4 Common Conditions That are Highly Treatable With Physiotherapy
March 9, 2020
Nancy Littke, PT
Many people, old and young alike experience pain, stiffness, or balance problems that limit their daily activities or independence. While some may think these problems are typical of the aging process, no one should expect that they must simply live with limited function because they are getting older. Although a physiotherapist may not reverse the underlying condition leading to these symptoms, they can help you manage your condition and limit any loss of function you may experience. A physiotherapist can identify the source of any limitations, develop exercise programs to address impairments, and teach you how to manage your condition, allowing you to continue or return to the activities you enjoy.
These conditions all have two things in common:
They involve weakened or poorly trained muscles
They are highly treatable by physiotherapy
1. Rotator cuff problems
Pain and loss of movement in the shoulder are relatively common at any age. It is estimated that nearly half of the population experiences shoulder pain at some time.1 Approximately half of the time this pain is related to rotator cuff problems.1 The rotator cuff is a group of four muscles that move and support the shoulder. Although rotator cuff injuries can occur at any age, they are most common in females between 50-60 years of age.2
Rotator cuff problems may cause shoulder pain and weakness when moving the arm out to the side and/or reaching behind the back as if to scratch between your shoulder blades. Weakness in the individual muscles, poor posture and a history of regular overhead work and/or sport participation (such as volleyball, baseball) are common factors in rotator cuff problems.1
The pain and limitation may be significant enough to make you think you need to consider shoulder surgery. However, the evidence suggests that surgery incurs more risks, is more costly and often results in no better functional outcomes than conservative approaches such as physiotherapy.2 Physiotherapy treatments include exercises to improve the strength of the individual rotator cuff muscles and the function of these muscles when they work as a group to support the shoulder. You may also be provided with an exercise program that targets the strength and function of the muscles around your shoulder blade which help maintain good posture.
Arthritis is another very common condition that affects 6 million Canadians or 1 in 5 adults.3 Osteoarthritis (arthritis that affects the cartilage in a joint) is the most common cause of mobility challenges and disability in older adults.4 Although osteoarthritis (OA) is experienced by 5% of the population under 54, approximately 30% of Canadians between 50 – 70 suffer with OA and this percentage increases in individuals over 70.4
However, a diagnosis of OA does not mean that you need to immediately schedule joint replacement surgery. Current Canadian medical guidelines for the treatment of mild to moderate OA of the knee and hip recommend conservative treatment approaches as the first line of care.4,5,6
Examples of these treatments include:
Weight control strategies
Participation in community-based activity programs4,5,6
Medications and some assistive devices (shoe inserts, braces or walking aids) to help manage the symptoms may be added as appropriate.4 Surgery should only be considered as an option with severe osteoarthritis that has not responded to conservative therapy and is causing sufficient pain and disability to limit daily activity.4
As movement experts, physiotherapists can help you manage the pain and inflammation of arthritis and limit the affects of OA on your ability to do your usual activities. Exercises can help minimize the stiffness and maintain or increase the strength of muscles around your knees and hips. This will make it easier to move, walk, climb stairs, get on/off the toilet or get down to the floor to play with your children or grandchildren.
Talking to a physiotherapist when you first notice pain and stiffness in your joints can help limit the affects of OA on your everyday activities and give you the tools you need to manage your own condition.
Urinary incontinence, or the loss of bladder control, affects more than 4 in 10 women 65 or older.7 Although women are more than twice as likely to have urinary incontinence,7 men can also be affected. Individuals who experience urinary incontinence may find that they limit their activities outside of the home to prevent embarrassing incidents. However, there is help! There are more treatments for urinary incontinence than ever before. It is important to understand what is causing the incontinence and then to direct treatment at the source of the problem.
Incontinence is often caused when the pelvic floor muscles that help the bladder hold or pass urine become stretched or weakened.7 Leakage of urine may occur with sudden pressure on the bladder when you lift something, cough, laugh or sneeze.7,8 If the bladder control problem is related to pelvic floor muscle weakness, exercises to address this weakness are often indicated.8 In other cases, the problem may not be weakness of the pelvic floor muscles, but rather muscle spasm or over activity that causes problems with passing urine. Physiotherapists working in the area of pelvic health physiotherapy can help.
Many injury-related hospitalizations (at least one night spent in the hospital) of Canadian seniors over 64 are related to falls.9 In 2017, more than 4,000 Canadians aged 75 or older died due to complications after an accidental fall.10 However, just because something is common does not make it normal. Balance problems and falls are not something you need to just live with or avoid by simply not moving about.
As we age, the systems that help us maintain our balance age as well. Our eyesight may become poorer, our inner ear structures become stiffer and less reactive to changes in our body position, and our feet become less sensitive.11 On top of these changes, an overall decrease in strength and endurance can increase the risk of falling.12 All of these changes cause us to react more slowly to uneven ground surfaces or sudden changes in our balance, resulting in falls.11
Physiotherapists are trained to assess balance problems and help determine what factors may put you at an increased risk of falling. Current best-practice guidelines identify that an exercise program should be the primary focus of any fall or dizziness treatment program.12
An exercise program unique to you and your situation may decrease your risks, help manage your symptoms and improve your overall ability to move safely and confidently within your environment or in the community. A balance training program may include a combination of exercises that:12
Specifically work on balance and practicing functional activities like walking on uneven surfaces or around obstacles that challenge your balance
Increase the general strength of your ankle, knee and hip muscles13
Improve your walking endurance
Expose you to situations where you feel dizzy or unbalanced and challenge your balance reactions
All of these conditions involve poor muscle function or weakness and are treatable by physiotherapists. For the best results, it is important that you seek treatment as soon as you recognize the symptoms or feel your mobility or lifestyle is being affected. As movement experts, physiotherapists can help you improve your muscle function, strength, and balance to help you to confidently and safely live life the way you want to.
Magee DJ, Zachazewski JE, Quillen WS, Manske RC. Pathology and intervention in Musculoskeletal Rehabilitation. Elsevier Health Sciences, 2015. Https://books.google.ca/books?Id=R3mCgAAQBAJ&dg=shoulder+surgery-chepeha&lr=&source=gbs_navlinks_s
Bechay J, Lawrence C & Namdari S.(2020) Calcific tendinopathy of the rotator cuff: a review of operative versus nonoperative management, The Physician and Sportsmedicine, DOI: 10.1080/00913847.2019.1710617 Accessed Jan 30, 2020.
Badley EM, Wilfong JM, Zahid S, Perruccio AV. (2019) The status of arthritis in Canada: National Report. Prepared for the Arthritis Society: August 2019. Available at https://arthritis.ca/getmedia/13aff08f-f206-4c6e-a709-beb80b97bd51/ACREU_Arthritis-Society_National-Report-2019_final.pdf Accessed Feb 3, 2020
Gla:D Canada. Treatment for osteoarthritis. Available at https://gladcanada.ca/index.php/treatment-for-osteoarthritis/ Accessed Feb 10, 2020.
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr. Cartil; 27 (2019) pg 1578-1589. Accessed Feb 3, 2020.
Bone and Joint Canada. Managing Hip and Knee Osteoarthritis in Canada. June 27, 2019. Available at http://boneandjointcanada.com/wp-content/uploads/2019/06/Managing-hip-and-knee-osteoarthritis-in-Canada_Final_June2019.pdf Accessed Feb 3, 2020.
U.S. Department of Health & Human Services: Office on women’s Health: Urinary incontinence. Available at https://www.womenshealth.gov/a-z-topics/urinary-incontinence Accessed Feb 3, 2020.
U.S. Department of Health & Human Services: National Institute on Aging: Urinary incontinence in older adults. Available at https://www.nia.nih.gov/health/urinary-incontinence-older-adults Accessed Feb 3, 2020.
Canadian Institute for Health Information. Injuries among seniors. Available at https://www.cihi.ca/en/injuries-among-seniors Accessed Feb 3, 2020.
Statistics Canada. Causes of death, 2017. Available at https://www150.statcan.gc.ca/n1/daily-quotidien/190530/dq190530c-eng.htm Accessed Feb 3, 2020.
Watson MA, Black FO, Crowson M. The Vestibular Disorders Association: About Vestibular Disorders. The Human Balance System. Available at https://vestibular.org/understanding-vestibular-disorder/human-balance-system Accessed Feb 10, 2020.
Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016 Apr;40(2):124-55. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795094/ Accessed Feb 3, 2020.
Sherrington C, Tiedemann A (2015) Physiotherapy in the prevention of falls in older people. Journal of Physiotherapy61: 54–60. Available at https://www.sciencedirect.com/science/article/pii/S1836955315000120 Accessed Feb 24, 2020.
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.