SHOULDER PAIN – EVIDENCE BASED TREATMENT
Shoulder pain is in the top 3 most common reasons why people present to physiotherapists, and rotator cuff issues make up a large majority of these. It is always important that clinicians take an evidence-based approach to patient care, and thankfully the shoulder is an area that has been thoroughly researched.
Common conservative interventions given to treat shoulder pain include manual therapy, exercise, taping, anti-inflammatory drugs (NSAIDS), shockwave therapy, laser therapy and cortisone injections. But which interventions are best supported by the evidence?
A recently published systematic review of the literature assessed the effectiveness of these conservative interventions by analysing over 200 trials (Steuri et al., 2017). It concluded:
*Exercise is effective in improving pain, function and range of motion.
*Exercise should be prescribed as the primary intervention for all shoulder patients.
*Specific exercise is more effective than general exercise (exercise that is prescribed on an individualised basis to the patient).
*The addition of manual therapy, taping, shockwave or laser therapy may add a small additional benefit when prescribed in combination with exercise – but there is not enough evidence to justify their use on their own.
Exercise is medicine, and the evidence for its use in the treatment of the majority of musculoskeletal complaints is overwhelming. It is important that the public takes on board this message, and that we are questioning clinicians who solely rely on passive interventions with minimal supporting evidence.
B. Health Sciences (Physio), APAM