Patients whose rotator cuff injury limits their ROM and strength typically have a long road to recovery. Fortunately, making the patient an active participant in their recovery speeds improvement while preserving your utilization stats. According to a 2016 study published in Clinical Rehabilitation:
Self-managed home exercise programs show similar outcomes to those directed in-office. (1)
Rotator cuff rehab should begin with gentle range of motion exercises such as Codman pendulum, wall walking, towel and GHIR stretches. Rehab should progress to focus on restoring adduction, internal rotation and external rotation. This may be accomplished via a cross body stretch and sleeper stretch.
Clinicians should address any likely concurrent deficits in scapular mechanics by implementing a scapular dyskenesis protocol including YTWL scapular depression and serratus anterior activation exercises. Stabilization exercises will progress from isotonic strengthening to more sport-specific actions, including eccentric strengthening and endurance. In throwers, clinicians should correct deficits of hip mobility or trunk stability.
Once the patient has regained full ROM of the glenohumeral joint and understands how to stabilize their scapula, transition them to progressive resistance exercises for the external rotators, serratus anterior and lower trapezius.
The recent study demonstrated that this type of self-managed program works:
“After six months, the patients in the self-managed exercise group reported a 29.1 point decrease in SPADI score and the patients in the usual physiotherapy treatment group reported a 23.5 point change.”
The ChiroUp protocol for rotator cuff tendinopathy is up-to-date with current “best practices”. Once you make a diagnosis, you can be confident that you are prescribing the most appropriate exercises and activity modification advice. Plus, Outcome Tracker® allows you to measure results so we can all learn from each other as a fellowship of like-minded, evidence-based providers working together to make our profession the undeniable best choice for patients and payors alike.
- Littlewood, C., Bateman, M., Brown, K., Bury, J., Mawson, S., May, S., & Walters, S. J. (2016). A self managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clinical Rehabilitation, 30(7), 686-696.
About the Author
Dr. Tim Bertelsman
DC, CCSP, DACO
Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.
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