I’ve Torn My Rotator Cuff. Can Physical Therapy Fix It?
If you’ve suffered a rotator cuff injury, you’re undoubtedly hoping to avoid surgery. Fortunately, if you don’t have a complete tear, there’s a good chance you’ll be able to rehab with nonsurgical options, including steroid injections and physical therapy.
Each year, about 2 million Americans suffer some sort of rotator cuff problem. Surgery is the only option to completely repair the damage. However, it’s estimated that 80 percent of people with partial tears can regain function and reduce pain without needing surgery.
How Do Rotator Cuff Injuries Occur?
You can think of the rotator cuff as an array of muscles and tendons, whose job is to keep the head of your upper arm bone firmly seated within the shallow shoulder socket. They also help lift your arms away from your body. In cases where there is a complete tear, it is almost impossible to move the arm.
Rotator cuff injuries are generally the result of one of two things. The first is through abrupt overextension caused by a traumatic injury. This could happen, for example, during a fall that might also cause a broken collarbone or dislocated shoulder.
The second is a more gradual condition, caused by a combination of aging and general wear. These are particularly common with people who have jobs that require repetitive shoulder motions. These include:
- Athletes who play baseball, softball or tennis
Rotator Cuff Stretches
One of the first objectives in physical therapy is improving your posture, which can be a significant contributor to these injuries.
Among the recommended stretches:
- Doorway stretch: Standing in a doorway, grip both sides of the frame, at or below shoulder height. Lean forward though the doorway until you feel a slight stretch in the front of your shoulder. Keep your back straight and shift your weight onto your toes.
- Over-the-head stretch: Start out lying flat on the floor or a bed. Hold a cane or rod in both hands, placed at your hips. Keep your arms straight as you slowly raise the rod in an arc until it stops above your head.
- Up-the-back stretch: You’ll be standing for this one, with arms at your side, holding the rod in both hands behind your back. Slowly raise the rod up your back, bending your elbows as you go – until it starts to feel uncomfortable.
Rotator Cuff Exercises
Rehab exercise plans vary from person to person, depending on risk factors and the severity of the injury. In some cases, you may start with isometric exercises that strengthen the damaged area without movement. A next step would be isotonic exercises, using resistance bands.
A physical therapist can help develop an exercise plan that’s best for you, but among the exercises that might be recommended:
- Isometric shoulder flexion: Stand facing a wall, bending the elbow of the injured shoulder with your hand in a fist. Put a folded towel between your fist and wall and then press your fist into the wall for five seconds.
- Isometric shoulder abduction: Stand perpendicular to the wall, with your injured shoulder about six inches away from it. Again, press your fist into the wall as if you are trying to raise your arm to the side and hold it for five seconds.
- Isometric shoulder internal rotation: Stand in a doorframe facing a wall, bending the elbow of the injured shoulder with your hand in a fist. Put a folded towel between your inner forearm and the wall and then rotate your forearm into the wall for five seconds.
- Isometric shoulder external rotation: Stand in a doorframe facing a wall, bending the elbow of the injured shoulder with your hand in a fist. Put a folded towel between your outer forearm and the wall and then rotate your forearm into the wall for five seconds.
- High-to-low rows: Attach a resistance band to something at or above shoulder height. Get down on one knee, so that the knee on the same side as your injured arm is on the ground. Your other hand will be rested on the raised knee. Hold the band in your injured arm and pull your elbow toward your body, while keeping your back straight and squeezing your shoulder blades together and down.
- Reverse fly: Stand with your feet shoulder-width apart and knees slightly bent. Keep your back straight as you bend forward slightly at the waist. Holding a light weight in each hand, extend your arms and raise them away from your body, without locking your elbows. Your arms should not be raised above shoulder height.
- V arm raise: Start in a standing position and then extend your arms forward, bringing your hands together with thumbs pointed up. Slowly raise your arms to the ceiling, keeping your arms in that V shape. You can add a pound or two of weight as you progress.
You will generally want to start off slow and easy, avoiding anything that causes significant pain. You’ll also want to be wary of non-exercise activities that can cause further damage. One example of this is sitting in the front seat of a car. Avoid reaching behind you to grab something from the back seat. Also avoid overhead lifting and activities (painting a room, for example) that require repetitive motions with your shoulder.
It's also good to keep in mind that recovering from a rotator cuff tear is not quick. Mild tears might take only a month of rehab. But more serious injuries can take six months to a year.
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