The right load | Torn rotator cuff – physiotherapy, exercises and healing

The right load

The shoulder joint consists of the socket (acromion), shoulder blade, collarbone and upper arm. All joint partners are responsible for the movement of the arm, and each individual joint partner can cause limited movement or pain in the event of a disorder. Depending on whether surgery or conservative treatment has been performed, the load capacity is determined.

• In a conservative treatment, cortisone injections are given in addition to physiotherapy to reduce inflammation and pain. The treatment lasts for several weeks and should above all lead to an improvement in movement and pain relief. However, since there is no bandage or splint, a continuous load is constantly present, which minimizes the success of the therapy.

  At the beginning of the therapy, the shoulder is mobilized both passively and actively. If this works almost painlessly, small weights can be used. With increasing strength and mobility, the range of movement and training weight is adjusted and progressively increased.

• After a surgical treatment, the patient is given an abduction pillow, which prohibits adduction and further movement over the adjustment of the pillow.

  The movement may only be done with the help of a physiotherapist, because the patient would have immediate muscle tension. At the beginning only purely passive measures are allowed. The positioning in the abduction pillow lasts for about 6 weeks and the surgeon creates an individual treatment plan tailored to the injury.

  This plan should be followed by the therapist and the patient. As soon as the abduction pillow can be removed, the patient can move freely. Furthermore, the carrying of loads and the supporting of the patient should be avoided. The doctors do not allow full load capacity for at least six months.

Exercises for at home

In the case of a rotator cuff rupture, some exercises are very effective and should be performed regularly at home. In particular, the surrounding musculature is trained in order to reduce the load on the shoulder joint. Further exercises can be found in the articles: “Rotator cuff rupture – exercises to imitate” and “Exercises for the rotator cuff“.

• Neck muscles: In supine position lift the head and try to hold for several seconds. The cervical spine is stretched. Slowly increase the duration.

  In the same way in the seat, place your hand against your cheek, rotate your head to one side, build up tension against your hand and hold for a few seconds.

• Upper back: The upper back is also extremely important, because the muscles in the GCS and between the shoulder blades should be strong enough to move the shoulder joint as much as possible without getting out of the way of the back. Especially the rhomboids are important. Exercises Rhomboids: keep upright seat, abdomen and back tension, pull elbows backwards at a 90° angle on the body and pull shoulder blades together (rowing movement).

  Alternatively, the exercise can also be performed in the prone position and reinforced with a bar or theraband. The stick is pulled into the neck and the view is directed downwards.

• Upper back: The latissimus starts at the shoulder and pulls the complete lateral to central back along and ensures that the shoulder is pulled down. If the musculature is too weak, the positive aspect of pulling down can be cancelled and should be trained accordingly.

  In case of a painful shoulder, the arm can be placed on the edge of a table with approx. 80° flexion in the elbow joint. This then exerts pressure on the table top. In the case of a painless freedom of movement, the muscle can be trained differently: sit upright, keep abdominal and back tension, stretch arms upwards and pull elbows down at a 90° angle on the sides, thereby pulling shoulder blades together (lat pull).

• In the acute phase, the pendulum exercise is a very pleasant relief exercise, provided that the arm is not to remain fixed in an abduction cushion. Just let the arm hang next to the body and swing.
• To loosen the entire shoulder-neck area in between, circle the shoulders or stretch the trapezius by stretching one arm downwards and moving the head to the opposite side.