The Three Most Common Shoulder Myths
by Troy Vander Molen, PT, DPT
People with shoulder problems are a common sight at our clinics. Shoulder problems are the third most common condition we treat at Kinetic Edge. We estimate that we have had nearly 10,000 treatment sessions with people experiencing shoulder pain at our five clinics in the past three years. That’s a lot of shoulder pain!
One of the best things about being a physical therapist is that you get to build relationships with your clients. During our 45-minute treatment sessions, we learn a lot about them: both their hopes and their fears. And having a pain problem definitely elicits many fears.
Sometimes those fears are fanned by false beliefs. So, this month I’d like to share with you the three most common myths we hear from our clients about shoulder pain so that we can give you hope about a healthy future.
Myth #1: “My shoulder hurts. I need an MRI to figure out what’s really going on before I can fix it.”
There is no doubt that in the modern age there are many technologies available that are really exciting and allow us to understand what kind of pathology exists within our bodies. Thus, it is very tempting to default to an MRI when you’ve been experiencing pain for some time. After all, wouldn’t it be easier to fix the problem if we knew exactly what was going on in there?
There are several problems with this approach. First, MRIs are expensive. They often cost $2,000-$3,000 – sometimes even more – because the technology is advanced and expensive. Add in the cost of the medical experts who read and report on the findings, and the costs climb.
You might think, “That’s why I have insurance.” While insurance may help reduce your direct costs, these costs end up having an indirect impact on other and future medical costs. You might be able to justify the expense if the results of the testing resulted in a positive outcome. Unfortunately, most MRIs don’t change the plan of care, and, thus, they are unnecessary.
A study that looked at medical expenses in 2009 found that Americans spent $6.8 billion on 12 unnecessary tests and treatments, which included the use of MRIs. In other words, $6.8 billion was a conservative estimate of the cost of unnecessary care. This is a big part of the health care crisis we’re experiencing in America today!
The primary problem with MRIs is that they are very sensitive, but they aren’t very specific. In other words, you can clearly see evidence of wear and tear (sensitivity), but that evidence does not necessary tell you why you are hurting (specificity). That means that the information obtained in an MRI can be very misleading and lead to even more unnecessary and ineffective treatments.
You see, pathology does not equal pain. The tissue damage you might find on an MRI is evidence of wear and tear, but recent research shows that many asymptomatic people – people without pain – have evidence of tissue damage identified on an MRI. Wear and tear is normal, and it becomes more common as we get older, but having evidence of wear and tear doesn’t mean that you will experience pain. And, it doesn’t mean that you can eliminate pain by getting rid of the damage.
Most people with shoulder pain don’t need an MRI. What they do need is to figure out if their shoulder is experiencing mechanical stress due to some type of movement inefficiency in the shoulder complex. It is much more effective – and much less costly – to visit a physical therapist that specializes in evaluation and treatment of the shoulder than to immediately default to an expensive MRI. If conservative care fails, an MRI may be a good choice later in the process.
Myth #2: “I have a rotator cuff tear. I guess I’ll need surgery to fix it.”
In the previous section, I spoke about the sensitivity of diagnostic testing while cautioning you about the lack of specificity. Finding a problem with an MRI can lead to treatments that are either ineffective or unnecessary.
Let me give you some details about what I mean about that:
- A study by Tempelhof et al (1999) revealed that 23% of people with pain-free shoulders had a rotator cuff tear. Newer research indicates that 35-40% of healthy people – people with no shoulder pain – have rotator cuff tears, and this number rises to 2/3 of people age 70 and above.
- Recent research indicates that more than 1/3 of people who undergo a successful rotator cuff surgery still have a rotator cuff tear. 16% still have partial tears and 20% still have complete tears.
Why get a surgery to fix something that many pain-free people also have? The goal is to improve the movement and reduce the pain – to feel better and function better – not fix the rotator cuff, and this can occur without going under the knife.
Myth #3: “I’ve already tried physical therapy. It didn’t work, so I shouldn’t waste my time again.”
We’ve heard this one a lot, and, believe me, I understand your hesitance to try something again that didn’t work in the past. But, I want to share something that it took me many years to learn. Sometimes physical therapists haven’t figured it out yet.
I’ve been practicing physical therapy for 21 years. When I was a young therapist, I swear that sometimes my clients got better despite me. It stroked my ego when a former client came back to me and said something like this, “Troy, you helped me so much six months ago. My shoulder is hurting again, and I want you to work your magic like you did back then.” Of course, that message immediately felt good, but eventually I had to be honest with myself. Did I really help them if the pain came right back?
Almost every physical therapist is good at making people feel better. Rest, ice, ultrasound, massage, and basic exercises can eliminate pain. But, would it surprise you if I said that my goal isn’t to get rid of your pain?
Yes, I want you to feel better, but that is only half the battle. I want you to feel better AND to function better. Something in your shoulder is hurting because it is experiencing some kind of mechanical stress. That mechanical stress results in inflammation and pain, and as physical therapists (like the health care centers that own the MRI machines) we own some cool technology, tools and treatment devices that can help reduce the inflammation and get rid of the pain… at least temporarily.
However, if I have not helped you improve the efficiency of movement of all the parts in and around the shoulder, that mechanical stress still exists, and your inflammation and pain will likely return. I have only helped you feel better, not function better.
At Kinetic Edge, we have identified two major areas that are often overlooked in people that have shoulder pain. Like all areas of the body, one area is directly influenced by its closest neighbors. By improving movement capabilities in the entire system – not just reducing inflammation in the area of pain – we can help you eliminate the mechanical stress and solve the root problem. That’s the only way to have long-term success with shoulder problems.
If you’d like to have one of the Kinetic Edge shoulder experts perform a free injury screen and look at those two major areas in your body, give us a call. We are happy to give you a brief screen at no cost or obligation to you. Just call now at 866- 588-0230 because spots are limited.