For rotator cuff tear physical therapy is as effective as surgery

By: Bel Marra Health | Bone Health | Friday, December 18, 2015 - 02:00 PM

Patient with painful shoulderFor a rotator cuff tear physical therapy is as effective as surgery. A study from Finland conducted follow-ups on 167 shoulders which were treated for a rotator cuff tear and found “conservative treatment should be considered as the primary treatment for this condition.”

The study was conducted on 173 patients over the age of 55 with a rotator cuff tear. Patients were split into three groups: receive physical therapy, received acromioplasty and physical therapy or received surgery, acromioplasty and physiotherapy. Through drop-outs and exclusion the study consisted of 167 patients.

Physical therapy was the same across all three groups and was guided by a professional therapist and patients were given at-home exercises to perform. Physical therapy consisted of glenohumeral motion and active scapular retraction and increased to building strength and resistance training up to six months.

Patients were assessed at three, six and 12 months where the authors wrote, “Contrary to our hypothesis, surgical repair of a supraspinatus tear does not improve the Constant score when compared with acromioplasty only or conservative treatment.”

The study contradicted the placebo effect because all patients were aware of their mode of treatment and patients knowing they were receiving surgery did not alter perception of treatment. The findings reveal that physical therapy can be an effective means to treating a rotator cuff tear.

Rotator cuff tear causescauses

The rotator cuff is comprised of four muscles – supraspinatus, infraspinatus, subscapularis, and teres minor – which help move and stabilize the shoulder. Damage to any of the muscles or ligaments can be caused by injury, overuse, or aging. Rotator cuff injury can lead to disability, limited movement of the shoulder and pain.

Supporting muscles – deltoid, teres major, corachobrachialis, latissimus dorsi, and pectoralis major – also help move and stabilize the shoulder and so problems to these muscles can also lead to symptoms of pain and limited motion.

Complications related to damage of the rotator cuff can lead to pain, limited movement and movements which are not smooth, fluid accumulation and even arthritis and calcium deposits forming which can impact motion.

A rotator cuff can endure three main injuries: acute tear, chronic tear and tendinitis. In an acute tear it is usually caused by injury or overuse. A chronic tear, too, can result from injury or stem from previous acute tears. Repetitive trauma to the rotator cuff can lead to reduced mobility for years and tendonitis is the degeneration of the muscles which support the shoulder which can occur through aging.

Rotator cuff injury treatmenttreatment

The primary mode of treatment for an injured rotator cuff is rest. Resting the shoulder can allow it to heal. To speed up healing and prevent pain icing the shoulder immediately after injury or when pain is felt is essential. A sling may also be helpful so that you do not continue to use the injured shoulder.

Lastly, anti-inflammatory medication can reduce pain and swelling but always check with your doctor to ensure you do not have any underlying issues which can lead to complications by taking anti-inflammatory medications.

If the injury is severe, your doctor may even recommend surgery, but as stated physical therapy can also be an effective treatment to rehabilitate the shoulder.

Rotator cuff exercises

Exercise can be beneficial in treating a rotator cuff injury. If you attend physical therapy, your therapist can offer suggestions of exercises in order to strengthen the shoulder and surrounding muscles which can be done at home. Here are some examples of those exercises in order to improve the rotator cuff.

Doorway stretch: After warming arm stand at a doorway and spread your arms out to either side so you are holding onto each side of the door frame. Hands should be below your shoulders or slightly above your waist height. Lean forward into the doorway so that you feel a stretch in your shoulders. Do this by shifting your weight onto your toes. Hold this position and return back on your feet.

Side-lying external rotation: Lay on the floor on your side. Keep your arm along your body but have your arm bent at the elbow in front. With a light weight in hand raise the weight up to the ceiling with your arm and elbow always on your body. Once lifted bring it back down in front.

Reverse fly: Stand with feet shoulder width apart with knees slightly bent. Lean slightly forward with your back straight. With a light weight in each hand extend arms away from the body as if you are a bird flapping your wings. You should feel your shoulder blades coming together. Bring arms back down in front and repeat.

Lawn mower pull: With the use of a resistance band have opposite foot of injured shoulder on one end of the band to keep it down and hold onto the other side with the affected shoulder. Feet should be shoulder width apart. Proceed with a motion as if you were starting a lawn mower – start down and pull up keeping your elbow tight to your body but moving in a backward motion. Once contracted release back down and repeat.

These are just some exercises you can try in order to help improve your rotator cuff. As mentioned the help of a physical therapist can provide you with more specific exercises based on your injury needs.



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Related Reading:

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Sources:

http://www.apta.org/PTinMotion/NewsNow/2014/3/12/RotatorCuffTears/?blogid=10737418615
http://www.emedicinehealth.com/rotator_cuff_injury/page6_em.htm
http://www.healthline.com/health/rotator-cuff-injury-stretches#5

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