Forum / Let's Discuss! / Rotator Cuff Tear
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| April On: November 23, 2013 13:10 PM |
I would love some suggestions for exercises to help rehab and strengthen a torn rotator cuff. I would like to avoid surgery, but teach Pilates and yoga, as well as cycle daily, and everything aggravates the injury. Any ideas would be greatly appreciated. Thanks so much. |
| Casey H On: November 25, 2013 12:18 PM |
HI Andy, The rotator cuff can be the hardest to rehab especially for a mover! This group of muscles can be thought of as local, core structures of the shoulder and head of the humerus. Big range of motion especially with weight will only aggravate the injury. When you are cycling try not to sit in your shoulders and keep the scapula in a easy home position on the back of the ribcage. For beginning to heal I recommend release work on the lower arm, upper arm, sub occipitals and around the scapula. Pair that with really good joint movement. Very small, subtle movement and little to no weight. So Release work and precise joint mobilization are king for a long time for you! One of my favorite rehab exercises is the Finger Wall Crawl . You can do this both facing the wall and to the side of the wall. If there is a bit of manageable discomfort as you move through it that is ok. Any sharp pains then you have gone too far or done too many and you need a rest. Finger Wall Crawl to the Side Stand so that one side of the body faces the wall. The arm should be slightly in front of the body at about 30 degrees. ( the wrist will be in front of the shoulder) The arm should be straight with the fingertips just touching the wall. Crawl the fingertips up the wall as high as possible with good form ( No arching the back) and no sharp pains. The tip of the scapula should glide down and lateral ( as if it is swinging to the front of the body) as the fingers climb up the wall. The shoulder should not hike to the ear or the back arch in order to get the arm up. Once the arm is up hold for 10 to 30 seconds if possible. Walk the fingers down the wall with good, controlled form. Do 2 to 4 times two times a day. Finger Wall Crawl facing the wall Do the same as above but now face the wall. Here the wrist can start in line with the shoulder. As the fingers walk up the wall the shoulder blade should swing down and around to the front of the body. No hiking of the shoulder to the ear or arching the back. Again hold for 10 to 30 seconds at the top if possible. Walk down slowly and with good form. Do 2 to 4 times two times a day. I hope this helps. Let me know how you do. Jen |
| April On: November 29, 2013 22:31 PM |
Thanks so much Jen. I just got the results of my MRI. The doctor said he recommends surgery. I have opted for cortisone and PT for a month. He seems to think it's a ticking time bomb and I should do it before it completely ruptures and I can't lift my arm. Also, as I get older, the recovery becomes more difficult. Yet he is talking 6 months of recovery, which is absolutely unthinkable for me - as you can imagine! Here are the findings: There is a fulll-thickness entheseal tear of the supraspinatus 2.5 x 2.5cm; hypertrophy of acromioclavicular joint and mild subacromial-subdeltoid bursitis; superior labral tear violating biceps anchor; small to moderate glenohumeral joint effusion/arthritis. What are your thoughts about my ability to avoid surgery? |
| April On: December 01, 2013 09:22 AM |
Had an MRI and there is a full-thickness tear of the supraspinatus; some infraspinatus involvement; hypertrophy of acromioclavicular joint and mild subacromial-subdeltoid bursitis; superior labral tear violating biceps anchor; small to moderate glenohumeral joint effusion/arthritis and osteoarthritis. Basically, as he said, it's very bad, much worse than he expected. He said surgery is really only option. I am opting for PT and a cortisone injection, which I got yesterday. I really want to avoid surgery if I can, for many reasons other that the obvious. Hoping for a miracle... the recovery is 6-12 months! 4-6 weeks of complete immobilization. Yikes. Any more thoughts, suggestions...? Am crawling my fingers like crazy :) |
| Casey H On: December 01, 2013 22:21 PM |
Hi Andy, Wow. It is great that you have all this information and that you are exploring all possibilities before surgery. I totally agree that all options before surgery have to be explored. However, there are many cases of severe shoulder injury and trauma that do require some western medicine. I would definitely get a second opinion before deciding on the surgery. The shoulder area is a very mobile area with not much musculature. The ball and socket of the hip has so much more. The ball of the humerus is held in its shallow socket by those small rotator cuff muscles and these are easily injured and hard to rehab. When the injury becomes too severe sometimes surgery is an option. I have known many people in the same boat as you and they held off on surgery for a long time and when they finally got it they wondered why they had waited so long. But you have to be sure that surgery is right for you and that you have the right doctor caring for you. Your doctor has to understand that your body is your livelihood and that you will be very depressed if you lose your ability to move freely. You have to express this to him or her and really make them understand your life situation so they can help you make the best choices. Add some release work to your rehab exercises. Try this wall rolling release exercise for your medial scapula. Use a green spikey ball or a regular tennis ball. Place the ball between the left shoulder blade and spine in the rhomboid area. Walk the feet away from the wall and soften the knees. Cross the arms in front of you Genie style or just drape them across the chest. Reach your tissue into the ball and do a very small roll up and down. Look for any sensitive spots, hold and breath into them until they release. ( Only hold 10 to 20 seconds) Move the ball to another spot either up or down from the previous one. Change sides. You might want to also look into Laser Touch One. This is a personal cool laser and stem system unit for pain management. It is pricey but very, very good. I am wishing you the best. Please keep us up on how it is going for you and what you decide to do. Love, Jen |
| Veronique On: December 04, 2013 17:13 PM |
I am also an instructor. And a skier. I kept hurting both shoulders, the left was worst. I functioned for years thinking I just had a "bad" shoulder. When I eventually had an MRI after yet another debilitating fall, my supraspinatus was so badly atrophied the muscle had shrunk into the tendons. Surgeon did his best to fill in the gap with tissue from infraspinatus but it disintgrated and was beyond repair. Advised against shoulder replacement until pain in unbearable. I am good now with most closed chain exercise and my ROM is beyond good (which could be considered not so good, hypermobility has not helped me in the past!). Open chain leads to pain. I dislocated the other shoulder and had MRI immediately only to find that, too, had been torn for years (probably not ruptured). This time the surgery went well but a year later (a year is conservative for rehabbing rotator cuff repair) I shattered the glenoid. Also successfully repaired. Now I have 2 rather dysfunctional and very differently behaving shoulders. It is hard. I am in perpetual "rehab" mode, looking after myself very carefully. I am not so young either (60 now) but I do what I can within my limitations and I stay positive. I teach. I explain if I cannot demonstrate and I work around it. I wish Andy all the best with his decision making and rebabbing. |
| April On: December 04, 2013 17:48 PM |
Thank you for replying, Tessa. I happen to be a female "Andy," just to let you know - and a very unhappy one at the moment. I got a second opinion today and there is no doubt that I need surgery. And the longer I wait, the less there will be to work with - movement will just continue to cause fraying and deterioration. I had really hoped to put it off until summer, as this is my busy season for teaching. Everything I am told is that this is a very painful surgery, as is the recovery and rehab. It seems a year is about the expected length of time til I am as good as I'll get. Needless to say, I am dreading this. I am trying to stay positive and prepare myself as much as possible. I appreciate all of the input from this thread! |
| Veronique On: December 04, 2013 20:05 PM |
Yes, your surgeon is giving good advice - don't leave it too long! I found I had to work through my loss of function as a grieving process culminating in acceptance. It is the only way to go! I can't say it is not painful, physically and emotionally. But you are motivated to do the PT diligently like I did. Take the painkillers as prescribed because if you get behind in them thinking you are able to cut back it just makes it worse. My Pilates teacher is also trained in therapeutic Pilates and other methods and what she did was better than any physical therapist, if you can find someone like that, go for it! I wish you all the best, from the bottom of my heart. |
| April On: December 04, 2013 20:32 PM |
Thank you so much, Tessa. It is funny you mention acceptance - when I found out the MRI results just before Thanksgiving, I went into a mental blackout - and realized that I could not make any decisions until I came to a place of acceptance. I even shared this with family and friends. Then yesterday, I cried, which is very rare, feeling terrible grief and sadness. And fear. I think this is all part of what I need to go through to get a a place of acceptance. I am doing research now, finding out what I need to get ahead of time and hoping to feel prepared - even though I know I am really powerless beyond a certain point. People have recommended things like an ice pump to keep my should iced at all times, sleeping on a recliner, etc. I have bought a TV for the office where the recliner is and am looking into a spinning bike, because I have to believe I will be able to at least move my lower body soon enough. I ride a road bike - every day - at least 15 miles. Being immobile is a fate worse than pain. Thank you again for your kind words and support. It certainly sounds like you have endured even more - and come through it with grace. You give me hope. By the way, I am 59! xo |
| Veronique On: December 04, 2013 20:56 PM |
Sounds like we are in different places on the same path to wellness and activity. I know exactly how you feel about being inactive. Use the down time to do other things you love, like music research for classes if you use it, playlists for Spinning, all the reading you - if you are like me - tell yourself you will get round to one day! Also, the body heals from sleeping and the pain killers make you drowsy too. Amazing how quickly the recovery period flies by! Do let me know how it all goes. |