Every patient’s rotator cuff tear is different. A good rehabilitation plan is always a personalized one that takes into account the differences and the other deciding factors. The successful outcome of the surgery is largely dependent on the post-operative rehabilitation plan and the best rehabilitation program for rotator cuff tear allows the tendon’s bone to heal thereby preventing shoulder stiffness. There are a number of factors that the rehabilitation plan should be dependent on like the type and size of the tear, the surgical technique used, the tissue quality, the number of tendons involved, the patient’s age, secure repair, the patient’s activity level, and their personal goals and other co-morbidities including increased BMI and diabetes.
Rehabilitation can be a very difficult phase but when coupled with good rest, nutrition and physical therapy can work wonders in treating rotator cuff tears. Post-operative rehabilitation for Rotator Cuff Surgery are of two types; Conservative approach that is best suited for complex or massive tears or when there is tendon involvement, or in patients over the age of 50 with poor tissue quality. In the case of acute tears, a slower rehabilitation protocol will be needed to protect the surgical repair. In the case of patients that are prone to developing postoperative shoulder stiffness will need early mobilization. The accelerated methodology of rehabilitation is mostly used for patients under the age of 50 and those having small tears and better tissue quality.
The patient’s periodic assessmentsare what determines the various rehabilitation phases and ideally each phase of the rehabilitation treatment should have a home exercise program as well. Only an experienced therapist can help decide when the patient can progress from one phase to the next. Regular follow up is another integral part of the rehabilitation plan that will contribute to a complete recovery after Rotator Cuff Surgery.
A typical rehabilitation program is often divided into 4 major phases; the immediate postoperative period, the protection and active motion period, early strengthening period and advanced strengthening period. In the first phase which is the immediate postoperative period the maintenance and protection of the rotator cuff repair can involve sling or braces, sleeping with a sling in place in a reclined position and keeping the sling on at all times except during grooming or exercising. Cold therapy can be used for pain relief and better healing. Exercises in this phase can be cervical spine stretches, pendulum exercises or a range of motion exercises involving elbow, hand and wrist. In the second phase which is from week 4 to 10 after surgery the aim is to slowly restore the passive range of motion. There will be a gradual progression to finally incorporate specially formulatedscapulothoracic and submaximal isometric exercises.
The main objective in the third phase which is from week 10 to 14 is the beginning of muscle strengthening activities. Once a full active range of motion is established restoring strength and muscular endurance will follow. Exercises designed for better neuromuscular control will be done and this could mean a gradual return to routine activities. Previous functionality levels can be restored completely in the fourth phase which is from week 14 to 22. Once the normal muscular strength and endurance is regained sporting activities may be resumed as well. Extreme care should be taken to never overdo anything in any of the phases even if you feel a little better. Your therapist is always your best judge in this case.
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