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Osteopathy techniques vs Physiotherapy and Injection Therapy in the treatment of shoulder girdle pain and synovial joint pain of the shoulder.

Blog edited by Jason Dodd, Clinic Manager of Bodylogics The Sports Therapy Clinic and supported by research from the British Medical Journal of Sports Medicine.

The study here aims to offer a comparison between the effects of three common modalities for the specific treatment of shoulder pain.  At least 40% of the population will experience shoulder pain at some stage of their lives.  After a previous blog, we have already highlighted the lack of evidence surrounding shoulder surgery and that it is no better than placebo for the treatment of pain.  The three modalities of treatment discussed here are Physiotherapy, Osteopathy and Corticosteroid injection.  The data, methods and results of each are outlined below with graphs to illustrate the effects.

The groups

The synovial group consisted of patients with pain or limited movement in one or several directions of the glenohumeral joint. These complaints originated from disorders of the subacromial structures, the acromioclavicular joint, the glenohumeral joint, or combinations of these (the synovial structures).

The shoulder girdle group consisted of patients with pain and sometimes slightly limited range of active movement of the glenohumeral joint. These problems were not related to the synovial structures but, instead, probably originated from functional disorders of the cervical spine, upper thoracic spine, or the upper ribs (the shoulder girdle).

Treatment

Corticosteroid injection consisted of an injection of 1 ml of 40 mg/ml triamcinolone acetonide in combination with 9 ml of 10 mg/ml lignocaine. One to three injections were given by the participating doctors immediately after randomisation, one week later, and, if needed, after a further two weeks. In each treatment session two out of the three synovial structures (glenohumeral joint capsule, subacromial space, and acromioclavicular joint) were injected. Our injection techniques were standardised: the intra-articular injection was given from the posterior side, the subacromial injection from the lateral side, and the acromioclavicular injection perpendicularly from the upper side of the joint.

Physiotherapy was given twice a week by local physiotherapists. They were instructed to use “classic” physiotherapy–such as exercise therapy, massage, and physical applications. No mobilisation techniques or manipulative techniques were allowed.

Manipulation consisted of mobilisation and manipulation of the cervical spine, upper thoracic spine, upper ribs (on the segmental level), acromioclavicular joint, and the glenohumeral joint once a week with a maximum of six treatment sessions. The manipulation was done by either the participating general practitioners or physiotherapists.  They were instructed in which techniques to use.

The Results

Osteopathy techniques vs Physiotherapy and Injection Therapy in the treatment of shoulder girdle pain and synovial joint pain of the shoulder. Bodylogics
Figure above shows the survival analysis of the shoulder girdle group. Manipulation was superior to physiotherapy: at five weeks after randomisation almost 70% of the patients in the manipulation group considered themselves to be cured compared with 10% of the physiotherapy group. Drop out because of treatment failure was significantly higher in the physiotherapy group (45% (13/29) of patients) than in the manipulation group (20% (6/29) of patients).

Osteopathy techniques vs Physiotherapy and Injection Therapy in the treatment of shoulder girdle pain and synovial joint pain of the shoulder. Bodylogics
Figure shows the survival analysis of the three treatment groups in the synovial group. The corticosteroid injection group (average number of injections was 1.8) improved rapidly, while the physiotherapy group improved slowly and the manipulation group did only slightly better: at five weeks after randomisation, 75% of patients in the injection group were “cured” compared with 20% in the physiotherapy group and 40% in the manipulation group. Drop out because of treatment failure was much lower in the injection group (17% (7/47)) than in the physiotherapy group (51% (18/35)) and manipulation group (59% (19/32)).

What does this all tell us then?

The source and location of your pain will determine the relevant method for treatment.  What is vital is that you have a thorough assessment carried out first before deciding any form of treatment.  Osteopaths are renowned for their ability to find the source of your pain and advise on a treatment plan from there.  The shoulder girdle applies to the whole of the shoulder complex whereas the synovial aspect refers to the pocket of fluid that surrounds the socket where your humerus sits.  Once your assessment has been completed you can begin your first stage of treatment and begin the journey to full recovery.

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