My experience using shockwave for shoulder problems are good outcomes. My patients see pain levels go down, range of motion improves, and activities of daily living (arm reaches, lifting, carrying, and sleeping) gets better. This suggests the treatment is helping and decreases inflammation associated with calcific deposits. I think the individualized protocols I use for treatment such as number of pulses, the variety of applicators I use, frequency of treatment, as well as having the use of 3 different types of pulse therapy machines makes a difference. I can also use Pulse EMF and laser light approaches to help difficult shoulder cases along.
Bannuru et al. (2014) conducted a systematic review (n=28 RCTs/1307 subjects) of the evidence to assess the efficacy of Extracorporeal Shock Wave Therapy (ESWT) in patients with calcific and non-calcific tendinitis. The outcome measures included pain, function and calcification resolution which was evaluated only in calcific tendinitis trials. High-energy Shock Wave Therapy was found to be statistically significantly better than placebo for both pain and function.
In a 2013 systematic review and meta-analysis, Loppolo et al. looked at ESWT compared to sham treatment or placebo for calcific shoulder tendinopathy. Greater shoulder function and pain improvements were found at 6 months with ESWT over placebo.
Lee et al. (2011) performed a systematic review of RCTs examining the midterm effectiveness of ESWT for calcified rotator cuff tendinitis. The review found consistent evidence of midterm effectiveness of ESWT in reducing pain and improving shoulder function.
Call 310-444-9393 for an appointment.
Aching and stiffness in the shoulders and neck are an extremely common problem, especially for those involved in desk and computer working. If you feel like you need a daily massage, the real cause tends to be postural. Whilst seated, staring at a screen for hours on end, it is easy to fall into a slumped position, with rounded shoulders and the neck protruding forwards. Assuming this position day-in, day-out can result in shortening of the chest muscles and weakening of the small, postural upper back and neck muscles which work to pull the shoulders back. This results in the larger back and neck muscles such as Trapezius and the Rhomboids working harder and becoming tight and achy. Working on correcting these imbalances, by stretching the chest muscles and building endurance strength in the postural muscles such as the lower Trapz and Serratus Anterior can result in a long-term fix.
I treat neck and shoulder pain with soft tissue therapy, mobilization of the stiff joints, ELDOA exercises, shockwave, laser, and posture training.
If you have any of the above, have you tried Pneumatic Lymphatic Pump Therapy?
One of the most neglected systems of the body is the Lymphatic system. An innovative treatment for chronic pain, foot pain, hip pain, inflammation, neck pain, shoulder pain, & TMJ pain is Lymph Drainage Therapy (DLT). In my office I use state of the art technology called LymphaTouch for DLT. Benefits of the LympaTouch Pump Therapy include reduction in limb circumference, pain, increase in range of motion, scar mobility and improved functioning of the immune system. The immune system is stimulated through increased lymph flow. The additional flow carries more antigens to the lymph nodes, thereby increasing antibody/antigen contact. This has been found to help with chronic or subacute inflammatory processes — chronic fatigue syndrome, autoimmune disease, bronchitis, sinusitis, tonsillitis, laryngitis, arthritis, acne and eczema.
Call 310-444-9393 to schedule an appointment
February 15, 2011 (San Diego, California) — A physical therapy program can effectively treat most patients who present with atraumatic full-thickness rotator cuff tears and shoulder pain, without the need for surgery, researchers announced at the American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting.
“Our non-operative program is successful in over 90% of patients and the effect seems to last at least 2 years,” John E. Kuhn, MD, associate professor and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee, and director of the Multicenter Orthopedic Outcomes Network (MOON) Shoulder Group, said.
In the United States, at least 10% of persons over age 60 years, or nearly 6 million people, will develop a rotator cuff tear.
Prospective Cohort Study
The study included 396 patients age 18 to 100 years who had atraumatic full-thickness tears documented by magnetic resonance imaging and no other abnormality. The primary symptom was pain in most patients.
Patients were assigned to a physical therapy program that included daily postural exercises, active-assisted motion, active training of scapula muscles, and active range of motion, along with anterior and posterior shoulder stretching. They also performed thrice-weekly rotator cuff and scapula exercises. The program has been shown to be effective in patients with impingement syndrome.
Study participants also did manual mobilization exercises with assistance from a therapist.
Patients returned at 6 and 12 weeks. At this point they could decide that 1) treatment was successful and they needed no formal follow-up, 2) they had improved but would like to continue therapy with scheduled reassessment in 6 weeks, or 3) nonoperative treatment had failed and they would undergo arthroscopic rotator cuff repair.
Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit.
Improvements on Multiple Outcome Measures
Six-week data indicate that fewer than 10% of patients had decided to undergo surgery.
Of patients in whom follow-up data were available for at least 2 years, only 2% had opted for surgery.
The analysis also revealed that patients who decided to undergo surgery generally made their decision within 6 to 12 weeks of starting physical therapy. In addition, patients did most of their physical therapy at home and usually made only 1 weekly visit to the physical therapist.
Finally, Dr. Kuhn emphasized that the physical therapy program alleviated pain without “doing anything to the tear.” The finding suggests that pain may be a less suitable indication for rotator cuff repair than is weakness or loss of function.
American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting; Abstract #319. Presented February 15, 2011.
These findings are typical of what I find in my rehab practice. Those clients that do the exercises improve.
I enjoyed your helpful article in Dynamic Chiropractic on shoulder evaluation & scauplar positioning.
I am 60 yrs old and have practised 37 years. I am kyphotic and have worked hard in both diversified adjusting and forcing down the lever for distraction adjusting on Cox tables a long time now. After a couple firm jolts I now find myself with acromial impingement, MRI recently shows a small osteophyte subacromial with supra spinatus impingement. There is no calcification nor cuff tears.
An orthopedic friend suggested a scope cleaning. Im afraid of any sequela which would be low I think.
What muscles would you emphasize to work on to realign the scapula-glenoid complex?Your article specifies some,but am slightly confused.Thanks for any suggestions.
Dr. Tucker’s response: For years we were taught that the supraspinatus muscle strengthening exercise was the “empty can” or “full can”. Controversy exists about that maneuver in the literature. I think a good rotator cuff exercise should produce the greatest supraspinatus activity while minimizing the deltoid activation. Theoretically, reducing deltoid activation decreases the upward shear of the humerus during arm elevation, which may be desirable when prescribing exercise to strengthen the suprapsinatus in impingement patients.
In a study published in Medicine and Science and Sports and Exercise, subjects performed 5 isometric exercises in random order while measuring the EMG activity of the deltoid, supraspinatus, and infraspinatus. The exercises were: full can, empty can, prone elevation, elastic external rotation, and prone external rotation. The researchers noted that all exercises produced similar high levels of supraspinatus activity, while the full and empty can exercises also had higher levels of deltoid activity.
The researchers concluded that shoulder external rotation at 0° of abduction with an elastic band
and prone external rotation
were preferable exercises for the supraspinatus. While the full- and empty-can exercises are traditionally favored to isolate the supraspinatus, the authors noted that elastic external rotation and prone external rotation did not activate the deltoid at high levels
compared to the full- and empty-can exercises. In addition, the exercises also exhibited high levels of infraspinatus
In summary, clinicians should consider using Thera-Band® exercise bands for resisted external rotation and isotonic prone shoulder external rotation exercises because they preferentially activate the supraspinatus and infraspinatus without activating the deltoid, which may be more beneficial for patients with impingement.
If you are not sure how to perform these exercises, google the name of each one and you will get photos; or go to the theraband website for photos. I would be diligent in performing these exercises every other day, beginning with 3 sets of 10, progress to 3 sets of 20. Try it for 5-6 weeks before making any surgical decisions. Good luck, Jeff www.DrJeffreyTucker.com