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People with shoulder pain who expect physiotherapy to help them are likely to have a better recovery than those who expect only minimal or no improvement, according to our latest study. We also found that people are likely to have a better recovery if they are confident they will be able to continue doing things that are important to them, such as socializing, hobbies and work.

Shoulder pain affects people of all ages and can become persistent. Injury and overuse are common causes of shoulder pain, but sometimes the cause is unclear. It can disturb sleep, interfere with work, leisure and everyday activities like washing and dressing. Exercise, prescribed by physiotherapists, is an effective treatment for shoulder pain, but not everyone benefits from physiotherapy.
Researchers from the University of East Anglia and the University of Hertfordshire in the south-east of England, together with local physiotherapists, wanted to find out more about the characteristics of people who benefit from physiotherapy compared with those who continue to experience persistent pain and disability.

Knowing the outcome is important for people with shoulder pain as it helps them decide whether or not to pursue a course of physiotherapy.

Our study, published in the British Journal of Sports Medicine, included 1,030 people attending physiotherapy for musculoskeletal shoulder pain in 11 NHS trusts across the east of England. We collected information on 71 patient characteristics, such as age, lifestyle and medical history, and clinical examination findings before and during the patients’ first physiotherapy appointment.

A total of 811 people provided information on their shoulder pain and function six months later.

Surprise finding

What surprised us was that patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”.

The most important predictor of outcome was the person’s pain and disability at the first appointment. Higher levels of pain and disability were associated with higher levels six months later. And lower baseline levels were associated lower levels six months later. But this relationship often changed for people who had high “pain self-efficacy”, that is, confidence in the ability to carry on doing most things, despite having shoulder pain.

Another surprise finding was that people with high baseline pain and disability, but with high levels of pain self-efficacy did as well as, and sometimes better than, people with low baseline pain and disability and low pain self-efficacy.

First study of its kind

This is the first study to investigate patient expectations of the outcome of physiotherapy for shoulder pain. Earlier research shows that high patient expectation of recovery predicts a better outcome following physiotherapy for back pain and neck pain, and a better outcome following orthopaedic surgery.

On a similar note, this is the first study to show that higher pain self-efficacy predicts a better outcome in non-surgically managed shoulder pain. Previous research has shown that self-efficacy predicts a better outcome for a range of other health conditions. Also, people with higher self-efficacy are more likely to do the home-exercise programmed suggested by their physiotherapist.

If you have shoulder pain, there are several ways to increase your pain self-efficacy. Work with your physiotherapist to understand and manage your symptoms. Practice your exercises together and ask your physiotherapist for feedback, including how to adjust your exercises to make them harder or easier. Finally, make sure you discuss what you want with your physiotherapy and the activities that are important to you.The Conversation

Rachel Chester, Lecturer in Physiotherapy, University of East Anglia
This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australian researchers are working with an international team to understand the relationship between sitting for long periods and bone health.

Sitting for long periods may be bad for your bones, with Australian researchers contributing to a global study to explore links to osteoporosis.

Experts at the Baker Heart and Diabetes Institute in Melbourne have teamed up with researchers in the United Kingdom to find out if breaking up sedentary behaviour could reverse or slow down any potential damage of the disease.

“We know that in extreme environments, such as total bed rest, bone loss is very high,” the institute’s Professor Neville Owen said in a statement on Thursday.

“In everyday life, long periods of immobility such as this are rare however, sedentary lifestyles are commonplace in modern society, through transport, work and leisure.
“If the proof of concept study identifies a significant effect of sedentary behaviour on bone metabolism, promoting frequent breaks from sitting could be a possible, and simple, preventative intervention for osteoporosis in later life.”

The study will use data and blood samples already collected – but yet to be analysed – in previous sedentary behaviour studies by the research group.

About 1.2 million Australians are estimated to have osteoporosis while 6.3 million fellow residents have low bone density, the institute states.

The institute’s Professor David Dunstan also added the study would shed light on the mechanisms behind osteoporosis and give a greater understanding of the relationship between lifestyle and bone health.

Article Source : http://physiostudio.com.au/resources/heel-pain-and-plantar-fasciitis/

Plantar fasciitis is a common complaint, characterised by pain in the sole of the foot that is at its worst first thing in the morning or upon getting back up after a period of rest. Pain can be localised to the arch of the foot or under the heel.

Onset is often gradual with no particular cause noticed at the time. Once entrenched, pain can be stubborn and frustrating, lasting many months.

The plantar fascia is a rugged, stretchy tendon structure of the anatomy of the foot that bridges the arch from the heel to the base of the toes to act like a spring. This serves to improve efficiency by returning elastic energy at the end of our step when we are walking or running.

Coming into summer I feel it is a good time to look at some of the potential factors that contribute to plantar fasciitis and heel pain.
Whilst working as a physiotherapist with the military population in Darwin I noticed some clinical patterns developing. It seemed that the incidence of onset was quite high in patients who had recently moved up to Darwin from the southern states.

This change of environment was associated with a change in lifestyle- both due to the different tropical climate and the style of the housing typical to Darwin. Essentially, patients would spend less time in supportive shoes (to which they had previously become accustomed), and more of this time was spent on hard concrete, tiled or paved surfaces. Carpet and timber floors were a rarity.

Symptoms would not commence immediately, but often after the first month or two. I believe it is no coincidence that this correlates with natural history of pathological failed tissue adaptations we see in tendinopathy.

In recent years I have relocated to open my own physiotherapy clinic, the PhysioStudio in East Maitland in the Hunter Valley, whereby I have observed another cyclical pattern – presentations of plantar fasciitis and heel pain more commonly present through summer, probably as peoples’ footwear and lifestyles change due to the warmer weather.

Out of curiosity, I utilised the Google Trends function to explore this pattern. By investigating the search history of the term “plantar fasciitis” over the longer term in the United States there is a clear cycle of increased searching in the Northern summer months, and for August in particular.

The pattern is similar for “heel pain”, but by contrast not for other common injuries search terms such as “shoulder pain” or “impingement syndrome” or “rotator cuff tear”.

Based on this and our current understanding of tendon pathology I feel the best advice is to prevent the onset of plantar fasciitis.

Maintaining consistency is the key to preventing tendon injuries. Relative consistency of physical activity and lifestyle helps maintain tissue homeostasis. The likelihood is that a too rapid increase in the physical loads exerted on the plantar fascia exceed the tissue’s capacity to adapt and remodel in a sustainable way.

If these increased loads are maintained, they do not allow the sufficient time for tendon tissue to adapt healthily. This results in an upregulation of T- cell activity, expression of inflammatory cytokines, degradation of the collagen matrix, and pain.

It is understood that healthy tendon tissue adaptation takes at least 16 weeks in ideal circumstances.

It is not that summer is bad for our feet or unhealthy and it is equally untrue that a good pair of Havaianas at the beach or playing barefoot bowls on grass is dangerous. Rather that it is a significant change from the shape, structure, support and ramp angle of the footwear we more typically wear at other times of the year.

I’d suggest that, as much as wearing supportive shoes more in summer is a good idea, so too is it a good idea to moderate the use of footwear in the cooler months.

Similarly, if we are active outdoors during the warmer months we should aim to do better in maintaining our levels of physical activity through winter.

As with other tendon related injuries, physiotherapy advice can be very helpful. Education and exercise therapy have great evidence and should be the cornerstone of any treatment plan.

Specifically, isometric exercises progressing towards the inclusion of prescribed doses of eccentric loads can manipulate the cell activity within the plantar fascia and facilitate healthy tendon remodelling.

Building strength through the calf and foot, and leg system generally is also essential to allow the patient to walk and move without focusing excessive loads on passive structures such as the plantar fasciitis.

This together with careful ‘load management’ of the patient’s physical activity through their normal living day and sporting/recreational pursuits, will ensure improvement. Improvement is slow, and morning pain on rising to one’s feet can take many months to resolve.

In the past cortisone injections, and more recently PRP protein injections and shock wave therapy have been used to treat plantar fasciitis. Unfortunately, strong evidence for these treatments is lacking, and this is probably because they do not directly influence the modelling and alignment of the collagen structure within the tissue.

About the Author:
Jon Davis is a Titled APA Sports Physiotherapist from East Maitland in NSW.
Before opening his PhysioStudio clinic he was a senior Sports Physiotherapist at the Australian Institute of Sport in Canberra where he worked under renowned tendon research publisher Craig Purdam. Jon has a special interest in overuse injuries including tendon and bone injuries. Jon was a physiotherapist at the 2014 Glasgow Commonwealth Games, 2018 Gold Coast Commonwealth Games and the 2014 Sochi Winter Paralympics.