Recently a large Milltown Physio contingent attended IFOMPT – the prestigious conference showcasing the latest and most cutting edge evidence in physiotherapy. I’m delighted to say that our clinical specialist chartered physiotherapist Gráinne Wall has agreed to share her review below.
Jeremy Lewis – The Conundrum That Is The Shoulder: Expanding Our Ability To Manage Shoulder Pain.
Jeremy Lewis presented a comprehensive keynote lecture on managing shoulder pain. He outlined the complexity in treating shoulder pain and the emerging evidence in the conservative versus surgical debate.
Much like other joints of the body, shoulder imaging provides limited information to the clinician as imaging studies do not correlate with the presence or intensity of pain and up to 96% of asymptomatic individuals have structural changes on imaging. He then followed his presentation discussing how “orthopaedic special tests aren’t special” and they are not specific in identifying structural pathology. He asked the delegates to consider this; how many patients have a false positive clinical test followed by a false positive scan result which is often followed by an unnecessary surgical intervention?
He outlines his Shoulder Symptom Modification Procedure (SSMP) and like many others he encourages a holistic approach to the management of shoulder pain, ensuring adequate assessment of the whole body kinematics. SSMP systematically investigates the influence of scapular and thoracic postures and humeral head position on shoulder symptoms. The assessment findings from the SSMP that are found to reduce symptoms are then incorporated into rehabilitations methods. Rehabilitation should be gradual, tailored and specific to the individual’s needs. Scapular rehabilitation was touched upon yet our research into both posture and scapular positioning shows poor correlation in relation to shoulder pain.
Smart rehabilitation matches up to surgical treatment of common shoulder conditions such as subacromial pain, rotator cuff tendinopathy and rotator cuff tears and this conservative regime would seem like a favorable and cost effective treatment plan.