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. . . practically every individual has some advantage over all others because he possesses unique information of which beneficial use might be made, but of which use can be made only if the decisions depending on it are left to him or are made with his active cooperation.” -- Friedrich Hayek: The Use of Knowledge in Society.

That “unique information of which beneficial use might be made” includes naturally subjective preferences of which no bureaucracy can be aware, but about which no consumer can be wrong.

Just published 🔥

The Major Biological Pain Mechanisms behind Rotator cuff‐related Shoulder Pain

👉 Rotator cuff‐related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP.

https://www.researchgate.net/publication/362228984_Rotator_Cuff_Related_Shoulder_Pain_An_Update_of_Potential_Pathoaetiological_Factors,

❓ So what is the primary biological pain mechanisms (nociceptive, nociplastic, neuropathic) behind rotator cuff‐related shoulder pain?

Lo et al. conducted a narrative review on current evidence to answer this important question.

https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1719

👉 The results

🟥 Among the nociceptive mechanism, current research does not support mechanical irritation as the primary source of RCRSP since the traditional mechanical factors such as decrease in the subacromial distance, scapular dyskinesia and acromial shapes were found to have no correlation with RCRSP.

🟩 In contrast, biochemical changes such as inflammatory molecules in the subacromial bursa, levels of IL‐1 β and IL‐6 in the synovial fluid of the glenohumeral joint and serum levels of VEGF have demonstrated moderate to strong correlations (r = 0.66–0.75). S. picture

🤷 Research on neuropathic and nociplastic mechanisms related to RCRSP is limited and the results are unclear.

👉 Conclusion

📣 Based on the available research literature, the main component of RCRSP may be a biochemical disorder which triggers inflammatory changes at the tissue level and pain, rather than a mechanical overuse injury. The mechanical factors, neuropathic changes and central sensitisation can occur simultaneously as contributing factors to a certain extent. Any of these three aspects may have a greater effect in individual cases of RCRSP.

92% of those recommended for surgery were able to forego after going through the program

Can spinal surgery be prevented by aggressive strengthening exercises? A prospective study of cervical and lumbar patients. - PubMed - NCBI Arch Phys Med Rehabil. 1999 Jan;80(1):20-5. Comparative Study