SHOULDER SURGERY

Pain or injury in the upper limb can be quite debilitating. Rotator Cuff degeneration or tears are often blamed for shoulder pain, yet many people are able to use their shoulders very well with “torn” rotator cuffs on scans. Shoulder impingement syndrome accounts for 70% of all shoulder problems (Mitchell et. al 2005). Common contributing factors include tendons of the rotator cuff or irritation of bursae (“bursitis”). While surgery to remove bone lipping, bursa, and/or releasing ligaments was common there was a ten-fold increase from 2500 surgeries a year to 21,000 a year over 10 years in England alone. (Judge et al 2014) Recent ground-breaking research (Beard et al 2017, Schreurs 2018) showed there was no difference between surgery, “fake” surgery & no surgery.   

Research Findings

Corticosteroid injections (CSI) may provide short-term relief.

• However there is also mounting concerns regarding damaging effects of CSIs on tendon health (Dean 2014).
• A quality review of the published research showed physiotherapy just as effective (Camarinos 2009).
• In fact, surgery was no better than physiotherapy treatment involving education, advice and exercise (Camarinos 2009, Babatunde 2017).

Shoulder Pain

• A recent study on exercise treatment for shoulder pain showed Clinical Pilates to be more effective than general exercise in helping to reduce pain and disability (Atiglan 2017).
• Ongoing, shoulder pain can often be related to the nerves from the neck travelling into the shoulder & arm. A thorough assessment of a shoulder problem MUST include the neck, especially if there is pain in the arm (“sciatica” of the arm) (Slaven and Mathers 2010).

Clinical Pilates and Shoulder Pain

When irreversible shoulder surgery is being considered, it is critical to complete a comprehensive assessment as the source of the problem may not be located in the shoulder at all. Shoulder surgery will not fix a neck problem so many shoulder surgeries  can fail. Physiotherapy assessment and a trial of conservative treatment that includes specific individualised exercise therapy must be undertaken to avoid making a costly mistake. Physiotherapists trained in Clinical Pilates select or de-select exercises based on a direction-sensitive clinical assessment, rather than exercises in all directions. This approach is especially suitable for specific, individualized therapeutic exercise treatment, not simply a generic exercise program. DMA Clinical Pilates and Physiotherapy has trained over 10,000 physiotherapists world-wide in pilates-based functional restoration methods, and continues to grow in its sucess.  DMA Clinical Pilates and Physiotherapy and affiliated Clinical Pilates Network (CPN) Physiotherapists are leaders in Clinical Pilates Rehab and Prehab treatment programs