K-Tape For Shoulder Pain? A 'sticky' subject!

Source: 

Akshay Date & Luthfur Rahman (2020) Frozen Shoulder: Overview of Clinical Presentation and Review of the Current Evidence Base for Management Strategies, Future Science OA, 6:10, FSO647, DOI: 10.2144/fsoa-2020-0145

Frozen shoulder is a common condition which occurs in approximately 2-5% of the population with a peak incidence between 40-70 years of age. It is characterised by varying levels of pain and limitation in range which is more common in women and can occur in both shoulders in roughly 20-30% of cases.

 While frozen shoulders are normally self limiting, symptoms can continue for a number of years with varying levels of pain and functional limitation and in some instances may never fully resolve. 

 There are 2 reasons why people can go on to develop frozen shoulder:

·       Primary : The most common presentation where pain and limitation are noted however without an underlying cause

·       Secondary : Frozen shoulder can occur following trauma, shoulder surgery, prolonged immobilisation, diabetes, thyroid disease or other autoimmune disorders

Pathophysiology and presentation

 The reason as to why people develop primary frozen shoulder is still not full understood, however research has shown that the joint capsule that surround the shoulder becomes thickened and tight with evidence of inflammatory cell within the capsule with some suggestion of an autoimmune cause for primary shoulder pain.

 It is proposed that there are 4 stages of frozen shoulder that is demonstrated in the table below. Ther onset of symptoms however can be gradual over a period of months with symptoms being poorly locaused and reported as a deep ache, with night pain being an common feature. On examination people usually demonstrate good rotator cuff strength and no specific tenderness on palpation however a marked loss of range of movement, partiucuarly into rotation. As frozen shoulder affects the joint capsule, any form imaging such as an x-ray is normal but can helpful to rull out any other types of pathology.

1. Neuropathic Pain: Defined as 'pain caused by a lesion or a disease of the somatosensory nervous system'. In other words, back pain associated with a disc herniation, which causes compression of the nerve leading to symptoms down into the leg
2. Nociceptive Pain: Defined as '  pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. Nociceptors are triggered by mechanical, chemical, or thermal stimuli arising from all innervated structures’. In other words, pain that arises from another structure around the lower back but not associated with nerves.

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting techniqueis associated with LBP (Saraceni et al 2021)

People with chronic lower back pain usually report difficulty in bending forward, in particular when attempting to lift anything heavy. This study attempted to review biomechanical movement pattern differences in manual labourers with and without chronic lower back pain (>5 years).

What they identified was that those with lower back pain used a different lifting technique when compared to those without lower back pain. Those with back pain performed more of a slower, 'squat' type lift, with a greater knee bend and straighter lumbar and thoracic spine as well as greater peak knee forces when standing. Those without lower back pain performed the lifting task with a quicker, more stooped like posture with less knee bend.

Their conclusion was that the common assumptions around lower back pain associated with movements and the forces produced during a lifting task were not observed and brings into question the current belief around safe lifting.

From protection to non-protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain (Wernli et al, 2021)

This mixed method study design examined the benefit of Cognitive Functional Therapy (CFT) in people with chronic lower back pain (CLBP). 12 people were interview at the start of the study, identifying their beliefs about their back and the 3 movements and postures that they find most provoking. A course of CFT was delivered over a period of 12 weeks, where participants were interviewed afterwards to review their movements and their perceptions of their symptoms.

At the end of the 12 weeks, 11/12 people had reported significant improvements in their pain and function, enabling them to return to their usual activities and in some instances (7/12 people) not think about their back pain at all. The authors of this study identified two groups for both before and after the intervention which I believe is extremely useful:

Before Intervention

1. Non-Conscious Protection - A lived experience of being stiff, restricted, tense, locked or seized up 
2. Conscious Protection - Tense, guarded, careful and cautious movements and postures due to belief of structural damage / vulnerability, fear and worry of damage, pain, future +/- diagnostic uncertainty

1. Conscious Non-Protection - Purposefully relaxed, fluid, free movements and postures that reduce pain and increase function (including integration into valued activities)
2. Non-Conscious Non-Protection - Automatic, natural, relaxed, fluid, free movements and postures secondary to positive experiences that disconfirm or violate previous beliefs, worries or expectations, and individualised education about their condition and the meaning of pain

Recently. the UK Government announced changes to their guidance and laws on how to manage the COVID-19 Pandemic. According to the recently published 'Living with COVID-19', regular asymptomatic testing and required self isolation should you test positive has been removed. However, the UK government still recommend:

• Wearing a face covering in crowded and enclosed spaces
• Testing if you do develop symptoms (the NHS still suggest that a temperature, loss of sense of taste or smell and a new continuous cough are the most common signs)
• Stay at home if you are unwell
• Regular hand washing

The current recommendations the Public Health England Infection Protection and Control Teams is that PPE shall continue within a healthcare setting until advised otherwise. Therefore Matt Ross Physiotherapy shall continue with:

• The wearing of full PPE
• Strict cleaning procedures both before, after and inbetween patient appointment times
• Sufficent gaps in between patients to ensure adequate social distancing

While facemasks have not been mandatory for a while now, the clinic has a broad range of clients from different ages and diffent medical conditions and I have a duty to ensure everyones safety during this time. I therefore kindly request that all clients continue to wear a face covering whilst on the premises (unless medically exempt or for any other valid reason).

If you feel unwell, please do not attend your appointment and notify me so we can arrange at your earlies convenience

This guidance will be reviewed on the 1st April 2022. Many thanks for your continued support.

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• Thursday to Saturday: 8.30am to 6pm
• Sunday: 10am to 4pm.
• Emergency appointments may be available at request - please contact directly.

• The wearing of full PPE
• Thorough cleaning between customers
• Gaps between appointment times to ensure that you do not come into contact with other customers.
• Personal lateral flow testing 2 times per week.