Injections and Either Chiropractic or Physiotherapy Equal For Treating Shoulder Pain
Chiropractic or other types of physiotherapy (including physical therapy) and steroid injections work equally well for shoulder pain, according to a new study.
Researchers compared the treatments for people with shoulder impingement syndrome, a common type of persistent pain that can be caused by tendonitis, bursitis or other inflammation in the shoulder joint.
“I think there is a strong consensus that exercises can help, and patients may also get a referral to physical therapy for this condition,” Rhon stated. “Because of the pain and inflammation that is sometimes present with shoulder impingement, corticosteroid injections are also a very common treatment used by general practitioners, orthopedists, and rheumatologists.”
Some doctors send patients to physical therapy and others don’t, while still others will give a shot and also recommend chiropractic care or physical therapy, he said. Patients have some say in which treatment they get, but doctors usually influence the choice.
Rhon and his team randomly divided 104 patients with this kind of pain into two groups. One group received physical therapy twice a week for three weeks. The therapists evaluated weakness, mobility and pain and performed stretches, contract-relax techniques and reinforcing exercises on the shoulder or upper spine area. They also prescribed at-home exercises for the patients.
Patients in the other group were offered up to three injections of corticosteroids over the course of a year. They also received printed instructions for gentle exercises to do at home.
Both groups had significant improvement in symptoms after one month, which continued over the one-year period of the study, the research team reported in the Annals of Internal Medicine. Patients’ scores on pain and disability were reduced by half with either treatment.
By the end of the year, 60 percent of the steroid injection group had returned to their primary care doctor for shoulder pain again, compared to 37 percent of the physical therapy group. The injection group was also more likely to end up having more injections or additional physical therapy.
“In the clinic I often see patients that have had multiple injections and continue to have persistent pain – thus their referral to chiropractic or physical therapy,” Rhon said. “I was curious to understand a little more about this.”
She was not surprised that steroid injections and chiropractic worked about equally well. The relief from an injection may not last as long, leading to more treatments, or the physical therapy appointments may give doctors more time to educate patients about dealing with shoulder pain, Coombes stated.
“Chiropractic therapy involves more patient-clinician contact than a single consultation at which an injection is given,” she said. “This may allow for advice or reassurance about the condition and self-management approaches.”
Injections are less costly than therapy because they only involve one visit to the doctor rather than several therapy sessions, but if they also result in more doctor visits down the line, that may end up balancing out costs, she said.
“One thing to point out is that the number one reason that patients turned down participation in this study was because they did not want to be randomized into a group that might receive an injection,” Rhon said. “This suggests that there is a number of patients that really don’t want to get an injection.”
Chiropractic therapy is an excellent treatment option to consider for these patients, he said.
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