[Closed] Any Physios/ Osteopaths in the House? Rotator Cuff issues

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 😉

"Osteopathy - NHS" https://www.nhs.uk/conditions/osteopathy/

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.

https://www.england.nhs.uk/ahp/role/

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?