A conservative therapy is particularly suitable for smaller ruptures where pain is the primary concern. Physiotherapeutic exercises cannot restore the original anatomical state, but they can prevent joint stiffness through passive mobilization, painless movement exercises, strengthening and stretching of the muscles. The aim is to reduce pain and regain full mobility.
In the beginning, the physiotherapist releases tension in the muscles and performs passive, low-stress movements. Once the normal range of motion has been largely restored, active training begins. The physiotherapist proceeds from proximal (close to the trunk) to distal (trunk). This means that the chest and trunk muscles are strengthened first in order to correct or prevent postural disorders.
Contents of the physiotherapy
- Pain relief
- Manual therapy
- Muscle building
- Mobilization
- Physical therapy
- Coordination
In manual therapy, there are various treatment techniques for treating functional limitations in the musculoskeletal system. In the case of a rotator cuff rupture, the tendons can be treated by targeted friction. In the case of friction, the therapist applies pressure to the tendon at right angles to the course of the fibers in order to stretch it.
The blood circulation and flexibility of the tendon is thereby promoted. This technique can be quite painful. Joint mobilizations are also possible, especially if movement is restricted after prolonged rest or if there are evasive mechanisms.
The therapist grasps the joint close to the joint gap and positions it in such a way that at the end of the current range of motion, he improves the sliding of the joint surfaces over each other. This gliding is physiologically necessary to enable movement in the joint. Through immobilization or diseases in the joint, the sliding behavior can change and be improved again through targeted manual therapy.
Manual therapy is very much influenced by the work of the therapist. However, it also happens time and again that the patient has to perform active exercises or is given this as homework. Manual therapy is carried out by physiotherapists with appropriate training and must be prescribed by the doctor.
You can find more information in the article: Manual TherapyFor rotator cuffs, two groups of patients are in the foreground: athletes who have injured their shoulder due to trauma and persons with degenerative changes that can lead to a spontaneous tear. In both cases, the rehabilitation therapy focuses on muscle training after the tear has healed. Targeted training of the shoulder-stabilizing muscles can protect the joint from secondary diseases such as arthrosis.
The original mobility and strength is regained and new tears can be prevented. Particularly for athletes, training can also be carried out in a sport-specific manner, so that the patient is directly and specifically prepared for the stress in his or her sport. The muscle build-up training can only take place when the rupture is released for exercises again and the shoulder is sufficiently resilient.
The intensity of the exercises is increased in the course of the therapy, so that muscle build-up by training with the weight of the arm can be sufficient at the beginning, while weights or even equipment-supported training can be considered later. During a physiotherapeutic follow-up treatment, exercises are worked out which the patient should definitely do at home in order to achieve an optimal training effect. Strength training to build up muscles is usually done in 3-4 sets of 8-12 repetitions and should be demanding.
The technique is always in the foreground. Exercise 1: The patient sits on a chair, for example, and supports himself with his hands on the sides of his buttocks. Now the patient presses his arms firmly through so that his back is stretched upwards.
Only then are the muscles of the shoulder trained. The focus here is on stabilizing the shoulder blade and centering the head of humerus in the shoulder joint. Exercise 2: In the first few weeks, for example, shoulder circling is a useful exercise.
The patient sits on a chair, lets his arms hang to the side and begins to move his shoulders backwards and downwards. Exercise 3: Shoulder lifting is just as suitable: the patient alternately lifts the shoulders to the ears and then presses them down.Exercise 4: To practice adduction (pressing the arm against the body), the patient sits on a chair, for example, with a towel clamped between elbow and waist. The elbows are bent about 90 degrees – then the patient presses the towel with his arm against his body.
Exercise 5: The external rotation can be trained by the patient sitting down and bending the arms next to the body at the elbows 90 degrees. The elbows touch the hips and now the patient rotates the arms outwards and then inwards again. In the next step isometric exercises are performed: Exercise 6: A Theraband is attached to a rung at hip level of the patient.
The patient grasps the ends of the Theraband, the shoulders are in neutral position. Now the patient pulls the Theraband towards him and releases the tension afterwards. All exercises must also be practiced by the patient independently – even after the symptoms have subsided.
In addition, electrotherapy, manual therapy, taping and physical measures can be applied. If there is no success after six months, an operation will be considered. Further exercises can be found in the articles:
- Rotator cuff rupture – exercises to imitate
- Exercises for the rotator cuff
- Torn rotator cuff
In physical therapy, for example, heat or cold applications, baths or even a sling table are used.
Electrotherapy is also a part of physical therapy. In the case of a rotator cuff rupture, electrotherapy is an ideal way of providing targeted support for the structures of the shoulder joint. The joint is better supplied with blood by means of electricity, and pain and inflammation of the tendons or surrounding structures can be reduced.
Heat applications are particularly suitable for tensions of the surrounding muscles. The rotator cuff rupture can greatly restrict the mobility of the shoulder joint. Gentle mechanisms and reflective muscle tension can lead to tension in the entire shoulder and neck area, which can be treated with red light, hot air or fango as part of physical therapy.
Cold applications are used especially for acute irritations, but also during therapy. In the case of friction treatments at the tendon attachments, alternating strong cooling, for example with an ice lollipop, can alleviate pain during treatment, stimulate the blood circulation and improve the effect of the therapy. There are a variety of other therapy options in physical therapy. However, the above-mentioned measures are particularly suitable for treating a rotator cuff rupture.
