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blueman2
02-05-2010, 01:21 PM
I've read a lot of threads with people with Rotator Cuff Tears who have described trying PT and have ended up having surgery anyway or had surgery and then underwent PT but I've seen nothing from anyone who has successfully rehabbed a tear. I'd love to hear a few people chime in who have successfully rehabbed a tear. Anyone out there?

Therapy is the course I was on but I'm beginning to doubt whether or not it's going to work. It's been about 4 months. I have full range of motion, which I did from the beginning, but any type of exertion involving the shoulder brings on prolonged soreness. I'm really tired of not playing tennis.

While I'm at it, if anyone responding is from the Philadelphia area who has had surgery and can really recommend a surgeon, I'd appreciate.

Thanks

Mike

DrpShot!
02-05-2010, 01:36 PM
Me. PT with rubber therapy bands did the trick, no surgery, I couldn't lift my arm above shoulder height for like 6 months before starting PT. If you go to a surgeon he'll send you to PT first anyway, no way around that. In PT they'll show you this stuff, or you can look up warmups for baseball pitchers using therapy bands, or rotator cuff exercises for therapy bands.

Rotator cuff tears are caused by muscle imbalances in the shoulder. Front muscles get bigger from being worked all the time, the back muscles don't, this causes soft connective tissue between them to tear. You want to strengthen the muscles in the back and the sides of the shoulders.

First and foremost are internal and external rotations - with band tied around a poll next to you, pull the band across your midsection, keep the arm bent at 90 degrees, do it the opposite way as well; hold a band in front of you and pull it apart as many times as you can; put the band under a foot and pull up with arms out to the side; pulling up with arms straight ahead; pull straight forward with band coming over your shoulder; pull straight back; starting with arms out to either side with elbows bent at 90 degrees then rotating arms up at the elbow; etc. Good luck.

El Diablo
02-05-2010, 01:47 PM
Surgeons send you to PT because they have to -- many insurance companies balk at paying for surgery until PT has failed. Close friend of mine had the surgery. Wore the sling and took it easy for months, is now back to playing tennis without symptoms.

jhp49
02-05-2010, 03:23 PM
I'm using PT exercise plus a reflex bag (free-standing boxing speed bag). The PT exercises build range of motion and strength. The reflex bag helps me build strength to overcome the inertia of the tennis ball. I found with PT exercises alone I could get strength and ROM back, but couldn't adjust to hitting a tennis ball. I felt discomfort at ball impact. My PT suggested trying the reflex bag. I box against it as well as hitting tennis strokes with an empty hand. It seems to be helping. I'm going to try hitting tennis balls again next week.

blueman2
02-05-2010, 04:07 PM
Drpshot

Had therapy for about 4 months now using bands and other exercises. Very very slight progress. Trying to figure out if it's time for the knife or if I should give it more time. Tennis season's coming soon.

ttbrowne
02-06-2010, 07:29 AM
I was very diligent with the bands. They worked! Haven't had any problems in over 4 years. My advice: Get serious about the bands. You may think they are a crock...but they work.

blueman2
02-06-2010, 08:04 AM
I was very diligent with the bands. They worked! Haven't had any problems in over 4 years. My advice: Get serious about the bands. You may think they are a crock...but they work.

Didn't say they were a crock. I do them every day. Maybe too much

Playtimefun
02-06-2010, 06:55 PM
Hi there

Dont give up on the physiotherapy. For starters, if your physiotherapist thinks that you can heal it without surgery and through rehab then by all means keep doing the rehab. The recovery time after surgery is easily a lot longer then a normal rehab with physio IF you dont over-push the muscles during the recovery.

A friend had her shoulder muscles fixed with surgery last august and she is now reaching the same point that I was 3 months after a similar tear but mine was not bad enough to warrant surgery although I had that option.

I am a canadian, so its not an insurance issue at all. It was all about what is working or not. So discussions with the physiotherapist were all about how is the arm reacting to the physio and if necessary to have surgery done.

It does take a long time for physio to work because the first thing that needs to happen is to decrease the swelling. When the muscles are swollen, each movement strains them even more. Also, until the swelling comes down the healing process does not truly begin. It is healing but much slower.

Thats why you have to do really light resistance bands at the start until the swelling is down. Then slowly building up of the strength afterwards.

During this whole process you should be seeing your physiotherapist every 2 to 3 weeks for sessions where he/she can work the muscles. The big thing is that the scar tissue will form but they will work it "laying" out the strands of muscle to help it start healing with a layered effect. This helps prevent "balls" of scar tissue. The funny thing is that I had tore muscles in my lower arm 8 years previous and one of those scars ended up causing me a lot of pain because that portion of muscle was being asked to compensate for the other muscles.

Using therma bands or another brand is the best way to help rehabilitate the muscles.

And yes, you can VERY EASILY hurt your muscles by pushing them too far thinking that it works to help build the muscles faster. IT DOESNT!!! Speaking from experience on this one. I was like ok - 20 reps doesnt hurt, lets do 3 sets of 30. Well the next thing I knew, I was actually doing more harm then good and it set me back a couple of weeks. If your physiotherapist says light therma band reps, then follow it until he says to start doing more.

Yes it drives a person nuts not playing tennis. Especially if your having good success. My gf and I had just won a 5.0 mixed event with some incredible good (and lucky) tennis and I tore my supersinatous (cant remember how its spelt) and my pectoral muscles in 2 locations.

I tore the muscles in August as just cleared to play a couple of weeks ago as we figured that my muscles were about 85% healed. Trouble was I played a tournament last weekend and found out that a persons strength sure is not there nand partially did some damage again - but very minorly. The biggest thing that happened was that I did not have any strength and as a result of that I developed a really bad case of tennis elbow. I use the Wilson KPS 88 - which is a very heavy racquet, so you need your strength with it. As a result I am typing this with a bag of ice on my elbow right now! But I was able to play tennis today.

Even after you are cleared to play (begining gently - taking it easy), you will be needing to heat up the shoulder with a hot water bottle or bean bag, etc. and after you play you will need to ice it down.

It takes a great deal of time for the muscles to heal and build up their strength again.

Yes, it is a huge pain in the ***. But it is far better than surgery!!!

Tim aka Playtimefun

blueman2
02-07-2010, 06:34 AM
Thanks Tim,
I've heard from too few that felt they were recovered enough from PT alone to get back on the court. So I appreciate your input.

The weirdest thing happened. Last wed, after PT I was very sore again and had an appt. with my orthopd thurs morning. That next morning at the orthopod's office I was still sore from the day before and we both decided that after 4 or 5 months I should be making more progress so we scheduled an appt with the surgeon. Although I still had soreness, that afternoon I decided to try somethings I hadn't done in months since I was committed to surgery anyway.I had to do some truck repairs that I had been dreading. Miraculously, it really didn't bother me that much to do them. What I had to do was in an awkward position and I definitely had to extend my shoulder in ways I hadn't. In fact, for the first time, instead of more soreness following use, it was better than it had been that morning. 2 days later we had the snowstorm. I just got back in from shoveling for the 2nd day in a row with very little post soreness. I can't figure this out unless I suddenly turned a sharp corner which I didn't expect to happen.

I made an appointment with a 2nd well known surgeon so I think I'll still let the surgeons take a look and get their input but if things stay as they are, I may change my mind about it. My only fear is that a month or so down the line I'll regret putting of the inevitable.

Thanks
Mike

Playtimefun
02-07-2010, 09:20 AM
Hi Mike

I know what your talking about.

I experienced a very similar thing. Basically the way my physiotherapist explained it to me is that the muscles have healed themselves at least partially and then you exert them past what they are ready for. Its like you have absoloutely no strength and there may be pain as well. If there is pain it is generally because the torn muscle has become swollen again and it starts binding on the bone or other muscles.

It happens when atheletes get hurt and rush themselves into being back in the gym. The muscles are used more then they are ready for and you get a delayed soreness from the effort. I think my physiotherapist called it 24 hour soreness. You feel fine doing the work and then all of a sudden it hits you hard!! BUT when I experienced it, what I did find afterwards is that it actually felt like I managed to stretch out a few of the muscles and it seemed better then what it had for a long time.

Again, its a really slow healing process. And once it gets to a point, it really starts to strength more quickly. The first 3 months for me were slow and then it started to pick up in strength quite a bit more quickly.

Try doing some very very light stretching as well. DO NOT bounce the stretch or super push it. Just real light stretching to help loosen up the muscles a little as you continue doing your exercises.

One of the things that my physiotherapist told me to do to help keep the muscles from tightening up was to take a weight and holding it in my hand, with my arm hanging straight down, make small circles slowly with the weight. You can place your left hand on a kitchen counter or table etc., and arch your back slightly. Try and keep your shoulders from slumping though. And just make little 10 inch diameter circles with the weight. You will feel the muscle being stretched and loosening up a bit.

Another thing is look at buying a massager or get your gf/wife to work the muscles with a massage. You dont want to put the vibrator on the sore point and push it hard. But working the vibrator around the muscles (all of the shoulder muscles) will help to keep them loose and it promotes oxygen getting into the muscles. Its kind of like doing a mini workout for the muscles.

I am very lucky in that while my physiotherapist is not a tennis player, he used to be a wrestler in university. So he is not just a guy who took classes and deals with atheletes on a regular basis, he has personal experience and talks about the symptons and how the muscle is reacting a lot to me.

Your physiotherapist should know their stuff enough to tell you if the muscles are healing or not after 3 or 4 months. If your forced to work at the same time in a job that works the muscle, then that could also be delaying the healing process as it over exerts the muscles.

I enjoy hunting and I was wanting to go out and my physiotherapist cautioned me to not be shooting my magnum rifles because it could put too much stress on my shoulder. In fact I went pheasant hunting and had to shoot left handed, which made it semi-safe for the birds but at least I was able to go out.

All I can suggest is talking with your physiotherapist to have a good review of how it is healing. Mine warned me that we may not see any results for the first 2 to 3 months and then we would know if it was being successful or not and we would make the determination then if surgery was required.

Also, it is really easy to self-diagnois yourself and to do it incorrectly. And to question if a person should be doing surgery. Believe me, I was like I want to know... because in Canada health care does not cost us anything but it can take you 6 months or more to get in to see a surgeon.

I would go in to my physiotherapist saying that the arm is hurting worse and he would just kind of tell me to lets see the results in another 2 weeks. Well after a few sessions, I was still wondering and he was like... I can feel the scar tissue forming... later he did some strength tests with me and it was very apparent. He told me, its hard to diagnois yourself when your doing it every day, but when I am seeing you every 2 weeks, I can see the progression.

Hopefully this helps a bit with how I experienced things.

Tim

blueman2
02-07-2010, 09:49 AM
Tim,

Great stuff. I discovered the pendulum swing about 3 weeks ago and it really does seem to be one of the more beneficial stretches.I definitely feel that helps with the soreness.

I think I'm going to keep my appoint to be evaluated by the surgeon so I at least have that done. Hopefully he can tell me if he thinks there's something (bony projection, etc) that might cause future problems in which case I might opt to go ahead with it. In the meantime I'll keep at the PT for another couple of weeks and hope that finally it's heading in the right direction and I can avoid surgery altogether. Both my orhthopedist and the Therapist felt that most partial tears can be cured with therapy. It's good to hear some living proof. I was beginning to doubt it.

Mike

Playtimefun
02-07-2010, 10:15 AM
Yep keep the appointment. They are too hard to come by so you sure dont want to turn one down if you have one. And my ultrasound showed that I did not have any major calcium buildup or bone projections which of course tennis players after years of the sport are likely to build up.

I was just thinking that if you have to do stuff like shovelling snow. Make sure you warm up that shoulder first. And I mean using a hot water bottle, electric heating blanket etc., for 25 to 30 minutes BEFORE you go and do the work. And then as soon as your done the work, ice it down.

It goes a long way to helping those shoulder muscles to stay loose and prevent additional swelling.

Tim

ttbrowne
02-08-2010, 02:17 PM
Didn't say they were a crock. I do them every day. Maybe too much

Don't overdo, Mike. It'll come along but it's a long process cause it's a serious injury. It's ended professional pitcher's careers man.