Shoulder Pain and Frozen Shoulder

Shoulder pain with a “stuck” or frozen shoulder is one of the more common shoulder conditions we see in the physical therapy world.  This condition is also known as adhesive capsulitis. It is characterized by shoulder pain and loss of motion in multiple directions, especially movements that involve rotating the lower arm outward and reaching out to the side, away from the body. The condition usually starts with shoulder pain alone and then progresses into limited movement in some motions and progresses to all motions around the shoulder joint. If allowed to worsen, this can cause severe limitation in movement with associated functional limitations. Physical Therapy is commonly prescribed to help and we see good results.

Here are three essential things you should know about the condition of Adhesive Capsulitis, aka Frozen Shoulder:

Number One:

This condition more frequent in those ages 40-65 years is more common in women than in men. It is also more common in individuals with diabetes mellitus, thyroid disease, and those who have had adhesive capsulitis in the past.

Number Two:

Adhesive capsulitis can look like other medical or orthopedic conditions, so it is important that you have an evaluation with your health care provider (physician, nurse practitioner, physical therapist, etc.). They will help you determine the best direction of care for your individual shoulder issues. Injections and/or physical therapy treatments are common, evidence-based interventions that may be recommended.

Here’s what to expect if you are referred for physical therapy:

 A comprehensive evaluation.

Based on your particular presentation and movement tolerance, the physical therapy evaluation will likely include a self-report functional measure, pain assessment, motion measurements, and functional review.

 A treatment intervention plan tailored to your needs and goals.

This may include: 1) Education/instruction in the condition, activity modifications, stretching, and other topics.  2) Treatment modalities to decrease pain, promote healing, and promote tissue extensibility. This may include therapeutic ultrasound, electrical stimulation, or other modalities.  3) Joint mobilization to reduce pain and improve motion and function. 4) Individually tailored stretching exercises to improve movement and function.

Number Three:

A frozen shoulder can be quite limiting and interfere with daily activities. Unfortunately, adhesive capsulitis is not uncommon. It is reported 2% to 5.3% of the general population is affected by this condition. The good news is that there are treatments that can help you have less pain, improve your motion, and regain your function.

Want to learn more about how we can help your shoulder pain or frozen shoulder? Call ATW at (315)765-0063 for your FREE CONSULTATION and if indicated, we can help you get started with a comprehensive physical therapy evaluation and treatment plan.  Learn more about our Physical Therapy Services for orthopedic conditions here.

References:

https://www.jospt.org/doi/full/10.2519/jospt.2013.0302

Back Pain

Back Pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and usually doesn’t require surgery either. Why is it so expensive?

The first reason is that it’s so common. The second reason is that our current system isn’t very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls “high value” treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they’re likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That’s about half the rate of attendance found in the lowest co-pay group.

The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.

Do you or someone you love have back pain? We can help. Call (315)765-0063 today!