3, 5, 6, 8, 10, 11
Patients with SAIS who received thoracic spine thrust manipulations demonstrated signi!cant decreases in pain and disability scores at 48 hours.3
A combined program of manual therapy and upper quarter strengthening has demonstrated improved symptoms and disability in patients with SAIS.9
Systematic reviews support the utilization of rotator cu" and scapular strengthening, in combination with manual therapy, for patients with SAIS.6, 8
Continued on back...
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Connect With Us
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WALDRON’S PEAK PHYSICAL THERAPY P.C. DECEMBER 2012
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Patients should consider Physical Therapy for the conservative management of shoulder pain and dysfunction associated with reaching, lifting, upper extremity and overhead activities. To determine if these interventions are appropriate for your condition contact your Physical Therapist at Waldron’s Peak Physical Therapist.
Evidence in the medical literature supports the utilization of manual therapy and exercise interventions to the spine and shoulder girdle for the management of shoulder pain disorders1,2,3,5,6,8,10,11. Boyles et al. demonstrated significant reductions in shoulder pain and disability in patients 48 hours after being treated with thoracic manipulation interventions3. In addition to spinal interventions, multiple systematic reviews support a multimodal approach to the management of SIS including manual therapy and exercise interventions to the upper quarter6,8,.9. Manual therapy interventions involve passive movements applied to the joints and structures of the upper quarter in an attempt to reduce pain and improve active range of motion in the shoulder joint. As noted in the Boyles et al. study many of these benefits can be experienced within a single session.
In multiple musculoskeletal conditions, including the shoulder, the combination of manual therapy and patient specific exercise seems to produce the greatest long term results. Recent medical literature reviews support the combination of manual therapy
and strengthening exercises on long term reductions in pain and disability in the shoulder6,8. In particular, evidence supports the utilization of manual therapy and exercise interventions tailored to a patient’s individual signs and symptoms. Bang et al. reported significantly greater improvements in motion, strength, pain and function in a group of patients treated with this combined approach vs. exercise alone1. Based on the evidence it appears manual therapy interventions rapidly decrease pain and allow a more streamlined transition into a strengthening program. Bergman et al. demonstrated usual care interventions prescribed by a physician (medications, rest) took 52 weeks to reach the same level of recovery and functional improvement as manual therapy plus usual care reached in only 12 weeks (see graph)2. Finally, the combined approach of manual therapy and exercise has been shown to be equally effective as surgical interventions for SIS, but with a fraction of the cost and risk associated with these more aggressive procedures4.
Referral:
Evidence:
Multiple articles in the research literature describe the e!ectiveness of a multimodal approach to treating shoulder pain utilizing manual therapy to the upper quarter and therapeutic exercise.1, 2, 5, 6, 8, 10
Bang et al. reported signi"cantly greater improvements in motion, strength, pain and function in a group treated with manual therapy and exercise compared with exercise alone.1
Manipulative physical therapy when combined with supervised exercise has been shown to produce faster improvements in pain, ROM and function in patients with SAIS compared to patients who just performed exercise or received self care alone.1, 5, 10
#e addition of manual therapy to patients receiving usual care for their shoulder complaints accelerated their recovery to previous functional levels.2
Speci"cally, the usual care group took 52 weeks to demonstrate the functional improvement noted in the manual therapy group at 12 weeks (see graph).2
Brox et al. has demonstrated a physical therapy program was as e!ective as surgical sub-acromial decompression in the treatment of stage II primary impingement.4
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Physicians should consider referral of patients with symptoms of shoulder pain and dysfunction associated with reaching, li$ing, repetitive upper extremity activities, or over head activities.
Research supports the utilization of manual therapy and exercise in this patient population for reduction of pain and disability associated with shoulder pain. Physical #erapy combined with primary care management can accelerate recovery associated with these symptoms.1, 2, 5
References
1. Bang, M. et al. Comparison of supervised exercise with and without manual physical therapy for patients with subacromial impingement syndrome. JOSPT. 2000. 30(3):126-137.
2. Bergman, G. et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain. A RCT. Ann Int Med. 2004. 141:432-439.
3 Boyles R, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. 2009. 14:375-380
4. Brox, J. et al. Arthroscopic surgery compared with supervised exercise in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 1993. 307(6909):899-903.
5. Kachingwe A, Phillip B, Sletten E, Plunkett S. Comparison of manual therapy techniques with therapeutic exercise in the treatment of shoulder impingement: a randomized controlled pilot clinical trial. J Man Manip Ther. 2008. 16:238-247.
6. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009. 18:138-160
7. Luime J. et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004. 33:73–81.
8. Michener, L. et al. Effectiveness of Rehabilitation for Patients with Subacromial Impingement Syndrome: A Systematic Review. J Hand Ther. 2004. 17:152–164.
9. Picavet H. et al. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003. 102:167-178
10. Senbursa G. et al. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthro. 2007. 15:915-921
11. Tate A, et al. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. JOSPT. 2010. 40:474-491.
12. Winters J. et al. The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology. 1999. 38:160–3
13. Wofford J. et al. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: secondary data analysis of the National Ambulatory Medical Care Survey. BMC Musculoskelet Disord 2005. 6:4.
12 weeks 52 weeks
% P
erce
ived
Rec
over
y
Man + Ex
Usual
010203040506070
WALDRON’S PEAK PHYSICAL THERAPY P.C. DECEMBER 2012
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References:
Multiple articles in the research literature describe the e!ectiveness of a multimodal approach to treating shoulder pain utilizing manual therapy to the upper quarter and therapeutic exercise.1, 2, 5, 6, 8, 10
Bang et al. reported signi"cantly greater improvements in motion, strength, pain and function in a group treated with manual therapy and exercise compared with exercise alone.1
Manipulative physical therapy when combined with supervised exercise has been shown to produce faster improvements in pain, ROM and function in patients with SAIS compared to patients who just performed exercise or received self care alone.1, 5, 10
#e addition of manual therapy to patients receiving usual care for their shoulder complaints accelerated their recovery to previous functional levels.2
Speci"cally, the usual care group took 52 weeks to demonstrate the functional improvement noted in the manual therapy group at 12 weeks (see graph).2
Brox et al. has demonstrated a physical therapy program was as e!ective as surgical sub-acromial decompression in the treatment of stage II primary impingement.4
!"#$!%&!'
(!)!((*+'
Physicians should consider referral of patients with symptoms of shoulder pain and dysfunction associated with reaching, li$ing, repetitive upper extremity activities, or over head activities.
Research supports the utilization of manual therapy and exercise in this patient population for reduction of pain and disability associated with shoulder pain. Physical #erapy combined with primary care management can accelerate recovery associated with these symptoms.1, 2, 5
References
1. Bang, M. et al. Comparison of supervised exercise with and without manual physical therapy for patients with subacromial impingement syndrome. JOSPT. 2000. 30(3):126-137.
2. Bergman, G. et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain. A RCT. Ann Int Med. 2004. 141:432-439.
3 Boyles R, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. 2009. 14:375-380
4. Brox, J. et al. Arthroscopic surgery compared with supervised exercise in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 1993. 307(6909):899-903.
5. Kachingwe A, Phillip B, Sletten E, Plunkett S. Comparison of manual therapy techniques with therapeutic exercise in the treatment of shoulder impingement: a randomized controlled pilot clinical trial. J Man Manip Ther. 2008. 16:238-247.
6. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009. 18:138-160
7. Luime J. et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004. 33:73–81.
8. Michener, L. et al. Effectiveness of Rehabilitation for Patients with Subacromial Impingement Syndrome: A Systematic Review. J Hand Ther. 2004. 17:152–164.
9. Picavet H. et al. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003. 102:167-178
10. Senbursa G. et al. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthro. 2007. 15:915-921
11. Tate A, et al. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. JOSPT. 2010. 40:474-491.
12. Winters J. et al. The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology. 1999. 38:160–3
13. Wofford J. et al. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: secondary data analysis of the National Ambulatory Medical Care Survey. BMC Musculoskelet Disord 2005. 6:4.
12 weeks 52 weeks
% P
erce
ived
Rec
over
y
Man + Ex
Usual
010203040506070
