UKC

Hey,

So I've been having some pain in my shoulder/arms over the past months and seen both an osteopath and physio.

I've been told by both of them that I have rounded shoulders and that's causing the pain. After seeing both for a bit and doing the exercises I'm wondering who would you go and see about fixing posture?

Does anyone have dealt with this and got any tips?

Cheers!

My logic is always find a great physio and stick with them. Changing anything on your body takes a long time and dedication to the exercises/stretches. 

Would something like yoga or pilates not help more with posture?

Stick with the physio and the exercises, do them religiously. There isn't a miracle cure to fix the body and it will take time (depending how bad the symptoms are/how long they've been going on expect many months of religiously done rehab). If they haven't addressed the posture, ask them why not and if you're not that happy with them, find another physio but the exercises are likely to help with the posture in the long run, it will just take time

A good physio (the "good" part is important)

Having had a bunch of problems with my neck, back and hips over the years, I've found a combination of NHS physio and pilates work well together. The physios tend to be a bit focussed on the current specific problem, whereas the pilates instructors tend to take a wider long term view in terms of why there was a weakness/imbalance in the first place and address that. If you can find a pilates instructor who is a physio as well (as I did) then that makes life easier.

Osteopathy - actual regulated medical treatment, practitioners have formal degrees.

Chiropractic - witch doctors who once in a while cripple or kill their patients.

Having had issues with my neck and upper back for years, I view all of the manipulation work as fire-fighting.  For long term progress you need a broader approach that is focussed on the underlying issues.  Physios tend more toward this, but I agree that actually pilates can be a game changer.

I have an osteopath who is also a physio, and a pilates teacher who's also a physio, and I feel very lucky to have access to them both.

Forget chiron. Osteopaths have one trick, they manipulate bones, joints. Results, tend to be instantaneous.

Physio is your friend. They vary in quality a lot. Modern physio has cooped a lot of osteo stuff. 

I've got a physio I'm happy with, everyone I speak to seems to suggest something else which always throws me off.

Was looking into Pilate classes then lockdown happened so will start looking for somewhere now actually!

+1 for the physio from me. And +1 for the "have patience and do the exercises". If you have been DOING the exercises prescribed for several months and been back to the physio a couple of times so they can see how it's going and maybe change your exercises a bit and you _still_ don't see any improvement, maybe something else is worth a punt.

Well this is the internet!

More seriously, the reason is that 'fixing the body' is rarely a simple matter. Whatever the problem you have, a lot will depend on the how it arose, your lifestyle (do you sit at work), your age, your genetics...

Different people will find that different things works for them (and not necessarily for anyone else) because they have a unique history.

I tend to be of the opinion that primarily the body heals itself if you give it a chance. Intervention is just to help it along and to stop whatever was the root cause making the problem worse. Or even pain-avoidance making things worse.

One thing I would add is that patience and persistence are vital. Nothing is going to be a 'quick fix'. If you are lucky (and young) your might find that in a few months the problem (with help) gets sorted out and never reoccurs. More likely you'll have to make some permanent changes to your lifestyle (I hate that word, but it serves a purpose here). I find I can keep most of my historical problems at bay by doing a reasonably well defined set of exercises 'most' days. Missing the odd day doesn't matter, but I now know - from bitter experience - that if I  let them slip for a few weeks then the problems are likely to come back with a vengeance and it's going to be a lot of work and time to get back to what passes for 'normal'.

Also, assuming your problem is chronic rather than acute, it's really important to get to the root cause of the problem rather than just treating the symptoms. I would judge your physio (or whatever health professional) on their attitude to root cause vs. symptoms.

Good luck.

Check out the NHS and wikipedia pages for osteopathy and you might feel a little less positive about them. This link focuses on osteopaths in the US where they are often qualified as MDs but the crossovers in dubious beliefs work for the UK also. https://quackwatch.org/consumer-education/QA/osteo/

Also have formal degrees in some cases, doesn't stop them from being pseudoscience.

Physios - from my admittedly limited research - seem to get an excellent and evidence based training. However, I found this review which questions the extent to which physios are actually following best practice techniques and guidelines whilst practising https://bmjopen.bmj.com/content/9/10/e032329.

In conclusion, I go to a physio and as I'm not an expert I hope that they're good.

I prolapsed  a disc in my neck for the second time recently and the pain has been horrendous. Physio gave me exercises and for 6 weeks the pain has got worse and I have been drugged up to the eyeballs for pain relief. Finally I followed my instincts and stopped the exercises, and it is very slowly resolving. It appears now that the exercises were aggravating the problem and increasing the inflammatory response. I still do very light stretching ( mostly back) and will restart the exercises when things settle a bit. 

I have had mixed results with Physios in the past. I had a severe rotator cuff injury several years ago and saw a young inexperienced NHS Physio. Her examination involved grabbing my arm and thrusting it vertically in the air, I screamed in pain and collapsed on the floor....

Unbelievable!

I used to work in a casualty dept and know you always move an injured limb carefully and assess the pain levels before trying to move it into the required position.

I go to a physio and an osteopath regularly. I was initially sceptical about osteopaths, but a colleague, who is also a climber, said he'd managed to get proper relief from a trapped nerve, which the physio hadn't managed to release. Given that my problem was also a pinched nerve, I went to see if it would do any good. The pain relief was immediate and profound.

Osteos do vary wildly in their practices but the one I work with focuses on muscle tension and balance, joint alignment and motion. Combined with the rehab and preventative regime delivered by my physio, it's just about a perfect balance. Pricy though, if you're visiting regularly.

I'd give it a try.

Osteopaths seems to vary from black magic to evidence based treatment and all areas in between. I've found a good one in Fort William that knows climbers well. I see them every month or two as I have three fused vertebrae and few bad discs. He keeps things in check when my body starts to stiffen up and I trust their treatment. 

However, I've been to a few bad ones whilst finding this one. I tried various physios but they seemed a bit less hands on (my osteopath is also a very good deep tissue massager) and I didn't get the results I expected. 

10 years of seeing a few good osteopaths and I'm now climbing lots even with my long term problems.. I'm happy with that. Your results may very

I had something similar to you recently (disc in neck) although to be fair it doesn't sound as serious as your prolapse. I found a physio with experience dealing with these things who really helped. She didn't give me ANY excersises the first time I saw her but did a deep massage on my neck above the injury to relieve pressure on the area which helped - she also used some ultrasound thing on it which I'll admit at first I thought was quackery but it actually helped reduce the inflammation. She said all I should do is movement across it's full range if possible and gentle stretching but stop if it causes pain. After a couple of weeks she then gave me excersises to strengthen the area and it has worked. Had about 3 weeks off climbing which fortunately coincided with the November lockdown before gently restarting. And buying some belay glasses!! 
 

Apologies to OP for slightly off topic post but my experience of physios - who have specific experience dealing with the actual issue - has only been good.

Chiropractic - witch doctors who once in a while cripple or kill their patients.

No. I disagree. While you may have a personal gripe about a certain chiropractor I have only had good experiences and have been treated by around 10 different ones. I also have used physios  and Osteopathy. Like all of these things there are good and bad ones but in the UK the accreditation appears to be better than some countries and certainly those that qualify from Bournemouth have a good reputation. 

I've never been near a chiropractor.  Whilst I don't deny your experience of getting good results from them, the facts are simple: chiropractors occasionally kill people, osteopaths don't.

https://www.google.com/search?q=chiropractic+deaths&oq=chiropractic+dea...

It's quite illuminating that when you Google for 'osteopath deaths', you get results about chiropractors killing people!

My experience is that they are good for different things.

I once developed a painful lower back over a month until I was struggling to get through the day and spending as much time as possible flat on my back. A friend recommended a chiropractor. He diagnosed the joint between my spine and pelvis being out of place. After three "bone-crunching" sessions in a week I was out winter climbing fine the next weekend. I had some more follow up sessions as needed.

I have found an Osteopath brilliant for dealing with muscles in spasm (trigger point therapy?). First time was a bout of sciatica which stopped me walking without great discomfort. He diagnosed a muscle in spasm in my bum irritating a nerve and relieved it. Another time I woke up with my neck in horrendous spasm and he sorted it with one session. Another time I got a sudden shoulder pain which made climbing impossible. A couple of physio sessions  made no difference. The osteopath diagnosed a muscle in spasm in my upper back and sorted it completely in one session. The osteopath has also effectively performed precisely the same "bone-crunching" manoeuvre as the chiropractor when my lower back has been grumbling.

I have found a physio effective for longer term overuse issues and traumatic injuries to tendons in elbows and  knees both in treatment and in prescribing stretches for rehabilitation.

These days I am generally able to tell whether I am best off heading for my osteopath or physio (I don't go to a chiropractor because my osteopath can do the stuff a chiropractor does).

I’m in no way an expert but from my limited understanding the work of physios is based off actual evidence in the form of clinician trials (ideally double blinded randomised control studies).

Both osteopathy and chiropractic have very little in the way of quality evidence that would indicate that they actually are more effective than no treatment at all. However, the power of placebo can be very strong particularly when the intervention is more dramatic (say someone forcefully cracking your back rather than doing some physio exercises for 10 weeks). Combine this with the cyclical nature of chronic pain, especially back pain, where you are most likely to seek help when it is at its worst. It then becomes very difficult to convince someone that their chiropractor or osteopath have had no effect and it’s more likely down to placebo and regression to the mean.

Some might argue that if the placebo effect works then why question osteopaths or chiropractors, even with physio’s it’s likely the placebo effect is partly responsible for any benefit. However, I think that’s a slippery slope to go down and you could say the same for any other alternative medicine with a poor evidence base, be that homeopathy, acupuncture or blood letting. Science based medicine has come a long way and we should be holding everything to the same rigorous standard.

Chiropractors, or, as they like to grandiosely call themselves, doctors of chiropractic, have one diagnosis and one diagnosis only: your spine, and the joints next to it, are out of alignment. But guess what? The body is not symmetrical, nature has not designed a spine to be in perfect alignment. This simple fact is lost on chiropractors.

They have only one treatment, and small subvariations of it, manipulating the spine.

Unfortunately they will tell you that it is only successful if you book yourself in for three sessions a week for the next eight weeks. Unfortunately chiropractors embed in the patient's mind that only the chiropractor can sort this for the patient. 

Conversely, the goal of a genuine therapist should be to minimise the amount of times the patient needs to see the therapist, instead unlocking the problem in the first consultation then providing the patient with the skills and mindset to sort the problem largely by themselves through rehab. 

Chiropractors disempower patients for profit. 

I'm really very scientific in my outlook (probably as much as Robert is).  I understand completely that some fraction of what's happening is regression to the mean and placebo.

NICE does say that there is 'moderate quality evidence' that osteopathy improves certain conditions.

It may well be that what is helping is the manual massage, and the manipulations are just theatre.  I've had more than one occasion when I've been to my osteopath with a neck only capable of rotating 45 degrees each way, and 40 minutes and a few crunches later I walk out able to rotate more like 80 degrees each way.  I know that the plural of anecdote is not data, and the test, I guess, would be to ask him to do everything but the final manipulations, but frankly I just want my neck to start to work again!

God knows there is a lot of woo in osteopathy, even now, but I think it's in the process of converging with mainstream medicine.  To call yourself an osteopath in the UK you need to be a member of the GOsC, which effectively means you need to have done a real degree in a real university (Brookes, just up the road from me, has a Masters course). 

I think they've done themselves a lot of damage with unproven (and frankly ridiculous) claims in the past - particularly the ones regarding asthma.  

While I can understand your comment based on the google link, I think it is worth knowing that the NHS will sometimes refer people to Chiropractors. 
I believe tighter regulation has happened in the UK even in the last couple of years which can only be a good thing.

I think with all 3 types of manipulation it’s important to recognise that “one size doesn’t fit all”. For whatever reason different people respond to different treatments and what works for one person may not work for another. I guess knowing your own body is the key and you only get to that stage through trying different methods.

I do remember seeing a chiropractor one time and being barely able to stand up. My lower back was killing me. 6 hours later I was literally flying up routes in Portland. I usually climb fast but that day I was on fire. 

Gosh, that does sound impressive.  I hope you weren't literally on fire though.

😂

Do you mean that someone who works in the NHS has referred someone? 

Tighter regulation of Quackery is still Quackery.

I am going through exactly the same treatment for (I assume) exactly the same problem. My posture is out so my shoulders are painful. I'm using a physio and, as with all things, its up to me to make the effort. 

This is a chronic issue caused by sitting incorrectly at a computer. Sitting is the new smoking. Having been everything from a farm worker to a paratrooper, a climber, skier, canoeist and kayaker I have found that the greatest issue to my health has been working in an office.

I’m not sure I really agree with the logic here. You could argue that some people get benefit from treatments considered very whacky, say homeopathy or reiki, that doesn’t mean it’s actually working.

Again, I’m definitely a lay person in this with no experience other than having visited physios before and an interest in the topic. However, I imagine human physiology and anatomy is fairly similiar between most people, that’s how 99% of any medical treatment works. You take antibiotics ‘x’ for infection ‘y’ and in most humans antibiotic ‘x’ works and clinical trials demonstrate it is more effective than no treatment or placebo.

The problem with osteopathy and chiropractic adjustment is the evidence of it working is lacking. Much of the persuasive part of both of these practices is found in anecdotal evidence which is next to useless in judging efficacy.

I’m sure you can find examples of bad physios who either aren’t following current evidence or are ignoring it in favour of anecdotal evidence. However chiropractic medicine and osteopathy are both rooted in beliefs that are not based on following good, non biased evidence, whereas at least physios are trying too...

It's tricky. I consider myself very rational and look on stuff like homeopathy as a joke (their is no conceivable mechanism by which it possibly could work). Yet I have undeniably had almost instant relief from debilitating pain from both a chiropractor and from an osteopath. Whatever they did, it worked.

We’re hardwired to believe correlation always equals causation. It kept our ancestors alive. Cave person ate a certain berry, then died afterwords. Thus, berry must equal death.

The problem with this hard wired attribute is that it can often be wrong. Maybe the cave person above eating the berry was going to die anyway? 

In your case, how can you be sure that the pain wouldn’t have went away by itself afterwards? How do you know the placebo effect wasn’t at work? Pain in particular is troublesome on this regard because it’s complex, subjective and has a massively under examined psychological component.

The only really way to test these assumptions is carefully controlled experiments, where bias is managed and control groups are used to monitor the placebo effect. Unfortunately experiments such as the above have shown that the benefit of osteopathy and chiropractic work is low.

Surgery, The Ultimate Placebo by Ian Harris is really interesting reading in relation the above. It’s questioning many common surgeries rather than chiros or osteopaths but the underlying principle is the same.

Until last year, the NHS was spending tens of thousands per year on homeopathy!

In reply to CMcBain:

It's shown that the benefit of osteopathy is low for some issues and moderate for others, but frankly the evidential basis of almost all lower back treatments beyond taking painkillers is pretty poor.  

I completely agree that both chiropractic and osteopathy are rooted in belief in woo (I suspect that a lot of physio is too!) but osteopathy is heading firmly towards an evidential basis for practice whereas chiropractic is not.

Where I land on this can be summarised:

(1) manual therapies (massage, stretching, etc) are probably effective

(2) manipulations are possibly effective, with a lower and more limited evidence base

A physio only offers (1); an osteopath offers both; a chiropractor generally offers only (2).  Also, there's a non-zero chance that a chiropractor might kill me.  So I tend to go to an osteopath.

At that point surely the only thing that differentiates physios from osteos is the latter’s origins in ‘woo’. Surely just rename themselves physios and go through the same training? As far as I know manual therapy is part of physio as well, albeit not as often performed as other things such as prescribed exercises etc.

I suppose my issue doesn’t necessary stem from the particular treatment that the practitioner uses but rather the belief system behind it. Of the three practitioners above, physios come closest to trying to put objective scientific evidence into clinical practice.

One of the things my Physio uses is dry needling:

Dry needling - Physiopedia (physio-pedia.com)

It's certainly an interesting experience that does seem to work but I will suspend judgement until my treatment is over.

I can’t fault your logic but I know it works for me......

Until last year, the NHS was spending tens of thousands per year on homeopathy!

I can believe that ! 

Do you mean that someone who works in the NHS has referred someone?

Regular referrals. 

Is it not possible that something really does work but people in the past have made up complete woo to explain how they work and that they just await a proper scientific explanation? Is it any different from explaining the movement of the moon, sun and planets in terms of earth-centric epicycles?

But is this NHS policy or is it confined to some individual doctors? Doctors will regularly rely on the placebo effect for many things. Doesn't necessarily reflect an endorsement of the practice.

All I know is that Doctors can and do refer patients to Chiropractors. I know that from a Chiropractor. I don’t know about NHS policy.

The NHS website suggests it is within policy, but perhaps only begrudgingly:

“Getting chiropractic on the NHS 

Chiropractic is not widely available on the NHS, but it may be offered in exceptional circumstances in some areas.

To find out if you can see a chiropractor on the NHS in your area:

ask a GP

contact your local clinical commissioning group (CCG)

If you need hands-on treatment, a GP is more likely to refer you to a physiotherapist.”

I’ve no idea what “exceptional circumstances” might entail. The physio post is vacant and the GP wants to offer you something so you get out of their office?

Shaman

Not really.  A physio won't use any manipulations, so if it turns out they are effective then we've just lost that avenue.

Also, the approaches are somewhat different.  These characterisations are all on average, of course, but typically physio, as you suggest, is more about getting you to do exercises; and osteo is more towards a massage therapist and tends towards working on you themselves.  Both approaches have their benefits, and I think it's why I see osteo more as firefighting and physio as long term rehabilitation.  My own guy is both a physio and an osteo, and it's fairly easy for me to see which of his skill sets is being used at any point.

Maybe the GP thinks the patient would benefit from a potent placebo. 

Or failing that a broken neck.

You might be on to something there. I’m sure there are some patients for whom that feels all too appealing.

”You know what Mr Miggins? I think I do have something I can suggest for you after all...”