Keep your Shoulder Healthy: Avoid Surgery with Therapy
Studies Show Shoulder Surgery can be Avoided with Therapy:
Rotator cuff injuries are one of the most common causes of shoulder pain in the United States with the risk for rotator cuff tears increasing as we age. An estimated 30% of people over the age of 60 years and 40% of people over the age of 70 years have a rotator cuff tear. Most people who develop rotator cuff tears initially do not have pain. However, over half of rotator cuff tears become symptomatic and can cause you pain within 3 to 5 years. Therefore it is important to understand the reasons for developing rotator cuff tears and your options for keeping your shoulders healthy after you have suffered a tear.
The rotator cuff includes four muscles in the shoulder called the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis muscles. They attach from the shoulder blade to the upper arm and assist with all shoulder movements. Factors that increase your likelihood of developing a rotator cuff tear include repetitive overhead activities, sports that require greater shoulder motion such as pitching and tennis, poor posture, decreased shoulder strength, and decreased flexibility of the shoulder. Traumatic activities such as a fall or motor vehicle accident can also cause rotator cuff tears. Other contributing factors to rotator cuff tears include smoking, high cholesterol and diabetes.
The good news is that the majority of rotator cuff tears can be treated conservatively. A recent study in The Bone & Joint Journal examined over a hundred people with shoulder pain from partial rotator cuff tears. The patients were placed into a program of either physical therapy or shoulder surgery. The group receiving physical therapy underwent a specialized strengthening and mobility exercise program for the shoulder. The surgical group had arthroscopic surgery to the shoulder followed by the same physical therapy care that was received in the other group. At the conclusion of the study, they found no difference in functional outcomes between the two groups at the one year follow-up. Excellent patient satisfaction of at least 85% or more was obtained in both groups. Additionally, the physical therapy group experienced less pain better than those in the surgical group. The researchers concluded that physical therapy should be considered first as a treatment for rotator cuffs tears as it is a less costly and has similar results.
Image from The Bone and Joint Journal study comparing Surgery vs Conservative care for management of rotator cuff tears. Note: Group 1 is the conservative group.
Another study in the Journal of Shoulder and Elbow Surgery followed a group of 381 people for 2 years who had large (full-thickness) tears of the rotator cuff. The participants performed 6-12 weeks of physical therapy focusing on specialized stretching, strengthening, and postural exercises for the shoulder. Participants also received hands on manual therapy to muscles and joints. The good news is that the study found that 3 out of 4 participants were able to avoid rotator cuff repair surgery.
A coordinated team approach with your physician and physical therapist is best to optimize function and quality of life. Evidence shows that if people with rotator cuff tears do not choose to have surgery within the first 6-12-weeks of conservative physical therapy care, they are unlikely to need to have surgery. Indeed, it is important to understand the risk factors for rotator cuff disease and empower yourself with the tools to keep your shoulders healthy!
In addition to the exercises below from the the Journal of Shoulder and Elbow Surgery study noted above, a comprehensive physical therapy examination focused on evidence based practice, movement and restoring function is optimal for rehabilitation success. Every person and body is different. Below are sample basic exercises and should be performed within the limits of one’s own comfort, ability, and symptom free ranges.
Exercises: