So you started having shoulder pain, you saw a physician and it says there is a rotator cuff tear on the MRI and you want to avoid surgery. You’re worried because you have a lot of questions and not a lot of answers. A common question I get in the clinic with shoulders is, “Will this rotator cuff tear get better without surgery?”. I’m here to tell you that most of the time it can!
So let me start by saying that imaging can be a little biased. It is human nature to want a clear reason for why we are hurting, so when we hear that the MRI shows a tear, our mind naturally puts two and two together thinking that this must be the problem. But the truth is there are a number of people walking around with rotator cuff tears every day and have no idea because it is not causing them any pain.
Now what this tells us is that a tear is not correlated to pain and just because you have pain, does not mean there is a tear. There are a number of people with shoulder pain that have absolutely nothing abnormal on an MRI, and are frustrated because they can’t get an answer to why they are in so much pain. An image is just one single snapshot. It does not see what is happening while you move.
Pain is also multifactorial and very complex. As I mentioned, we have found that there is not much correlation between what is shown on an image and someone’s pain. We do know however that being told something is broken, torn, ruptured, etc from a medical provider or being told to not do something or move a certain way DOES correlate very highly with pain. That’s because pain is a response. One that is based on your personal past experiences or perceived threats that get finely tuned in the brain. We are naturally hard-wired to demand an explanation of pain, so when we are told about an abnormal finding on an MRI, we think that having surgery to “fix it” is the answer, but a lot of incredible studies show otherwise.
A recent study, published in 2016 compared physical therapy to rotator cuff repairs as far as pain levels and function 1 year later. There was no clinically significant difference between surgery and active physical therapy at the 1-year follow-up. They both had a very similar reduction in pain and improvement in shoulder function.¹ This study was a meta-analysis study, which is a fancy way of saying a study that looked at a lot of research articles, so it’s not just one study that is showing this, but multiple ones that are all saying the same thing. And what they’re showing is that; physical therapy is significantly less expensive than surgery and has significantly less risk for complications; therefore, it is advocated to take this route for treatment.
So what do we know so far? We now know that an MRI doesn’t show the full picture AND physical therapy can not only reduce your pain, but can get you out of pain and improve function without the added risks, time off work, or stress that comes with major surgery. Not to mention, the follow-up care that comes with surgery which is going to include physical therapy.
So whether you have had an MRI or not, a skilled physical therapist is able to tell if you will be able to get out of pain and reach your goals after a thorough evaluation. They will take a look at your needs and goals, do a thorough examination of your shoulder and assess your movements in order to come up with an extremely effective treatment plan.
So if you have a rotator cuff tear or just dealing with some shoulder pain reach out to a physical therapist first for treatment!