The article Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial reveals no difference between the fake (or sham) surgery and the real surgery.
This type of shoulder surgery, know as subacromial decompression (SAD) is unfortunately still prevalent in the U.S. In this research study, both the sham surgery group and the real surgery group had something important in common: in both groups the shoulder joint was irrigated. Essentially the joint was power-washed. I believe this to be the key part of the intervention, the reason why both the fake and real surgeries provided the same results.
What I find in the clinic is that many joints have a piece of debris obstructing the joint's motion and causing pain. In the extremity joints this is thought to be a piece of fat, cartilage, bone, tendon, or similar. Of course, this can be effectively "power-washed" with repeated movement, too. My job is to find the movement that moves that piece of debris out of the way. My patient's job is then to perform that movement throughout the day and temporarily avoid movements in the opposite direction.
If you have been contemplating shoulder surgery, please read this study and/or contact me with any questions. Hopefully medical providers will no longer suggest this as an option. -- Laura
Joel Laing, a McKenzie specialist in Australia, gives a great demonstration of a rapidly resolvable shoulder issue - specifically, shoulder pain and loss of motion. The wonderful thing about the McKenzie method is that we are trained to actually LOOK for these problems. I was not trained to look for these problems during my physical therapy doctoral program. Now that I know how to diagnose these issues, most patients get better in a handful of visits or less versus weeks/months of PT.
In his case he needs to repeatedly move his shoulder backwards with his palm down. Typically when we find the healing movement the patient needs, the patient does a few sets per day. As Joel also points out, there are often certain movements that make the problem worse as well. While the shoulder heals, we usually ask the patient to avoid those motions for a few days if possible.
When it comes to shoulder pain, the top two diagnoses I see are:
1. The pain is actually coming from the neck or upper mid-back, so we treat the spine with movement and the shoulder pain goes away.
2. The pain is quickly resolvable with targeted shoulder movement (like in Joel's case).
Don't let shoulder pain affect your life; in the large majority of cases we can get it better fast. And don't get a diagnosis based on an MRI. Most people over 30 will have problems in the shoulder on an MRI. Since problems on an image (a torn labrum, degenerated tendons, a torn rotator cuff, bone spurs) are so prevalent in people without pain, what you see doesn't necessarily correlate with your pain. You instead need a quality McKenzie clinical exam. -- Laura
Painful thumbs? Numb fingers or hands? Weak grip? The nerves in the neck and the upper mid-back control the hands. Specifically, nerves C6, C7, C8, and T1. (The "C" stands for cervical, which means neck. The "T" stands for thoracic, which refers to the mid-back.) Most hand issues are a result of the nerves in the neck/upper mid-back being compressed. If someone has problems in BOTH hands, the issue is almost ALWAYS coming from the spine. While it is normal for your hand to fall asleep if you lie on it in a weird position, it is not normal to experience numbness/tingling/pain on a regular basis, even with sleeping. If I determine that your hand symptoms are indeed coming from the nerves in your spine, I treat it with two things: movements to decompress the nerves and postural correction. Posture can refer to your sitting, lounging, and/or sleeping habits. I often suggest modifications to your car seat too. --Laura
This topic has been coming up a lot with my patients recently. Many patients report that they don’t feel pain exactly - they feel tight, or, more usually, really tight. This can apply to the neck, low back, and extremities. Determining the reason a patient feels tight (the diagnosis) and helping fix it is, of course, my job.
True muscle tightness certainly exists. What do I mean by “true muscle tightness?” I mean that the reason you feel tight in a muscle, say the hamstring muscle, is because the hamstring muscle is actually tight. This is most typically a result of an increased or altered load on a muscle – like a workout - and sets in 1-2 days after the change in demand. This tightness may be called soreness, and is a result of normal breakdown in the muscle itself and/or inflammation in the muscle. While people might choose to intervene to reduce this tightness (such as going for a walk, stretching, getting a massage, etc.), it is imperative to note that this tightness is normal, and will pass within a few days on its own. People don’t usually seek medical care for this.
True muscle tightness can come from less strenuous events too. For example, if you wear a new pair of shoes while walking around a city for hours, you might experience tightness in a muscle or two the next day since your muscles experienced a new load due to the different position of your feet. Alternatively, if you were in a cast for 8 weeks, your muscles may also feel tight while they are immobilized. And, of course, if you tear a muscle, if will feel tight as inflammation and then immature scar tissue replaces the torn muscle tissue. In all of these scenarios, the cause of the tightness is normal, obvious, and reversible.
Again, patients usually don’t come to me reporting tightness of the normal variety (since normal muscle tightness will pass on its own). So what makes patients feel tight if it’s not normal true muscle tightness? There are two possibilities:
1. The abnormal sensation of tightness is referred from a joint, either nearby or distant.
A common situation here is a spine joint being out of place and referring a feeling of tightness to a separate area. It can be nearby, like the neck joints sending tightness signals to the upper shoulders. Or it can be more distant, like the low back joints sending tightness signals to the calf. Extremity joints can also send tightness signals. With extremity joints, the signal usually stays close to the problematic joint. The hip joint may send a feeling of tightness down the thigh a bit, for instance. This tightness can be constant or it can come and go.
2. The abnormal sensation of tightness is nerve tension/tightness.
Nerves run throughout our body, passing through and next to muscles. If a nerve is compressed somewhere along its path, it will lose the ability to lengthen, making it indeed tight. The most frequent example of this is the sciatic nerve. When compressed in the low back, it can create a feeling of tightness in the back of the thigh, calf, or foot. Most people, however, just blame the muscle in the area of tightness, not understanding that a nerve is also in that area! This tightness, also, can be constant or it can come and go.
There are movements and simple tests I use in the clinic to determine what is causing the tightness. A simple slump test is used to help differentiate if a hamstring muscle or a sciatic nerve is tight, for instance. The take home message is this: true muscle tightness is usually normal, but persistent or recurring (chronic) tightness is not normal, and is almost always arising from a location away from the site where the tightness is felt. You shouldn’t be stretching, foam rolling, or massaging your arm, back, or leg muscles all the time. Find the joint or nerve causing the feeling of tightness and fix that to get relief for good. -- Laura
Centralization is a very important concept, and is well-documented in many research studies. Problems in the spine often cause pain/numbness/tingling in the extremities (legs, feet, arms, hands) as affected nerves carry symptoms along the distribution of the nerve. Centralization is when symptoms move toward the spine. This is a GOOD thing - even if the spine pain is temporarily more intense (before it goes away for good). By the same token, peripheralization is not a good thing. We don't want pain that is moving farther away from the spine into the periphery (extremities). Keep in mind that centralization also applies when left or right low back pain or left or right neck pain moves to the center of the low back or neck.
Not all patients will experience centralization. Some extremity pain just goes away without moving to the spine first. If you are receiving treatment or are just monitoring or treating yourself, remember to avoid things that peripheralize your symptoms and to perform the activities or movements that centralize your symptoms. When I treat patients with spine or extremity symptoms, I use specific movements to elicit centralization - and prevent peripheralization. If you experience centralization, you know you're on the right track!
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