Mike, you seem to be implying that you treat the frozen shoulder with manual therapy and PROM before the thawing phase. Why? There's overwhelming evidence that no amount of manual therapy is useful for frozen shoulder mobility nor pain except with cortisone injections. Can you clarify and justify, please?
I definitely do! In fact, I think I see a lot of people that may be "freezing" with shoulder pain that we prevent from advancing. They patient (and myself) never really know if they would have progressed or not. But to your point, not sure I would say there is overwhelming evidence that manual therapy is not useful. It's hard to build these studies and provide adequate control. Plus their outcome measurements may differ from mine. If I can help my patients get through the period with any relief in pain, mobility, or movement patterns, I'm happy.
Okay, but there is a lot of evidence that doing nothing and waiting until the thawing phase starts has the same effects. There's also evidence that treating frozen shoulder during the two first phases just creates undue pain. If you haven't read Adam Meakin's post about it, I think it gives a good overview of the current literrature thesports.physio/2015/11/18/frozen-shoulder-let-it-go-let-it-go/
Very hard to define those studies and control them perfectly. - Regarding same effect, realize that means that in 2 years the people with and without PT had similar ROM. Do you consider that valid? Do you think there are treatments that can be performed within those 2 years that could reduce pain, improve mobility, and enhance function? - what treatments were perform that created "undue pain?" Could you do something different/better? My guess is the treatments performed were inappropriate. It really depends on your patients, my patients don't want to "let it go," maybe Adam's do?
Yes, it really depends on the patient. I don't work with as many athletes as you seem to, so most of what I do is trying to keep them more active: they are interested in pain more than performance in most cases, so once I cleared the spine and shoulder with Mckenzie repeated movements and made sure that Mulligan MWM don't work, I try to keep them active with a shoulder sport that doesn't aggravate them, like swimming or tennis without serves, for instance. That is until the thawing phase is starting (then I tell them to come back to PT because I also told them to self-monitor at home). As always, the most important part of treatment is trying to get people to exercise safely. Motion is lotion, right?
Thank you!!
How should my scapula function during the exercise @ 0:02 ? Thanks
What are specific exercises you like to use throughout the different phases of frozen shoulder?
Big topic
The quad show
Mike, you seem to be implying that you treat the frozen shoulder with manual therapy and PROM before the thawing phase. Why? There's overwhelming evidence that no amount of manual therapy is useful for frozen shoulder mobility nor pain except with cortisone injections. Can you clarify and justify, please?
I definitely do! In fact, I think I see a lot of people that may be "freezing" with shoulder pain that we prevent from advancing. They patient (and myself) never really know if they would have progressed or not.
But to your point, not sure I would say there is overwhelming evidence that manual therapy is not useful. It's hard to build these studies and provide adequate control. Plus their outcome measurements may differ from mine. If I can help my patients get through the period with any relief in pain, mobility, or movement patterns, I'm happy.
Okay, but there is a lot of evidence that doing nothing and waiting until the thawing phase starts has the same effects. There's also evidence that treating frozen shoulder during the two first phases just creates undue pain. If you haven't read Adam Meakin's post about it, I think it gives a good overview of the current literrature thesports.physio/2015/11/18/frozen-shoulder-let-it-go-let-it-go/
Very hard to define those studies and control them perfectly.
- Regarding same effect, realize that means that in 2 years the people with and without PT had similar ROM. Do you consider that valid? Do you think there are treatments that can be performed within those 2 years that could reduce pain, improve mobility, and enhance function?
- what treatments were perform that created "undue pain?" Could you do something different/better? My guess is the treatments performed were inappropriate.
It really depends on your patients, my patients don't want to "let it go," maybe Adam's do?
Yes, it really depends on the patient. I don't work with as many athletes as you seem to, so most of what I do is trying to keep them more active: they are interested in pain more than performance in most cases, so once I cleared the spine and shoulder with Mckenzie repeated movements and made sure that Mulligan MWM don't work, I try to keep them active with a shoulder sport that doesn't aggravate them, like swimming or tennis without serves, for instance. That is until the thawing phase is starting (then I tell them to come back to PT because I also told them to self-monitor at home). As always, the most important part of treatment is trying to get people to exercise safely. Motion is lotion, right?
#research-hardo