I thought I had a tear and I looked up stuff about impingement and I did the impingement workouts and my shoulder felt better literally 3 days after after constantly doing it and my shoulder wouldn’t fix itself on its own doing those exercises def fixed it.
Decompression works for people with bone spurs.. I have no bone spurs, or inflamed bursa, and yet I have an impingement. Supposedly shoulder instability, and arthroscopy showed no impinging structures. Idk wtf I'm meant to do. Can't bench or shoulder press for 7 years.
I love the fact you cite recent studies and don't just follow out dated dogma. You tube is filled with clinicians regurgitating information that by and far should go way of the dodo bird. Quality information is presented here, at least one should consider what is presented and logically formulate a hypothesis based on updated information. Thank You Physiotutors.
latest hot umbrella term I came across is Rotator-cuff-related shoulder pain (RCRSP) (Cook & Lewis, 2019).The NSLBP equivalent for the shoulder in essence!
After 3 injections in both shoulders and an mri my shoulder pain was relieved only after physical therapy. Im pain free with normal range of motion after about 2 years of pain.
Could you do a similar myth busting on FAI (since CAM and or pincer structures are present at the same level in symptomatic and asymptomatic populations)?
Thanks for the vidéo I always have troubles trying to explain this kind of stuff to patients who come with a prescription for "Sub-acromial compression syndrome reeducation ", I guess we are a few years late on the studies once again...
So what's the implication of that? We should stretch instead of strengthen the rotator cuff? work on the positioning of the scapola (trap inf etc) it's useless??
Loved the presentation. Makes sense. Repetitive overload does seem more likely given the evidence you present. Thank you for changing my outlook. You also touched on something I have always wondered about... How often is it that the benefit from surgery actually comes from post-surgical physical therapy rather than the actual surgical procedure? I would love to hear more about that. Also, what is your proposal of dysfunction for the repetitive overload of these rotator cuff tendons? Are you thinking scapular dyskinesia or malposition? Do you think the cervical or thoracic spine or even rib dysfunction may play a role?
A lot of surgeries are being compared with sham surgeries now. We hardly know of any that is better than sham and this even concerns surgeries like full knee replacements. We think it's not only the post-surgical physical therapy but also the relative rest period after surgery. On top of that surgery is a huge placebo. Tendons can become reactive when capacity is exceeded by a combination of tensile and compressive loads. Oftentimes capacity is reduced after a period of rest or decreased load (p.e. off-season etc.). At the same time, pain is so much more complex than just biomechanics, so could also be other psychosocial factors triggering a pain response.
It says "There is impingement of the subacromial subdeltoid bursa with bunching of fluid upon shoulder abduction. Correlate for subacromial impingement syndrome". What does it mean ?
Just an n of 1, but I broke my superspinatus in a fall over 20 years ago. While he was reattaching the tendon at its insertion point the surgeon nipped a bit of bone off the acromion. I do have shoulder pain in the unoperated shoulder that identifies with impingement.
A meta analysis by Morelli et al 2018 (doi: 10.1002/ca.23309), which actually included Gil et al (2002), conflicts with your claims about acromion morphology, and found that a hooked acromion type was associated with a 3 times greater odds for RC tear.
If there are multiple studies showing that the correlation is not there and a few others that show there might be some, you do not have strong evidence that the correlation is there. You have strong evidence that the correlation is NOT there. If there were a strong correlation, you'd have more than one study demonstrating it. A meta analysis is subject to authors' biases, as you end up relying on their interpretations and massaging of data (especially when you read only the abstract).
@@Uprighthealth to be fair, ALL papers are subject to the biases of the authors. As for just reading an abstract: when a meta-analysis is conducted, the exact statistical findings have to be entered and weighed in. As for your point about reading only the abstract, that's fair, but it also applies to all papers -- not just meta-analyses. So I get where you're coming from, but the problems you're speaking of aren't exclusive to the MA world. I do agree rather strongly with your opening points about evidence of correlations and how we shouldn't cherry-pick a minority of the evidence to form our interpretation of the topic as a whole.
For the record I have had this procedure done on both my shoulders. Both times my pain was very much lessened. Just as there are bad in almost group. Physicans are no exception. I tried physical therapy for almost 3 years. My shoulders just stayed the same. On my right shoulder the Surgeon found the bone had a very sharp edge and had over time done a lot of damage to the shoulder under it. I might be that rare exception but surgery has given me back the full use of both of my shoulders. This is just an idea, but maybe people should take notice this person stands to get all the insurance money from these cases. How do you know you are getting the entire story? Like I said I have had this surgery two times now. Both shoulders had a rapid recovery and I only took OTC meds for pain. Just saying!
Not saying surgery does not work, but probably it's working because of the placebo effect, rest and rehab afterwards. Physical therapy is not = physical therapy. A lot of bad treatment is done in our profession unfortunately and twice on the shoulder. Yet research always sees average and it might have been just right for you
@@Physiotutors No, it was not a placebo effect. Before my procedures I was taking a lot of pain meds to help me through PT. I finally got those shoulders fixed. I'm not in disagreement with the overall aim of PT in dealing with these things. That bone in my right shoulder was sharp and was destroying the things under it. Just don't call this type of surgery a myth, while maybe 99% of the people could get good results from PT, there are situations from time to time where surgery is required. My case was such a time. I don't object to the main points you make, I just object to that term myth.
How can you say that there wasn't a placebo effect? You might have had the same effect if they did a sham operation. The word myth refers to the impingement theory in general which is flawed in several ways.
@@Physiotutors I note your reply and call BS on it all! I get you make your money from doing PT. You make your mistake when you don't allow for OTHER valid treatments, this is how I know you are full of it!
I have been debating getting subacromial decompression on my right shoulder. I had a posterior labral tear. I had surgery and have been suffering from rotator cuff impingement ever since. MRI show my rotator cuff is in excellent condition but due to the atrophy has been getting caught in the subacromial space. I've done nothing but external rotation exercises and rear delt exercises with no complete relief of pain. I have to say I think surgery would definitely be the only fixed because I can literally feel tendon being pinched with certain movements.
Agreed, probably not compression but tension on the tendon is maximal. Same story in tendons where compression is not a factor (tennis elbow, midportion achilles tendinopathy etc.)
@@Physiotutors So usually it is said that impingement of the supraspinatus occurs, if the distance between the top of the humeral head and acromion is too short, so that the humeral head jams into the acromion, right? And what you are basically saying is, that this jamming into the acromion doesn't occur since then the tendon will be damaged on the upperside. So how do I know when I my supraspinatus tendon is compressed by load ? does it happen when the humeral head is pulled down too much by a load, for instace when doing the shoulder press?
Man I wish I was watching this since I was taking it for some class of mine or rotation but I have type 4 acromian process it’s painful as hell need to get some form of therapy or more properly diagnosed lol
Ah great. I’ve been struggling with this issue for six month now. Really, really in pain. Have been doing physio religiously. A quick fix advice? If it doesn’t exist must be imagining the pain and suppose?
My supra and infra spinatus and frozen shoulder has been linked to a downcurving acromium type 2. It’s really painful. If no surgery what exercises should one do?
Hi , fist i would like to thnk you for your great videos. Then I'm quite confused because there are also studies that shows correlation between acromial morphology and rotator cuff tear, plus there are Still videos on this channel about shoulder impingement so What info should we learn?
Yeah, research doesn't stand still. The latest review from Morelli et al. (2019) indeed indicates that there might be a correlation: pubmed.ncbi.nlm.nih.gov/30362636/ but that is probably just factor amongst many considering that acromial resection is not better than placebo. All the other things we mention still stand the test of time. Forget about the old impingement theory.
I dislocated my left shoulder 15 times while doing backflip.but i can relocate my shoulder within 30 sec.i also dont feel pain.its been 4 months i stop doing backflip and my shoulder not dislocate.plz tell me surgery is needed or it can heal with exercise.
Impingement is not a stand alone condition. It's caused by shoulder instability due to weak rotator cuff muscles and weak rear deltoids. Also, muscle imbalances can cause this issue. Meaning the anterior shoulder muscles are stronger than the posterior. This causes bad posture putting the rotator cuff in the point of impingement. You see this a lot in weight lifters that focus on what they call mirror muscles. Which basically means they focus on the chest biceps front delts etc. And neglect the rear delts, rotator cuff, and back muscles.
Impingement is an outdated theory. What you suggest sounds a bit like the algorithm from Cools in 2008 which was largely based on theory and not on evidence.
Stopped watching after citation of the CSAW study.. look at the study and the re-do the video. The study design was weak. And just for the record: I am not saying impingement should be operated..
Yes Yes Yes It is about time health care stopped compartmentalizing disease, to make it fit tidily with a 'profession's' scope of practice. I am an older physiotherapist, and it has irked me since undergrad days that physios know and care next to nothing about the effect of non mechanical effects on muscle/tendon health. Hydration, nutrition, endocrine, and autoimmune factors are absolutely critical to msk degenerative rate. To ignore these factors in seeking cause and therapy for tendinopathy is pure bone headedness. It is known several tendinopathies are more common with diabetes and lupus. The first priority in determining cause of a particular pathology should be epidemiological studies. I have not seen one re tendinopathies studying incidence rates in different cultures/races with different lifestyles, diets, and comorbidities. In my experience, diet, hydration, and quality of rest/recovery play a greater role in tendinopathy than mechanics. I won't elaborate here. I suppose I'll be dead before the physio profession can accept this.
Can lupus Sjorgens??? Even accutane cause this years later? A vaccine? Not covid I did fall 12 feet and landed on my shoulder Two years ago I now have osteoarthritis in the vertebrae it’s so painful turning my neck sometimes I read I have congenital spinal stenosis (read that can lead to being paralyzed ….) Also have slight bulge in c3-c7 Impingement tendinitis bursitis in both shoulders My left one started after hpv vaccine (not an anti vax or whatever) I was told I prob won’t be 100% My arms kill so much I can’t even lift shirt over me I’m 32 I’m doing pt And it’s killing my body I’m so out of shape I’ve been feeling sick with health issues since 2009 it happened when I was on accutane And I know that does stuff to your joints As I had back pain while on it…. I feel trapped I’m in so much pain
Based on your conclusions, do you recommend the average weightlifter to do overhead pressing or is that a potentially higher risk exercise for the tendons?
You picked a couple of studies of young athletes to suit your narrative. Very poor form. In older people, particularly trades people, impingement is very real and proven. The reason the lower attachment of the supraspinatus tears in younger athletes is due to over-rotation of the shoulder or improper technique with overhead activities. Hell, you didn't even mention that there were three distinct types of sub acromial features, with type 3 being very much responsible for impingement of the supraspinatus.
Bullshit click bait video it is not a myth!!!, had AC resection and decompression on my left after terrible chronic trouble it's perfectly good now, but might now need my right doing due to bursitis.
@@moesadk4002 Good I do hard work and the shoulder I had operated on remains trouble free. Lots of stupid RU-vid videos about fixing shoulder/back/knee pain with couple exercises etc it's rubbish sometimes you need surgery but others you don't. They aren't myths back in the day these things ended sports people's careers, now they get extended. Far too easy to watch lots of videos while recovering in a sling. Only scary thing I have to mention is I had mine done twice keyhole first then open second, they didn't get the angles or spacing right first time with the keyhole. Same surgeon.
Best diagnostic tool is your subjective. Clustering tests performs better than singular tests but you get most out of the history. MRI is useless in this case and should be reserved to cases where you suspect sinister pathology.
I can find conflicting evidence for acromion shape as a risk factor for SAPS. Some studies are pro and the study mentioned in the video is con. Can you explain? Thanks in advance!
@@Physiotutors www.ncbi.nlm.nih.gov/pmc/articles/PMC3302047/ This was my first hit. I know it is a case control and also I didn't read it thoroughly, but still😅
You should check how the studies were done to show acromion shape as a risk factor. Early studies are almost always done in highly biased manner by orthopedic surgeons.
Rubbish I have had physio and nothing I do stops my pain. I’m waiting for a MRI scan so hopefully will get to the bottom of all this nerve/pain in my shoulder and down my arm. You physio s are always trying to justify what you do. That’s no offence either.
Stacey Brown how can you say that ? A MRI scan can show up clearly all the structures of the shoulder including nerve damage etc a physio cannot look into your shoulder that way and only base their findings from your symptoms. I think the sporting world would be horrified if you were dismissing scans as you say for chasing the pain only that’s an absolute load of rubbish if I ever heard it. Something that they can slice your shoulder into pieces is more likely to spot a problem than a hands on physio. Do you not agree this ?
stacey brown fair play to you i commend you on your passion and beliefs it’s way above my head what your saying but if your right then you keep preaching to the un educated 👏
stacey brown you don’t need to apologize I respect your views and the fact you took the time out to explain your side of it. Good luck in your future ventures I’m sure you will be a high flyer in your line of work 👍
Hey thankyou i been sturggling with pain from shoulder pain leftside yesterday benchpress with dumbells instead of bar and went arms flared at 90 degree. To far straight. What u think happened to it ? And how can i relieve it?
