The twelve weeks that emptied a surgery list

Method of the week

Every one of those 97 people was already booked in for shoulder surgery.

That is what makes this one worth your time. These were not mild cases… and they were not new ones.

Six months of pain at the least. Three months of other treatment already tried and already failed. All of them sitting on a waiting list for an operation to shave the bone above the shoulder.

Then a team in Sweden, led by Theresa Holmgren, split them in two and handed both halves exercises instead.

What each group got

One group got the tested program. Six exercises in all. Two for the cuff, done as slow lowering, which is the harder half of any movement. Three for the muscles that steady the shoulder blade. And one stretch for the back of the shoulder, the one we did on Monday.

Fifteen repetitions, three sets, twice a day, for eight weeks… then once a day for four weeks more. The stretch went 30 to 60 seconds, three times, twice a day.

And the load went up as they got stronger, with hand weights and a rubber band. That is the engine of it. Not the exercises themselves so much as the fact that they kept getting harder.

The other group got six movements for the neck and shoulder with no load on them at all. Ten repetitions, twice a day, at home. Nothing ever made harder.

Now here is what makes this trial worth trusting. Both groups went to the physical therapist the same number of times. Seven visits over the twelve weeks. Same clinic, same attention, same amount of somebody taking an interest.

What happened

On a 100 point shoulder score, the tested group finished 15 points ahead. The range around that ran from 8.5 to 20.6, so even the low end of it is a difference you would feel.

Then the surgeon asked each person the only question that really settles anything. Do you still want the operation?

In the tested exercise group, 10 out of 51 said yes. Twenty percent.

In the other group, 29 out of 46 said yes. Sixty three percent.

Meanwhile the shoulders themselves had not been operated on at all. Nothing had been shaved, opened or repaired. The only thing that changed was what those people could do with the arm.

What I take from it

Not that exercise beats surgery. That is not what was tested and I am not going to tell you it was.

What was tested is whether the right exercises change a person's mind about needing an operation. For two thirds of the people who would otherwise have gone through with it, they did.

And the gap was not attention, which is the objection I went looking for. Both groups exercised twice a day, and both went to the same clinic seven times. One lot had weight in the hand and a program that got harder. The other lot had movement.

Nor was it hope. Nobody was told which program was the one under test. They were told both were thought to work about equally well… and the specialist who scored their shoulders did not know who had been given what.

So if you were handed a sheet of shoulder exercises and nothing came of it, the exercises may not be the problem. The load might be. And whether anybody ever made them harder.

The honest limits

97 people is not many. One country, one set of clinics.

And nobody could check that people really did the exercises twice a day at home. That is self reported in both groups, and we all flatter ourselves a little.

Then there is the question itself. It was asked out loud, at three months, by the specialist. Somebody who has just put twelve weeks of work into a shoulder is in a different frame of mind than somebody who has not.

So if you take one thing to a physical therapist this fall, take the dose. Fifteen, three sets, twice a day, and made harder as the weeks go by.

I spent a year waving my arm around with nothing in my hand. It was not the waving that was wrong. It was the nothing.

Here is to twelve weeks and somebody watching,
Walt