Sixty-five percent of individuals who had a full thickness rotator cuff tear did not have any pain (16). Fifty-two percent of individuals had a disc bulge on lumbar spine MRI (17) while 90% had some sort of pathological finding on lumbar spine MRI (18) despite these patients not having symptoms. It is the job of the medical provider to determine if the symptoms are consistent with the abnormality on the diagnostic imaging study or if they are simply normal age related changes/normal variant. Many times, addressing the impairments as described in the services offered section will reduce the pain and allow you to return to your normal life despite having an abnormality on MRI, X-Ray, etc.
Many conditions occur normally with aging or are a normal variant (degenerative spine changes, degenerative joint arthritis, full thickness/partial tears of the rotator cuff, etc.) and can often times be managed without having to undergo any surgery or invasive procedures.
Manual Medicine Physical Therapy
Under non-emergent conditions, YOU have the choice whether you would like surgery or not. Physical therapy can many times help you to avoid surgery, however if the symptoms persist and you do decide to have surgery you will have better results after the procedure because your mobility and strength are at optimal levels going in.
The Orthopaedic Manual Physical Therapy (OMPT) approach has shown in many research studies that it can help to reduce pain and/or improve disability in individuals with low back pain with/without leg symptoms (1,2) neck pain with/without arm symptoms (3,4,5), hip pain (6,7), knee pain (8,9), ankle pain (10), shoulder pain (11,12), jaw pain (13,14), headaches (15), etc.
1Aure OF, Nilsen JH, Vasseljen O. Manual Therapy and Exercise Therapy In Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-year Follow-Up. Spine. 2003;28:525-531.
2Childs JD, Fritz JM, Flynn TW et al. A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A Validation Study. Annals of Internal Medicine. 2004;141(12):920-928.
3Walker MJ, Boyles RE, Young BA, et al. The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain: A Randomized Clinical Trial. Spine. 2008;33:2371-2378.
4Gross A, Miller J, D'Sylva J, et al. Manipulation or Mobilisation for Neck Pain: A Cochrane Review. Manual Therapy. 2010;15:315-333.
5Boyles R, Toy P, Mellon J, et al. Effectiveness of Manual Physical Therapy in the Treatment of Cervical Radiculopathy: A Systematic Review. Journal of Manual and Manipulative Therapy. 2011;19(3):135-142.
6Hoeksma HL, Dekker J, Ronday HK, et al. Comparison of Manual Therapy and Exercise Therapy in Osteoarthritis of the Hip. A Randomized Clinical Trial. Arthritis and Rheumatism. 2004;51:722-729.
7MacDonald CW, Whitman JM, Cleland JA, et al. Clinical Outcomes Following Manual Physical Therapy and Exercise for Hip Osteoarthritis: A Case Series. Journal of Orthopaedic and Sports Physical Therapy. 2006;36:588-599.
8Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of Manual Physical Therapy and Exercise In Osteoarthritis of the Knee.Annals of Internal Medicine. 2000;132(3):173-181.
9Deyle GD, Allison SC, Matekel RL, et al. Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee. A Randomized Comparison of Supervised Clinical Exercise and Manual Physical Therapy Procedures Versus a Home Exercise Program. Physical Therapy. 2005;85(12):1301-1317.
10Whitman JM, Cleland JA, Mintken P, et al. Predicting Short-term Response to Thrust and Non-Thrust Manipulation and Exercise In Patients Post-Inversion Ankle Sprains. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(3):188-200.
11Bang MD, Deyle GD. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients with Shoulder Impingement Syndrome. Journal of Orthopaedic and Sports Physical Therapy. 2000;30(3):126-137.
12Brantingham JW, Cassy TK, Bonnefin D, et al. Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systmatic Review. Journal of Manipulative and Physiological Therapeutics. 2011;34:314-346.
13La Touche R, Fernandez-De-Las-Penas C, Fernandez-Carnero J. The Effects of Manual Therapy and Exercise Directed at the Cervical Spine On Pain and Pressure Pain Sensitivity in Individuals with Myofasical Temporomandibular Disorders. Journal of Oral Rehabilitation. 2009;36:644-652.
14Furto ES, Cleland JA, Whitman JM, et al. Manual Physical Therapy Interventions and Exercise for Patients with Temporomandibular Disorders. Journal of Craniomandibular Practice. 2006;24(4):1-9.
15Jull G, Trott P, Potter H, et al. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache.Spine. 2002;27:1835-1843.
16Yamamoto A, Takagishi K, Kobayashi T, et al. Factors Involved In The Presence of Symptoms Associated With Rotator Cuffs: A Comparison of Symptomatic and Asymptomatic Rotator Cuff Tears in the General Population. Journal of Shoulder and Elbow Surgery. 2011;20:1133-1137.
17Jensen MC, Brandt-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic Resonance Imaging of the Lumbar Spine In People Without Low Back Pain. The New England Journal of Medicine. 1994;331(2):69-73.
18Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal Magnetic-Resonance Imaging Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation. Journal of Bone and Joint Surgery. 1990;72:403-408.
Many healthcare providers give black and white answers as to why individuals have pain (degenerative arthritis, bursitis, etc.) without considering or educating the patient on the important role that the nervous system (brain, spinal cord, and peripheral nerves) plays in regards to pain and especially persistent/chronic pain. We take this component very seriously and try to help you understand your pain and nervous system so that you can control it better. After all, it's the nervous system that actually causes pain.