We’ve had the pleasure of working alongside a shoulder surgeon, and we have therefore treated our fair share of people who have undergone a rotator cuff surgery. What’s the rotator cuff you wonder? See this past blog post for an explanation: My Shoulder Hurts, But What is a Rotator Cuff?
What’s the purpose of this post you wonder? We’re going to try and clarify the ins and outs of a rotator cuff repair. There’s LOTS to know, and if you’re going to go through any surgery, it’s nice to feel prepared!
How do I know if I even need a rotator cuff surgery?
Typically, to qualify for a surgical rotator cuff repair, the following statements are true:
Do I have to do pre-operative physiotherapy?
In short, yes, you should. It helps in the following ways:
On this note, we wanted to mention a few other things.
Sometimes, your rotator cuff is injured from an accident, like a fall. Sometimes during these accidents, additional body parts, like our wrists (for example), are injured. Additionally, it’s possible that shoulder pain alone can cause us to alter our posture, stop moving, or over-protect other joints.
We strongly recommend that you properly rehabilitate all other injuries/pains/tight feelings as much as possible before surgery. Rehabilitation may include bouts of physical therapy, massage therapy, or self-management. Your body will be working very hard to heal your shoulder after surgery, so you’ll want to make sure it only has to worry about one single injury.
To reiterate the final point above, physiotherapy can eliminate the need for surgery in the first place! This is true even if your MRI shows a tear in your rotator cuff. In fact, this is even true if you rip a rotator cuff muscle clean off the bone. Everyone is an individual. Everyone’s body heals differently. Everyone has different goals. And, as many of you may remember, imaging findings DO NOT correlate with pain and function. See here: Try Not to Become a V.O.M.I.T.
What else should I do before rotator cuff surgery?
How is rotator cuff surgery performed?
Every surgeon has their individual preferences, however, most surgeons do arthroscopic rotator cuff repairs. Arthroscopic means that the surgeon will use a tiny camera called an arthroscope. The arthroscope is inserted into your shoulder via a fairly small incision. The tools required to fix your rotator cuff are inserted through additional small incisions. Therefore, you’ll likely only have a few small incisions around your shoulder!
To repair the rotator cuff muscle/tendons, the surgeon will use ‘sutures’ and ‘suture anchors’ (or ‘anchors’ for short). The sutures and anchors will help to hold tears together or help to attach a torn tendon securely to the bone. These sutures and anchors are not removed. They are safe to stay in your shoulder for life.
Before we get into the next part of this blog post, it is important to note that everything in this blog post is for information purposes only. This blog post is not intended to be strict medical advice. As previously mentioned, everyone is an individual, and therefore, individual variances do occur. It is important to consult your physiotherapist, surgeon, or doctor for the most applicable advice for you.
What does the typical rehabilitation process look like?
Commonly, postoperative care looks something like this:
How long does it take to heal after a rotator cuff repair surgery?
In uncomplicated cases,
That last point carries some weight to it, and for many reasons! Due to the lengthy recovery associated with a rotator cuff repair surgery, here are some things to consider:
What exercises are safe to do right away after a rotator cuff surgery?
Although you should not move or exercise your shoulder/rotator cuff muscles immediately after surgery (see above), there are a few things you can work on right away. See a physiotherapist and get started on exercises for:
How much function and how little pain can I expect at the end of my rehabilitation?
Alas, the loaded question.
Again, everyone is an individual, everyone heals differently, and therefore final pain and function is highly individualized.
Here are some things we consider:
What are the potential complications associated with rotator cuff surgery?
All steps will be taken to limit complications postoperatively, however, it’s important to understand the possibilities. Complications include:
There’s a lot of information in this blog post. But there’s also a lot to know. Be informed, ask questions (even the hard ones), and look out for yourself.
Let us know if you thought this blog post was helpful, and we will try to post new ones outlining the helpful points for other types of surgeries!
Do you have a rotator cuff injury and need to know more? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Tyler Allen & Mike Major
Physiotherapists at Strive Physiotherapy and Performance
General Physio Myth:
Myth: I must get a doctor’s referral to see a physiotherapist.
Fact: In Ontario, physiotherapists are considered primary health care practitioners. This means that they are equipped to be your PRIMARY contact in the healthcare system. So, in short, you definitely do NOT need a referral to see a physiotherapist. That being said, some insurance companies may still require that you accompany your physiotherapy claim with a doctor’s referral. This is something that will hopefully change in the future.
Human Body/Position Myths:
Myth: My bad posture is causing my back pain.
Fact: Most of the scientific evidence does NOT support the claim that back pain is caused by posture. This alone could be a blog post. In fact, here’s an excellent one from Todd Hargrove on ‘Better Movement’.
That blog post provides multiple references to show that:
Most studies show no correlation between posture and pain
Some studies do show a correlation between posture and pain, however, correlation does not mean causation (this means that people who sit with ‘poor’ posture may also report back pain, but no study has shown that the actual CAUSE of their pain is their posture (pain is very multifactorial)).
That blog post also provides possible reasons as to why the research says this and what we can do about it! Go read it!
Tyler’s additional notes: Research says there’s no such thing as a “bad” posture. However, if you think your posture is causing you pain, MOVE! Although 1 particular posture isn’t “bad”, remaining completely static in any single posture is likely to cause some discomfort.
“The only GOOD posture is one that is often changing!”
Myth: The result on my MRI/x-ray/scan (i.e. a disc herniation), is the source of my pain.
Fact: I’ve written a full blog post on this (see here: Try Not To Become A V.O.M.I.T), and I’m pretty passionate about this topic. In short, multiple studies, on most body parts, have shown that many scan findings are also present in healthy people with NO PAIN. This means that in most cases, imaging results DO NOT CORRELATE with pain and function (for example, ‘severe arthritis’ shown on an x-ray does not mean you will have ‘severe pain’ or a ‘severe loss of function’).
Tyler’s additional notes: Pain science education is a crucial part of understanding the source of your pain. Melissa (a local counsellor), and Mike wrote an excellent blog post about pain, here: Why is My Pain So Stubborn
Myth: Our joints go out of alignment, or out of place (i.e. My back/hip is out of place, so I need to get it adjusted back into place).
Fact: Sure, our joints can go out of place. It’s called a dislocation, and it’s a serious injury. It did not happen just by walking around. If you had a significant trauma or accident, go to the hospital for proper evaluation. If you hurt something as part of an everyday movement, it’s highly unlikely that something is out of place. Our joints, especially our vertebrae (back joints), and hip joints are very strong and robust. They don’t go out of place. This started (hopefully) as a poor miswording, and things have gotten a little carried away!
Myth: The crack I hear/feel during a manipulation is my joint going back into place.
Fact: Since nothing was out of place to start with, nothing was put back into place with the manipulation. The noise you heard was most likely air being released from the joint, and the reasons you feel better afterwards can be related to other factors (i.e. supraspinal effects (like endorphin release), and decreasing muscle tone).
Myth: Sitting on an exercise ball at work is giving me a good core workout.
Fact: Here’s the conclusion from a study comparing sitting on a ball vs. sitting on a stool: “prolonged sitting on a dynamic, unstable seat surface does not significantly affect the magnitudes of muscle activation, spine posture, spine loads or overall spine stability.” (McGill et al., 2006). Therefore, no, unfortunately sitting on an exercise ball while you work does not give you a six pack.
Reference: McGill, S. M., Kavcic, N. S., & Harvey, E. (2006). Sitting on a chair or an exercise ball: various perspectives to guide decision making. Clinical Biomechanics, 21(4), 353-360
Tyler’s additional notes: Thank you, Krista (my beautiful wife), for trying to help spread the word on this one!
Myth: Therapeutic ultrasound is an effective modality for treating my pain/injuries.
Fact: In 2001, a review on the effectiveness of therapeutic ultrasound was conducted and published in “Physical Therapy” (a scientific journal). Here is the conclusion: “There [is] little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing”.
Source: Robertson, V. J., & Baker, K. G. (2001). A review of therapeutic ultrasound: effectiveness studies. Physical Therapy, 81(7), 1339-1350.
Tyler’s additional notes: This was 16 years ago, and yet therapeutic ultrasound is still widely used. In my opinion, we should switch our focus to more movement, exercise, and pain science.
Myth: No pain, no gain.
Fact: Modern pain science research has taught us that the “no pain, no gain” mentality is often not effective. When healing from most injuries, I prefer the saying: “Know pain, know gain”. Use your physiotherapist to help you understand what levels/locations/occurrences of pain are safe, and which are not.
Tyler’s additional notes: Admittedly, there are cases where pain may be necessary to make appropriate changes with rehab (i.e. after a knee replacement, or in cases of longstanding (chronic) pain), but that doesn’t mean that pain science doesn’t play a role. Also, we treat individual people, not injuries. Nothing is one size fits all.
Thank you for reading! If you have any other potential ‘myths’ you are curious about, feel free to ask us on social media! Our Facebook page is ‘Strive Physiotherapy & Performance’, or you can find us on Instagram @striveptandperf.
Be informed, and keep moving!
Strive Physiotherapy & Performance
Follow us for great information, news, and adventures as we grow.