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ultrasound

Shoulder pain

Rotator Cuff Tear Exercises: Heal Strong and Fast

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A Rotator cuff tear is one of the most feared injuries but shouldn’t be. Here’s what you need to know about rotator cuff tears to get them stronger, faster.

Just how common are they?

A rotator cuff tear is present in over 20% of the population, but don’t let that number fool you because not 1 in 5 of us actually have painful rotator cuffs. This is because, just like you can and probably do have joint degeneration in your knee that gives you no pain at all, you can have rotator cuff tears that are pain-free (asymptomatic).

So the real number you should be interested in is the number of symptomatic tears; 35% of rotator cuff tears on radiology are symptomatic, which is still very common!(1)

Rotator cuff tearWhat is the rotator cuff?

Put simply, it is a group of muscles which come from the front, back and top of your shoulder-blade and wraps around that ball and socket of your shoulder. Their job is to coordinate between themselves to help keep the ball positioned nicely in the socket while you move your arm.

Rotator cuff tears often happen in the tendon, close to the shoulder joint.

Does a rotator cuff tear need surgery?

Really, it is case by case but most rotator cuff injuries do not need surgery.

As a good guideline, with all rotator cuff tears, it is best to trial 12 weeks of conservative rehab and if that has not much improved the injury, then you look at seeing the surgeon.

A recent study actually showed that there was no difference between surgery and active physiotherapy at 1-year follow-up(2)

Physio Rehab exercises for a rotator cuff tear needs to cover three things:

  • Regaining range of motion and muscle activation
  • Improving strength
  • Regaining full control and function

We are going to cover these stages in three posts and here is Stage 1, which starts after 3-4 days of rest, or more if needed:

Stage 1: Regaining range and muscle activation

1. Pendular circles

YouTube player

2. Regular movement

Using a broomstick or a pulley, this is a great active-assisted exercise for regaining movement and stopping the shoulder stiffening up.

Hold onto the end of the stick with your injured side and help lift it up with the other hand.

Repeat this 20 times 5 times per day without pushing into pain.

Active assisted shoulder flexion Active assisted shoulder flexion

 

isometric rotator cuff strengthening exercise3. Rotator cuff activation

These exercises activate the rotator cuff in a safe way by doing gentle wall pushes. It is essential to load the rotator cuff in a safe way and gently to encourage strong healing and minimizes scar tissue formation.

  1. External rotation
  2. Abduction

 

Read for Stage 2 rotator cuff rehab? Follow this link to the next post in the series.


Health, physical therapy, physiotherapy

Therapeutic Ultrasound – Why is it still used?

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With therapeutic ultrasound not having a definite mechanism of action on injuries and having no significant evidence behind it  – I ask why ultrasound is still used so much as a treatment for musculoskeletal injuries?

Too often when treating in the clinic I am asked either “do you use ultrasound”, “why don’t you use ultrasound” or “normally my past physio just used ultrasound and a heat pack…”

Now I know everything has its place and its uses but when there are so much better alternatives than therapeutic ultrasound that do actually help more that placebo – why not use them?

Now, here is a little background info on ultrasound:

ultrasoundtherapyWhat it is: Therapeutic ultrasound (US) is a popular electrophysical treatment method that generates mechanical energy which propagates through tissues (1). Among physiotherapists, it is used to treat soft tissue injuries, accelerate the wound’s repair, augment fracture healing, on swellings resolution and to solve some bone and circulatory injuries.

Although many lab‐based studies have demonstrated a number of physiological effects of ultrasound upon living tissue, there is remarkably little evidence for real effect and benefit in the treatment of soft tissue injuries(2).

How much is it used?

Therapeutic US is still used almost daily throughout many countries as a go-to treatment for acute injuries and overuse injuries such as runners knee.

  • In Australia, it is used DAILY by 84% of health professionals
  • in England, it is used in 54% of all interventions in private clinics(1)

There are some countries which are ahead of the game with such as Sweden, where it is used less than 5% of the time and this needs to be followed by other developed countries(3).

EBP triadWhat’s the evidence then?

In most studies, therapeutic ultrasound proved to be no better than Placebo for a wide range of musculoskeletal conditions (4,5), and that there is a lot of variation in parameters used.

I could go into detail but the main point is, therapeutic US has been shown to be no better than placebo or exercises(6), so why would a therapist waste ten minutes of treatment time when they could be doing something else?

Evidence-based practice is becoming increasingly important in physiotherapy as we want to use what works for our patients – So why is US use still so rife in the profession? Is it lack of motivation, education or just plain lazy?

Let me know your thoughts!

 

Extra reading:

Paul Ingrahams post in a similar vein is a great read

 


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