Rotator cuff tears in my opinion ……

It is likely that if you ask around in your circle of friends, family and colleagues someone you know is likely to have been affected by a rotator cuff tear. Now this doesn’t always results in symptoms however it can at times. In fact rotator cuff tears can even be considered a normal sign of ageing!! A study that screened 644 shoulders under ultrasound found 147 had cuff tears and of these 147 only 35% had pain¹.

The shoulder joint is made up of the humerus and the scapula. The joint itself is controlled and stabilised by 7 muscles, 4 of the deepest are called the rotator cuff muscles. These include supraspinatus, infraspinatus, subscapularis and teres minor.

When one or more of these muscles are torn you very commonly see that surgery is the end treatment option. According to an American Study there are 75 000 – 250 000 rotator cuff surgery’s each year in the US where the failure rate is between 25%-90%.

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In 2013 Kuhn et al. performed a prospective cohort study over 2 years with 452 patients who had non traumatic full thickness tears. They found that physiotherapy was effective for treating non traumatic full thickness rotator cuff tears in approximately 75% of patients that were followed up over a 2 year period².

If you were wondering what the physiotherapy involved, it included:

  • Daily range of motion exercises
  • active training of the scapular muscles
  • Daily flexibility of the anterior and posterior shoulder
  • strengthening exercises 3 x week
  • Manual therapy to augment the exercise

As you can see most of it involved moving and strengthening with manual therapy as an adjunct as well as this most of strength work was done independently. What Kuhn et al. found was that patients had increase in their range of motion and improvements in patient reported measure outcomes.

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Now it is important to note that there is still 35% that did require surgery and it is also important to remember the realistic outcome that some rotator cuff muscles just don’t rehab that well.

Need some advice on shoulder strengthening or suffering from a rotator cuff tear? Click here to book a session.

References:

  1. Kuhn,J. 2009 Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol.18, 138-160. doi:10.1016/j.jse.2008.06.004
  2. Kuhn, J. E. et al. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 22(10), 1371–1379. doi:10.1016/j.jse.2013.01.026

How meditation can assist pain management in my opinion …..

I recently saw a meme going around the therapy social networks, that I quickly resonated with, it showed a great reflection of how it can some times feel when discussing pain science and pain education in general. I mean “Sheriff Woody’s” body language says a thousand words!

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Pain is complex, I guess because humans are complex. At the National Pain Summit in 2010 an explanation for pain was described as “An individual human experience that is entirely subjective and that can only be truly appreciated by the individual experiencing pain”.  I think humans are multidimensional beings and to think of pain as simply being a biological process is limiting. Pain is complex because there is a significant amount of social and emotional suffering that comes along with the physical aspects of pain. Often we talk about treating pain within a bio-psychosocial model, that is a model that understands that pain is a dance between the biological factors, psychological factors such as mood, personality, behaviour and social factors such as culture and familial. To simply just treat the symptoms alone, I have found with my experience, keeps you in a positive loop pattern that only leads to more pain.

Professor in neuroscience Lorimer Moseley (late physiotherapist turned neuroscientist) once said “what are the barriers to really deeply adopting the bio-psychosocial model? Often the application results in clinicians suggesting that pain is in the ‘bio’ and suffering and disability is the ‘psychosocial”. It really is a dance, this is where I feel meditation comes in. I think it is a great adjunct to therapy, I mean we really are mind & body and not just the body so why just treat the body?

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The way I see meditation used as a pain mediator; is that it allows us to see our thoughts & feelings in a non-reactive way. Sure it takes practice to get to this point, but so does everything. To be able to feel discomfort and watch your thoughts, decreases the chance of feeding the symptoms and inevitably increasing them. It allows us to practice being non-reactive to every sensation. This might sound wishy washy but luckily there has been more and more evidence to back this up. In 2016 Cherkin Et-al studied mindfulness and chronic back pain in 342 adults and found that mindfulness based stress therapy resulted in greater improvement in chronic low back pain and functional limitations at 26 weeks compared to usual care.

Another factor that is strongly correlated with chronic pain is fear! Fear avoidant patterns of movement can often keep you in a pain loop = You move with fear, these movements are not bio-mechanically efficient. This causes your body to work in unusual ways likely to cause more stiffness and pain. In the study from Schutze Et-al found that low mindfulness predicts pain catastrophizing in a fear avoidance model of chronic pain.

In my experience meditation allows you to see your thoughts and perhaps the patterns that are so repetitive you may have never realised they are there …. in a loop. I find by seeing this you immediately press the pause button on that loop.

Of course I don’t think meditation alone will alleviate all physical symptoms, however as and adjunct to movement, strength and manual therapy you are definitely giving your body an environment conducive to healing from a mind & body perspective.

Ericka has completed a meditation teacher training and is a daily meditator. Ask her how to include this in your therapy. Meditation.

 

References:

  1. Checkin et al. 2016, Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. March 22/29. doi:10.1001/jama.2016.2323
  2. Schutze et al. 2010, Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. January vol 148, page 120-127. doi.org/10.1016/j.pain.2009.10.030