Did you catch our last blog? If so, you’ve probably got a pretty good idea about what FAI and labral tears are. Hopefully this will make it easier for you to talk to your physician and physical therapist about your healthcare. There’s a lot of options out there, but everyone involved – patients, surgeons, and rehab professionals alike – agrees that targeted sport-specific physical therapy is essential to a full recovery, with or without medical intervention.
“Calm stuff down, then build stuff back up”. This quote from Greg Lehman, a dual-doctorate physical therapist and chiropractor, basically sums up how a physical therapist works to help you get past your hip pain and back to your sport. First – and we know athletes in particular need to hear this – the rehab process generally needs to start with a de-load. Taking time away from the activities that aggravate your hip is necessary to allow the joint to calm down and get out of an inflammatory state. However, it’s important that you stay active in ways that don’t aggravate your hip to avoid weakness and deconditioning (and to keep you sane, of course). If you have pain with running, for instance, try swimming or cycling; If you’re struggling to play a full 90 minutes of soccer, try decreasing your time on the field or avoiding drills that you know will flare things up. The decrease in load through the joint will help it calm down. If your physical therapist is familiar with your sport, they can take a look at your training plan and/or talk with your coach to determine what might look like for you, and for how long.
A physical therapist can also help decrease joint irritation with manual therapy. Especially when FAI is at play and stiffness is present, a PT can use their hands to move the head of the femur away from the acetabulum, creating space within the joint. This allows fluid to pass through the joint more easily – carrying in nutrients and carrying out waste and inflammatory cells (movement does this too, hence staying active!). Painful joints can also cause muscles to tense up, so a physical therapist can help release and relax those muscles. On the other end of the spectrum, some labral tears occur due to too much motion of the joint versus an impingement. In these cases, joint mobilization is not a good idea, but soft tissue work can be great as the muscles around the joint tense up to protect it.
Manual therapy (and similar adjuncts like dry needling and cupping) feels good, but the secret sauce of physical therapy is targeted strength training. This is how we “build stuff up”. Pain tends to shut down muscle function around the joint. This is your body’s way of protecting yourself (“it hurts, so don’t move!”). Strength training can get those muscles activated again, and research shows that strength training can actually help control pain. Your PT should be working one-on-one with you to find exercises that feel good, and don’t aggravate your symptoms.
Once you have a baseline of pain-free strength behind you, you and your PT will work together to gradually progress you back to your sport. We call this “graded exposure” to movements that become more and more sport-specific as your pain decreases and you get stronger. For most sports this means increasing the range of motion you move through, increasing the load you’re using during training, and progressively increasing your impact activity. We monitor how you feel for 24 hours following an increase in activity to make sure your hip is happy with the load, and just keep climbing the ladder from there. This is why it’s so important, as an athlete, for you to see a clinician who specializes in sports rehab. They are the only ones who understand the demands of your sport and know how to appropriately progress you back to meeting those demands on a regular basis.
If you are struggling with hip pain that’s significantly impacting your ability to train and compete, contact our sports specialist, Dr. Kate. She’s been through this too, and is here to help!
You can email Kate with any questions or comments: [email protected]
If you’re young and athletic and are experiencing pain at the front of your hip, know that you’re not alone. Anterior hip pain is actually a very common experience among runners, triathletes, soccer and hockey athletes, as well as dancers and gymnasts.
Like other parts of the body, pain at the front of your hip can mean a lot of different things. For runners and soccer players especially, repetitive impact activity can lead to a stress fracture of the femoral neck or shaft – which presents as pain at the anterior hip with running, walking, and jumping. Soccer and hockey players are also susceptible to groin strains, or pubic bone pathology due to the strain on the inner thigh during that sport. A diagnosis that’s common among all of these sports, and many more, is femoroacetabular impingement (FAI) and labral pathology.
The hip is a ball and socket joint, formed by the acetabulum – the “socket” – on the pelvis -and the head of the femur, on your thigh bone. The joint is surrounded by a rim of cartilage called the labrum (heard this term before? There’s one on your shoulder joint too!), which helps the joint absorb shock and also deepens the socket, creating more stability through the joint.
Femoroacetabular impingement – FAI – can be diagnosed with an x-ray. Essentially what impingement means is that ball-and-socket joint isn’t fitting together perfectly, and there are three ways this can occur. First is “pincer” impingement, which means that there is an outgrowth of bone on the socket. This leads to the acetabulum and femur coming into contact too early in the range of motion. Second, there is “cam” impingement, which means there is a bony growth on the head of the femur, meaning that it cannot glide in the socket without “catching” or “pinching” on the labrum. Lastly, it is actually most common to have a combination of these.
FAI can occur without labral pathology, and labral pathology can also occur without FAI; but, frequently, they do occur together. Labral tears can cause a significant amount of pain, however it must be said that just because a tear is seen on imaging does NOT mean this is the source of pain. There have been several studies showing that when imaging the hips of young, active individuals who don’t have hip pain, up to 70% of them have labral tears.
SO…you’ve been diagnosed with FAI and/or a labral tear. Now what?
Luckily, there has been an explosion of medical interventions for hip pain, as well as significant improvement in the way rehab professionals treat.
Injection Therapies: An orthopedic surgeon may choose to inject the joint with a corticosteroid to decrease any inflammation in the joint. Alternatively, some surgeons can do “regenerative injections” – either Platelet-Rich Plasma (PRP) or bone marrow aspirate concentration (BMAC), both of which serve to stimulate healing of the labrum and cartilage.
Surgical Interventions: There are several arthroscopic surgical techniques that can be used to correct FAI and repair labral tears. For FAI, the surgeon may perform an osteoplasty – essentially shaving down the bony outgrowths so that the joint surfaces can roll and glide on each other smoothly. Surgeons can also use sutures or anchors to secure torn portions of the labrum back to the acetabulum; this can significantly decrease painful clicking and catching. In more involved cases, the surgeon can also take cadaver tissue and create a brand new labrum for the patient.
It is important to note that these medical interventions, advanced as they are, do not guarantee pain relief. Surgery in particular CAN be extremely helpful, and as such it is still considered the gold standard treatment – but like we talked about earlier – pathology does not always equal pain. Therefore “fixing” or eliminating the pathology does not guarantee elimination of pain. Surgery should be considered a last result option, if injection therapy and high-quality sports rehab do not help.
Speaking of sports rehab….stay tuned for our next article to learn how we help our athletes with hip pain back to the playing field – with or without surgery! Have questions?Email me at [email protected]
Kate Wason, PT, DPT
What is it exactly, and how can you get back to the things you love? Unfortunately, we hear the phrases above far too often. If you have arthritis and have had an x-ray to confirm your diagnosis, you’ve likely heard one or two of these troubling phrases. The truth is, sometimes these are a poor choice of words. I hope aim to provide you with some peace of mind, by explaining what arthritis is, the reasons why it develops, and what you can do about it.
What is Osteoarthritis?
Osteoarthritis (OA) is a condition that has been affecting an increasing amount of the aging population. It typically affects the larger, weight bearing joints in the body, but can also be found within the smaller joints of the hands, feet, wrists, etc. Development occurs when the cartilage begins to wear down over time. This can lead to increased loading of bony tissue, poor movement mechanics, or even the growth of new bony tissue usually called bone spurs.
Since arthritis usually becomes painful, it is typically associated with a decrease in activity level. This decrease, which I’m sure most of you can attest to, is out of fear of making things worse due to something a doctor or friend has told you. Interestingly enough, reductions in activity can actually increase symptoms, pain, and progression of the disease. Although it is counter-intuitive, it’s true!
Whats the deal with my cartilage?
Cartilage helps our joints absorb forces and move smoothly. Did you know that the cartilage in your joints is actually 10x’s more slippery than ice?! This is what allows our joints to flex and extend without much effort. So, whats the number one thing you can do to keep your cartilage healthy? Move! Every tissue in our body is highly specialized and needs certain stimuli to thrive and survive, and cartilage is no exception.
Lets think about the knee for example: Compression and sliding of the joint surfaces create a sponge-like mechanism for the cartilage. When compressed, metabolites are squeezed out and when relaxed the cartilage expands again taking in nutrients. It’s just like a living breathing tissue! When activity is stopped or avoided, this process no longer occurs which can exacerbate the degenerative process leading to worsening arthritis. So what can movement do for your cartilage?
- Movement stimulates the cells that make cartilage to reproduce, which allows these cells to create more cartilage.
- Movement promotes tissue nourishment.
- Movement reduces the amount of metabolites within the tissue.
Why else should you exercise for arthritis?
Just like cartilage, muscles are important for protecting joints as well. They function to not only help us move and stabilize our joints, but also to help dissipate forces going to the joints. Without adequate strength, these forces need to be absorbed by other structures (think cartilage in our joints). This is another reason why avoiding activity with arthritis can actually make the pathology worse.
People with OA are often told to avoid certain activities including squatting, running, etc. However, I believe this is the opposite of what should be done (see above). OA develops over a long period of time, not after one set of squats. Continuing to squat, run, or any other activity is not going to independently speed up the degenerative process.
That said, there are some ways to begin activity to help set you up for success:
- Slowly ramp up activity within your pain tolerance to allow the cartilage to mature and adapt
- Build a strong base of muscles to be able to dissipate the forces being placed on the joint
- Find activities that may be lower impact to build strength before loading the joint (water aerobics, swimming, etc.)
- Find a great PT to help you along the path to recovery and improvement of function
You should always discuss your options and activities with your healthcare provider before starting any new regimen or treatment. If your skeptical, we challenge you to try increasing your activity slowly, stick with it for one month, and see how you feel. I’m willing to bet you may find you have less pain.
If your not sure where to start, feel free to call to book and appointment or reach out to me at [email protected] to get started!
Here’s a great article that discusses the benefits of exercise for OA and may be a good reference for where to start. I promise it is an easy read!
Chronic back pain is caused by a number of different contributors, and is defined as back pain that lasts longer than three months or that occurs episodically. It can affect people of all walks of life, regardless of age or physical condition.
The medical community doesn’t understand everything about chronic back pain yet. Questions persist on why some people have it and others don’t; or why some episodes last longer than others; and why imaging results don’t always paint the correct picture. Imaging and blood work may even show things like lumbar degeneration or disc herniation, though these findings don’t prove useful because these positive findings often don’t come with pain or other symptoms at all. On the other hand, so many people with chronic back pain will receive no positive findings from blood work or imaging at all.
The good news is that backs are just like any other body part, and the will heal.
We do have a good understanding of some common causes of chronic back pain as well as an understanding of how pain can manifest itself. Many people experience going to bed feeling fine and waking up with significant back pain. This can be caused by swelling of a disc as it re-hydrates during the night. Another common trigger is doing something simple like reaching for the milk carton and the back suddenly spasms. This is the result of poor motor control and the spasm is a protective mechanism. Sometimes it is more obvious and we experience pain during an effort of some kind like sneezing or lifting something heavy. However focusing only on the possibility of what has been “damaged” can lead us into unnecessary imaging, inappropriate treatments and much higher healthcare costs while still not solving the underlying problem.
Pain is defined as an unpleasant physical and emotional sensation that we experience when injured OR when there is a threat of injury and no actual tissue damage present.
It is a protective mechanism our brain uses to keep us from getting hurt. It has biological components, psychological components and sociological components. Unfortunately, we can get stuck in a loop where we get very good at experiencing pain and our brain tells us our back is hurting even when nothing has been done to injure it. This short video does an excellent job of explaining further.
If you experience this, here are some things to consider.
- Your back will heal- just like an arm or an ankle. If you twist your ankle one year, and then several years later you do it again, you don’t become fearful of having a ‘bad ankle’. The same holds true for your back.
- Move around as much as you can as pain allows. Moving is better than resting. If it isn’t resolving quickly, considering seeing a chiropractor or physical therapist. They are trained to help relieve your symptoms and give you the tools needed to reduce the likelihood of future episodes, and help you learn to better manage such things on your own.
If your chronic back pain is constant and not episodic, then a multi-modal approach is best, especially if it hasn’t responded well to individual treatments. There is excellent evidence for a multidisciplinary approach as well as solid evidence for exercise therapy and spinal manipulation. You can read the full guidelines from the American Academy of Family Physicians here.
You should have a team that includes a pain management physician, a chiropractor or physical therapist and a mental health therapist that work with you to help with your symptoms. A psychologist trained in Cognitive Behavioral Therapy can be very helpful in these situations. If you’re having chronic back pain and have questions, please feel free to email me at [email protected]
Samuel S. Spillman, DC
Frozen Shoulder is real, and doesn’t only occur in the winter! Generally the condition doesn’t have a definite start point, ie. patients often can’t think of an injury that started the pain. Some warning signs to look for include pain and a loss of motion in multiple directions.
Medically termed adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is a sheath of tissue that maintains fluid within the joint and maintains pressure, ensuring relative stability. Inflammation causes the capsule to become more fibrous and thicken. This causes limitations in range of motion and pain. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best
way to help effective progress.
Who gets it?
Although anyone can get this condition for a variety of different reasons, there are a few predisposing factors:
- Most prevalent in women ages 45 to 65
- Diabetes and Thyroid disease
- Previous episode on opposite shoulder
- Immobilization of the shoulder following certain surgeries
- This condition can also develop after a minor shoulder injury
There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has certain treatments that may be beneficial to help speed recovery, which will be discussed below.
Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage:
The Start (months 0-3)
What to expect:
- Pain begins with no initial injury, can be sharp and/or dull in nature
- This is when inflammation occurs, but adhesions haven’t formed
- Pain most notable at endrange movements, but can be present at rest
- Trouble sleeping is common
In this stage, you should see a physical therapist for a few visits to learn exercises to maintain range and slow the loss of motion. You will also be educated on the condition and general progression through the stages.
A few tips:
- Use the shoulder as normally as possible without exacerbating symptoms.
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain.
- Listen to your body, if your causing a significant increase in pain you’re doing too much
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Freezing (months 3-9)
What to expect:
- Loss of motion in all directions, with external rotation and raising the arm to the side are usually most affected
- Range of motion becomes progressively worse
- Daily activities (reaching, dressing, bathing, workouts) can become more uncomfortable
- Increased inflammation and blood flow present within tissue
Physical therapy continues to be beneficial in this stage to maintain ROM and function. PT interventions will be tuned to the amount of tissue irritability the patient is experiencing.
A few tips:
- Continue using the shoulder as normally as possible
- Performing range of motion exercises will be helpful in maintaining range
- Listen to your body, if there is an increase in pain with activities and exercising, there may also be an increase in inflammation
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Frozen (months 9-15)
What to expect:
- Increased fibrosis = increased loss of motion
- Your joint will be much more stiff, but pain will begin subsiding
- Your shoulder is likely to have large range of motion deficits in this stage
You will likely be working with a home program for care at this point. Let your PT know if you have any changes that you have questions during this stage.
A few tips:
- Once again, continue using that shoulder as normally as possible
- Try to avoid movements that are too uncomfortable to complete
Thawing (months 15-24)
What to expect:
- Pain will begin improving, and eventually resolve
- Significant stiffness will remain, but will improve slowly
- Minor range of motion loss may persist after resolution
- Fibrosis of joint capsule, but decreased inflammation
The shoulder will begin During this stage you should begin appointments with your PT for more intensive stretching and manual therapy. Functional strengthening exercises will be used to begin returning the shoulder to normal.
A few tips:
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain
- Begin a strengthening program that challenges your range of motion as well
- Be sure to work with your PT to develop a comprehensive program to return your shoulder to normal
Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery.
Bryan Esherick PT, DPT Have questions? Email me at [email protected]
Information adapted from the clinical practice guidelines Shoulder Pain and Mobility Deficits: Adhesive Capsulitis from the JOSPT.
CBD oil is gaining in popularity and is showing up everywhere – across the web and on store shelves everywhere. But, many of us are just hearing about it and have some questions – so let’s take a closer look.
CBD stands for cannabidiol – and it is a compound found in both cannabis and cannabis sativa (better known as hemp).
While both plants have hundreds of compounds that may be pharmacologically active, the best known is THC, which has a psychoactive component. However, both plants also contain CBD which also has pharmacological effects but NO psychoactive component. The CBD products at health food stores, grocery stores, and doctor’s offices are sourced from hemp and have no psychoactive properties.
OK, but why is it suddenly all over the place?
There are a number of reasons. It has been found to help with certain seizure disorders and recently the Virginia board of medicine has added it to the legal formula and it can now be prescribed for this purpose. But it is also available over the counter. The recent Farm Bill in 2018 among other things, designated CBD products to be “generally recognized as safe” or GRAS, which means it can be added to food stuffs and sold. For the time being the FDA and DEA have not taken any steps to change that, although they could at any time. Common side effects may include tiredness, diarrhea and changes of appetite/weight.
What can CBD oil do and why would anyone take it? Well in addition to the above mentioned anti seizure properties, there is some limited research that suggests that CBD oil can help people with chronic pain, as well as with sleep, and anxiety. Now the research is far from conclusive and there are many more double blind random control trials that need to be performed before the science and medical communities are going to get behind this being a new cure-all. However, as it has been generally recognized as safe and there are anecdotal reports popping up everywhere with people touting its benefits, people are flocking in droves to try it. We began carrying these products after a few patients requested them and they’ve proven to be very popular with patients for pain relief.
Samuel S. Spillman, DC
Have you ever experienced knee pain when beginning a new activity or increasing training volume? Does this pain go away after the warm-up, but come back the day after or when stopping the activity? You may have been of the lucky ones if these symptoms were short lived and went away within a few days. For many, this pain can become a chronic issue and affect everyday activities like sitting, stair climbing, and walking. This chronic condition is characterized by pain in the patellar tendon.
Jumper’s knee, runner’s knee, or patellar tendinopathy are all synonyms for this common condition. It generally affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. The tendinopathy is generally due to overstressing a poorly conditioned tissue, which can eventually lead to tendon dysrepair. Just like your muscles, bones, tendons, and ligaments also have to be trained to meet the demands you are putting on them. The reasons for pain with this condition is poorly understood, but it is believed that the brain and central nervous system play a big role in sensitization of the tissue. Once this process begins it is hard to reverse, which is likely why symptoms can last anywhere from a few weeks up to 2 years.
No matter the activity, whether you are increasing your training volume, load, surface, or equipment the degenerative process may begin. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is more prevalent at the beginning of a sporting season or training regimen. Have you ever wondered why marathon runners are very calculated in their training regimens in terms of increasing mileage? This condition is one of the reasons, as all tissues take time to adapt. Remember, the preseason is what prepares your body, and may be the most important part of the season to reduce injury risk.. Check out our upcoming blog in the spring on how to prevent training injuries.
As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, reconditioning the tissue, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition, and certain protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your state; if the tendon is stressed too much during recovery, the tendinopathy cycle will repeat itself and may become worse. Remember, there is no established timeframe for recovery, so being patient with recovery is important. The good news is that you can usually continue training, but it is best to consult your physical therapist about possible changes in impact training, training load, or training volume. Cookie cutter approaches to treatment won’t work, so be sure treatment is properly adjusted to meet your needs.
Bryan Esherick PT, DPT
If you’ve ever noticed an ache around the outside of your elbow that just doesn’t seem to go away, you might be experiencing a condition commonly known as tennis elbow. Once it starts, this type of injury can affect your strength and function in your arm. So, if you’re feeling that ache and haven’t done anything about it, now might be the time.
Despite its name, this condition rarely affects tennis players.
It’s most common in sports and occupations that require repetitive movements – think computer work, climbing, heavy labor jobs, etc. Tennis elbow is a form of a tendinopathy – affecting the tendons of the forearm muscles – classically called tendonitis. The tendons undergo a degenerative process as a result of highly repetitive stresses. This process causes: increased blood to flow to the area; collagen creating cells; and ground substance. This cascade of changes can lead to pain and discomfort in the area – as well as poorly formed tendon structure which is then vulnerable to further injury.
Due to the nature of the injury, and the general inability to stop activities that aggravate the condition, it can take from a few months to up to two years for the tendon to fully recover and for pain to subside. It is possible for the condition to subside on its own, but there are steps you can take to decrease the duration of the symptoms.
Treatments for this condition vary greatly from surgery at the most extreme end, and to wait-and-see on the other, with everything in between. At Balanced we focus on rehabilitating the tendon through gradual loading of the tissue to reorganize collagen; and soft tissue work to relax overactive muscles; and education to empower our patients to heal quicker. We generally recommend avoiding bracing, cortisone shots, and surgery. By optimizing the environment for the tissue to heal, our patients often obtain quicker results and are able to return to normal activity and reach their goals within a more predictable time frame.
Bryan Esherick PT,DPT
The knee joint is the most vulnerable and most common snow sport related injury. The good news is there are steps you can take to condition and prepare your body for winter sports such as skiing.
Things to do in preparation for your ski trip:
- Core and lower extremity exercises (listed below)
- Training your cardiovascular fitness- many injuries occur as a result of fatigue
- Proper equipment that is appropriate for your height and skill level
- Take a skiing technique class before hitting the slopes
Preventing Injury on the slopes:
- First off warm up your body before hitting the slopes each day
- Proper technique: Hands and weight forward, legs parallel and hips, knees and ankles flexed equally
- Stay on trails that are marked for skiing safely
The following are exercises should be preformed several weeks before you plan to ski. All of the exercises should be attempted for 1 minute and increase the time as you improve.
Standing on one leg reach the other leg toward an imaginary clock face. Repeat on other side.
With both feet close together bend your knees and jump side to side while maintaining a straight spine and a flat back as well as even weight in both feet.
Start from a squat position with feet close together jump from diagonal to diagonal landing on the balls of the feet.
Side to side skaters
Stand on one leg and take a large step to the with the other leg and then take another large step back to where you were. Make sure your pelvis stays level and your knee does not buckle inward.
Check out the full video for these fun and helpful exercises!
Rotator cuff is a term that many people fear when mentioned by a healthcare provider. This fear is usually warranted but, if a partial tear, can usually be treated conservatively if caught early. This fear may come from not knowing about conservative measures that can help. On the other hand, when conservative management fails or the tear is more significant, surgery is generally indicated. The goal of this blog is to help answer many of the questions you may have when a healthcare provider mentions that your rotator cuff may be the cause of your shoulder or arm pain. A brief description of the function of the cuff and the pathology will be followed by a look at the road to recovery and what to expect as you go through the weeks of rehabilitation.
The cuff’s main purpose is to improve shoulder stability by actively pulling the arm bone into the shoulder socket with arm motion. It does this through a concert of contractions of the 4 muscles that make up the structure. Each muscle works intricately with the other to provide the most stability possible: Even when one muscle is not working properly, it can lead to issues. Without the rotator cuff, the shoulder generally becomes unstable which can lead to further tearing or other injuries affecting the shoulder joint.
Tears are fairly common and can affect people of all ages. They occur most commonly in patients in their 50’s and above, likely due to tissue deconditioning and other age related changes. Tears also occur frequently in overhead throwing athletes. Cuff injuries generally occur gradually over a period of time where symptoms begin to evolve and worsen. Warning signs of tears include deep, dull shoulder pain, trouble sleeping, and an inability to move the shoulder through its full range of motion. Labral tears and biceps tendinopathy are common concurrent injuries that may also be addressed.
Surgery vs. conservative management will generally be decided on a case by case basis and based on failure to conservative treatment, imaging results, signs and symptoms, and quality of life reported by the patient.
Here is what to expect when surgical repair is indicated.
Day 1- week 2: Surgery is generally performed at an outpatient surgical center. Most repairs are done arthroscopically meaning a small camera will be inserted with tools on the end to complete the repair. A local nerve block as well as general anesthesia is used during the procedure so you will be asleep the entire time. The nerve block will also help to ease pain for the hours following surgery and likely into the next day. This usually only requires 2-3 small incisions in your skin. You will return home the same day following the surgery. Pain killers are generally prescribed to help ease pain, and they should be taken to make you more comfortable.
The next 2 weeks are used to allow the repair to heal properly and is the maximal protection phase. During this time your arm will be in a sling and you will likely sleep in a recliner to protect the repair. Moderate pain is a normal experience during this time so be sure to ice and take any medication as prescribed.
Week 2-4 Post-op: This is generally when physical therapy is initiated, but some surgeons will wait for 6 weeks before therapy is initiated. During this period in therapy, the therapist will move your arm for you to begin regaining normal motion. You will also begin working on activating the muscles around your shoulder blades. Gentle activation of your shoulder muscles will also start.
Weeks 5-10 Post-op: The goal of this phase is to obtain good range of motion and to be able to stabilize your shoulder throughout the range with your muscles. Range motion will continue to be progressed and active motion will be progressed gradually within relatively pain-free ranges to hopefully reach full range by week 7-8. Range of motion progresses differently in different patients so don’t be discouraged if it takes longer than normal. Strengthening exercises will also progress gradually to gain strength for normal activities.
Weeks 10-20 Post-op: The goal of this phase is to continue progressing strength and stability to prepare your shoulder for return to all prior activities. You will also be expected to become more independent with exercises. Challenging functional movements will be performed later in this stage. Complex movements like throwing will be broken down into parts to practice before performing the actual movement to ensure proper shoulder function. You will likely be weaned from PT and may be discharged to continue with comprehensive home program to continue toward the end of this period. Athletes that need more intense treatment will continue with therapy into the return to sport phase.
Be sure not to perform activities that are too taxing for your shoulder at this point. Your shoulder will be feeling much better, which makes this a common time for re-injury to occur. Although your shoulder is feeling better, that does not mean it is fully healed and ready for full return to all of your normal activities.
Weeks 20+: Typically the safe return to sport phase. You will progress back into your sport or other activities. Continue with your home exercises to continue building strength and stability throughout your shoulder complex.
You can expect to be checking in with your surgeon throughout this process to insure that everything is going as planned. Your therapist should be in contact with the surgeon throughout the process to ensure you are progressing as expected as well.
I hope this blog can ease any anxiety about your upcoming procedure and give you a brief guide for what to expect following a RTC repair. Surgery can be intimidating, but the more you know going into it, the better the outcomes!
We will be following one of our patients through rehab and will post exercise videos and updates throughout his recovery. Be sure to check them out!
Bryan Esherick, DPT