Prevention of fatigue and insomnia in shift workers

August 11, 2017

Excessive fatigue and insomnia are common among shift workers. Shift work has been shown to lead to physical and psychological disorders due to the desynchronisation of the biological clock. Reduced work performance, processing errors, accidents at work, absenteeism, reduced quality of life, and symptoms of depression are negative outcomes that have been linked with shift work.

 

Fatigue and insomnia resulting from disturbed sleep- wake cycles occurs frequently in shift workers and may manifest into what is known as “shift work disorder”. Shift Work Disorder is associated with symptoms of insomnia or excessive sleepiness. The condition is usually temporary and is associated with a work period that occurs during the normal habitual sleep phase. The consequences of shift work disorder can have a negative effect on physical and mental health, quality of life, productivity, and performance.

 

Richter et al. (2016) indicates estimations on the prevalence of shift work disorder in shift workers varies between 5% and about 20%; about one in three shift workers is affected by insomnia and up to 90% of shift workers report regular fatigue and sleepiness at the workplace.
Many authors have researched the risks that result from shift work, long working hours, and a short sleep duration and they found that shift work increases the risk for attention deficits and accidents at work.

 

Richter et al. (2016) identified that the most common non-pharmacological recommendations to improve sleep quality and to reduce insomnia and fatigue were scheduling, bright light exposure, napping, psychoeducation for sleep hygiene, and cognitive-behavioural measures. General recommendations for coping strategies that have been tested and are easy to apply in daily practice to prevent fatigue and insomnia include scheduled napping, exposure to light at work, and special nutrition guidelines.

 

Workers who suffer from fatigue and insomnia often have no choice but to work when tired. Education on the hazards and causes of fatigue should be promoted. Each company that employs shift workers should consider providing knowledge and support and implement coping strategies against fatigue and insomnia. Workplace health promotion should assist in identifying health-related risk factors and support the development of coping strategies that can help to protect mental and physical health.

 

Workplace Physiotherapy present provide training programs to organisations to assist identification of risks associated with shift work and development of strategies to assist with mitigation of the risks.

 

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Ref: Kneginja Richter, Jens Acker, Sophia Adam and Guenter Niklewski. Prevention of fatigue and insomnia in shift workers—a review of non-pharmacological Measures. The EPMA Journal (2016) 7:16

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

The impact of shift work on psychological and physical health

August 11, 2017

Shift work is common over a variety of industries. Concern has been raised as to the health impacts both physiologically and psychologically associated with the regular altered routines of shift workers.

 

Recently, a syndrome called “shift work disorder” has been identified and can be classified with the presence of alteration of circadian rhythm of sleep/wake, insomnia, excessive day sleepiness, and fatigue.
 

Ferri et al (2016) indicates that in particular, night shift can cause significant alterations of sleep and biological functions that can affect physical and psychological well-being as well as performance. An attempt to identify if shift work including nights, is associated with risk factors predisposing workers to poorer health conditions was compared to day work only.

 

The study sites that night shift work induces sleep deprivation which, in turn, alters the daily levels of alertness and job performance, favouring fatigue. The symptoms of fatigue, including “sleepiness and lack of energy,” “impaired concentration,” and “feelings of discomfort,” were more severe in those working night shifts than those who worked during the day. Fatigue related to night shifts can increase the risk of human errors and injuries and can negatively affect the quality of work.

 

Data indicates that shift work has a negative impact on psychological health. Health professionals who worked night shifts showed more psychological and mental health problems than day workers: irritability, somatisation, obsessive–compulsive disorder, interpersonal sensitivity, anxiety, altered mood, and paranoid disorders were significantly higher.

 

The study suggests that rotating night shift correlates with a higher risk for both job dissatisfaction and undesirable health effects. Reduced job satisfaction was associated with more frequent physical and psychological symptoms related to stress, suggesting a clear correlation between these two conditions.

 

Workplace Physiotherapy present provide training programs to organisations to assist identification of risks associated with shift work and development of strategies to assist with mitigation of the risks.

 

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Ref: Paola Ferri, Matteo Guadi, Luigi Marcheselli, Sara Balduzzi, Daniela Magnani, Rosaria Di Lorenzo The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shiftsRisk Management and Healthcare Policy 2016:9

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

The Relationship between overactivity and opioid use in chronic pain: a 5 day observational study

December 23, 2016

Research supports the short term efficacy of opioid use for pain relief. With the increasing use and prescription of opioids for individuals with chronic non cancer pain there is yet little evidence supporting the use of opioids in chronic pain conditions. Studies in the USA report increased mortality and admission to hospitals associated with opioid overdose in chronic pain conditions.

 

A recent qualitative study by Andrews et al (2015), has suggested a bidirectional relationship between habitual overactivity and reliance on opioids in the group of long term non-cancerous pain.
• Overactivity is described as where an individual experiences a significant increase in pain and a period of incapacity as a direct result of engaging in excessive physical or sustained positioning activity.
• Overactivity can also to be related to activity avoidance behaviours whereby Opioids are then used to allow an activity thought to cause increased pain flares to be able to be carried out.

 

Results in this observational study revealed that individuals reporting higher levels of habitual overactivity were more likely to have been prescribed opioids. In addition self-reporting of habitual overactivity indicated higher odds of individuals taking PRN opioids, more frequent medication use and a higher dose of medication than prescribed.

 

The current observational study indicated that the taking of PRN Opioids was not context driven- Opioids were taken to allow increased activity, also to manage the pain flare after a period of greater activity and also to manage sleep disturbance.

 

This study results offer a quantitative link between overactivity behaviour and opioid use. There is growing evidence to suggest that overactivity behaviour negatively impacts functional improvement, participation and results in increased pain. Opioid medication seems to reinforce this behaviour. The study also highlights that a number of patients take greater doses of medication than prescribed and further highlights the questionable use of PRN opioids in chronic pain conditions.

 

The implications of this study along with the Andrews et al study support the idea that habitual overactivity may play a role in the development of reliance on opioid medication.

 

This study highlights that a behavioural treatment option is available through pain clinics to manage this group of patients, whereby pain management intervention that targets overactivity behaviour through the use of activity pacing education and activity to scheduling may reduce the reliance on opioid medications.

 

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Ref: Andrews, NE, Strong, J, Meredith, P, Fleming JA. PAIN,2016;157:466-474; Andrews NE, Strong J, Meredith PJ, Gordon K, Bagraith KS. It is very hard to change yourself: an exploration of overactivity in people with chronic pain using phenomenological analysis. PAIN2105;156:1215-31- *1
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Efficacy of a workplace relaxation exercise program

November 8, 2016

Neck pain is common and leads to a high rate of work disability. There is a high prevalence of widely reported tension type headache and migraine, both episodic and chronic that can be related to muscle tenderness. Data on headache and neck pain collected in 797 individuals (Ashina et al 2015) showed that most presented with assessed pericranial tenderness.

headache-image

 

The effect of a relaxation exercise program on pericranial/ cervical muscle tenderness with headache and neck pain provided to a working community was investigated by Rota et al (2016) in order to assess outcomes with the intent of reducing work disability.

 

The 384 participant workers involved in the study were split into two groups. After the initial clinical examination, one group received instruction on a relaxation exercise that was to be performed once or twice a day, and three postural exercises that were to be performed briefly every 2-3 hours. Visual feedback was used by the participants to monitor excessive contraction of the head and neck muscles. These instructions were provided to the group again after two and four months.

 

The program, with relaxation/posture exercises and a visual feedback, was carried out for 6 months with data collected on head/neck pain. After six months of performing the scheduled program a second clinical examination was performed for all subjects with scores given following palpitation of pericranial and cervical muscles for tenderness and cumulative muscle tenderness. The second group commenced relaxation/posture exercise at this time and both groups continued to perform the exercises before a final clinical examination was performed at the end of the 14 months.

 

The first group to perform the relaxation exercise program showed a significant reduction in headache and neck and shoulder pain after 6 months of participation. This group also had a decrease in the muscle tenderness scores. An approximate 40% reduction in headache, neck and shoulder pain, along with an approximate 50% reduction in drug intake was identified in the clinical assessment. A noteworthy factor was that the decrease in muscle tenderness over time strictly paralleled pain reduction, with a long-term benefit of the educational/physical program on pericranial/ cervical muscle tenderness.

 

When the second group was provided with the exercise program, the significant difference in scores for tenderness and cumulative muscle tenderness was no longer significant at 14 months, showing that the exercise program had a positive effect on both groups following implementation of the program.

 

After 1 year from the beginning of the intervention, a significant decrease in the time lost to work was demonstrated by the data obtained. The total Migraine Disability Assessment Score was reduced by 40%, with around a 75% reduction in the missed work-days score.

 

The study overall indicates that the implementation of a workplace relaxation exercise program provides significant long-term decreases in pericranial/ cervical muscle tenderness and decreases in head-neck pain, correlating with a reduced work disability. The study emphasises that economically, this type of program is cost-effective, and yields significant, productive outcomes at a relatively low cost.

 

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Ref: Eugenia Rota, Andrea Evangelista, Manuela Ceccarelli, Luca Ferrero, Chantal Milani, Alessandro Ugolini, Franco Mongini. Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study. European Journal of Physical and Rehabilitation Medicine 2016 August;52(4):457-65
Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain in migraine and tension-type headache: A population study. Cephalalgia 2015;35:211-9.

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW/ SIRA or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Do Fear Avoidance Beliefs affect Physiotherapy Exercise based program outcomes in chronic low back pain?

November 8, 2016

Chronic low back pain is an ongoing and costly problem in both the developed and developing world. It is one of the most common causes of musculoskeletal system disability and is associated with high levels of health care usage.

 

Treatment for CLBP is usually conservative and consists of pharmacological agents in conjunction with an exercise based rehabilitation program. Unfortunately there is little evidence supporting any specific exercise programs as being more effective than others. Since the Quebec Task Forces Report in 1987 many national guidelines have been published throughout the world indicating that supervised exercises are generally recommended for CLBP management – specific exercise guidelines remain unspecified.

 

In considering CLBP, chronicity or progression to disability needs to be considered due to the high cost ratio of a small population. A recent prospective study carried out by Aloma et al considered the effects that Fear avoidance behaviours may have on the outcome of Physiotherapy intervention -exercise based treatment- in patients with CLBP.

 

Patients were included in the study if the main complaint of CLBP was pain based and pain was of >3 months duration. They were excluded if radicular pain or systemic diseases, pain was coming from other areas, or psychiatric disorders were present.

Pain intensity was measured using numerical rating scale (NRS) and function was measured using Roland Morris Disability Questionnaire. Scores were measured at baseline and post Physiotherapy exercise sessions (10 sessions) completed and 3 months post study. A responder to exercise based treatment was considered if NRS had decreased by 2 points after treatment using exercise.

 

The participants with a high Fear Avoidance behaviour score had poorer outcomes at both evaluations based on NRS. In addition if participants had pain from other areas the same results were seen.

 

The implications of this prospective study with regards to day to day treatment of CLBP indicate that Fear avoidance could be a barrier to recovery from low back pain and should be routinely tested for. This will provide better treatment strategies that should be incorporated into exercise based Physiotherapy treatment.

 

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Ref : Feitosa Aloma S.A, Lopes J, Bonfa E, Halpern Ari S.R.A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear avoidance beliefs and extraspinal pain. Rev Bras reumatol. 2016;56(5):384-390

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The comments above are the implicit advice of Workplace Physiotherapy.  The views expressed are based on current evidence-based research and accepted best practice approaches.  Unless otherwise stated, these comments are not the view of WorkCover NSW/ SIRA or any other professional body.  No reproduction or forwarding of this advice is permitted without the consent of the author.

Chronic neck and shoulder pain- associations between psychological factors and home based exercises in women

November 8, 2016

neck-stretchChronic neck and shoulder conditions share similar characteristics and consequences as other chronic conditions. The 1 year prevalence of neck pain in the general population is 25%. In complex chronic pain multiple factors such as social, psychological and neurobiological, come into consideration. Psychological factors have been linked to the perception of and adjustment to chronic pain. Psychological factors such as anxiety and depression, poor self-efficacy and catastrophizing are can increase the severity and complexity of a pain condition.

A recent study by Karlsson et al (2016) has looked at the links between maintaining a structured home based exercise program and psychological factors such as fear avoidance behaviour, fear of movement, self-efficacy and catastrophizing in women with neck and shoulder pain.

In systematic reviews, physical exercise has been found to be beneficial in chronic neck pain. To maintain adherence to an exercise program for 12 months in the presence of pain, requires psychological factors to be considered to ensure that a behavioural change is maintained.

The study prescribed a structured exercise program that was carried out 3 x/ week at home. There was ongoing contact with Physiotherapists and the follow ups were carried out at 4-6 months and at 12 months.

The outcomes of the study indicate that there are essential psychological components to consider ensuring ongoing adherence to a home based physical exercise program in neck and shoulder pain.
• High levels of fear of movement and fear avoidance behaviour in the presence of pain was shown to impair the ability to perform physical activities indicating a much lower compliance with treatment and perhaps indicates an exercise intervention that is not home based.
• Participants with low fear avoidance beliefs and low self-efficacy at baseline (BL) were associated more highly with positive effects of exercise than other psychological factors.
• Higher pain acceptance at baseline was also associated with participants who adhered to the program for 12 months.
• Outcomes of the study indicate that low fear avoidance beliefs are associated with decreased shoulder pain at 4-6 months and disability with exercise.
• Pain self-efficacy levels that are high at BL have been associated with increased benefits of maintaining a home based exercise program with positive relationships of reduced pain and disability at end of study.

In considering the prevalence of chronic neck and shoulder pain in society at 1 year mark, the study indicates that pain self-efficacy and fear avoidance behaviours need to be taken into consideration when prescribing home based exercise to ensure long term adherence with outcomes of reduced pain and disability.

 

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Ref :Karlsson Linn,Gerdle Bjorn,Takala Esa-Pekka, Andersson Gerhard, and Larsson Britt .Associations between psychological factors and the effect of home based physical exercise in women with chronic neck and shoulder pain Sage Open Medicine Vol4;1-12. 2016
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Ten weeks of physical-cognitive-mindfulness training reduces fear avoidant beliefs about work related activity

October 21, 2016

People with chronic musculoskeletal pain often experience pain related fear of movement and avoidance behaviour. The fear avoidance model proposes a possible mechanism at least partly explaining the development and maintenance of chronic pain. It is possible that people who interpret pain during movement as being potentially harmful may initiate a behavioural cycle by generating pain related fear of movement accompanied by avoidance behaviour.

 

Chronic pain has been defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms of damage.

 

It is well known that that occupationally derived musculoskeletal pain is often present in job tasks involving low force, static or quasi static repetitive and monotonous movements.

 

The recent study carried out by Jay et al (2016) looks at chronic pain of the neck, shoulder, upper and lower back, elbow and wrist in women working as laboratory assistants. The study is addressing both the physical and psychological interactions of chronic pain in the work place.

 

The study group was divided into 2- Reference group- maintaining current workplace activity initiatives vs Physical- cognitive – mindfulness training group.

 

The treatment group received a multifactorial intervention comprising of:
• slow joint mobility exercises focussing on precise motor control for the pain affected area
• 4 different strength training exercises with elastic bands
• Cognitive behavioural therapy involving education and counselling about the fear of movement, the positive effects of movement and de-catastrophising pain
• Mindfulness group training over 10 weeks.

 

Results of the 10 week targeted physical- cognitive- mindfulness intervention indicated significant effects on work related fear avoidance behaviour (FAB) with a reduction of 52% in pain intensity experienced across 6 body regions compared to the reference group.

 

yoga-class

There was a large correlation most painful body region and work related fear avoidance behaviour (FAB). This suggests that work related FAB are body region specific to the degree of experienced pain, and that by exercising that region with guidance in terms of movement and strength training in addition to pain education and reduced catastrophizing can result in a reduction in threat caused by moving that body part at work.

 

Mindfulness was not found to significantly reduce stress and pain fear avoidance behaviour in this study.

 

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Kenneth Jay MSc, Mikkel Brandt, Markus Due Jakobsen, Emil Sundstrup, Kasper Gymoese Berthelsen, mc schraefel, Gisela Sjogaard, Lars L Anderson, ten weeks of physical- cognitive- mindfulness training reduces fear-avoidance beliefs about work-related activity- Medicine 2016 95:43
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders (UEMSD) and symptoms: an update of evidence

September 7, 2016

Work related musculoskeletal disorders are a constellation of painful disorders of muscles, tendons, joints and nerves that can occur in the body, however, neck, back and upper limb injuries are the most common.

 

Upper extremity injuries are becoming more prevalent in both the first world and in developing nations where technology advances are occurring. Upper extremity disorders are significant causes of lost productivity and disability claims costs in many economic sectors world-wide.

 

In response to this burgeoning condition focused prevention campaigns are necessary.

 

In order to determine best preventative measures to avoid upper extremity disorders, a recent review of the literature has been able to determine best practise outcomes.

 

There is strong evidence to indicate that resistance exercise training programs using dumbbells and kettle bells have a positive effect on reducing onset of UEMSD.
• Message: Implementing a work based resistance training program can help prevent and manage UEMSD and symptoms.

 

There is moderate evidence indicating the use of forearm supports to work with a computer key board and also use of a vibrating mouse that provides feed back to the hand. Stretching programs also had a moderate level of evidence to indicate a role to manage UEMSD’s.
• Message: Consideration for implementing these strategies is important depending on work context.

 

Further interventions of EMG feedback, stress management and work station set up were also reviewed and were found to have no increased effect on UEMSD’s when carried out in isolation.  These interventions did not have a negative effect on symptoms or lost time however isolated use of these interventions showed no positive gains.
• Message: Use of these interventions should be used in conjunction with other active management strategies rather than in isolation if positive outcomes are expected in a reduction in UEMSD symptoms.

 

There are many more interventions that are used however there were limited studies demonstrating treatment effects.

 

When managing or trying to prevent UEMSD’s best practice management indicates that active rather than passive treatment is most effective depending on the context of the work.

 

Workplace Physiotherapy are highly experienced in the development of staff and task specific injury prevention programs.

 

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Ref: Van Eerd D,Munhall C,Irwin E, Rempel D, van der Beek AJ, Dennerlein JT, Tullar J, Skivington K, Pinion C Amick B Occup Environ Med doi:10.1136/oemed-2015-102992
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA/ icare NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Low Back Pain – Tailored V’s General Exercise Program

May 17, 2016

Low back pain is a significant global problem, with a large percentage (60-80%) of the population in developed countries experiencing an acute episode at some point in their lifetime. A significant number of these people go on to experience chronic low back pain (pain lasting longer than 3 months). Chronic low back pain (CLBP) is associated with decreased physical function, reduced social interaction, increased symptoms due to psychological distress and poorer quality of life. Physical activity and exercise therapy are clinically accepted treatments for rehabilitation post injury. They are also recommended as self-management strategies for this condition.

 

Saner et al (2015) opined that whilst exercise has been proven to be an effective treatment for patients with non-specific low back pain (NSLBP) and movement control impairment (MCI – based on the observation of aberrant movements accompanied by postural pain), with substantial reliability in diagnosis in previous studies, the type of exercises that are most beneficial to this subgroup still remain unclear. To investigate this further, the authors, using a multicentre randomised controlled trial (RCT), with patients (18-75 years of age) recruited from referring hospitals and resident physicians, as well as through advertising amongst the staff and students of the Zurich University of Applied Sciences, Winterthur, Switzerland. Patients were divided into two groups 52 in the Motor Control (MC) group and 54 in the General Exercise (GE) group.

 

MC treatment consisted of active exercises addressing the pain-provoking postures and control of the impaired movement/s. GE treatment aimed to improve the muscular strength of the lumbar and pelvic region and legs. In a standardised programme, as described in a study manual, all relevant muscle groups (abdominals, erector spinae, gluteals, quadriceps and hamstrings) were addressed in each treatment. Patients in both groups received individual treatment sessions of 30 minutes, preferably twice per week, over a period of 9-12 weeks. Progression of the treatment, in accordance with the treatment protocol, was determined by the physiotherapist. 10 minutes of each session was allowed for other physiotherapy applications, where necessary. The length and type of additional interventions were recorded and monitored. All patients received instructions for a minimum of three home exercises and were encouraged to practice them at least 2 x per week, for up to 1 year after treatment. Patients were contacted by telephone after six months and encouraged to maintain the training.

 

The primary outcome measurement was the Patient Specific Function Scale (PSFS), which the authors concluded showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly over the course of one year, and therefore indicated that there was no additional benefit of specific exercises targeting MCI.

 

In general, whist treatment is often recommended and is associated with recovery from low back pain, people who seek to self-manage their condition can achieve similar outcomes. More treatment can often be associated with poorer outcomes and therefore, vigilance with the monitoring of any intervention is imperative.

 

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Ref: Saner J, Kool J, Sieben JM, Luomajoki H, Bastiaenen CHG, de Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up. Manual Therapy 20 (2015) 672e679.
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

Frozen Shoulder (Part 1 of 4) – adhesive capsulitis

February 2, 2016

Frozen shoulder (Adhesive Capsulitis) is a common condition seen in about 3-5% of the general population. It generally occurs in people over the age of 40 years and is seen far more often in women than in men. It generally occurs spontaneously without any trauma, but can also occur after a significant traumatic event such as a fall, fracture, dislocation and sometimes after surgery. There is also a known association between frozen shoulder and people with Diabetes, as it is believed that excess glucose impacts the collagen in the shoulder. It has been estimated to affect about 20% of people with Diabetes.

 

This condition causes shoulder immobility (hence frozen shoulder) as well as pain with movements of the arm, and particularly at night. The lining of the shoulder (the capsule) becomes inflamed and contracted and the condition can occur in both shoulders in approximately 10% of people. Once the condition settles it rarely recurs. While the terms freezing, frozen and thawing are used there is no obvious change in temperature of the shoulder through the course of the condition.Frozen shoulder

 

There are 3 distinct phases of the frozen shoulder:

1. In the “freezing” stage, which may last from 6 weeks to 9 months, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion.
2. The “frozen” stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts 4 to 9 months.
3. The “thawing” stage is during which the shoulder motion slowly returns toward normal. This stage generally lasts 5 to 26 months.

 

The condition usually resolves without any treatment and in primarily time dependent, but may sometimes require analgesia, physiotherapy and intra-articular corticosteroid or local anaesthetic. Surgery is generally reserved for ‘resistant cases or functionally compromised patients’ and may involve manipulation under anaesthesia, and arthroscopic or open release.

 

The further parts of this series of injury management advises will look at the efficacy of conservative treatment and medical and surgical management.
 

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Ref: Treatment of frozen shoulder by manipulation under anaesthetic and injection: Does the timing of treatment affect the outcome? Thomas WJC, Jenkins EF, Owen JM, Sangster MJ, Kirubanandan, Beyon C, Woods DA. The Journal of Bone & Joint Surgery, October 2011.

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

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