Franklin Chiropractor | Rotator Cuff
About your problem Rotator Cuff StrainThe term “Rotator cuff” describes a group of four small muscles that hold your shoulder in its shallow socket while larger muscles move it. Strains and injuries to the rotator cuff are the most common cause of shoulder problems, accounting for 4.5 million doctor visits per year. Injuries are classified by the amount of damage as “partial tears”, “full thickness tears”or “ruptures”. A “partial tear” means that one side of your tendon has been partially frayed. A “full thickness tear”, sometimes called a “complete tear”, describes a hole or slit in your tendon, much like what would be created by running a knife length-wise down a rope. A “rupture” is the most serious injury and means that your tendon has been torn into two pieces. Less than 10% of rotator cuff tears are the result of an acute injury like falling, pushing, pulling, throwing or lifting. The vast majority of injuries are the result of repetitive strains over a long period of time. One of the most common reasons that patients develop a rotator cuff tear is something called ”impingement”. Impingement basically means that the area where your rotator cuff tendon lives has become too crowded and the rotator cuff tendon is being pinched each time you raise your arm. Those who perform repeated overhead activities are at greatest risk for impingement and rotator cuff tendon problems. This includes athletes who play baseball, volleyball, tennis, rowing, weight lifting, swimming and archery, and jobs that include carpentry, painting, wall paper hanging, cleaning windows and washing/waxing cars. Other known risk factors for rotator cuff problems include smoking, obesity, high cholesterol and prior cortisone injection. Patients who have suffered an acute rotator cuff injury often report a “tearing” or “snapping” sensation accompanied by severe pain and weakness. Most chronic strains begin silently with symptoms becoming more evident as the tear progresses. Pain is often localized to the front and outside of your shoulder but can sometimes radiate down your arm. Symptoms are usually aggravated by overhead activity and may progress to the point that you have difficulty raising your arm overhead. Pain is often worse at night, especially when you lie on the affected shoulder. Be sure to tell us if you suffer from significant neck pain, shortness of breath, chest pain or chest pressure. Young patients who have suffered an acute tear or rupture may require surgery, while most others will benefit from conservati ve treatments, like the type provided in this office. Be sure to avoid painful overhead activity or carrying heavy objects. Try not to sleep on your irritated side, especially with your arm stretched overhead. You may benefit by sleeping on your unaffected side with a pillow between your arm and trunk. Smokers should consider a program to help them quit, and overweight patients will recover quicker if they begin a diet and exercise program. Performing your home exercises is especially important. Our TreatmentHere is a brief description of the treatments the Franklin chiropractor may use to help manage your problem. 1.Joint Manipulation -Your Franklin chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your Franklin chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any“restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints. 2.Therapy Modalities -Your Franklin chiropractor may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed. 3.Myofascial Release -Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your Franklin chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft -tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility. 4.Therapeutic Exercise -Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your Franklin chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Your Home ExercisesPatients often ask “What caused my problem and how do I keep it from returning?” Sometimes the origin of a condition may be easily identified as an accident or injury. More often, the exact cause is more difficult to pinpoint because the problem was generated by a series of seemingly harmless events and circumstances (i.e. your posture, increased activity, mild repetitive strains, etc). Most conditions are started by a “recipe” of irritants rather than any single “ingredient”. Muscle, bone, joint and nerve problems begin when life’s physical demands exceed your bodies tolerance for those challenges. So the answer to the second half of the “…and how do I keep it from returning” question is answered by increasing your flexibility and strength, so you can increase your “thres hold” for future injury. When your injury threshold is greater than life’s demands-you win and stay healthy! The following exercises have been specifically selected to assist with your recovery and help minimize future problems. Exercises should be performed slowly and within a relatively comfortable range. Maintain good posture and breathe naturally. Do not hold your breath. Unless otherwise instructed, stop any exercises that cause pain, or radiating symptoms. Phase I1.YTWL Scapular Depression -Stand with your straight arms raised above your head in a “Y” position. Squeeze your shoulder blades together and downward throughout the following sequence of movements. Lower your straightened arms to shoulder level, into a “T” position. Next bend your elbows so that your fingers are pointing straight up while slightly lowering your elbows to make a “W”. Finally, while keeping your elbows bent 90 degrees, lower your arms to your sides so that your elbows are touching your ribs to form an “L” on each side and squeeze. Hold each position for 1-2 seconds and repeat 3 sets of 10 repetitions, twice per day or as directed. 2.Corner Pectoral Stretch -Begin standing, facing a corner with your palms on the walls above head level. Step toward the corner and “lean in” to stretch your chest muscles. Against the resistance of the wall, attempt to push your hands into the wall and toward each other for 7 seconds. Relax and “lean in” to increase the stretch. Lock into this new position and repeat 3 contract/ relax cycles, twice per day or as directed. Franklin Chiropractor 3.Glenohumeral Internal Rotation -Begin sitting or standing with good posture. Place the affected arm behind your back and reach towards your opposite hip. Using the unaffected arm, gently pull the wrist of your affected arm further toward your opposite hip. A stretch should be felt in the affected shoulder. Pull gently to the point of tightness ten times. Each pull should be slow and stopped if you feel a sharp pain. This stretch should be performed for ten repetitions, once per hour or as directed. 4.Codman Pendulum – Lean over a table using the uninvolved arm for support as shown. If directed, you may hold a light weight in your hand to increase traction. Allow the involved arm to hang freely. Use your torso to swing your involved arm in a clock-wise circle for 50 repetitions. Repeat in a counter-clockwise circle for 50 repetitions. Perform 50 repetitions in each direction twice per day or as directed. Phase IIThe following Phase II exercises will be started at a later date as you progress. Do not begin Phase II exercises until you are directed to do so by our office. You will continue your Phase I exercises until otherwise directed. 1.Low Row – Attach the center of an elastic exercise band to a doorknob or other sturdy object in front of you. Grasp one end of the band in each hand and with straight arms at your side, stretch the band backwards. Keep your palms facing backward and arms pointed straight down throughout the exercise. Return to neutral and repeat 3 sets of 10 repetitions daily, or as directed. 2.Brugger with Band -Begin sitting or standing with an elastic exercise band wrapped and secured around your palms. Begin with your arms at your side, elbows bent, forearm’s pointing forward. Move your hands apart from each other to maximally stretch the band while simultaneously rotating your palms out, straightening your arms, and pinching your shoulder blades together as your hands move behind your hips. Return to the start position and repeat 3 sets of 10 repetitions daily, or as directed.
3.Eccentric Supraspinatus -Begin standing, holding a weight with your arm outstretched at a 45 degree angle in front of you at shoulder level. Your thumb should be pointing down. Slowly lower the weight to your thigh at a count of 4 seconds. Use your “good” arm to remove the weight from your hand and return the weight back to your “affected” hand in the starting position. Repeat 3 sets of 10 repetitions daily, or as directed. 4.Eccentric Scapular Stabilizers -Begin in a side lying position holding a weight, with your arm outstretched toward the ceiling. Slowly lower the weight to the floor at a count of 4 seconds. Carefully return your arm to the starting position by keeping it close to your body. Repeat 3 sets of 10 repetitions daily, or asdirected. 5.Eccentric Shoulder ER’s -Begin in a side lying position holding a weight with your arm on your rib cage, elbow bent to 90 degrees, forearm pointing straight up. While keeping your arm on your ribs, slowly lower the weight toward the floor at a count of 4 seconds. Use your “good” arm to remove the weight from your hand and return the weight back to your “affected” hand in the starting position. Repeat 3 sets of 10 repetitions daily, or as directed.