Recommendations for

SHOULDER PAIN
From Physio Edge podcast 021 with Dr Jeremy Lewis.

1 7
Psychosocial factors are much bigger SSMP techniques that are found
predictors of outcome than physical to improve symptoms may be then
factors for people with shoulder pain used as part of management.

2 Making a clinical
8
The SSMP is NEVER a stand-
alone procedure and is typically
imbedded in a graduated exercise
program for rotator cuff related
diagnosis is difficult. shoulder pain
Orthopaedic tests are

9
good at reproducing Exercise has been shown to
symptoms but can’t be as effective as surgery
discriminate which for subacromial impingement
structures are causing syndrome and partial thickness
the symptoms. rotator cuff tears.

3 4
There is also
considerable
uncertainty
about the relationship
between upper body
posture, including
scapular dyskinesis,
and symptoms

Similar to
low back
pain, there
is a very poor

10
correlation It is also effective for atraumatic
between imaging full thickness rotator cuff tears
(x-ray US, MRI) (reducing the need for surgery
and shoulder pain up to 75%) So although surgery
is an option, try PT (for around

5
12 weeks) first
The evidence for the subacromial impingement
syndrome theory is highly equivocal.

6 11
Education, advice and shoulder
The Shoulder Symptom Modification exercise are the most important
Procedure (SSMP) attempts to address all treatment but may need to be
these uncertainties, and is one method of supported by other treatments,
trying to improve the patient’s symptoms such as addressing lifestyle and
without knowing the exact origin of them. whole of body exercises.

Find Jeremy on twitter @JeremyLewisPT

or at londonshoulderclinic.com
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