The internet is a wonderful place, but googling your symptoms can end up generating more anxiety than it does reassurance. There is mixed evidence out there about whether self-diagnosis is useful, and whilst some studies suggest that it can be beneficial[1, 2], others highlight that a lot of information online could be unhelpful, outdated or potentially harmful[3]. This is especially true when we encounter terminology such as ‘impingement’. So how do you know what information to trust?
The easy solution should be an assessment with a healthcare professional. Every physiotherapist has to undergo certain training requirements and continue to meet professional standards whilst practicing, which includes staying up to date with current research and advancing their skills[4, 5]. This means that your provider should have expertise in their specific area of physiotherapy, and be up to date with current research. But what if their explanation doesn’t quite tally up with what you’ve read online?
One good example of this is a shoulder diagnosis, often called subacromial impingement. This terminology has been around since the 1970’s, and was based upon the idea that one of the bones in the shoulder would irritate the tendons and structures underneath, and many surgeries have been performed to ‘decompress’ (shave the bone) shoulders that did not respond to physiotherapy[6]. Which clearly makes sense – if there is a bit of bone sticking out that is irritating you muscles surely it needs cutting out right?
Well not exactly. One study assessed 210 patients who were referred for shoulder surgery, giving one group exercise therapy, one group a decompression and the other group an arthroscopy or ‘sham surgery’. This study found that all 3 groups had significant improvements in pain and disability after treatment, and even 5 years later on there was no additional benefit for the patients who had the decompression surgery compared to the other groups[7]. Along with other evidence, this shows that clearly the ‘impingement’ model does not accurately explain what is going on in the shoulder[6, 8]. In other words – we got it wrong! So whilst the term impingement is still used (it’s been around for 50 years), we have now started to use other terminology to explain the symptoms. So what is going on in the shoulder then?
The short answer is – we don’t fully know. There are different models that explain things to some degree (you may have heard of ‘rotator cuff tendinopathy’, ‘bursitis’ or ‘sub-acromial pain’). Whilst this may seem quite concerning (I mean, if we can send men to the moon then why don’t we know why your shoulder hurts?), it is actually good news. If you have an ‘impingement’, you don’t need to be cut open and have surgery, you can get better with good quality exercise therapy! What is more, evidence suggests that our self-belief in our ability to improve is actually a good predictor of how well we will respond to treatment[9]. Whilst this may be easier said than done in some cases, we should see this as a positive – no matter how old we are or how disabling our symptoms might be, if we have some good quality rehabilitation and stay positive throughout, we have the best possible chance of getting better without the need for needles and scalpels.
So if you’ve googled your symptoms and think you’re ‘impinged’, ‘unstable’, ‘degenerative’ or any other form of ‘broken’, don’t just put up with it. With some good quality support and a positive outlook, there’s a good chance you’ll be back doing what you love sooner than you think!
If you have any back pain or other symptoms please check the NHS guidance at the following links and follow the advice relevant to your symptoms: Health A to Z - NHS (www.nhs.uk) ; Shoulder pain - NHS (www.nhs.uk)
References
1 – The effect of Dr Google on doctor–patient encounters in primary care: a quantitative, observational, cross-sectional study - PMC (nih.gov)
2 – A randomized controlled trial of online symptom searching to inform patient generated differential diagnoses | npj Digital Medicine (nature.com)
3 – Time to embrace Dr. Google? - PMC (nih.gov)
4 – Standards of education and training guidance | (hcpc-uk.org)
5 – standards-of-proficiency---physiotherapists.pdf (hcpc-uk.org)
6 – Rotator cuff related shoulder pain: Assessment, management and uncertainties (sciencedirectassets.com)
7 – Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial | British Journal of Sports Medicine (bmj.com)
8 – Guideline for diagnosis and treatment of subacromial pain syndrome - PMC (nih.gov)
9 – Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis (bmj.com)
