Rotator Cuff Tear

The Good News about Treatment for your Rotator Cuff Tear

Recent research suggests that conservative management with physiotherapy in the first 12 weeks following a rotator cuff tear, has just as good an outcome as surgery, without the risks involved with the surgery and no guarantee surgery will be successful.

Will Physiotherapy help?

Yes, Physiotherapy treatment is the first line of treatment for a rotator cuff tear or injury. At City Physio, your physiotherapist will conduct a full examination of your shoulder.  This will also involve looking at your shoulder muscles, tendons, ligaments, your shoulder joints, shoulder bursa, and your posture. We will also delve into the history of your shoulder to determine what may have contributed to your rotator cuff tear and how the muscles and surrounding structures were functioning prior to this issue arising.

If you haven’t had any medical imaging done, and your physiotherapist feels this will be useful in diagnosing your rotator cuff tear, they may refer you directly for MRI, Diagnostic Ultrasound, X- rays or other tests. No need to get a separate referral for this.

How your physiotherapist proceeds with the management of your rotator cuff tear will depend on if you have a partial or full-thickness tear, how large the tear actually is and what your end goals are for your shoulder. It could be your goals are normal everyday activities without pain or your goals may involve getting back to higher-level sports – for each of us, the rehabilitation of your rotator cuff tear will be slightly different.

What causes a Rotator Cuff Tear?

Sometimes an injury such as an unexpected fall will result in an acute tear in your rotator cuff tendons. Most commonly, the tear is the last stage of chronic wear and tear of your rotator cuff tendons. As we age your tendons can become frayed and you may notice you just can’t lift up your arm the way you previously did. 40% of people who are over 65 have degenerative tears in their rotator cuff tendons without any pain associated with it. They just feel their shoulder may not be as strong.

Posture and your Rotator Cuff

Your posture plays a large role in your shoulder function and a large part of your rehabilitation with city physiotherapy will be to ensure we address any underactive and overactive shoulder or postural muscles. If your posture is poor, your shoulder will not have been operating from its designed for starting position every time you have used your shoulder in the past.  Think about your posture at work, your posture when you sit on the couch, your posture when you are performing exercises at the gym, your posture when you drive, when you walk down the street and are on your mobile device, your posture when you sleep or how you lift objects. All of these and more will have made a contribution to your shoulder pain and dysfunction.  If you now have a rotator cuff tear and are in pain and have limited function, you will understand how much you use your shoulder in everyday life.

Physiotherapy Treatment of your Rotator Cuff Tear

Once we have diagnosed what type of rotator cuff tear you have and what has contributed to it tearing, your City Physiotherapy physiotherapist will start your treatment.  This might consist of hands on treatment to mobilise and release any tight structures around your shoulder. Dry Needling may also assist in relieving some of your shoulder pain, especially if your pain is also related to tight structures in your neck and thoracic spine. We will teach you corrective exercises to improve your shoulder stability. Often your scapula (shoulder blade) muscles are weak and will need to re-build some endurance capacity along with your neck, shoulder, spine and core muscles. Other modalities of treatment that we might use to treat your rotator cuff tear are supportive taping and advice.  It is important that for physiotherapy treatment to be effective, that you participate and engage in your rehabilitation process with us completely.

Rotator Cuff Tear – Why does it take so long to get better?

What is important to remember is that once you tear your rotator cuff tendons, even if it is a partial tear, they will not heal by themselves.  What physiotherapy management and treatment offers you are a decrease in the strain on your rotator cuff muscles by improving the stability and endurance capacity of your entire shoulder complex.  This takes time and commitment.

The first 6-12 weeks are the hardest part of your rehabilitation process. You will likely experience some acute pain and difficulty moving your arm. This part can be frustrating, and we understand this. At City Physiotherapy your physiotherapist will help you with advice on things like sleeping positions, how to rest your shoulder properly and when it’s best to undertake your exercises. There are things that it is best that you avoid doing, such as lifting, ironing, vacuuming, overhead reaching, washing windows, scrubbing shower cubicles or hanging up washing overhead. Even things like what type of meals you are preparing may be contributing to your pain – don’t try and chop difficult things up like pumpkin or large vegetables – This can place too much strain on your shoulder. I know these are things that are sometimes just too difficult to avoid but there are no short cuts when it comes to your rotator cuff. Rushing this phase will only set you back further and could lead to a more debilitating condition such as a frozen shoulder. This is very much where teamwork between you and your physiotherapist will play a large role in how you progress and recover.

After this first 12 weeks, your pain should diminish and you should regain some of your lost range of movement in your shoulder. Improvements will most likely plateau after this initial phase but keep persisting with your exercises and treatment being guided by your physiotherapist as to when to reintroduce certain movements or to progress your exercises as this is important in not taking steps backward and reaggravating your shoulder.  We are sometimes tempted to push ahead with movements or lifting weights that are too heavy in this phase because we feel we have held off for so long already. Trust us, it’s not worth forging ahead blindly.

How can I keep my rotator cuff rehab exercise interesting enough to keep going with it?

Most of us can get bored with what we are doing when it comes to exercises. Some of us do better when we are supervised as make that commitment to ourselves to keep doing what we need to do. At City Physiotherapy we have options for you based on the type of person you are.

If you already have a gym membership or a gym set up at home and are motivated to regularly get yourself into gym mode, then you may like to opt-in for a personalised gym program designed for you by our Physiotherapists.  This can be changed up and every few months to keep you going and on track.

If you find it hard to give yourself the motivation to go to the gym or do exercises at home by yourself, you might prefer having a 1:1 Physiotherapy Pilates – informed rehab exercise program designed by our Physiotherapists to help your recovery. This can lead to joining one of our physiotherapist supervised rehab exercise, small group classes.

All of these options are claimable under your physiotherapy extras cover as they are part of your rehabilitation. Call City Physiotherapy 0n 8212 4886 or Book your first appointment online 24/7 at www.cityphysiotherapy.com.au

What about Surgery for your Rotator Cuff Tear?

Depending on the type of tear, the extent of the tear and what you would like to be able to do with your shoulder, it may be necessary to have surgical intervention in the hopes that it may give you some pain relief and improved movement capacity.

Sometimes patients develop bone spurs on the end of their acromium process or they have a hooked acromium process. Surgery is usually targeted at removing these bone spurs or hooked end so that it stops irritating your shoulder by rubbing on your rotator cuff tendons or your subacromial bursa. Some tears can also be repaired surgically, however, should you go down the surgery pathway, you must remember that surgery is only one part of the process.  All the contributing factors that led you to this point of acute shoulder pain and movement dysfunction, still need to be addressed with physiotherapy treatment and targeted rehabilitation exercises. Surgery may be only be warranted if you aren’t responding to physiotherapy treatment and rehab and you have honestly committed to giving it everything you have.

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