Physiotherapy alone does as much long-term good for a shoulder condition as physiotherapy plus corticosteroid injections, says a paper published in the BMJ. Injections do, however, help to speed recovery in the early weeks.
Leeds physios Dickon Crawshaw and Simon Aldous and colleagues investigated treatments for subacromial impingement syndrome, a common shoulder-pain diagnosis. The main outcome they were looking for was improvement in pain and disability at 12 weeks. Shoulder pain is widespread, and earlier studies have shown the benefits either of exercise and manual therapy or of corticosteroid injections, but no large trials had evaluated the combination of these treatments. ‘We hypothesised that the use of exercise and manual therapy in the “window” of reduced pain after a corticosteroid injection could result in better outcomes,’ say the authors. ‘As these two treatments probably work by different mechanisms, the combined treatment approach could be more effective than the single components.’ Some 232 patients over 40, with moderate or severe shoulder pain, were divided into two groups. Both groups had exercises and manual therapy, while one group also received subacromial corticosteroid injections. Although those receiving injections were doing better at weeks one and six, by week 12 both groups had made equal progress. ‘Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial’ is on bmj.com www.tinyurl.com/32qxgvk
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