Rotator Cuff Tear Rehabilitation Plan

At Range of Motion Physical Therapy I work with a couple of Rugby and GAA teams and as a result I have worked with a number of players following Rotator Cuff Repair Surgery. In this blog I will discuss an overview plan of how best to rehab your Rotator Cuff following a type I tear.

The shoulder joint (Glenhumeral Joint) is described as a ball and socket joint and compared to a golf ball on a tee, this is due to the fact the humeral head is much larger than the surface it articulates with (Glenoid Fossa). As a result of this instability the Rotator Cuff muscles, ligaments, glenoid labrum and shoulder capsule, all have to work together to stabilise and move the shoulder.

The Rotator Cuff is made up of 4 muscles: Subscapularis, Supraspinatus, Infraspinatus and Teres Minor. Rotator cuff tears can occur in these muscles from falling on your arm, arm tackling in rugby or any large sudden force applied to the arm. Most Rotator cuff tears involve the Supra or Infraspinatus muscles.

Rotator cuff repair technique uses anchors and sutures, sutures are placed on both sides of the tear, the tendon is approximated back to the bone with various suture patterns to decrease local stress. Rehabilitation is vital to regaining movement, strength and function of the shoulder as soon as possible following surgery.

Phase 1: Rehab appointments should begin 1 week following surgery.

The goals of phase 1 are: reduce pain and swelling, maintain active ROM of Elbow and Wrist joints and protect healing tissue.

They type of exercises would be active range of motion of Elbow and Wrist joints, ball squeezes and passive range of motion for shoulder flexion and abduction, within pain range (0-50 degrees)

Phase 2: approx 2 weeks after surgery:

Goals are to restore passive and active range of motion exercises of shoulder, activate shoulder and scapular stabilisers of abduction (0-30 degrees) and correct postural dysfunctions

Exercises should include some gentle shoulder mobilisations e.g. Pendulum Exercises. Isometric internal and external rotation in (0-30 degrees) of abduction. Scapular pinches with the arm in neutral.

Client can progress to Phase 3 when they have full passive ROM and normal IR and ER strength, this can take between 5-7 weeks after surgery.

Phase 3: 5-7 weeks after surgery.

Goals are to achieve full ROM in all directions, normal strength in IR and ER at (0 degrees of abduction).

The types of exercises to help progress clients are Open Chain exercises e.g. cane exercises and Closed Chain exercises such as wall exercises. Shoulder IR and ER exercises with theraband or weights. Side lying shoulder Flexion and Abduction with scapular stabilisation.

Phase 4: usually 3 months after surgery

Goals of this phase is to achieve normal range of motion, strength and endurance at 90 degrees of abduction and scapular stabilisation. Develop proprioceptive strength and control and sport/work specific movements.

Progress exercises to include Multi-plane shoulder active range of movement with gradual increase in speed of movement e.g. Half kneeling shoulder chops. Continue open & closed chain exercises with scapula strengthening e.g. Half Kneeling Pulls.

Patient may look to begin some light jogging and building the time/distance they run over a period of a few weeks.

Phase 5: usually 4-5 months following surgery

Goals of this phase are full Rotator Cuff strength at 90 degrees of shoulder abduction and supraspinatus strength. It is important to focus on work/sport specific movements to ensure correct postural function and control.

Exercises should include work/sport specific strengthening exercises. Continue to strengthen rotator cuff in 90 degree abduction, building in strengthening and dynamic overhead exercises. Were required include throwing, gym or swimming programmes.

This programme is an outline, patients respond and heal at different rates. Similarly there may also be some minor set backs so it is advisable to progress at a gradual rate and use pain as a main indicator to the client to follow and adhere to.

Please contact us should you like more advise or wish to make an appointment.

 


Rotator cuff tear

Range of Motion Physical Therapy Newsletter August 13

Knee Pain & Exercises:

knee pain

Over the past month I have treated a large number of clients with knee pain, with this in mind a revisited a blog I had written last year and expanded on what are the best exercises to help with knee pain.I also wrote a blog on chondromalacia patellae, the most common cause of chronic knee pain, the condition is also called the patellofemoral syndrome(PFS).To read more on the causes and symptoms and how to manage knee pain follow the links below!!Knee Pain
Open & Closed Chain Exercises

Rotator Cuff Tear Rehabilitation
Over the past 5 months I have been working with two clients who suffered Rotator Cuff tears, both having fallen on an outstretched arm.

Rotator cuff tear
Both clients required surgery, with one of them being told it was a very severe tear and will take slow consistent rehabilitation and not to rush things.With this in mind I wrote a blog on a rehab programme for a Type I tear and what is expected at each phase on an ongoing basis. You can read the programme by following the link below.Rotator Cuff Tear Rehab Programme.