Getting tough on shoulder injuries
In the wake of rotator cuff surgery, traditional physical therapy might be enough for some people -- those who simply want to swing a tennis racket or take a book off a shelf. But for more macho types, those whose proclivities run toward hauling rebar and installing drywall, “traditional” isn’t always enough.
They appear to need barbells.
To regain adequate strength, flexibility and range of motion in their shoulders, physically strong people such as day laborers should go for intense training with free weights, a new study suggests. Similar exercise could also benefit those with less demanding jobs.
“For somebody who has any kind of activities in life, it’s going to take work to get your body physically capable of doing that,” says Jamie Stark, author of the study and director of research and development for Illinois-based ATI Physical Therapy. Some bodies -- baseball pitchers, swimmers, construction workers -- need to be stronger and more capable than, say, those who spend eight hours at a computer.
Four tendons constitute the rotator cuff, which connects the upper arm bone, or humerus, with the shoulder blade. Through repetitive movement or a fall, one or more of those tendons can tear, sometimes requiring surgery. Tennis players and other athletes who depend primarily on their upper bodies, plus people with physically demanding jobs, are especially at risk.
The study, presented at the annual Experimental Biology meeting last month, was conducted from 2000 to 2004. It followed 42 workers (nearly all men age 19 to 59) who had had surgery for job-related rotator cuff injuries and who were unable to work after conventional physical therapy.
A typical therapy program, according to Phil McClure, professor of physical therapy at Arcadia University in Glenside, Penn., begins with passive motion exercises -- the therapist or pulleys raise the arm but the muscle attached to the torn tendon isn’t actively engaged. That’s followed by having the patient raise the arm, first with no resistance, then with some resistance. Gradually more resistance is added, using weights or elastic bands to increase tension in the muscles. The final stage includes building muscle endurance and adding functional exercises.
In the study, participants’ workouts lasted four hours a day, five days a week for about six weeks. They began with warmups, stretching and core exercises for balance and proper technique. The weight portion of the workouts exercised both upper and lower body muscles, emphasizing functional movements. Typical moves included overhead presses, squats and dead lifts.
To better replicate what workers do on the job, Stark emphasized “multi-joint and plane movements,” with free weights instead of machines, so that more muscle groups were engaged. “We use compound movements -- the idea is that it’s much more dynamic, and they don’t learn everything in a single plane.” One exercise, for example, consisted of hoisting dumbbells on and off the rack, simulating lifting and carrying.
At the end of the study, workers were tested to determine their level of physical function. Ninety-six percent met or exceeded their previous levels of job-related physical function before surgery, and 90% returned to work, 75% at their previous jobs. During a two-year follow-up, the re-injury rate was 7%.
The study’s rigorous workout may be crucial for regaining strength after a rotator cuff injury, says McClure. “When certain areas of the body lack flexibility, strength and endurance, other areas take up the slack,” he says. “If you’re deconditioned in other areas [such as the back, spine and hips], it puts more load on the shoulder.”
Being in better condition overall, he adds, “the rest of your tissues are able to function better so that one isolated joint injury is less of a relative blow to the whole system.”
Some experts were skeptical about the study’s high success rate. Dr. W.Z. (Buz) Burkhead, president of American Shoulder and Elbow Surgeons, points out that the study did not include a control group. “You could take the same number of patients with the same size rotator cuff tear, and half of them do this program and half not to see if there was any measurable difference.”
Still, exercise is “hugely important” in rehabbing an injury such as a rotator cuff, says Burkhead. “But you have to, in a really graded fashion,” he says, “add stress and add weights to the repair site to avoid overloading it and re-tearing the tendon.”
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