Very few evidence based treatments for musculoskeletal pain require the utilization of electricity. One notable exception is the utilization of muscular stimulation on post operative musculature. This category of treatments under the larger umbrella of modalities have not fared well in the research due to having little or no effect, their inability to beat a placebo or detuned modality, or an inability to accelerate recovery compared to the natural history of the diagnosis. Clinical practice often outpaces our research or can disregard the existing research allowing these modalities to be used on patients with shoulder pain instead of evidence based treatments including manual therapy and exercise. A recent review of the literature highlights effective treatments for patients with shoulder pain.
Pieters and colleagues in the Journal of Orthopedic and Sports Physical Therapy reviewed the available evidence on the effectiveness of Physical Therapy interventions for the most common source of shoulder pain, subacromial impingement syndrome (2019). Authors reviewed 16 prior systematic reviews and made recommendations for treatment based on the available research. As expected the strongest evidence supported the utilization of Physical Therapy strengthening exercises as a first line treatment for this condition. These exercises were consistently shown to improve pain and function in patients suffering from subacromial impingement. In addition, strong evidence also supported the use of manual therapy in the short term to reduce pain and improve range of motion in preparation for a transition to a long term management strategy including high level strengthening exercises. Not surprisingly there was moderate evidence on the lack of effect of the aforementioned modalities including laser, extracorporeal shock wave therapy, or ultrasound on patients with shoulder pain. At the end of the day, the vast majority of musculoskeletal treatments only require excellent clinical decision making, high level exercise, and a selective utilization of manual therapy in the short term.
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