Physiotherapists, Osteopaths and Chiropractors
Most shoulder problems do not need surgery in order to get better. Many will resolve with time and can be helped on the way by simple actions such as avoiding whatever caused the pain in the first place, working on improving strength and control in the muscles around the shoulder and addressing the postural issues which plague our modern lifestyle.
This means that you don’t always need to see me and that treatment from a good therapist is often the most effective way of getting you pain free and back doing all the things you want to do.
And just because you do end up being referred to me does not mean that you need an operation.
I get sent patients who need different approaches in their recovery. Some just need to know that nothing serious is amiss and then they are happy to put up with their aches and discomfort. Some have a condition such as Frozen Shoulder where surgery is an option but perhaps 50% will choose to wait it out knowing it will improve eventually. Many can be helped by a steroid or hydrodistension injection that gets them pain free and allows their therapist to work on their rehabilitation rather than just fighting their pain. And of course there are those where surgery is either the first line of treatment or where therapy and injections have only given temporary relief.
Therapy is extremely important for patients with shoulder problems and therapists are very important for shoulder surgeons in order to get the best possible results for the patients on whom they end up operating. It is often quoted that the operation is only half the battle and that good quality rehabilitation is the other half i.e. neither surgery or therapy by themselves will do the trick and they need to be combined.
The key though is the ‘good quality’ bit and one of the biggest problems I face is the number of patients who have wasted months and hundreds of pounds on therapy that is really not up to scratch. What I dread hearing is that a patient has been sat in a room with a heat lamp on their shoulder or has had 20 minutes of ultra-sound or some such nonsense in an effort to treat their unstable shoulder. That is just not acceptable and does nothing for the patient and gives the whole therapist profession a bad name. In the same way as a surgeon who wants to operate on every painful shoulder gives our profession a bad name.
So, if you have had therapy I will always ask what they have been doing and you will probably be able to tell from my face whether I think they have been wasting your time. And when I send you for therapy it will be to someone who I know and who has worked successfully on my patients in the past – whether that is a physiotherapist an osteopath or a chiropractor. They will all keep their black boxes locked away and will work in a hands-on fashion with you re-educating your brain to hold your muscles in the right position and teaching them how to work in the right patterns to hold and move the shoulder and shoulder blade properly.
This can be very, very successful and, combined with a steroid injection, is the first line of treatment for most shoulder problems.
A good therapist will be perfectly happy to see someone who’s shoulder is no longer painful after a steroid injection because they have a better opportunity, faced with a pain-free patient, to look at why that shoulder became painful in the first place and maximise the function in it to minimise the chance of any recurrence. So if a therapist asks why you are here (after an injection has taken the pain away) and everything is ok so you don’t need therapy then walk away because you don’t need therapy from them – you need therapy from someone who understands that you do need help to prevent the pain coming back; to iron out the bad habits in your shoulder and get it strong and moving properly again.
Over the years I have built up an excellent relationship with the therapists I respect and who, in return, think I am doing a good job. Remember we both have choices and they won’t send you to see me if they don’t think my results are good and vice versa.
Therapy – good quality therapy, using the right techniques for the right indications on the right patient – is an essential, and often the main, part in getting your shoulder better.
And, as a surgeon, that is quite hard to admit!
