Getting old sucks!
I've got all the classic signs (according to gp telephone call appointment and google) or a rotator cuff injury. Impingement/ tear - who knows.
Apparently a 'thing' has been going on for the last 18 months and all the physios/ osteopaths in the area (accessed through NHS or private) can't see me until nearly Christmas - longer if I don't want to pay. So it's me and Doctors Google and Youtube for the foreseeable.
Question 1 - If I do 'stuff' that is not painful (e.g mountain biking, though putting the bike in the car is painful but lucky to be able to ride from the door) am I likely to make it worse? I'd imagine falling off in a bad way might be best avoided to it would be 'litecore' gnarrless for the moment.
Question 2 - I've found some non surgical recovery/repair exercises to do so thought I'd give that a bash - stopping before the point that I actually induce pain. Error?
Question 3 - A bit similar to Q1 - If there are upper body strength exercises (thinking TRX mainly here, but possible kettlebell too) that work other muscles and don't have me writhing around in pain is it OK to build those in to my life?
Supplementary question - if I am paying anyway would a physio or an osteopath be your go to? Similar waiting lists and similar money.
I broke my ribs (other side) quite badly in the summer and the drop in fitness (and mental wellbeing tbh) over the weeks of recovery time was pretty bad and I'd like to not repeat again now if possible.
Ta
Watching with interest......
I tore/injured a rotator cuff in an over the bars back in May this year, it has been slowly getting better but is still not right, and that arm is still weak during certain types of movements.
It hurts like hell if you move it in a certain way - I found that operating a gate latch from the opposite side of the latch was a particularly painful experience.
My preference would be to see the physio.
I have a really messed up shoulder: metal plate and 8 screws in clavicle + 50/60% torn supraspinatus and subscapularis (two of the four rotator cuff elements). I'm also an OT with a reasonable knowledge of MSK (Although I work in MH!).
Any malfunction will likely be causing an impingement that makes everything painful and ruins proper function. I'd begin by doing some gentle work to improve the space beneath the acromion. Basically, you are likely to benefit from your the ball of your shoulder joint being back and down.
Consider your posture (shoulders back and down not hunched). My go-to exercise is the face pull. See Athlean AX for example. You are likely to benefit from doing this without any weight. It's all about the strict movement. Add a band if needed.
And see a physio!
IANAD, however I had a shoulder reconstruction almost 2 years ago following a crash, which completely stretched and tore my RC, and shattered my humerus. 6 weeks post op I started basic physio with the NHS, really simple stretches, building after a month or so into routines with stretch bands. Along came lockdwown and i went private, seeing a mate who is a rugby sports masseur, and has a lot of personal shoulder experience. He continues with weekly stretching and manipulation when possible, and programmed me an increasing load set of daily homework using various bands, and working with bits of furniture in the house to get the right movement. Also dumbells, starting at 2kg, now up to 5kg.
Riding helped, especially gravel, where the risk of big bad tumble less, but the micro vibration stuff great for the repair. Initially a 20 min ride and it'd be aching and weak. When swimming pools reopended I was back in a few times a week, front crawl and at first only 10 mins or so, now back to previous of 1.5km per session. I think of all the exercises I have done, swimming front crawl probably has been the most impactful on strength rebuild.
So currently almost 2 yrs post surgery, it's still getting stronger weekly, but hard work. It'll never be what it was and will remain significantly weak in certain movements. but it doesn't really hamper life, or riding, now, thankfully.
Physio every time. Osteopaths are quacks
I tore mine - exercises helped but not a kettle bell or similar - it was a series of movements with those big rubber resistance bands
I'll see if I can find the exercise sheets but really it should be individual as the part of the rotator cuff affected alters the exercise needed
Convert - you have a pm
I put a little tear in my rotator cuff a few years ago. Took bloody ages to sort itself out, like a couple of years. The RC is tendons and ligaments, which heal very slowly anyway. Guessing you're not thinking surgery might be necessary?
Doing things that use your shoulder but don't hurt can't be a bad thing? The pain is there to tell you when to stop, so if you listen to that, you should be alright. (I'm also not a doctor).
Not seeing someone until Christmas probably isn't going to delay your healing much or at all.
In terms of who to see, ask around for recommendations from people who've had help with shoulder injuries. There are good and bad osteos and good and bad physios, I've seen a couple each of all 4!
I have done mine twice and each time it was sorted with anti-inflammatory drugs rather than physio (the drugs reduce swelling and allowing the injury to heal). In fact (IIRC) physio was never mentioned – I was in line for cortisone injections if the oral drugs didn't work.
Unfortunately it was some time ago and I don't recall what the drugs were.
Edit - a quick Google and I *think* it may have been naproxen.
Physio every time. Osteopaths are quacks
This.
Thanks so much TJ - received the link and hopefully when at home I can open it.
Physio every time. Osteopaths are quacks
This interests me though. Got to confess this was always my thought but was persuaded otherwise. But could easily be persuaded the other way too!
The summary reasoning was (this was a GP talking)..... Osteopath training is actually longer than a physio. Physios are not trained to diagnose but to carry out the therapy after a diagnosis from a doctor (hence the shorter training). Physios get a positive reputation because they are part of a larger 'system' whilst osteopaths are standalone trained diagnosis/treatment merchants so are looked down on by people in 'the system' - either through self-interest or ignorance. Physios are definitely the right person to do the rehab after surgery but (in the opinion of this GP) for direct self-referral of more minor non-surgical issues the osteopath might be the better bet.
If you ask around and you get solid recommendations of someone who's been very helpful for shoulder injuries, who's near enough that repeat trips aren't going to be a pain, go see them.
Don't travel twice as far for someone who's not as well-recommended, just because of the label. Especially as there's a lot of overlap in the treatments they use anyway. You want someone knowledgeable, experienced, interested in understanding your problem and how to work with you to make it better so you can get back to doing what you like doing.
Edit: posts crossed. what your GP says makes sense. But although it might make sense on a general level, you're looking for an individual. Any one of them might be amazing or deeply underwhelming, who'll just take your money and go through the motions.
Edit: posts crossed. what your GP says makes sense. But although it might make sense on a general level, you’re looking for an individual. Any one of them might be amazing or deeply underwhelming, who’ll just take your money and go through the motions.
good thoughts. Thanks.
Fwiw, I have found osteopaths really useful for joint and muscle issues, but rubbish when nerve damage was involved, when physios were much better.
TJs long held belief that osteopaths are quacks is well documented on here. I feel the same way about chiropractors!
I'd be changing GP.
I’d be changing GP.
I said 'a' GP, not 'my' GP. TBH I'm not sure who my GP is - practice has about 20 of them according to the website and I see the one that's free. No clue who is actually 'mine'! But this GP had no association to the health group that run the GP surgery I attend.
But what's you reasoning? Beyond, hearsay (which is how I held my opinion up until that conversation). Interested.
I've had good experience with both physios and osteos. But find someone who is recommended by other people who do similar physical stuff to you. Find a sports physio or osteo with particular experience of shoulder injuries. Local to us, the county cricket physio team do private work, and one of them will be knees and groins; others will be backs and others shoulders. They are all way better than the guys in general physio practices looking after sedentary people.
TJs long held belief that osteopaths are quacks is well documented on here. I feel the same way about chiropractors!
You're both right.
all the physios/ osteopaths in the area (accessed through NHS or private)
Where are you? I got a next-day appointment with a sports physio at a Nuffield gym last week without difficulty, also for a rotator cuff injury.
Incidentally, I asked very similar questions so will pass on her answers:
1. Any activity that doesn't cause debilitating pain is acceptable and will promote healing.
2. See 1. If you physically can't do the stretch then it's a bad idea.
3. She sent me to the attached gym to play with the weights after the appointment, so I assume yes.
She also advised that ibuprofen to limit pain during exercise is better for recovery than no ibuprofen and taking it easy.
For info, Nuffield have much greater availability for appointments if you call the gym directly instead of booking through the website.
Thanks for all that - really useful.
Location......Northern Highlands which might be the issue. Inverness is liveable drive away so I might just need to get on with phone around further from home. Nearest Nuffield is about 3hr 20mins drive sadly.
So, going through this at the moment following an off in May. Like you I can ride mostly without pain but some other stuff is intensely painful - eg lifting a bike over a fence.... Despite physio below I still can't sleep on the bad shoulder.
NHS wait times are *long* at the moment. Doctor referred but it was 3-4 months. We know a very good private physio who is an ex-endurance mtb-er so works around keeping you on the bike. (can pass on details if you in SE England area). She wanted a scan to ensure I hadn't done anything she was going to make worse so I got a private MRI. that showed up a break (healed and possibly unrelated to this crash but definitely not the pain) and some inflammation but not a tear.
Basically evidence on operating on rotator cuffs, even if they are torn, is mixed (and recovery is still very long - Katie had one op'ed) so now almost always work to strengthen muscles and ligaments around injury. By the time I saw the physio I'd already distorted a load of muscle groups to compensate so first step was to get those back in shape and then start on the RC. NHS physio came through a while later so went to that as well and ended up with very similar exercises from both which gave me some confidence.
Advice was
- need to do something (can't just rest).
- don't overdo it (stop *before* you make it painful)
but we're a long way in now and *is* getting better but still slowly.
I did in the meantime find a study online that had showed physio made no difference in RC injuries - they just take forever to get better.
I have done mine twice and each time it was sorted with anti-inflammatory drugs rather than physio (the drugs reduce swelling and allowing the injury to heal)
Interesting. My physio said that since the issue is tendons/ligaments anti-inflamatories don't do anything.
really it should be individual as the part of the rotator cuff affected alters the exercise needed
point above may relate to this. "Rotator cuff injury" probably covers a lot of diffent things.
osteopaths are quacks is well documented on here. I feel the same way about chiropractors!
Chiropractors are *Definitely* quacks. Osteo's I'm not sure. What I have realised over the years is that most of the time what you need to do is stretches/strength for particular muscles (or for your body in general). The exercises you get from a Physio, do with a personal trainer, or the postures in Yoga and Pilates are all the same.
But what’s you reasoning?
A GP shouldn't be recommending "alternative medicine" IMHO.
A GP shouldn’t be recommending “alternative medicine” IMHO.
I've helped numerous GPs over the years with MSK problems that were not responding to physio or other non "alternative medicine" etc. And I'm a "quack" chiropractor. Good and bad in all professions I would say. I'm good btw 😉
Chiropractors are *Definitely* quacks. Osteo’s I’m not sure.
Chiropractic is fundamentally based in quackery. Some (most?) modern chiropractors are what's called "mixers" which TL;DR means "chiro and other treatments" but then, well, why are you still calling what you do chiropractic if you're a physio in all but name?
Osteopathy is less clear-cut granted, but the principles aren't wholly dissimilar to above. There is vague evidence - and anecdotes as recently as "earlier on this thread" - that it may be efficacious for mild back pain and arthritis, but not much else despite claims to the contrary.
Interesting. My physio said that since the issue is tendons/ligaments anti-inflamatories don’t do anything.
My understanding is that the anti-inflammatories do their job which then allows the injury to heal – the NHS site does seem to back this up as a recommended treatment for such injuries and it certainly worked for me. The first time I did it (a pretty nasty snowboarding crash) I couldn't even lift my left arm up above head height to get dressed etc. I didn't have physio on either occasion and they both healed fully (of course some cuff injuries will have been more serious than mine were and possibly not suitable for drug treatment – I am just sharing my experience).
Both osteopaths and chiropractors are pure quackery
yes some osteos may use physio techniuies to good effect but its an unregulated ( self regulation is bunkum) the training and theories are pure baloney
that GP above needs his license withdrawn if he does not understand the difference between a regulated profession that is based on science and the bunkum that is both osteopathy and chiropractic
chiropractic is actually dangerous and leaves many folk worse off. Both "professions" have repeatedly had to have their claims removed from the literature because it doesn't add up
Most back pain and other musculoskeletal issues resolve spontaneously so someone has a course of "treatments" and get better they claim its the quackery but actually it would have got better spontaneously in the same of lessor timescale
there is no proper peer reviewed evidence for either piece of quackery doing any good bar perhaps some small reduction in back pain that is easily explained by the above plus placebo
apologies - osteopathy has some regulation.
Osteopathy is less clear-cut granted
Yet every time the subject comes up, you (and TJ) come on and say that people should not see osteopaths because they're all charlatans, and potentially putting people off seeing their nearest, best option for therapy.
Thats because they are quacks - every one of them. some just waste your money, some will damage you significantly. None of them have a training based in scientific knowledge
Garbage in, garbage out
the ones who use physio techniques cannot call themselves physios because they have not done physio training and "physio" is a regulated profession
the weight of evidence is overwhelming - its quackery and can be dangerous
This isnt going to answer your question, although i do have some rotator cuff exercises my daughter used a few years ago for some minor discomfort she had.
My suggestion to most on here is to get yourself to a good physio and start building a relationship now before you hurt yourself. I did it at the start of the year for my athlete daughter. Based on the comps she had and training schedules he has monitored her throughout the year and now only sees her bi monthly. I think he has had about 6 sessions with her (£300). Its about £50 a session so now works out quite reasonable. He is there 100% of the time for advice. He gives her small amounts of exercises to sort any little niggles and others to prevent future issues. He knows exactly what my daughters joints and muscles are capable of and if the worst happened and we needed quick access to a physio then i wouldnt be joining any queues and would be walking in to someone who knows exactly where she was before any injury..
you and TJ come on and say that people should not see osteopaths because they’re all charlatans,
I'm not saying that Osteopaths are charlatans. There's a lot of work and study involved in becoming an osteopath. Rather, I'm dismissing most of the claims they make. Osteopathy ain't gonna "balance your body's systems" or cure your asthma. It might you feel better, sure; other placebos are available.
Go see who you like, I don't care, but if you're actively soliciting advice on the forum then both my and I believe Jezza's advice would be "go see a medical professional." You went to a homeopath and your Cricket Armpit got better, well, good for you, I'm glad it worked out.
All of this stuff is born from an era when so-called "allelopathic" medicine was actively dangerous, taking a sugar cube was generally less fatal than having a hole drilled in your skull. They've had 100+ years since then to demonstrate that it works and they've thus far failed to do so.
their nearest, best
These two things are not equivalent.
apologies – osteopathy has some regulation.
FYI Chiropractic is also regulated by the General Chiropractic Council in the UK
These two things are not equivalent.
Of course they're not. they're complimentary. If you're in pain, do you want to travel 3 hours further for treatment that's 5% better, or even 20% worse? Your black and white assertions that all osteos are quacks (8 posts in) and physio is always better might be stopping people seeing someone who can help them - especially someone like convert in the North Highlands. His options are limited.
You and TJ lump osteopathy in with homeopathy, compare and contrast how the NHS describe the two.
https://www.nhs.uk/conditions/homeopathy/
https://www.nhs.uk/conditions/osteopathy/
Show me a single proper study in a reputable journal that shows significant good effects from Osteopathy please.
Also,
“go see a medical professional.”
Physios aren't medical professionals. Here they are, described by the NHS, alongside osteopaths as one of the 14 allied health professions.
got that study showing me that osteopathy works? You must have loads of them surely. Proper studies in reputable journals peer reviewed and all that gold standard stuff
FYI Chiropractic is also regulated by the General Chiropractic Council in the UK
AKA, "marking your own homework."
If you’re in pain, do you want to travel 3 hours further for treatment that’s 5% better, or even 20% worse?
Three hours further for help, where are you, the Orkney Islands?
compare and contrast how the NHS describe the two.
I know. They say that homeopathy doesn't work beyond placebo and there's little evidence for the efficacy of osteopathy beyond relief for mild back pain, which is what I said in the first place.
Physios aren’t medical professionals. Here they are
Well, that's some interesting reading. Thank you.
physio and osteo use all sorts of different techniques, a lot of techniques are used by both. Which techniques are you interested in?
"You must have loads of them surely." Don't know why you think that.
I'm weighing in because I object to you saying "always see a physio, never see an osteo" it's an absolute statement which might stop someone getting good results from a good therapist.
Your position is stronger than mine, so you're the one who should be providing the evidence. I'm assuming you've got plenty of randomised, double blind, placebo controlled trials for the efficacy of all physio techniques?
Last time we did this, we spent a long time arguing about a study about a particular technique, used by osteos and physios.
I'll just leave this here:
Osteopaths can use physio techniques and some physios may use osteopathic techniques. Its the technique that matters not the label of the practitioner.
guess who?
So you do not have any studies showing any significant positive effect from osteopathy then? I did of course know this already because I know none exist.
I think that proves the point
evidence based practice
Who regulates doctors, Cougar? Dentists?
Three hours further for help, where are you, the Orkney Islands?
Location……Northern Highlands which might be the issue. Inverness is liveable drive away so I might just need to get on with phone around further from home. Nearest Nuffield is about 3hr 20mins drive sadly.
You're correct on all counts, and def physio over osteo (sorry osteos)
The only potential fly in the ointment is that it might not be RCRSP - there's quite a few things that feel like it but isn't, but having said that if you stay around or below 3-4/10 pain and the pain doesn't hang around after you've finished you won't be doing yourself any harm, you just won't progress as you would hope
I’ll just leave this here: ... guess who?
Was that me? It may well have been but that's kinda slightly stalkery if it was because I don't recognise it at all. I can't really comment further on a single line taken out of context from presumably several years ago. I'm not wholly certain what I had for tea this evening.
In any case,
"Its the technique that matters not the label of the practitioner."
My hairdresser is quite handy at laying bricks, but she wouldn't be my first choice in building an extension.
This does actually ring a vague bell. I think my point may have been that if you're going to practise physiotherapy then advertise yourself as a physiotherapist rather than a chiropractor / osteopath. But jesus dude, come on, have you got a dossier on all STW posters or just a hardon for what I wrote years ago?
Who regulates doctors, Cougar? Dentists?
You tell us.
sorry tj, missed yours earlier.
studies tend to be restricted to particular techniques, rather than entire fields, but presumably you'd know that after searching for studies for the benefits of "physiotherapy".
If you want to prevent people from seeing osteopaths, (even well recommended ones, who might be cyclists with lots of experience with shoulder injuries) and state they should see any physio in preference (who might specialise in neurology or post-natal or rheumatology, and/or might involve a more lengthy, painful journey to visit) perhaps your attention would be better directed to Carolyn McDonald, Jennifer Keane, Ruth Crowder who are the Chief Allied Health Professions Advisors for Scotland, Northern Ireland and Wales respectively, and Suzanne Rastrick OBE, the Chief Allied Health Professions Officer in England.
The NHS, the Health and Care Professions Council, the General Osteopathic Council, the NI Department of Health, the Welsh Government and the Scottish Government are all committed to supporting Allied Health Professionals, a group of regulated healthcare professionals which has included osteopaths since 2017.
Until you get those conversations concluded to your satisfaction, could you please save those in pain looking for help on this forum from your inconsistently-applied, self-contradictory, sneering absolutism?
Thanks.
P.S Nothing personal, I completely, 100% agree with a lot of what you say on this forum.
Sorry dude but when osteopathy can actually produce some actual proper evidence of it working then i will lay off it
In the meantime i want to protect people from wasting their money on dangerous chaletans
yes some might not be dangerous chaletans but the lay person has no way of knowing and all are chaletans
Produce one tiny bit of proper evidence than ostopathy is effective - I have challenged yo on this before and you cannot do so - why?- because there is none.
So sorry dude but I will not lay off quacks who exploit vulnerable people
BTW - I commend you for your good temper in the face of my hostility 🙂
In the meantime i want to protect people from wasting their money on dangerous chaletans
Why aren't the NHS, the Health and Care Professions Council, the NI Department of Health, the Welsh Government and the Scottish Government united behind your crusade?
Was that me?
Not you, it was TJ. I'm not being stalkery, and not even to you, sorry.
I don't get wound up very often on here, and it tends to stick in the mind. And sticking 3 words in google to find a thread on here is hardly stalking.
"I'll always say you should see a medical professional"
Physios aren't medical professionals, they're health professionals as recognised by the NHS, alongside osteopaths
"but they're not regulated by a legally recognised body"
yes they are
"it doesn't count if it's got the same name in the title - self regulation doesn't count"
You'll be dismissing all of these out of hand then:
Health regulators
The General Dental Council (GDC)
The General Medical Council (GMC)
The General Optical Council (GOC)
The General Osteopathic Council (GOsC)
The Nursing and Midwifery Council (NMC)
General Pharmaceutical Council (GPhC)
Pharmaceutical Society of Northern Ireland (PSNI)
The Professional Standards Authority (PSA)Social Care regulators
Social Work England (SWE)
Northern Ireland Social Care Council (NISCC)
Social Care Wales
Scottish Social Services Council (SSSC)
Again, I have no problem with any criticism if it's fair an even-handed, but yours isn't. Absolute statements are very rarely correct. "Every physio is better than any osteo" is nonsense, and what you are backing it up with flaps in the wind. If you want to back up your absolute statements and potentially deprive people of well-needed reprieve from pain, you need to show why NHS, the Health and Care Professions Council, the General Osteopathic Council, the NI Department of Health, the Welsh Government and the Scottish Government are all wrong, and you're right.
Its really very simple - osteopathic is not based on any science. Osteopaths continually make claims for which there is no evidence such as treating babies for colic using cranial osteopathy. Almost all the claims have been comprehensively debunked by real medics and scientists, the only benefit that has been shown is for mild lower back pain there is a possible slight benefit.
None of the rest of the claims make any sense or have any evidence for them
Its not me making these claims - its a whole raft of scientists and medical professionals that have comprehensively debunked spinal manipulation and cranial osteopathy as nonsense and spinal manipulation as dangerous especially on the neck
the roots of osteopathy are classic quackery
My aim here is to provide the information people need to stop them wasting their money on pointless and dangerous treatments
if there was any evidence base yo would be able to point to proper studies showing benefit. the fact you cannot is very telling
Evidence based pratise is the key and the basis of osteopathy has no evidence base underlying it
https://www.badscience.net/2004/09/cranial-osteopathy/
https://quackwatch.org/consumer-education/QA/osteo/
Etc etc etc
the really scary thing is in the US a osteopathy is given similar rights and protections as a medical doctor
So when you jump on threads on here, people should see any physio over any osteopath, is it when people are asking about their baby's colic? Or Asthma?
Or is it invariably people asking about bad backs, shoulders, cycling injuries?
And when you make your blanket statements that people should see any physio over any osteopath, regardless of specialisation or recommendations, are you careful to warn them of the potential dangers of spinal manipulation techniques that both professions often use, and to ask them in advance what techniques they use?
Osteopaths continually make claims for which there is no evidence such as treating babies for colic using cranial osteopathy.
A fact the NHS link on osteopathy agrees with, along with other things they don't think it works for.
But the NHS does seem to think osteopaths can help with other conditions.
As ever, it's the belligerent absolutism that, if anything, undermines your argument.
But it's great to have the real TJ back again. 👍
Not quite true More cash
read the research quoted here
https://www.evidence.nhs.uk/search?q=osteopathy
ie "Collectively, these data fail to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain"
cranial osteopathy does nothing. No evidence that is of any good quality for spinal manipulation
Yes some osteopaths may use physio techniques - which are properly researched evidenced and effective but you have no way of knowing if you are going to end up with an osteopath doing physio, a quack who will rip you off with useless treatments and a dangerous quack who will damage your spine
Osteopathy is based on pure bunkum
None of us actually wanted to discuss treatment for RC injuries then?
TJ is 100% correct as far as it goes, in that Osteopathy is founded in little more than witchcraft. However, I'm a very black-and-white person and TJ is worse than me. Ultimately, does it really matter how it was founded so long as it works? Or an argument beloved of homeopaths, does it matter if we don't understand how it works so long as it does work?
And at this point, TJ is bang on the money because this is what boils down to and it really is this simple: "Prove it."
One could argue that cumin cures cancer (and will have a promising career ahead of them writing Daily Mail headlines) and a perfectly valid counter-argument may be "well, how? That makes no sense!" But does it matter? Worrying about the mechanism is secondary to worrying about the efficacy. Is it efficacious? Is it efficacious beyond placebo?
Which brings us worryingly back to homeopathy. You'd have to be off your gourd to think that homeopathy is anything other than a placebo treatment. But the elephant in the room here is, so long as people aren't forgoing actual medical intervention* is a placebo treatment a bad thing if patients feel it helps? I honestly don't know the answer to that.
(* - there seems to be a move away from terming pseudo-scientific horseshit unproven treatments "alternative medicine" and instead referring to them as "complimentary therapy" and I think that's a good thing. You can have whatever voodoo you choose alongside chemotherapy rather than instead of it.)
None of us actually wanted to discuss treatment for RC injuries then?
New here? (-:
None of us actually wanted to discuss treatment for RC injuries then?
Some of us had a go on the first page, TJ and Cougar have derailed it by getting on their poorly considered hobby horses. Unfortunately for me, I've weighed in, when I told myself I wasn't going to. Again.
I'm not an osteopath. I've seen 4 in the last 15, 18 years. 2 were underwhelming and I wouldn't see again, 2 were excellent and have helped me a great deal. That's as much skin in the game as I have. I'm not defending osteopathy, I'm attacking TJ and Cougar's "belligerent absolutism".
.
TJ and Cougar do not understand what they are talking about - on this topic. Their arguments make it clear they don't know much about Physiotherapy or Osteopathy.
History they constantly point at the origins of osteopathy as proof that a well recommended osteopath cannot help you. Have they examined the origins of physiotherapy in the same way and hold it to the same standards? Clearly not. snippets below.
"Physicians like Hippocrates, and later Galenus, are believed to have been the first practitioners of physiotherapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C.[4] After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physiotherapy."
"Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.[9][10] Later that decade, PTs started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings, rehabilitation centers, hospitals, and medical centers."
https://www.physio-pedia.com/Physiotherapy_/_Physical_Therapy
regulation - they do seem to have backed off this point, but I imagine it'll be back next time.
scientific background/training - have they looked at the course syllabuses of physios and osteopaths to establish the scientific content? Obviously not.
evidence base - this is the really big one. asking for evidence that osteopathy works - blind to the oft-repeated facts that it's a diverse selection of techniques, much like physiotherapy. The individual techniques are studied, not the entire profession. "Has "physiotherapy" been proven to work" - what a silly question that would be! - which bit?
Last time round, the main argument was around studies of spinal manipulation - presented as proof that osteopathy was rubbish, ignoring the fact that the studies took account of many patients of physiotherapists who had used the very same techniques.
Have they even looked into the evidence base for "physiotherapy techniques"? Do they know how long evidence based practice has been a "thing" in Physiotherapy? Do they even know what the profession's view is of EBP? Very clearly not!
A recent systematic review analysed "What do physical therapists think about evidence-based practice?" [12] and concluded that the barriers most frequently reported were:
lack of time,
inability to understand statistics
lack of support from employer
lack of resources
lack of interest and
lack of generalisation of results.
Although the majority of physiotherapists have a positive opinion about EBP, they consider that they need to improve their knowledge, skills and behaviour towards EBP.Limited research in some areas of physiotherapy also constitutes an obstacle to practising evidence-based physiotherapy (Fruth et al 2010).[13]
And despite, or rather because of, this absolutely terrible thinking, research, ability or inclination to learn, they jump on every thread like this, stating all physios can be recommended unreservedly, and all osteos are quacks, potentially depriving someone in pain of their best option for care and therapy.
Ned
Unfortunately its you that do not understand at all here
Osteopathy is pure bunkum. Proven fact. It has no evidence base worth talking about, it has no validity and its not based on science
I never stated that all physios can be recommended unreservedly however "evidence based practice" is the gold standard and physiotherapy is based on that.
Really dude - this is something I know a bit about. I have had osteopathy - damaged my back permanently. I have seen osteopaths taking eyewatering sums for known useless treatments from vulnerable people. I see them still advertising they can do things that are proven bunkum
,
potentially depriving someone in pain of their best option for care and therapy.
NOpe - potentially stopping them wasting money on useless snake oil and potentially stopping them being crippled by it
I do not control what others do with the information. all I can do is give the information.
the end of it is really simple. Osteopathy is dangerous and is not effective apart from a [possible slight reduction in lower back pain and even that is unproven. Every other claim for it has been solidly debunked by proper science
Do you know how long evidence based practice has been a “thing” in Physiotherapy?
Do you even know what the profession’s view is of evidence based practice?
Yes - I know the answers to both of those things.
However this discussion has reached the point of futility.
apparently so.
I think you (cougar,ned,tj) should just agree to disagree ....... please for all our sakes
TJ and Cougar have derailed it by getting on their poorly considered hobby horses
That's rich! 😂
Can I just ask (I think flaperon gave some good points) is it better to just carry on and not rest an injured shoulder.
My job has been hard going (curtain maker wrestling with heavy velvet fabrics), which has aggravated my old 'neck of femur' injury. Is it better to do my physio exercises and carry on with the work, or rest the arm as much as possible, but still do the exercises?
I've had both osteo and physio treatment for shoulder injuries, and if you gave me a blind test and asked me, when I was on the table being managed and manipulated, which practitioner was working on me I couldn't tell you. Osteopaths probably have a better knowledge of the structure and mechanics of the body - the training is very thorough. Yes, some osteopathic techniques are bunkum - cranial, and some of the 'crunches' they used to do - but I've not had an osteopath suggest either to me for years. So my personal experience, which is obviously not a scientific study, suggests that both physio and osteo can be useful to someone in the OP's situation.
For @convert
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004258/full
TL;DR:
There is some evidence from methodologically weak trials to indicate that some physiotherapy interventions are effective for some specific shoulder disorders. The results overall provide little evidence to guide treatment.
Worth a ctrl+F for "rotator cuff." Apparently, mobilisation/manipulation plus guided exercise might help, but a corticosteroid injection might help more, although ibuprofen might help just as much.
Most up to date study for shoulders suggests advice is just as good as exercise interventions (with or without cortico-steroid injection).
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00846-1/fulltext
FWIW I am a physio, I am a researcher, I also know a fair amount of what the professional body wants. The above study was a robust investigation delivered by an awesome team out of Oxford. So the hands on stuff isn't always any better than a leaflet or a bit of a chin wag...
There is a paucity of robust evidence to support a number of things we as physios do in our day to day practice (same can be aimed at many AHP's including Osteo), however, due to our breadth of specialities we work in we have some fairly decent evidence too in specific areas of practice (respiratory). I think the evidence for any intervention for musculoskeletal issues is less robust.
We as AHPs have a responsibility to provide clinically reasoned, evidence informed practice (as do all the others), and we follow the evidence where available and our clinical reasoning to determine the best approach from what we assess.
I think putting physios on a pedal stall and taking aim at Osteo / Chiro is a bit unfair. Sure they come from rather peculiar beginnings, but so did physio - remedial gymnastics anyone? Physiotherapy came about as an offshoot of nursing when they were provinding massage therapy and didn't want to be thought of as offering 'other' types of massage...
I think there are good and less good practitioners in all professions, and that's why a number of people get hauled up before the HCPC, GMC, NMC etc for fitness to practice hearings and that's why our professional bodies pay out a huge amount to provide personal liability insurance to members.
I think this is the study I found before (review of databases rather than a new study) but more recent.
https://www.csp.org.uk/frontline/article/effectiveness-exercise-rotator-cuff-related-shoulder-pain
Resisted and progressive exercise provides an uncertain clinically meaningful improvement in pain and function compared to no treatment or placebo among people with rotator cuff related pain. In contrast, there is low certainty evidence of no benefit in all outcomes with non-resisted or non-progressive exercise.
TJ and Cougar do not understand what they are talking about – on this topic. Their arguments make it clear they don’t know much about Physiotherapy or Osteopathy.
I was at odds with TJ. Are we both wrong whilst disagreeing with each other?
[lots of typing basically saying physios are also quacks]
At the end of the day, if you're a practising whatever-you-are then you need to back up any claims to efficacy that you're making. If physiotherapy should be in the same bag as the others then I hold my hand up, I did not know that. Do you know of many physios claiming that they can cure asthma or colic?
they jump on every thread like this, stating all physios can be recommended unreservedly, and all osteos are quacks, potentially depriving someone in pain of their best option for care and therapy.
I find this a weird coda. I've never stated that "all physios can be recommended," I wouldn't be rash enough to say that about "all" anything. All GPs? All plumbers? I know plenty of shit technicians and engineers in my own fields.
And, "best option"? Is it? What you've just described there is at best "least worst."
n=1 and all that, but the stupidest* person I have ever met** has wound up as an osteopath after various failed careers.
*As in dangerously stupid. As in has been a member of various religious cults in the past, believes every single conspiracy theory going etc.
** Met while we were both studying for bioscience PhD's - the PhD which they proudly display on their website as some kind of proof of not being a quack unfortunately.
Sorry, Cougar, I might have got a little sloppy with my language, but after a few of threads trying to get across what marp said above, with no success, I'd got a little frustrated.
lots of typing basically saying physios are also quacks
That's not what I said at all. I've not leveled blanket accusations at anyone.
All I've ever said is that some manual therapists are good and some are bad, people should ask for recommendations for someone who's good at dealing with the issues they have.
I've been frustrated at blanket accusations thrown at one field on the basis of evidence, history, regulation, and scientific basis without much attempt to view the other field through the same lenses.
Edit: And you're still shit at even basic checks of your position, even after the abuse I gave you earlier?
Do you know of many physios claiming that they can cure asthma or colic"
Google "physiotherapy colic" how many pages before you find one? 3rd result down in the first page for me.
Where's wanmankylung when you need him lol
Lol... you lot!!
As per post number 3... if you have sore shoulders then go and do some "Face pulls"*
In fact, go and do some even if your shoulders feel ok.
Do them properly. Just one or two sets of these will help restore function, coordination and joint space. But you have to do them properly.
*Don't do these if it make the impinging pain worse.... this is highly unlikely 🙂
Reading this with interest as I’ve got a rotator cuff injury too, through a combo of doing ninja warrior locally and also via Ferrata clinging to a rockface!
It doesn’t affect my riding at all at the moment but can I reach a glass from when in bed, not easily!
Trouble is I am quite bad at doing my physio exercises and I guess I need to be better basically! I am 10 weeks into MTB Fitness too and thinking some exercises I really shouldn’t be doing like pull ups! Did I read that so long as the shoulder is down and back then it’s better? So for example deadlifts so long as I’m not trying to lift a very heavy weight. Resistance bands seem to be the best by the sounds and I’ve got a few exercises with those to do from the NHS. Might be worth me seeing a physio though!