One of the best parts of being an empowerment-based chiropractor is that you are able to see chronic pain sufferers recovery on their own. It’s ridiculously powerful because you get to see the shift from “I am so weak” or “I shouldn’t have waited for decades before seeking help” to “I can carry groceries by myself” or “I no longer need to take arcoxia everyday”.
We don’t deny that exercise as a therapy comes with its downsides. For one, you need to put in the hard work yourself to see results. Secondly, it always tend to hurt a little more at the start. The upside to all of this is that you are not dependent on anyone for pain relief. You are in charge of your own pain management. To me, this is the most beautiful part my work.
You don’t understand, I have a tear in my shoulder.
There are many types of tears that can occur in the shoulder. For this article, we are going to strictly focus on rotator cuff tears. We have four rotator cuffs in our shoulders, the supraspinatus, infraspinatus, subscapularis, and teres minor. Most tears usually occur on the supraspinatus tendon.
Because you have a torn supraspinatus and shoulder pain, you believe that your shoulder pain is coming from your rotator cuff tear. Well, that may not be true!
In fact, rotator cuff tears are common in asymptomatic population. Asymptomatic (i.e., pain free) tears are twice as common as symptomatic ones. This means that there is a good chance your shoulder pain is not actually coming from your torn tendon.
To put this in perspective, the rooster crows at dawn and the sun rises after the rooster crows. Does that mean the sun rises because of the roosters’ crows?
It is possible that you already had a rotator cuff injury BEFORE your shoulder pain started, and you only found out about the tear because you went for a MRI for your shoulder pain. Without a baseline (i.e., pre-injury) MRI, it’s impossible to know if the tear was already there to begin with.
Tear or no tear, exercise still works for your shoulder pain.
We know that people do see improvement in their conditions when they choose to undergo surgery. This is true. However, exercise is pretty much compulsory for post-surgical rehabilitation. In that sense, how do we know if the recovery is coming from the surgery or the exercise?
Yes, we attribute the recovery success because it makes sense to us. It fits our bias. I have a torn rotator cuff. I went for surgery to repair it. I feel better. Therefore, surgery works. This is all good and dainty besides for that you also would have done exercise rehabilitation after surgery. In fact, we know that it’s of utmost important that you complete your rehab for you to get good recovery outcomes.
With this in mind, then doesn’t it make sense to think that the benefits of going for surgery stems from the exercise rather than the surgery itself?
Exercise does indeed work as well as surgery
The best way to answer this question is to look at people who undergo surgery and those who undergo conservative care such as exercise. Remember, if the torn tendon is the sole reason you have pain, getting it fixed via surgery should yield extraordinary outcomes. Because you are literally addressing the problem.
However, this is not the case.
A meta-analysis published last year compared patients who went for rotator cuff surgery and those who didn’t to compare their recovery outcomes. While those in the operative group did experience slightly better results, the improvement was not clinically meaningful. In other words, it’s not high enough for the patients to be able to perceive it.
In other, other words, from the patient’s perspective, there is no discernible difference between going under the knife versus exercise-only.
So ya, going for operation to “fix” a tear may make sense. But the data suggest that you don’t need to repair the tear for you to achieve good recovery.
If you circle back to the earlier study on that asymptomatic aka pain-free rotator cuff tear is common, then it suddenly make sense. You have shoulder pain. You have a supraspinatus tear. Period. These two things do not necessarily need to be related.
Retears are possible after surgery
The other thing about rotator cuff repair is that retears are common. So, perhaps, the better solution is to not “fix” them to begin with. Because what are you going to do after you tear them again?
Of course to fix a failed rotator cuff procedure is always an option but surgery is expensive. Even if your insurance is willing to cover for it and the lobster meals you get as part of your VIP treatment, surgery still comes with risks.
And also, months of pain as you work through your rehabilitation. Again.
We are not saying that surgery is absolutely useless okay? We are saying the exercise is comparable to surgery, and with a lot less risks. You also won’t need to worry about retearing your rotator cuff with exercise because you never “fixed” it to begin with.
Also, one of the side effects of rotator cuff repair is “significant and difficult to treat postoperative pain“. I quoted it because not I say one. It’s what is published in Anaesthesia, which is a very reputable peer reviewed journal.
Imagine that, not only are re-tears common. But having worse pain after surgery is a possible side effect. It’s kinda not worth not matter how you look at it. If you really tried everything, including an evidence-based exercise programme, and still not better, then okay. I gets that you want to consider surgery.
But if all you have tried is your own exercise or some voodoo chiropractic adjustment or some basic and gentle physiotherapy stretches … then my suggestion is to book in for an appointment with us first. Because our shoulder pain clients can do shoulder press, clean and jerks, and snatches.
No placebo-randomised control trial for rotator cuff repair
I absolutely hate it when people say chiropractic is pseudoscience and is not congruent with evidence-based practice. Yes, I know some chiropractors in Singapore are the voodoo types and treat everything from cancer to infertility, but not all chiropractors are like that okay?
It irks me even more when medical practitioners say that because can I just remind you that most surgeries are ASSUMED to work? For rotator cuff repairs, I wasn’t able to find a placebo/randomised control trial to suggest it works better placebo. But yet we have been doing rotator repairs for what … decades?
Okay, I didn’t search very hard so it’s possible that there is a placebo-randomised control trial out there for all I know. But if I cannot readily find it, then my guess is that it’s not a high quality study. Probably from a journal with low impact factor.
I bring this up because there are procedures (e.g., keyhole decompression surgery) that have been done for forever that are now found to be useless (aka no better than placebo). The bigger problem is that these procedures are commonly performed. In fact, keyhole decompression surgery is the most commonly performed shoulder surgery!
Got it. My shoulder hurts. Can you help?
If you are willing to put in the hard work, yes! We can give it a shot. We follow evidence-based clinical guidelines and help our clients help themselves find freedom from pain.
For us, true recovery is about being able to live the life you want. This means getting you back to doing what is important to you. From participating in sports like tennis or just being able to carry your grandchildren, we want to help!
To find out more about our treatment approach, drop us a message via the link below.
WANT TO GET STARTED IMMEDIATELY?
Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.