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Does Subacromial Decompression Surgery Really Do Anything?

Subacromial decompression surgery is a very common procedure performed for people with shoulder pain.  The procedure is often recommended for people with “impingement syndrome” and was originally theorized to open up the subacromial space and help reduce biomechanical impingement.  

But recent research has challenged the effectiveness of the procedure, and even the diagnosis of “subacromial impingement” itself.

 

Subacromial Decompression Surgery for Adults with Shoulder Pain: A Systematic Review with Meta-Analysis

A recent article in the British Journal of Sports Medicine reviewed the results of 9 clinical trials in over 1000 patients with shoulder pain.  The authors includes studies that compared subacromial decompression surgery with placebo surgery and exercise therapy.

The study noted that subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy. 

In particular, they found that surgery did not provide any additional benefit for pain, function, and quality of life at the 6- and 12-month mark after surgery.

 

 

 

As you can see, there does not appear to be a significant benefit in undergoing subacromial decompression surgery for shoulder pain or function.

 

What’s All This Mean?

Based on the results of several studies recently, it sure looks like we’re going to be seeing less subacromial decompression surgeries in the future.

It seems like the benefit of undergoing surgery may be related to the postoperative rehabilitation and application of graded exercise postoperatively.

This is another one of those surgical procedures that seems like it was missing the boat anyway.

Thinking purley biomechanically, rather than addressing the underlying concern that may be causing “impingement,” such as stiffness or loss of dynamic stability, we simply just make more space?  

Seems overly simplistic, right?

We probably haven’t address the underlying cause.

But based on all this, perhaps we shouldn’t even be using the term “impingement” anyway.

From a non-biomechanical perspective, I’m not even sure we truly understand the etiology of shoulder pain at times and always seem to rush towards a biomechanical “impingement” approach.  There could be numerous reasons why graded exercise can help reduce shoulder pain other than purely biomechanical factors.

But let’s not forget one main point here from this study.  At 5 years down the road, these patients still had shoulder pain between a 1.5 and 3 out of 10 on a visual analog scale.  

So advising people to ignore the biomechanics and simply work through some pain may not be an ideal approach as well.  

I’d hate to see us go down that road.

These patients had shoulder pain for greater than 3 months to be included in this study.  It’s difficult to quantify the degree of rotator cuff pathology present in these people, how this impacted their shoulder function, and what their long term prognosis will be going forward.  There is still underlying inflammation of the rotator cuff.

 

Image from Wikipedia

 

So What Should We Do?

As research like this continues to be published, we’re probably going to be seeing less of these procedures.

Maximizing the function of the shoulder is going to become even more important, regardless of whether or not something is causing “impingement.”  

I’ve had a lot of success with people by keeping it simple.  Rather than worry about the exact specifics of the pain, just simply focus on normalizing motion, increasing strength of the rotator cuff and scapular muscles, enhancing dynamic stability, and then gradually building tissue capacity through loading.

This is a great example of when focusing on the functional deficits is more impactful than the structural diagnosis.  

Optimize the person, don’t just treat the pain.

 

 

How to Read Research Articles

Do you ever feel like you are stuck in a rut, doing the same exercises and manual techniques with every person?  If you have been reading this website, my books or journal articles, or have seen me present at meetings, you know one thing I do is pride myself in is being up to date in current research.  I stay on top of all the research because I am always trying to get better.  If there is one thing I get complimented on the most, is that my teachings are up-to-date and everything I do is backed by research.  I don’t mind saying this hear to the 1000’s of people that will read this, but staying on top of the research is one of my “secrets” that has helped me become one of the “experts” in our fields (and I use that term loosely…).

I’ve written about how I think that implementing evidence based medicine into your practice doesn’t have to be that hard, and I truly believe this, but I still receive feedback from people that reading research articles is overwhelming.  Furthermore, many people still comment to me that they find it difficult to read journal articles and determine the quality of the study and if it has any clinical implications to us.  Honestly, that is part of why I started this website, to help with this exact problem.

Set Yourself Apart

I’ve said it over and over again but we need to be integrating current research into our evidence based practices.  This is what sets you apart from everyone else in our fields and what produces amazing outcomes.

 

How to Read Research Articles

Since the beginning of this website, I have always wanted to write a guide of some sorts on how to read and interpret research.  Luckily I never did get around to this as Mark Young has just recently released a new product called How to Read Fitness Research, and there is no way I would have made a product as good as Mark’s!  Rehab specialists, don’t let “Fitness” in the title make you think you won’t benefit, this applies to all research.   I haven’t talked to Mark yet, but I actually want to include some of his info in my online CEU programs.

I was lucky enough to receive a copy of the program and I must say Mark has paid great attention to detail and has come up with a program to help us all get more out of research!  Mark has taken a pretty important, yet boring, topic and made it really simple and easy to understand things such as:

  • Learn where research comes from
  • Discover who pays for research and why it matters
  • Find out where to get research
  • Know which journals to read and which are a waste of time
  • Stop being confused with statistics and research jargon
  • Learn to apply research to your programs for INCREDIBLE results

 

How to Read Research

 

Here is a little preview of part of the program where Mark talks about some tips on staying on how he stays on top of the research, which is exactly what I do as well:

 

As you can see, it offers some value.  Don’t get me wrong, if you just recently graduated and have gone through a ton of research design courses, this probably isn’t to the level of detail that you are going to need this product, but for the majority of us, it is a pretty good review.

There is one thing I would add to the program for physical therapists, athletic trainers, and other rehabilitation specialists.  Mark talks about what journals he recommends you staying on top of for fitness specialists, I would add a few more:

  • JOSPT – Journal of Orthopedic Sports and Physical Therapy – the cream of the crop for ortho and sports PT journals.  Pretty technical but still quality.  The best reason to join the APTA and sports or ortho sections.
  • AJSM – American Journal of Sports Medicine – another elite journal, geared more towards ortho and sports physicians and surgeons and a gold mine of information for us too.
  • Sports Health – A fairly new journal designed for us all – docs, PT’s, ATC’s, fitnes specialists, etc. A little less technical (which is often good), but great.
  • JAT – Journal of Athletic Training – Official journal of the NATA and always has some good content.  Similar to JOSPT, likely the best benefit of joining the NATA.
  • JBMT – Journal of Bodywork and Movement Therapies – For those of us that enjoy different approaches, manual therapy, and expanding outside of the typical American thought process.  Edited by Leon Chaitow, you’ll enjoy the content.  As a side note, I believe that this is where Tom Myer’s Anatomy Trains concept really took a jump start.

 

Click here to find out more about How to Read Fitness Research

Updated 1/2016