The law on consent requires health practitioners to inform patients of the benefits and risks of treatment and alternative treatments. This article is part of a series to equip practitioners to inform their patients. It is to be noted that it is difficult to find information on benefits and risks of treatments so please feel free to provide feedback so we can develop this resource.
This list is a generalised list to use a resource and needs to be applied using your osteopathic expertise, based on the patient’s condition, presentation, preferences and understanding.
N.B. this information is written for practitioners with medical knowledge, if you are suffering with shoulder pain please seek advice from a health practitioner.
Education and activity modification
Pain education. Start activity as soon as possible (few days rest with severe sprain). Reassurance about natural progression of condition. Weight loss. Supportive shoes, avoid barefoot with fasciitis. Ice packs.
Achilles tendinopathy – 12 weeks for symptoms to resolve
Plantar fasciitis – 6 months to complete recovery, 80% complete resolution within 1 year
Benefits: low-cost option, possibility of improvement in pain, empowers patient
Risks: Yellow flags may be barriers to improvement
Orthotics and heel pads
May offer some benefit. Custom orthoses offer no significant benefit over shelf orthoses. Magnetic insoles no better than ordinary. Heel lift of 12mm beneficial for tendinopathy.
Night splints are generally not advisable due to poor compliance and lack of effectiveness.
Benefits: Relatively low cost, reduced pain
Risks: Dependency on orthotic, weakening of foot muscles and arch supports
Manual Therapy and exercise
Extracorporeal shock-wave therapy – may be beneficial, efficacy uncertain
Low level laser therapy – increases collagen production
Hydrotherapy, mobilisation, exercise. Strengthen by eccentric loading exercises and correcting lower limb biomechanics for tendinopathy. Plantar fasciitis – stretching dorsiflexion and rolling on ball.
Taping may offer short-term benefit.
Benefits: Helps improve range of motion and reduce muscle tension, may help reduce likelihood of recurrence of symptoms. Reduction in pain. Pre-operative preparation. Empower patient.
Risks: May have increased tenderness after hands-on treatment for 24-48 hours (1 in 2), improvement may take a few sessions. Small risk of nerve compression causing temporary tingling and numbness (1 in 100).
Not beneficial for tendinopathy – causes atrophy and tendon rupture in 8%. Useful for short-term relief of pain but unlikely to affect long-term outcome.
Benefits: Pain reduction
Risks: infection, tendon rupture, hyperglycaemia in people with diabetes, local tissue atrophy, flushing, fat pad atrophy
Aim: to control pain and help the person keep active
|Paracetamol||No gastrointestinal toxicity, well-tolerated||More effective taken regularly, rather than as required|
|NSAIDs – Ibuprofen
|Anti-inflammatory. Limited evidence of effectiveness for short-term pain reduction.||Dyspepsia
Cardiovascular and renal adverse effects
|Not effective for neuropathic pain
Gastroprotection may be required
|Topical NSAID||May be of benefit, especially in acute conditions. Diclofenac cream may help with knee OA.||Large amounts can cause systemic effects including hypersensitivity and asthma. Photosensitivity is also a risk so care is needed in sun.|
|Combined analgesics||Combined beneficial effects
*Reduces number of tablets to be taken.
|Risk of overdose and renal toxicity||*Now recommended to be taken as separate tablets apart from chronic stable pain, although limited evidence|
|Codeine (weak opioid), dihydrocodeine, tramadol||Mild-moderate pain treatment, tramadol may be effective with neuropathic pain||Constipation, aggravate asthma, risk of dependence, drowsiness, renal side-effects
Tramadol – rarely – convulsions, psychiatric reactions.
|Sedative effects can add to psychological factors and exacerbate feelings of helplessness and depression.
Remove fibrotic tissue and adhesions, surgical release of tissues. Not unless had pain for long period > 6 months. Surgical repair is necessary in tendon rupture asap.
Benefits: Increased mobility, decreased pain
Risks: Thrombosis, infection, nerve or blood vessel damage, complex regional pain syndrome, strokes, heart failure, pain, bruising, swelling, no change or recurrence of symptoms, scar tissue, reaction to anaesthetic
NICE Clinical Knowledge Summaries, available at: http://cks.nice.org.uk/
Evidently Cochrane website http://www.evidentlycochrane.net