Most people who develop neck pain will improve without any interventions, usually within a few days or weeks. But for some, the problem continues or may even worsen. Between 50–85% of patients report symptoms that don’t completely resolve, and almost half of these individuals will go on to develop chronic neck pain. This term is used to describe pain that lasts for more than three months, which can lead to additional issues like stress, anxiety, a reduced quality of life, and a tendency to avoid certain behaviors that could aggravate the pain.

It is therefore important to develop strategies to treat patients with chronic neck pain early to help them avoid further complications. Physical therapy is among the most reliable and effective treatments for neck pain in general, but research suggests that it may need to be supplemented by additional interventions for those with chronic neck pain to produce the best possible outcomes.

Study conducted to gauge the value of self–management for chronic neck pain

Self–management programs provide patients with the education and skills that are necessary to effectively manage their condition and improve their wellbeing in the long term. These types of programs have been used and researched in other populations with musculoskeletal pain, but not to a significant extent in those with chronic neck pain. Therefore, a study was conducted to determine if adding self–management treatment to a physical therapy program was more effective than physical therapy treatment alone for chronic neck pain patients.

For the study, patients with chronic neck pain for at least 6 months were recruited and screened for inclusion. This process led to 53 patients being accepted, who were randomly assigned to either the control group or the experimental group. Patients in the control group underwent a physical therapy program designed to improve the joint and soft tissue function, posture, coordination, and movement patterns. The sessions included manual therapy techniques, stretching exercises, and coordination and stabilization techniques.

Patients in the experimental group underwent the same physical therapy program as the control group plus a self–management program. This program was based on social learning theory and emphasized the importance of patients partnering with physical therapists to manage their own health. It was structured around giving patients more control of their treatments and included educational information, symptom management, problem–solving, and relaxation techniques. The program lasted 30 minutes and took place twice per week for four weeks. All patients were assessed before the interventions began, immediately afterwards, and three months later for several outcome measures, including neck disability, fear–avoidance beliefs, pain, and health–related quality of life.

Immediately after the interventions, patients in both groups experienced improvements in all variables, but the improvements in fear–avoidance beliefs, pain, and health–related quality of life were significantly greater in the experimental group than the control group. Similar results were identified at the three–month follow–up, as patients in the experimental group reported significantly greater improvements in all four outcomes—neck disability, fear–avoidance beliefs, pain, and health–related quality of life—than the control group.

These findings highlight the importance physical therapy for chronic neck pain, but also show that empowering patients with self–management strategies can help them experience even greater benefits. Therefore, patients with chronic neck pain are strongly encouraged to see a physical therapist for a comprehensive assessment and an individualized treatment program that will likely lead them to less pain, greater functionality, and a better overall quality of life.

The spine is made up of 24 bones called vertebrae that are stacked on top of one another. Together, these bones connect to create a canal that protects the spinal cord from damage. The uppermost portion of the spine that begins at the base of the skull is called the cervical spine. It contains nerves that carry messages between the brain and muscles in the shoulders, arms, and hands. This is achieved through nerve roots that travel through the spinal canal and branch out through openings in the vertebrae called foramen.

Cervical radiculopathy, which is also referred to as a pinched nerve, occurs when one of these nerve roots is compressed or pinched when it branches away from the spinal cord. This is caused by any condition that injures or irritates one or more nerves in the cervical region of the spine, including a herniated disc, spinal stenosis, or degenerative disc disease. In most cases, patients with cervical radiculopathy experience a burning pain that starts in the neck and travels down the arm. This pain can get worse from turning or straining the neck. Other symptoms include tingling, as well as weakness or loss of sensation in the shoulders, arms, or hands.

Some patients with cervical radiculopathy will get better on their own over time, while others will continue to experience symptoms for extended periods. For patients that fail to improve, conservative treatments—particularly physical therapy—are typically recommended as the first step. A standard physical therapy program for cervical radiculopathy will include a variety of stretching and strengthening exercises, as well as a manual therapy component.

Study was conducted to investigate the effectiveness of manual therapy on sensory features for patients with cervical radiculopathy

Manual therapy involves numerous hands–on mobilization and manipulation techniques that are intended to alleviate pain and improve mobility and function. Although studies have shown that manipulation and mobilization of the cervical spine is effective for improving pain and function in cervical radiculopathy, research is lacking on the effects of these interventions on sensory features. Therefore, a study was conducted to evaluate the effectiveness cervical mobilization for patients with cervical radiculopathy.

The type of study performed was called a randomized–controlled trial, in which 28 patients with a history of cervical radiculopathy for at least 3 months were randomly assigned to either the experimental group or the comparison group. Patients in the experimental group underwent an individualized cervical mobilization technique that consisted of posterior–anterior or lateral vertebral glides. Both techniques involved a physical therapist applying pressure at grade 3 to different areas of the cervical spine for 3 sets of 1 or 2 minutes. For patients in the comparison group, the therapist applied a minimal amount of pressure to the most pain region of the cervical spine for 3 sets of 2 minutes.

All patients were also instructed to perform strengthening exercises for the deep flexor muscles and participated in an educational session about pain and the safety of manual therapy and exercises. Patients were assessed before treatment began, 5 minutes after the first session, and then 5 minutes after the sixth session for several outcome measures, including the hypersensitivity for pressure and thresholds thermal—or heat/cold–related—pain.

Results showed that patients in the experimental group experienced greater improvements than the comparison group in mechanical pain hypersensitivity, which was demonstrated by an increased threshold to mechanical pain after the sixth session. These patients also self–reported greater improvements in the intensity of pain, neck function, and active cervical range of motion, which corroborates the improvements in mechanical pain thresholds.

These findings suggest that cervical mobilization techniques can lead to various benefits for patients with cervical radiculopathy, which could translate to better functionality and quality of life. Additional research is needed to confirm these findings, but patients with cervical radiculopathy should strongly consider seeing a physical therapist for a personalized program that will likely include some manual therapy component.

In our next and final post, we review another study on the benefits of physical therapy for chronic neck pain.

The neck has an incredibly important job to do. It supports the head and allows us to move it in a wide range of directions so that we can better navigate the world around us. But because of how frequently it’s used and its position in the body, as we’ve already seen, the neck is also a very common location for pain. And as anyone that’s been there before can attest to, sometimes all it takes is one bad night’s sleep to ruin your day.

For each person, there are a variety of factors that may contribute to the development of neck pain. What’s most important to understand is that some of these factors are out of your control, while others can be addressed to reduce your chances of experiencing neck pain.

For example, age–related changes to the structures of the upper spine are inevitable in all individuals, and these changes may be a cause of neck pain for some. While nothing can be done to slow down or stop the aging process, there are several steps you can take right now to help prevent neck pain from developing. One of the most impactful things you can do is to keep your upper spine strong and flexible through regular physical activity and targeted exercises for the muscles of the neck. Therefore, to help you in the process, here are our top 3 exercises for reducing your risk for neck pain:

Our top 3 neck pain prevention exercises

To see videos of each exercise, go to www.MyRTR.net and enter prescription code RJWH77HK1

1. Upper cervical flexion in supine
   • Lie on your back with your head supported on a rolled towel or ball
   • Slowly bring your chin toward chest
   • Return to the starting position
   • Repeat for one set of 5 repetitions, twice per day
2. Active cervical rotation
   • Lie on your back on a flat surface
   • Slowly rotate your head to one side until a comfortable stretch is felt
   • Hold for 20 seconds
   • Slowly rotate your head to the opposite side until a comfortable stretch is felt
   • Repeat for one set of 5 repetitions, twice per day
3. Active cervical side bending
   • Lie on your back on a flat surface
   • Slowly bring your ear toward your shoulder; if necessary, use your hand to gently pull your ear toward your shoulder Hold for 20 seconds
   • Return to the midline
   • Repeat for one set of 5 repetitions, twice per day

Regularly performing these exercises will bolster the strength of neck muscles and increase the flexibility of supporting joints, which will lower your chances for developing neck pain in the process. However, even when preventive measures such as these are taken, pain may still develop due to the multifactorial nature of neck pain. When this occurs, physical therapy is your best option available, and in our next two posts, we summarize some research that shows why.

Most of us can recall one or more occasions when the day got off to a rough start because of a stiff neck. This can be explained by the fact that neck pain ranks among the most common types of pain you can get. Statistics vary on just how many people encounter neck pain, but recent evidence suggests that its lifetime prevalence is between 20–70% and that 10–20% of individuals are affected by it at any given time.

Dealing with neck pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick an item off the ground or twisting your torso when looking to the side might suddenly take more time and make you less mobile in the process. Being regularly bothered by pain and movement limitations will often lead one to wonder what’s causing the pain and what steps can be taken to address it.

The truth is that the specific cause of neck pain is usually difficult to pinpoint, and regardless of its cause, the most effective treatment is usually a comprehensive, individualized course of physical therapy. Nonetheless, there are a few signs that could be a “red flag” that warrants further investigation. To help you better understand what could be causing your neck pain and what to do next, here are the 7 most common causes of neck pain seen by physical therapists and some red flags to be aware of:

The 7 most common neck pain conditions treated by physical therapists

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can damage or tear it; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck strains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Sprains and strains are responsible for most cases of neck pain, particularly in younger patients; these injuries can occur either from a single incident or result from repetitive stress over time
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; herniated discs are more common in the lower back, but also occur in the neck; typical symptoms include a sharp or burning pain in the shoulder or arm, as well as numbness or tingling and weakness
• Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is typically only seen in older adults
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of neck pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; patients typically experience pain and stiffness, and possibly weakness or numbness in the neck as well
• Cervical radiculopathy: occurs when one of the nerve roots in the neck is compressed or pinched when it branches away from the spinal cord, which is caused by any condition that injures or irritates these nerves; symptoms include a burning pain that starts in the neck and travels down the arm, chest, upper back, and/or shoulders, and weakness, numbness, and/or tingling in the fingers

Red flags

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of neck pain in patients under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

In our next post, we describe our top exercises to reduce your risk for neck pain.

Tennis is a great form of physical activity that works out many parts of the body due to its demanding dynamics, but just like every other sport, it also comes with a risk for injury. The most common injury in the sport is called lateral epicondylitis, which is often referred to as tennis elbow.

The lateral epicondyle is a bony bump on the outside of the elbow that serves as an attachment point for several muscles, tendons, and ligaments of the elbow and forearm. When the arm is overworked, a muscle in this region called the extensor carpi radialis brevis (ECRB) gets weakened, which eventually leads to microscopic tears in its tendon, which attaches to the lateral epicondyle. This results in inflammation of the ECRB tendon, which is called lateral epicondylitis, or tennis elbow.

As we explained in our first post, tennis elbow is a repetitive strain injury that’s caused by repeatedly performing certain movements over a long period. Athletes who play tennis and other racquet sports have an elevated risk for developing tennis elbow, particularly due to the groundstroke in these sports, which directly puts a strain on the ECRB. But tennis elbow can occur in anyone who performs repeated movements that involve the elbow, such as painters, plumbers, and carpenters. When tennis elbow occurs, the most common symptoms are pain and a burning sensation in the outer part of the forearm and elbow that gets worse with activity, as well as weakened grip strength.

Fortunately, 90% of patients with tennis elbow will significantly improve with nonsurgical treatment alone, such as physical therapy. Physical therapists are movement experts who will first perform a thorough evaluation to identify the source of your pain and determine if any of your movements or activities may be contributing factors. From there, the therapist will design a personalized, evidence‐based treatment program designed to alleviate your symptoms and restore your physical function with a variety of interventions.

19 studies are accepted into comprehensive review

A recently published study called a systematic review highlights just how effective physical therapy can be for this condition. For the study, researchers performed a comprehensive search for published literature that evaluated various physical therapy interventions for tennis elbow. This search led to 19 studies being accepted into the review, all of which were published in the last five years. Each study assessed the effectiveness of one or more physical therapy interventions, including therapeutic exercises, manual (hands‐on) therapy, taping, orthotic devices, and pain‐relieving modalities like ultrasound, ice, and heat.

Results showed that the physical therapy techniques analyzed generally had a positive effect on patients’ symptoms and helped to resolve the clinical signs of tennis elbow. The two interventions found to produce the most benefits were strength training exercises and manual therapy—including massage and stretching exercises—both of which also had a very favorable cost‐benefit ratio. Most of the other techniques analyzed were also found to have positive effects on patients with tennis elbow.

These findings provide further evidence that many of the interventions frequently used in physical therapy are beneficial for tennis elbow by helping to alleviate painful symptoms. Therefore, patients who are bothered by symptoms that may suggest tennis elbow should strongly consider consulting a physical therapist for an evaluation that will likely lead to a comprehensive treatment program and an eventual path to recovery.

The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to most of our fingers. If these tendons and soft tissue thicken or any other swelling occurs in the area, the tunnel narrows, which puts pressure on the median nerve and leads to carpal tunnel syndrome. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm. As carpal tunnel syndrome progresses, symptoms usually get worse when holding certain items, and the weakness and numbness may occur more frequently if pressure on the nerve persists.

Carpal tunnel syndrome affects about 5% of the population, and the greatest risk factor is performing any task that requires repetitive hand motions, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Although office work and repetitive typing may be a potential cause, the professions most frequently associated with carpal tunnel syndrome are those that involve sewing, baking, cleaning, and assembly-line work.

Surgery and conservative (non-surgical) interventions like physical therapy are both frequently used to treat carpal tunnel syndrome. Guidelines for carpal tunnel syndrome vary, with some recommending surgery and others recommending different conservative treatments like exercise, orthotic devices, and manual therapy, and there is not yet a consensus on which approach is more effective; however, surgery is the most common treatment approach for carpal tunnel syndrome, despite this lack of evidence.

Over 100 women are assessed over four-year period

To shed light on this topic, a study was conducted that compared the long-term effectiveness of surgery to manual therapy, a conservative intervention frequently used by physical therapists. The study was a continuation of a randomized-controlled trial in which 120 women with carpal tunnel syndrome were randomly assigned to undergo either manual therapy or surgery and then followed up for four years.

Patients assigned to the manual therapy group received one 30-minute treatment session per week for three weeks. The session consisted of the therapist performing a series of mobilization techniques with their hands that targeted sites that could potentially trap the median nerve, as well as tendon gliding exercises and mobilization techniques to the upper spine. Patients in the surgery group underwent a surgical procedure called carpal tunnel release and were then educated on how to perform the same exercises as the manual therapy group. All patients were assessed for the level of hand pain before the study began and then periodically for the next four years.

Of the 120 original participants, 97 (81%) completed the four-year follow-up. In the original trial patients in the manual therapy group reported greater decreases in pain intensity than the surgery group at 1, 3, and 6 months. At the one-year and four-year follow-up, there were no significant differences between the manual therapy and surgery group. There were also no significant differences between groups in the rate of surgery over four years, and patient’s self-reported scores on their perceived improvements were similar as well.

These results suggest that surgery and manual therapy lead to similar outcomes over four years for women with carpal tunnel syndrome. It is therefore advised that patients with carpal tunnel syndrome first attempt a trial of conservative treatment that includes interventions like manual therapy before considering surgery, which runs counter to the current trend of most patients receiving surgery. Patients should also be aware that surgery is typically associated with greater costs and potential risks, whereas physical therapy is universally regarded as a safe and effective treatment with minimal risks.

In our next post, we summarize a study that reviewed the most effective physical therapy interventions for tennis elbow.

Most people don’t realize just how much they rely on their wrists and elbows to function properly until a problem arises. This is often the case for anyone with wrist or elbow pain, which can cause daily life to become a series of obstacles to overcome, often leading many patients to skip many activities altogether to avoid aggravating pain. This in turn can cause performance issues at work or in sports, which may equate to lost wages or fitness impairments over time.

Therefore, it’s important to take steps to reduce your risk for wrist and elbow pain in the first place. Many people are unaware that their profession itself could be contributing to this type of pain, especially if repetitive movements&like typing on a computer, cutting hair, working on an assembly line&are involved. While we would never recommend changing your professions unless the circumstances were dire, there are some ways you can reduce your risk for repetitive strain injuries, such as adjusting your posture and the positioning of your hands and wrists, trying to avoid repetitive and straining movements, and modifying your workstation positioning and habits. In addition, we strongly recommend the following exercises for boosting your strength and flexibility, which will in turn help you avoid injury:

Our top 3 exercises to prevent wrist or elbow pain To see videos of each exercise, go to www.MyRTR.net and enter prescription code XGXLMGKL

1. Resisted Elbow Extension with Weight
   • Lie on your back with one elbow supported by the opposite arm
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Straighten your elbow against the resistance of the weight
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week
2. Resisted Hammer Curls with Weight
   • Stand with your arms by your side with your thumb facing forward
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Bend your elbow, leading with your thumb
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week
3. Resisted Elbow Flexion: Palm Up
   • Stand with your arms by your side and palm facing forward
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Flex your elbow while bringing your hand toward shoulder
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week

In our next post, we’ll break down a study that highlights the benefits of physical therapy for carpal tunnel syndrome.

In a typical day, you use your hands, wrists, and elbows extremely frequently. From vigorously brushing your teeth in the morning to switching the lights off before bed and during most other actions in between, these joints are very often in a state of movement. But over time, performing certain tasks on a repetitive basis can go on to damage some of these structures and lead to injury.

A repetitive strain injury is a potentially disabling condition that results from overuse of a body region or structure—usually the hand or wrist, and sometimes the elbow—after performing the same movement over and over. Repetitive motions, like typing on a computer, cutting hair, working on an assembly line, or even using a cellphone can all cause increase stress and fatigue of different structures, resulting in pain and other symptoms in these regions.

Common wrist and elbow conditions vs red flags

Carpal tunnel syndrome is by far the most common and well-known repetitive strain injury in these areas, as it affects up to 5% of the adult population. But there are several other repetitive strain injuries that can also affect the wrist or elbow. Below, we break down some of the most common conditions that can produce pain and limit movement in the wrist and elbow, all of which can be effectively treated by a physical therapist. This is followed by some key red flags to be aware of that may suggest a bigger issue is present:

• Carpal tunnel syndrome: a repetitive strain injury that is likely caused by tasks that involve repeated hand motions, awkward positioning of the hand or wrist, vibration, or excessive gripping; individuals who work in industries like manufacturing, food processing, and textiles are likely at the highest risk; over time, these movements can cause the median nerve within the carpal tunnel to be compressed, which leads to pain, tingling, weakness, and/or numbness in the hand or wrist
• Wrist tendinitis: a condition in which one or more tendons in the wrist becomes inflamed and irritated, which leads to pain and disability; tendinitis can occur at any age but is more common in adults; as tendons age, they become less elastic and can tolerate less stress, which makes it easier for them to become damaged
• De Quervain’s tenosynovitis: this is a type of tendinitis that develops on the thumb side of the wrist; it causes pain and tenderness in the wrist or below the base of the thumb and often gets worse with repetitive hand or wrist movements; as with other types of tendinitis, tenosynovitis is more common after the age of 40
• Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position; the causes of this condition are unknown, but it’ more common in men over the age of 50
• Ulnar tunnel syndrome (Guyon’s canal syndrome): this condition is similar to carpal tunnel syndrome, but it involves compression of the ulnar nerve, which leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists
• Golfer’s elbow (medical epicondylitis): this condition results from repeated bending of the wrist, which damages the muscles and tendons in the elbow and eventually leads to inflammation; it’s most common in golfers, but can occur from other sports and activities that strain the elbow, and the clearest indication is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities
• Tennis elbow (lateral epicondylitis): a repetitive strain injury caused by repeatedly performing the same movements—in tennis, other racquet sports, or one’s profession—over and over; common symptoms are pain and a burning sensation on the outside of the forearm and elbow that gets worse with activity, as well as weakened grip strength

Red flags

• Signs of infection or septic arthritis (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Constant pain, including pain at night
• Deep, intense pain
• Pain associated with unexplained weight loss and/or fever
• Suspected fracture or dislocation from severe trauma to the wrist or elbow
• Known or suspected cancer (eg, significant bone pain, which may be suggestive of a bone tumor)
• Persistent swelling and pain without any recent injury
• Severe muscle spasm

In our next post, we’ll provide you with our top picks for exercises that can reduce your risk for developing wrist or elbow pain.

One of the few common shoulder diagnoses that does not directly involve the rotator cuff is adhesive capsulitis, or frozen shoulder. This condition occurs when scar tissue forms within the shoulder, causing the shoulder capsule to thicken and tighten around the shoulder joint and reducing the amount of space for the shoulder normally. Although frozen shoulder affects up to 5% of the population, the reasons why it develops are not yet clear. Common consensus suggests that not moving the shoulder normally for long periods is a leading factor, as most people who get frozen shoulder have kept their shoulder immobilized due to a recent injury, surgery, or pain. People between the ages of 40–60, women, and patients with arthritis, diabetes, cardiovascular disease, and other health conditions are also more likely to develop frozen shoulder.

Frozen shoulder usually comes on slowly and gets progressively worse over time with more pain and loss of motion. It is typically divided into the following four stages:

• Stage 1: consists of the onset of symptoms, which gradually get worse over 1–3 months
• Stage 2: the “freezing” stage, which generally occurs 3–9 months after symptoms begin and is very painful
• Stage 3: the “frozen” stage, which involves the shoulder becoming even more stiff and difficult to move
• Stage 4: the “thawing” stage, which occurs within 12–15 months and involves pain decreasing significantly and range of motion starting to improve

Physical therapy is commonly recommended for frozen shoulder because it is an effective intervention that addresses symptoms at every stage; however, certain questions about the exercises used in physical therapy remain unanswered. Therefore, a comprehensive study called a systematic review and meta–analysis was conducted to 1) compare the effectiveness of exercises alone and exercises in combination with other interventions and no exercises and 2) determine what kind of exercises are most effective for frozen shoulder.

33 studies evaluating exercise therapy for frozen shoulder are reviewed

To conduct the study, researchers performed a search of three medical databases for relevant studies about the effectiveness of exercise therapy for frozen shoulder. This led to 33 studies being accepted into the review, which saw patients treated with a variety of exercises, including individually prescribed exercises and those prescribed as part of a comprehensive treatment program. The findings of all included studies were then reviewed and analyzed with the goal of answering the two stated research questions.

Results showed that exercises—both on their own and as part of a program—improved range of motion (ROM), function, disability, and pain, and the type of exercise performed had little to no impact on these improvements. Also, adding physical modalities—like ultrasound, ice, or heat—to exercises did not provide any benefits to treatment outcomes, and programs that included exercises resulted in larger active ROM gains than programs that did not. These findings support the effectiveness of physical therapy for frozen shoulder and suggest that the type of exercises performed and whether they are done alone or combined with other interventions may not be important, so long as they are featured in a rehabilitation program.

Therefore, if you’re currently dealing with symptoms that sound like frozen shoulder, we strongly recommend contacting us to schedule an appointment and getting started on a path to recovery.

As we discussed in our first post, nearly 85% of shoulder conditions involve the rotator cuff, and among the most common of these is shoulder impingement syndrome (SIS). SIS results from the rotator cuff tendons becoming compressed—or “impinged”—as they pass through a small bone on top of the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, which eventually leads to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement, and pain.

SIS is most prevalent in individuals that regularly perform lots of overhead activities like golfers, swimmers, baseball and tennis players, as well as painters and construction workers. The condition can also result from an injury that compresses the structures of the shoulder—like a fall—or from frequently sleeping on your side. Sleeping in this position regularly can strain the shoulder and cause impingement over time.

SIS is closely related to rotator cuff tendinitis and subacromial pain, and in some cases, the terms are used interchangeably. When any of these conditions develop, the best course of action is a comprehensive physical therapy program, which helps patients work through their pain to regain strength, flexibility, and physical function; however, many patients still opt to undergo a surgical procedure called arthroscopic subacromial decompression (ASD) to treat their shoulder pain. An abundance of research has shown that this procedure does not lead to any significant benefits, but it remains one of the most frequently performed procedures in the world, and some professionals still advocate for it. To better understand the outcomes of these patients, a study was conducted that compared the return–to–work rates for patients with subacromial pain who underwent different interventions.

Study periodically monitors more than 200 patients for 5 years

A total of 210 patients with subacromial pain for more than 3 months were enrolled in the study and randomly assigned to one of three treatment groups: exercise therapy, diagnostic arthroscopy, or ASD. Patients in the exercise therapy group underwent a supervised, individually designed physical therapy program that included daily home exercises and 15 visits to a physical therapy clinic. Patients in the diagnostic arthroscopy group underwent a “sham” procedure in which an examination of the shoulder was performed with a small camera inserted surgically, but no repairs were made to the shoulder. Patients in the ASD group were treated surgically with the ASD procedure, which involved the careful removal of some portions of bone and a structure called the bursa. Patients in the diagnostic arthroscopy and ASD groups also participated in a postoperative physical therapy program. All patients were assessed at the beginning of the study and then again 2 years and 5 years later.

Two years after these interventions, 78% of patients in the exercise group, 80% of patients in the diagnostic arthroscopy group, and 82% of patients in the ASD group were found to be actively working. Five years after the intervention, these figures were 66% for the exercise group, 69% for the diagnostic arthroscopy group, and 67% for the ASD group, meaning there were no significant differences between the three groups at both 2 years and 5 years after the interventions. Therefore, based on these findings, physical therapy can be considered just as effective as ASD for helping patients with subacromial pain recover and maintain their improvements in the long term. Given the fact that exercise therapy is also safer and less expensive than surgery, it’s clear why it continues to be the recommended option for most patients with SIS and why surgery should be avoided.

If you’re dealing with symptoms that sound like subacromial pain, please take the first step in your path to recovery by giving us a call and scheduling an appointment.

In our next post, we’ll break down another study that underlines the beneficial effects of physical therapy for frozen shoulder.