Patients with arm pain do better if they try to keep active

Pain in the distal arm (i.e. in the elbow, forearm, wrist or hand) is common. It is also disabling, and the cause of several million working days lost each year, and studies have shown that among people referred to physiotherapy with distal arm pain, around half still report pain one year later.

The various risk factors that predict whether someone will get distal arm pain, and/or whether it will be longlasting, are very similar to the risk factors for low back pain. However, the two conditions are managed very differently. For the majority of patients with back pain, rest is strongly discouraged. Whereas, patients with distal arm pain are commonly advised to rest and referred to physiotherapy.

The aim of this study, among patients referred to physiotherapy with distal arm pain, was to test whether those who received advice to remain active did better in the long‐term, compared to those advised to rest.

What did we do?

We took more than 500 people who had been referred for physiotherapy with distal arm pain. They were then divided into three groups. Two groups remained on the waiting list for physiotherapy and given either:

1. Advice to remain active, or
2. Advice to rest.

The third group was offered ‘fast‐track’ treatment and were seen by a physiotherapist immediately. We sent all patients postal questionnaires over the next six months in which we asked questions about 11 common daily activities, such as carrying bags, getting dressed, writing, etc. We considered that the patients were completely recovered if they reported limitations in none of these activities six months later.

What did we find?

In total, 538 patients took part from 14 NHS physiotherapy departments across the UK, nearly 40% of whom were completely recovered at six months. Patients who were advised to remain active were nearly twice as likely to be completely recovered compared to those who were advised to rest. However, those who received fast‐track physiotherapy were no more (or no less) likely to report complete recovery, compared to patients who had to wait to see a therapist.

What does this mean?

Current NHS advice for patients with distal arm pain is to “rest your injured arm and stop doing the activity that's causing the problem”. Our results challenge this advice and show that, in the long‐term, patients actually do better if they try and stay active while waiting for their physiotherapy.

Also, while there are many reasons that fast‐track physiotherapy is an attractive option, for patients with distal arm pain, waiting for treatment does not seem to be advantageous in terms of long‐term likelihood of recovery.

Who funded this work?

This study was funded by Versus Arthritis.

Where can I read more?

You can read the full scientific paper here.