You suffer from
a pain in your shoulder and you need to see a
specialist who can find the cause and give you a
cure. The question arises: orthopaedic
specialist or physiatrist?
A first distinction is needed: an orthopaedic
cures diseases of bones and joints with medical,
surgery or physical treatments. The field of a
physiatrist is wider because not only do they
cure the joint diseases, but they also work in
the neurological sections of the problem, from
childhood diseases to those disorders which are
typical of older age persons(such as palsy).
The orthopaedic doctor often “hands over” the patients
to the physiatrist for a post-surgery rehabilitation, or
even sends them for a muscular tone up therapy which can
make the intervention easier and facilitates the
post-surgery course.
We have seen how complex the articular structure of the
shoulder is; as a consequence of this the rehabilitation
is long and difficult. We have asked a physiatrist,
Doctor Marcello Ancona, who has extensive experience,
some ways in which to understand the physiatric approach
to our pain. We report here what he explained, listed
according to some important key words:
Semiotics first of all: modern
technology offers diagnostic exams (XR, CAT, magnetic
resonance) which help the specialist understand the
problem. According to Doctor Ancona the observation of
the patient, his posture, dialogue and in depth
check-ups are as important, “as the doctors used to do
once.”
Semiotics: (from the Greek
sìmeio¯tiké 'study, examination of the signs', from
sìmeio¯tikós 'that observes the signs') field of the
medical science which studies the symptoms of diseases
with the purpose of diagnosys.
Synergy work: finding the cause
of, and solution to, pain is not a mathematic
process; it is above all a system of human and
professional relations. The physiatrist has the
task to establish the cause of the problem and
give the physiotherapist initial therapeutic
directions (diagnosis, type of therapy and
sessions of the treatment); the physiotherapist,
with his preparation and sensitivity, can treat
the patient and give the physiatrist feedback.
The patient has to actively interact with the
physiotherapist to acquire awareness of his/her
state of health and then carry on with the
exercises at home.
Thermal water:
rehabilitation in the water, especially if
thermal, is the most effective therapy ever. Thermal water is heavier and therefore allows
better floating. Its heat helps muscular
relaxation. With the help of qualified staff
specialized in the movements of the shoulder
with both passive and active exercise, articular
mobility improves after just two sessions.
Move with all the possible effort: the
patient’s collaboration is essential, both during the
session with the physiotherapist and at home. Shoulder
mobilization is necessary even when the pain is strong.
Keeping it blocked leads to the worsening of the
situation. Therefore do the effort and exercise when at
home, following the physiotherapist’s advice (no do it
yourself in this case!).
Exercise
of the pendulum: lie face down, on the
bed or on a table, keeping the arm and
shoulder that hurt out of the edge. Let the
stretched arm dangle, so that all muscles
can relax. 1. Let the arm swing back and
forth, and involve the shoulder in the
movement. 2. Keeping the arm stretched, draw
circles with the hand first in one
direction, then in the other, involving the
shoulder in the movement.
“Chase away the pain” therapy:
In case of strong pain let’s not
demonize painkiller and anti-inflammatory
pharmacology, which allows the necessary relief
to continue the mobilization of the
articulations. Drugs help, but they have to be
considered a temporary solution and not a cure.
Don’t forget the gastric surface!
Cortisone infiltration kills the pain in a very short time
because of its anti-inflammatory effect, but has
strong counter-effects (it can, in time, cause
tendons to wear away).
As an alternative to
drugs, instrumental therapies such as antalgic
currents, are also an effective painkiller.
Advice:
In the acute phase avoid sources of heat near the
painful part.
Ice gives immediate relief and soothes the
pain, but later gives a bounce effect.
The editorial
office thanks, for the in depth information:
Doctor Marcello Ancona Specialist in orthopaedics and traumatology.
Specialist in physiokinesitherapy
GB Thermae Hotels - La Residence & Idrokinesis®
We have asked some experts and specialists to help us improve our understanding of the causes and therapeutic
modalities of shoulder pains. In the following pages you
can find some explanations and suggestions which cannot
replace medical advice, but they try to highlight the
importance of prevention and prompt action by calling a
specialist who can locate the cause of the problem and
who can give the most suitable therapeutic solutions.
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At the spa for two
How wonderful and complicated is
a relationship! Let’s try to
understand how to create moments
for two rich in cuddles and
communication perhaps while you
are plunged into thermal water.
