Osteopathic Journals and Research by Darren Chandler

 

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  1. Content

    • Who gets persistent pain
    • Why some pain is persistent
    • What can be done

    Who gets persistent pain

    Over 14 million people in the UK have persistent pain. Of them nearly 1 in 4 said it had stopped them from their usual activities including work.

    Why some pain is persistent

    When someone injures themselves our body recognises this as pain which initiates the body to repair itself. Usually this resolves the problem and the pain disappears. However some injuries are incapable of healing themselves. This maybe because the initial injury was particulary bad or something is maintaining the injury for example a working posture, weakness of a muscle or inflexibility. In cases such as this treatment from your osteopath will address any underlying issues and correct your injury.

    Occasionally however in other forms of persistent pain your symptoms can continue even after the injury has repaired. It occurs because our nerves become over-sensitised. In other words our nerves become too good at sensing pain. As a result of our nerves being so sensitive it means a painful response will be triggered far more easily than normal. You could think of this as a sensitive car alarm that goes off in error when someone walks past. As unpleasant as this is it doesn’t always mean you are doing yourself any harm simply by moving. However deciding what activities you do and don’t do should be made by your osteopath or suitable healthcare practitioner to avoid the potential of further injury.

    What can be done

    If you have an injury that simply won’t heal by itself then you should consult your osteopath for treatment. Injuries resistant to standard over the counter treatments are common in osteopathic clinics.

    This is some general advise on how to manage your pain

    • Being less active causes the joints to stiffen and weight gain. Weak or under-used muscles/joints can feel more pain. Keeping active can in some cases reduce pain. Seek appropriate advice from your osteopath or appropriate healthcare provider before deciding what activities to do or you could potentially injure yourself further.
    • Pace your activities. Try and separate a job into more manageable chunks and with time to recover between activities.
    • Set goals by writing a list of things you can do rather than can’t do.
    • Sleep depravation can be a major problem with persistent pain and cause your symptoms to worsen. Avoid napping during the day if you can. Experiment with different sleeping positions and pillows or using different beds in the house to find one most comfortable. Some patients perform exercises or take measures they find helps their symptoms before they go to bed for a better night sleep. 
    • Negative thinking and low moods is a common problem with persistent pain. More so if your pain affects your relationships and work causing financial worries. Any pre-existing mental health problems are likely to be aggravated with persistent pain and it’s best to talk about things with friends, family or your GP. 
    • Keep hydrated. Dehydration can be a common cause of persistent chronic aching pains.

     

  2. Content

    • What is frozen shoulder
    • Who gets frozen shoulder
    • The treatment of frozen shoulder

    What is frozen shoulder

    The joint capsule of the shoulder encases and forms an outer ‘skin’ of the shoulder joint. A frozen shoulder occurs when scar tissue forms inside the shoulder capsule causing it to thicken, swell and tighten(1). On top of this patients’ experience tightness of the muscles and other soft tissues giving pain and restricted movement(2).

     Frozen shoulder has three stages(1). The average length of these stages without treatment is 30 months(2):

    • Stage one: the shoulder aches becoming painful when reaching out for things or when you lie on the bad side. This can last two to nine months.
    • Stage two: the shoulder becomes increasingly stiff. The pain may not get worse and could even start to decrease. The muscles around the shoulder start to waste as they're not being used. This can last for four to twelve months.
    • Stage three: slowly you’ll regain some movement in your shoulder. The pain starts to fade, although it may temporary return as the stiffness eases.

    The most common position that patients find limited is the position your arm goes into when you put it up to wave (flexion/abduction/external rotation)(2).

     Who gets frozen shoulder

    Up to 1 in 20 people in the UK may be affected by frozen shoulder.

    You are more at risk from developing a frozen shoulder if you have(1):

    • Previous shoulder injury or shoulder surgery
    • Inactivity of the shoulder
    • Diabetes (type 1 or 2)
    • Dupuytren's contracture 
    • Heart disease and stroke
    • Lung disease
    • Hyper- or hypothyroidism
    • Breast cancer (or shoulder cancer(2))

    Near enough all the frozen shoulders we see in the clinic are due to another shoulder injury or immobility of the shoulder for whatever reason. However it is good practice to be examined by your GP prior to any treatment.

    The treatment of frozen shoulder

    Conservative (non-invasive) treatment options include(1):

    • Antiinflammatories and pain killers
    • Corticosteroid injection
    • Stretch, massage and home exercises

    Surgical treatment options include(1):

    • Manipulation under anaesthetic: the shoulder is ‘numbed’ with an anaesthetic and manipulated to break up adhesions.
    • Arthroscopic capsular release: a special probe is inserted in the shoulder that emits a high-frequency radio wave which is used to cut out the thickened parts of the shoulder capsule.
    • Arthrographic distension (hydrodilation): the shoulder joint is ‘inflated’ with a steroid and saline solution to stretch the shoulder joint.

    Research grading the effectiveness of different treatment options for frozen shoulder has found manual therapy to mobilise (move) the shoulder and home exercises to be effective in reducing pain and increasing movement(3). These can be performed by your osteopath who can also use massage and manipulation to relieve any other associated problems that develop along side your frozen shoulder.

    References

    (1) http://www.nhs.uk/Conditions/Frozen-shoulder/Pages/Introduction.aspx

    (2) Adhesive Capsulitis: use the evidence to integrate your interventions (2010). Page P Labbe A

    (3) Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study (2009). Jewell D. V., Riddle D. L., Thacker L. R.