Without question, physiotherapy is the gold standard for treating all types of rotator cuff tears of the shoulder. A well designed and executed physio program delivers excellent results for the vast majority of patients. In fact, research has shown that if patients participate in an appropriate rehab program for 6-12 weeks, 85% of them will do as well or better than if they had the tear surgically repaired. Therefore, the key to solving your rotator cuff problem is to ensure you have the right physiotherapist delivering the right program.
Rotator cuff tears are very common. In fact, imaging studies have shown that about 40% of people over 50, 54% of people over 60 and 65% of people over 70 have a rotator cuff tear (1). Not all tears cause pain or weakness though, so much of the population is walking around with a tear that they are unaware of. It is estimated that about one third of non-symptomatic tears will eventually become painful (2).
Causes of Rotator Cuff Tears
There are two main types of rotator cuff tears, traumatic and degenerative.
Traumatic tears occur rapidly when the strain on the rotator cuff exceeds its strength and the tissue fails. These tears are sudden and often painful so the patient is typically aware of having injured their shoulder. Typically, there is a rapid loss of function and pain that begins to improve over the course of a week when the inflammatory response to the injury begins to resolve.
Degenerative rotator cuff tears have multiple causes that can be categorized as factors that are extrinsic (outside of) to the tendon and intrinsic (inside of) to the tendon.
Extrinsic Factors Effecting Rotator Cuff Tears
– Impingement of the rotator cuff within the shoulder
– Shoulder muscle imbalances
– Poor shoulder blade position and stability
– Shape of the acromion and acromioclavicular (A/C) joint
– History of repetitive or overhead shoulder tasks
Intrinsic Factors Effecting Rotator Cuff Tears
– Overall tissue health of the patient
– Concurrent thyroid disease
– Genetic predisposition
– Poor blood flow to the tendon
Physiotherapy Assessment of Rotator Cuff Tears
It’s easy to appreciate that each tear has a different list of factors that have led to the development of the problem. This is why it is critical that recovery begins with an expert orthopaedic physiotherapist who will conduct a detailed assessment of your condition and design a rehab program that addresses the causes of your tear. A thorough physiotherapy assessment for a rotator cuff tear should consist of:
• A complete history of the shoulder problem
• A complete personal medical history to understand how other conditions might have increased your risk of injury
• Examination procedures to rule out other causes of your pain (referred pain)
• Discovery of habits or maladaptive behaviours that are making the problem worse
(e.g. consistently sleeping on the injured side)
• Observation of shoulder and spinal posture in sitting and standing
• Evaluation of functional movements of the shoulder (pushing, pulling, elevation)
• An examination of the rotor cuff length, strength and motor control (movement patterns)
• Examination of the strength, length and motor control of the larger muscle groups of the shoulder
• Examination of shoulder blade position, movement, strength and coordination
• Examination of rib cage and spinal mobility
Only after looking at all of this information is it possible to create a treatment plan that will focus on rapidly changing the factors that are causing your specific problem, maximizing your likelihood of success.
Physiotherapy Treatment of Rotator Cuff Tears
The treatment that is recommended should match with the findings of your assessment. Your progress should be re-evaluated regularly and your treatment plan adjusted. A treatment plan may consist of some of the following;
– Stretching or strengthening of specific muscle groups to correct imbalances
– Manual therapy to correct tissue imbalances and improve shoulder mobility
– Proprioceptive exercises to improve your sense of joint position and motor control
– Spinal mobility or stability exercises
– Modification of posture
– Activity limitation / modification
– Interventions to improve overall health (nutrition, cardiovascular exercise, smoking cessation)
– Treatment of the torn tissue itself with manual therapy and other physiotherapy techniques
A well-designed program will only have the elements that will help you. Participating in a generalized or non-specific program will mean that you will be doing a lot of things that may not have any benefit for you and it may leave out other key components.
Rotator cuff tears can be very painful and debilitating. But rest assured that an expert orthopaedic physiotherapist can have you back in the game in short order. At Cornerstone Physiotherapy we are committed to orthopaedic excellence and our therapists undergo specialized training to learn how to manage complex shoulder injuries. If you are suffering from what you suspect to be a rotator cuff tear, give us a call.
1) Abnormal findings on magnetic resonance images of asymptomatic shoulders.
Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB
J Bone Joint Surg Am. 1995 Jan; 77(1):10-5.
2) Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically.
Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD
J Shoulder Elbow Surg. 2001 May-Jun; 10(3):199-203.
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