Do you suffer from excruciating pain in the shoulder that often radiates to other parts of your arm? Is it painful to even pick up a small pail of water? You could be suffering from a condition known as the rotator cuff. But, don’t worry. There are ways you can treat it.

Would you like to know more? Please give this post a read!

Rotator Cuff – An Overview:

Rotator cuff is a tear in the shoulder. This injury largely affects 4 to 32% people from all walks of life, and it is more evident in people above 40 years of age (1). It is one of the major reasons for acute pain in the shoulder, and leads to shoulder instability, weakness and change in kinematics.

Rotator cuff repair requires surgery followed by rehabilitation protocol consisting of therapies and exercises.

Purpose Of Rotator Cuff Exercises:

According to the American Academy of Orthopaedic Surgeons, strengthening of the rotator cuff, along with enhanced flexibility of the muscle is the primary concern of rotator cuff exercises. These exercises strengthen and support the muscles to ensure the shoulder joint stays stable. This prevents future injuries and shoulder pains. The muscle gets flexible and these exercises can also reduce muscle soreness.

Rotator cuff exercises target the following muscles:

• Deltoids
• Biceps
• Triceps
• Teres
• Supraspinatus
• Infraspinatus
• Rhomboid
• Trapezius
• Subscapularis

Diagnosis:

If you have continuous irritating pain in the shoulders, and you are unable to lift anything heavy, it is high time you visited a doctor. A torn rotator cuff can be diagnosed by the following tests:

1. Physical Examination:

Your doctor would conduct a physical examination of the affected shoulder and check for pain, muscle soreness, motion restraint and popping sound on movement.

2. X-Ray:

He would recommend an X-ray of the shoulder.

3. MRI:

An MRI would give a clear picture of the internal tissues and where exactly the problem lies.

Rotator cuff tears need proper care and attention. Exercises are a way out, but not in every case. Most rotator cuff cases need surgery to eliminate bone spur and restore torn muscles. Surgery helps in reducing the pain and bringing the shoulder back in shape. One needs to wear a sling after the surgery, but not for too long.

Patients often complain of discomfort while moving the shoulder even after many months post surgery. As per an article published in the Cleaveland and Clinic website, the healing process takes time in case of rotator cuff injuries even if exercises are part of the treatment protocol. This said, after the surgery, physical therapy is a must for the surgery to be a success (2). These exercises aid in recovery. One needs to take out just five minutes every day to perform the exercises.

Treatment Process:

Once you get operated for rotator cuff, your doctor would call you for examination after a couple of weeks. He would remove all the stitches. Till then you need to take proper precautions and keep the incision dry and clean. If required, take painkillers an hour prior to doing exercise. But once the stitches are removed, take a hot water shower to get rid of the pain. That is better than painkillers. Avoid driving during the initial month after the surgery.

Why Postoperative Treatment?

Therapies after surgery aim at minimizing the stiffness of the shoulder muscle (3). Moreover, they also reduce muscle atrophy and maximize healing. They improve tissue quality and the repair process. Not only is the immobilization caused owing to the pain is minimized by these therapies, but the collagen orientation is also improved.

Phases Of Rotator Cuff Exercises After Surgery:

Phase I:

The initial phase of Postoperative Exercises or the Phase I is aimed at the protection of repaired tissues. Passive motions including abduction, flexion, and external rotation are restricted during this stage. In this stage, the therapist ensures that the newly formed collagen network starts affecting fiber orientation, resulting in active motion. Some of the exercises undertaken in this stage include:

• Joint Oscillations in short arm traction
• Passive Range of Motion (PROM) for forward flexion
• Isolated Scapular Depression
• Scapular Clock Exercises and Retractions

The patient should be able to perform passive forward motion at least up to 125 degrees, passive internal rotation to 75 degrees, and passive glenohumeral abduction at 90 degrees to move on to the phase II.

Phase II:

This phase concentrates on the active assisted range of motion and active range of motion (AAROM) rehabilitation programs. Adequate PROM is added in this stage of recovery, like shoulder hiking with elevation. This stage continues for a couple of months post surgery. The National Institutes of Health suggest the following exercises in this stage:

• Supine Glenohumeral External and Internal Rotation
• Supine Flexion Exercises
• AAROM Internal Rotation Exercises with the help of a cane
• Slow AAROM Exercises in neck deep water
• Scapulothoracic Musculature Exercise in prone position
• Salute Exercise
• Sub Maximal Isometric External and Internal Rotation Exercises

Phase III:

The aim of Phase III is to strengthen the repaired rotator cuff (4). By this stage, the patient should be able to do passive and active glenohumeral motion exercises. This stage of the therapy should start by 2-3 months after the surgery, and the patient should continue with PROM and AAROM exercises. Some of the exercises that patients perform during this stage include:

• Isotonic & Light Closed Chain Stability Exercises
• Bear Hug Exercise
• Elastic Resistance Exercises
• Standing Sport Cord Row Exercise
• Bicep Curls & Triceps Extension Exercises
• Chest Press Exercise
• Closed Chain Stability Exercises

Phase IV:

You may start with Phase IV of rehab exercises almost after 12-16 weeks of surgery. By now you are through with the re-modelling phase, and daily living activities do not pain any more. This phase is sports specific and following the exercises are recommended during this stage:

• External Rotation against elastic resistance at 45 degrees
• Elastic Resistance Exercises combining bench press
• Supine Scapular Protraction Exercises
• Push Ups with plus progression
• Rapid Oscillation with a rubber bar
• Advanced Closed Chain Stability Exercises with quadruped position
• Statue of Liberty Exercise
• Throwing Exercises against a rebounder

Tips For Facilitating Healing:

Post rotator cuff surgery, one should ensure not to over-exert the affected shoulder or subject it to any kind of stress (5). All you need to keep in mind is the following:

If carrying a weight, carry it close to body. Stand straight always. Avoid bending your shoulders. Sleep on the other shoulder, which is not affected. Don’t give your shoulder undue pressure.

Safety:

As per the National Institutes of Health, rotator cuff rehabilitation programs vary for different patients and so does their recovery. There is no cure for rotator cuff injury other than surgery and exercises. These exercises are safe and play an important role in recovery after the rotator cuff surgery.

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by Daiwik Suresh Gejji via STYLECRAZE