Author: Dr. Dan Witte

The Importance of Adequate Sleep

February 21, 2023

We have been told by our doctors for years that eight hours of sleep per night is necessary. They continue to preach this, even today. While we are all aware of the eight-hour threshold, many of us may not be reaching that each night. And some of us may not understand why the eight hours is so necessary. With this blog, we will dive into the importance of adequate sleep, what constitutes a good sleep, and steps we can take to make sure we are getting enough sleep for proper function.

Why is sleep important?

                There are many benefits for our minds and bodies that sleep can provide. Sleeping has the ability to reduce stress. If we aren’t getting enough sleep, we tend to have higher cortisol levels due to the irritability we may feel throughout our day. The higher the cortisol levels, the higher the stress or anxiety in our system. Sleep is also known to help maintain an ideal weight. The less sleep we get, the more food we are likely to consume. This increases body weight or BMI and could potentially be detrimental to our health. It is known that our appetite increases when we haven’t received enough sleep and rest, causing us to eat more and gain extra pounds. Finally, sleep has the ability to alter our decision-making.  When we are deprived of sleep, our brain is not functioning at its optimal level, leaving us to make choices that may not be the best for us.

What constitutes a good sleep?

                As mentioned earlier, the best sleep for an adult is going to be between 7 and 9 hours long.  Any more, or less, and you may be looking at some of the issues described above. You’ll know you’ve had enough sleep when you can wake up feeling refreshed and re-energized, ready to take on the day! While some sleep all night, it may not be a restful sleep. Some may suffer from disorders that prevent restful sleep, such as sleep apnea, and continually feel fatigued throughout their day. Tests can be administered to determine whether or not a person suffers from one of these disorders. It is said that a person may enter in and out of “cycles of sleep” throughout the night with about 25% of your sleep being considered “deep”. As the body spends most of the night sleeping, it has the ability to heal and repair muscle tissue and balance hormones. 

How do we get enough sleep?

                The easiest adjustment to ensure plenty of sleep is changing your bedtime. Don’t be afraid to jump into bed earlier to make sure you hit at least the 7 hours of recommended sleep. Setting an alarm 10-15 minutes before bedtime may be a good reminder to wind down for the night. Creating a good sleeping space will also help you obtain the hours of sleep needed for one night. Put up some dark curtains, make the room a comfortable temperature, and utilize a fan or sound machine for a gentle, steady noise you can sleep to. If you have a favorite blanket or pillow, make sure those are nearby for optimal comfort. Finally, avoid electronics. The blue light from the screens is known to keep your brain firing and your body wide awake. Place all electronics out of reach and consider reading before your head hits the pillow. This will help your body move towards a relaxed state and prepare for a good nights’ sleep!

Resources:

https://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleep

https://www.bannerhealth.com/healthcareblog/teach-me/how-sleep-can-affect-stress#:~:text=Sleep%20decreases%20cortisol%20levels,in%20anticipation%20of%20a%20fight.

https://www.healthline.com/nutrition/sleep-and-weight-loss#:~:text=Getting%20enough%20sleep%20may%20help%20prevent%20increases%20in%20calorie%20intake,intake%20(%2016%20%2C%2017%20).

https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

CMC Joint Arthoplasty Rehab

February 7, 2023

Did you know that one of the most common joints to get arthritis in your body is at the base of your thumb? Many of us as we age see a “squaring” of the base of our thumb joint. This is often due to arthritis and if painful and restrictive could mean that joint needs replaced. Replacing it often decreases your pain and improves your function with things like grip, pinch, and grasp. While the surgery helps to improve these things, it often requires some rehab afterwards to improve your function and maximize your potential.

After surgery you are typically in a splint for 4-6 weeks consistently. After that time your surgeon will speak with you about weaning off of your splint and starting for physical therapy. Physical therapy typically starts with ensuring proper motion of your neck, shoulder, elbow, and wrist. These joints are often not used as you are recovering and could have become weak and stiff. Therapy also will discuss your sleep pattern, diet, and activity modification at home. Therapy will also spend the first few visits working on improving your range of motion passively and within the restrictions of your replacement.

About 6 weeks after surgery you can begin to work on range of motion actively. Your therapist will help you with the progression and restrictions of this new phase. As your motion improves you will be instructed to begin working on very light functional activities, such as writing. As these things improve over the next month you will be able to move into a strengthening phase.

About 10 weeks after surgery, you can begin to strengthen your thumb and hand. Working on gripping, pinching, and grasping on introduced. By this point you are nearly out of your splint with most activities and trying to start to return to normal activities without compensation. Most patients are back to using their hand with normal daily activities at about 12 weeks and will regain fully restored functional use of their thumb by about 6 months.

If you are have had a CMC replacement or are considering it please reach out to Witte Physical Therapy with any questions you may have!

https://www.verywellhealth.com/carpometacarpal-joint-arthroplasty-5208414#:~:text=CMC%20joint%20arthroplasty%20is%20a,treatments%20fail%20to%20relieve%20symptoms

https://www.paragonorthopedic.com/client_files/File/ThumbCMCPostOp-jan2019.pdf

https://www.ofc-clinic.com/sites/ofc-clinic.com/files/mcnamara_protocols/McNamara-CMC-arthroplasty-Protocol-McNamara.pdf

Total Hip Replacement Rehab

January 31, 2023

Have you been suffering from hip pain? Has it been ongoing for years? Is it limiting your ability to enjoy life? Total hip arthroplasties have been a cure for hip pain since the late 1800’s; however, the FDA approved the first total hip operation in the USA in 1969. Since then, the number of total hip surgeries performed in the USA has grown to nearly 400,000 per year, making it a very common operation today. But what does a total hip arthroplasty entail? How do you know if you need one? Will therapy be recommended afterwards?

                The hip joint is a ball-and-socket joint. It is formed by the acetabulum of the pelvis (the socket) and the head of the femur (the ball), which is the largest bone in the body! The hip takes the brunt of body weight as we walk and complete activities throughout our day. Because of the high demand on this joint, it can have a tendency to wear-down. Arthritis is one of the main reasons for needing a hip replacement. Arthritis can cause excess pain and inflammation in the joint and even limit your motion. This loss of function combined with pain will send patients to the doctor seeking replacement surgery. Fractures can be another reason for a replacement. While fractures typically have the ability to heal without surgical intervention, it becomes more difficult for the healing process to occur in our older age. Weakness within the bones and decreased healing may prompt the doctor to opt for surgery.

A total hip arthroplasty involves replacing the two sections of the pelvis and femur bone that come together to form the hip joint. Both get removed and replaced with metal or ceramic parts to allow for improved function. There are a couple different ways to access the hip joint. Surgeons will choose to use either the anterior approach or the posterolateral approach. With the anterior approach, they make an incision on the front side of the hip and push the muscles aside to reach the bones that need replacing. With this approach, there are some precautions to be aware of following the surgery. You want to avoid flexion and internal rotation (turning your foot inward) at the same time as well as crossing your legs and sitting in low chairs for the first 6 weeks. A posterolateral approach involves an incision on the backside of the hip joint. The doctor will cut through muscle tissue rather than push the muscle aside. The precautions for this approach are similar to that of an anterior approach. Too much flexion, crossing legs, and sitting in low seats or tubs will put you at risk of dislocation.

As with any replacement surgery, your doctor will likely send you to physical therapy afterwards. Each approach has its own protocol in which the physical therapists will use as a guideline to get you back to normal function. Within phase 1 of the protocol, the therapist will work to regain your range of motion and begin muscle activation of the entire leg. Early muscle activation includes isometric training which is engaging muscles without joint movement. The doctor will give you a walker to help with ambulation immediately after surgery. There are no weight bearing restrictions, so as soon as you feel you are able to put all of your weight through your leg, you can! This helps in progressing towards phase 2. Phase 2 of the protocol will include strength training within the entire leg with continued work on range of motion at the hip. Your physical therapist will typically work with you to get you out of the walker and onto a crutch or cane (if needed) at this time. Phase 3 will include resistance training for progressed strengthening of the muscles in the leg. This is also the point where balance training and stretching will be introduced.

Once you have completed each phase of the protocol successfully with your physical therapist, you will be able to make a steady return to your daily activities. You may not be up to jumping right into all the activities you did before surgery, but with a gradual return, you will feel better than ever! If you feel you are in need of exercises or surgery for your hip, consult with your primary doctor, local orthopedic specialist, or local physical therapist. They will be able to help set up a plan that best suits your needs. For a consult with a Physical Therapist, call us at Witte Physical Therapy. We have staff here ready and eager to help you take the first step to recovery!

Tips for Walking on Ice or Snow

January 24, 2023

This time of year we are worrying every week about ice and snow. It seems like lately we are getting more ice than snow and this can create some slippery issues. Let’s talk about some tips to avoid those slips and falls on the ice and snow that can land you in the ER!

Plan Ahead: It is important to plan extra time for your travel. Whether you are driving or walking, slowing down and taking some time can help you avoid the big fall. This extra time also will allow you to take a minute to survey your surroundings and set your course before you take off

Shoe Traction: Make sure you buy and wear the appropriate shoes with the right amount of traction. Avoid heels and wear shoes with rubber or neoprene bottoms for better traction.

Use Caution When Entering or Exiting Your Car or a Building: Use your hands to grab onto handrails, car doors, or the vehicle itself. Keep your hands out of your pockets and available to help. Take your time to make sure you look before you step down or up and keep your center of gravity over the leg you are standing on.

Walk on Sidewalks: Make sure to stay on paths where the snow is clear. Avoid walking over grass, uneven terrain, or large piles of snow or ice. Don’t use your phone when walking.

Walk Safely: It is important to take smaller steps and to stay slightly forward and your toes and soles of your feet. Avoid walking on your heels or leaning back.

Of course we can do all of these great things and still have a slip or fall. If you do fall try not to reach out your hand or arm to catch yourself. Try to make sequential contact with your thigh, hip, or shoulder. Tuck your chin and try to avoid hitting your head on ground.

References: https://www.ehs.iastate.edu/weather/winter/walking#:~:text=Walk%20safely%20on%20snow%20or%20ice.&text=Bend%20slightly%20forward%20and%20walk,your%20thigh%2C%20hip%20and%20shoulder.

Why Start a Wellness Program?

January 17, 2023

There are over 35,000 physical therapy clinics in the United States alone! That is an amazing number of patients coming through looking for help with their pain. In many cases, physical therapists can assist in relieving your pain and symptoms for good. In other cases, it may take further intervention such as injection or surgery. While you may not immediately feel the effects of therapy treatment, it can be very beneficial when the plan of care is followed all the way through. Therapists have the ability to teach you how to stretch, strengthen, stabilize, and even improve your cardiovascular endurance. Continuing with all of these tools, even after you’ve been discharged from therapy, will allow you to keep down a healthy, pain-free path.

                We occasionally see returning patients that have a sudden onset of symptoms similar to, if not identical to, the original symptoms they went to therapy for. There have been many occasions in which the returning patient admits to not complying with the home program the therapist discharged them with. Life tends to get in the way and schedules get busy, lessening the time we have to focus on the exercises that keep us feeling healthy and strong. With a decreased focus on our health, pain tends to slowly creep back into our lives. Wellness programs can be made for just this reason.

                A wellness program is similar to a home program you may receive from your physical therapist. But instead of a handful of exercises tailored to your specific pain, it can encompass all areas of health, as mentioned above. We can create a progressive program that gradually increases in intensity as you stick with it and get stronger. It can be created to fit into your personal schedule, so you won’t feel time is keeping you from staying healthy. With an all-compassing, tailored, easy-to-follow program, we will be able to help you maintain a pain-free, healthy lifestyle and decrease your odds of receiving a more invasive procedure or returning to square one with physical therapy treatment.

                After discharge, it can be common for a patient to forget how to successfully complete all of their home exercises. They may feel lost on what to do once an exercise begins to feel easy. Wellness programs can take the guess work out of your routine. Exercises, number of repetitions, level of resistance, and frequency per week can all be set out in the wellness program for you. With the therapists’ knowledge, they will be able to talk you through how to progress with each of these.

                Physical therapy clinics may have different policies on providing wellness programs. Some may require a visit every couple months to keep up-to-date with your changes in health and progress your program. Others may only need to see you once a year, similar to an annual check up with your doctor. In either case, it is less hands-on than a therapy regimen in which the patient comes into the clinic 2 to 3 times per week. However, it is more engaging than a discharge in which the patient is left on their own with solely the home program.

                If a full wellness program doesn’t suit you, but you feel you may need some guidance from your therapist, you can schedule a clinic session each year. You can discuss all you’ve done since your last visit, how you feel your improving, and areas you feel you are regressing or still need work in. Rather than a full program, the therapist can teach you the few exercises you would benefit from most.

                No matter what stage you feel you are at in the rehab process, your therapist can always be by your side to keep you headed in the right direction. To get set up with physical therapy, a home program, or a wellness program, contact your primary doctor or local physical therapist. Find out what your options are and what path is best for you.

References:

Tips for Shoveling Snow

January 10, 2023

With the winter months upon us, we are now experiencing cold outdoor temperatures, windy nights, and snow! As beautiful as the snow is when it falls, it comes with many challenges, especially for those of us who may be struggling with health. Whether you have to scoop it with a shovel or push a blower through the piles, it requires some physical effort that can be challenging if you are having trouble with chronic back pain. Pain will prevent us from completing many activities or job duties, but for some of us, we feel we have no choice. If we don’t get the job done, who will? So what do we need to watch for when taking care of these more demanding tasks such as scooping snow?

                Posture! Posture! Posture! This is the number one rule when completing any physically demanding task. We, as physical therapists, will discuss this all day long with our patients. Knowing how to maintain proper alignment through the spine, bracing your core, and utilizing the power in your legs will help prevent pain.

 I always start at the neck. Keeping your chin tucked, or pushed back gently, will place your head in a neutral position and take strain off your posterior neck muscles. These posterior neck muscles start at the top of the spine and connect towards the middle of the back or near the shoulders. With these muscles strained, it is likely you will feel discomfort not only in the neck, but also in the regions the muscles attach. You can see the difference between the two diagrams below.

                Next are the shoulders. Your shoulders should always be back! We tell our patients to think about positioning your shoulder blades back towards the spine and down towards the buttocks. This will allow for the chest wall to open up and the postural muscles near the spine to engage. Similar to the posterior neck, by keeping your shoulder blades back and down you are able to keep strain off of the muscles by the spine, allowing for improved function. By using your postural muscles when holding a shovel out in front of you, you may avoid over-utilizing the wrong muscles, such as your neck. Many patients will begin to feel tightness in their upper traps when they don’t have their shoulder blades properly stabilized. The next diagram portrays the difference between a “slumped” back and a “straight” one.

                Now that you know how to obtain the correct posture, the next step is to brace your core. The core consists not only of your “six pack” muscles, but also the deep, inner muscles that sit under the six pack. These muslces are important as they assist in maintaining your posture and providing stability when you go to lift that heavy shovel or push the snow blower. During therapy treatments, we tell our patients to make the “s” sound. As you slowly release your breath and the sound, you will notice some tightening within the lower abdominal muscles by your hip bones. The first step is to practice with the sound. Once you have that down, you can work on engaging those muscles without the sound. The third step would be to complete this “brace” with leg movements. Try to hold it while you complete marches or kickouts. This will prepare you to maintain the bracing while you lift and toss the shovel. This is arguably one of the most important steps as it will protect the spine and allow for proper alignment, decreasing your risk of injury.  

                The last thing to keep in mind when scooping snow is to use your legs! We have two, and they are both made of large bones and muscles, allowing them to take on a great deal of load. In the midst of your manual labor, it is sometimes hard to stop and think about your body positioning. However, if you can get set in good posture before lifting the shovel, you will save yourself from pain or injury. Good posture involves all 3 steps listed above. Tuck your chin, pull your shoulders back and down, and brace your core. At this point, the legs take over the heaviest portion of the movement. Get into a squat position to scoop, and return to standing when transitioning to toss the snow. This allows for the spine to remain straight, the core to stabilize, and the largest leg muscles to work as they should.

                So next time you have a job to do, stop and think about the task at hand. Picture your body positioning as it should be and imagine how completing the task with this body positioning will look. Take the time to get set so you can prevent injury and pain that has the potential to stick around for years. If you still aren’t sure on how to improve your posture or lift properly, discuss physical therapy with your primary doctor. Getting a script for therapy will allow a trained professional to get you on the track to better health not only today, but for years to come.

References:

https://www.physio-pedia.com/Forward_Head_Posture

https://reliva.in/cause-back-pain-poor-posture/

https://cprnj.com/stop-back-pain-with-proper-snow-shoveling-technique/

How to Reduce Holiday Stress

January 3, 2023

We all know how stressful the hustle and bustle of the holiday season can be. Every year, the days seem to tick by a little faster, and it is seemingly harder and harder to keep pace. Between cleaning the house to host the family, cooking for the company potluck, and running through all the stores gathering gifts for the kids, it’s a wonder we make it through! Our bodies cope with stress in many different ways, most of which are not healthy for us! We may have a sudden onset of migraines or muscle soreness. Our backs may tighten up and make it hard to stand in the kitchen for longer hours. We may even experience increased heart rates and blood pressure levels. If we don’t get a handle on these symptoms, it is likely we will struggle finding some peace and joy these coming holidays.

                Here are some tips to managing your stress so you can relax and enjoy your Christmas and New Years with your family and friends.

1. Make lists: Writing out all the errands, gifts, and groceries you need will help you manage your free time. The lists will keep you feeling organized and help you track your path from store to store. There is nothing more stressful than walking up and down every grocery aisle trying to piece together the needed ingredients in your head. With them on paper in front of you, you can easily snatch up the necessary items and quickly leave the rest behind. Listing the stores you need in order from furthest away to nearest, or first open to last, will help prevent unnecessary driving around the city. And we all know how stressful driving around the holidays can be! As far as gifts, it is common to sometimes forget all we’ve ordered or purchased! Write them down as you bring them home. Make note of what you have and still need. Seeing this on paper will help you remember what you’re looking for when you are out and about.
2. Don’t cram: Cramming can be detrimental to our sanity! Begin planning a month or two ahead of time. This helps prevent the anxiety that might come with last minute shopping or baking. Many treats or meals can be pre-made and frozen until the night before or day of a gathering. This could save you time and back-aches from a full, non-stop day of baking in the kitchen. Many stores have started their holiday sales as early as October. This is great news for those of us that know what we want to purchase for our loved ones! By beginning the shopping a couple months ahead of time, you will be able to avoid the stress-filled parking lots and checkout lines and still feel confident you’ve found good deals.
3. Take time for you: Don’t let the craziness of a holiday to-do list get in the way of your regular routine. If you are a daily gym-goer, continue that routine. If you take an hour each night to do a little reading to unwind, keep it up! Maybe you drink a tea and do a little yoga or meditation in the mornings. Don’t stop! This will keep your body and mind in sync and your anxiety levels low, allowing you to better manage your schedule and lists.
4. Stretch: This may seem a bit silly, but by taking a few minutes to stretch each day, your muscles will feel alive and well and, in turn, you will be more apt to move and complete your errands. Many of us tend to carry stress and anxiety within our muscles. The upper trap is one of the main muscles that gets abused when we hold stress inside us. Tightening of the upper trap can lead to pain within the neck, upper back, and shoulders. Stretching each muscle group 2 to 3 times for 30 to 45 second holds will help prevent trigger points from forming and relieve any built-up tension.

By keeping these simple points in mind, you will feel relaxed and accomplished rather than stressed and anxious going into the holiday season. That never-ending to-do list will suddenly feel less of a burden and become much more manageable for you. Your body and mind will thank you for taking the appropriate actions to bring calm and joy into your holidays! If you have been struggling with stress or anxiety and feel it is beginning to affect your muscles and joints, ask for a physical therapy script from your primary care doctor. A physical therapist will be able to help you manage your symptoms and get you back on track!

The Importance of Transitioning from Discharge of PT to a Home Exercise Program

December 27, 2022

So, you have been discharged from Physical Therapy and feel like yourself again and can complete the activities you want without an increase in discomfort, so what is next? The goal of PT is to return our patients back to their prior level of function before the onset of their symptoms. As you go through PT, we tailor exercises to fit you and your goals. The patient often becomes familiar and comfortable with these exercises and when the time comes for our patients to discharge from therapy, we give them a home exercise program to continue outside of therapy. These exercises are meant to maintain or exceed where they currently are by further challenging their strength and endurance to improve their gains outside of physical therapy.

When this moment comes, we often see patients discontinue their exercises because they are feeling better and are without pain. Too often when this occurs, the patient’s symptoms can slowly begin to return because they discontinued what was helping them maintain their pain-free way of life. It is important to maintain this muscular strength via a HEP so this setback does not occur, and our patients can maintain their upward trajectory.

A HEP often contains anywhere from 5-10 exercises that the patient enjoys, is comfortable with, and will complete. The most important exercise to give patients is the one they will complete outside of therapy. These exercises are completed 3-5x a week and take anywhere from 5-20 minutes to complete. If one thinks of all the time in a week, Physical Therapy is not asking for much time to complete these exercises so the patient can maintain or improve their current pain-free way of life.

Alex Trautman, PT, DPT, EP-C, has a special interest in transitioning patients from their physical therapy program to a wellness program. His undergraduate degree in exercise physiology gives him extra training and knowledge in this transition. He would love to chat with you about how you can continue to improve your wellness after physical therapy.

A Physical Therapy Holiday Survival Guide

December 20, 2022

Keeping up with physical therapy during the holidays is tough. There are so many other things to do – cooking, parties, shopping, travel, and visiting with family and friends. But if you’re in physical therapy over the holidays, there’s a reason. You’re having pain, or not moving as well as you want to. These issues place limitations on your life, which are going to affect your ability to do things – like cooking, partying, shopping, traveling, or enjoying time with friends and family. So even though keeping up with your PT this time of year is tough, it’s important. That’s why we’re going to give you our best tips to help you through the holidays.

Plan

Some of what makes the holidays challenging is the crazy schedule. To survive this, you’re going to have to plan ahead. We’re not just talking about appointments on your calendar, either (although those are important). Here are some things to think about planning ahead:

Your PT appointments

Your schedule is busy during the holidays. So is your PT’s. Plan and schedule your appointments in advance. You’ll get the times and days that work best for you, and you’ll already have your PT appointments in your calendar to plan other things around.

Your exercise

Hopefully you have a regular time to exercise. With the holiday mania about to shake up your routine, that time may no longer work. Think about when you’re going to exercise ahead of time and you’ll stay consistent.

Your diet

Healthy eating often gets derailed during the holidays. Putting low quality fuel into your body won’t help you feel better. Think about planning what you’re going to eat ahead of time. We’re not saying to skip every holiday treat offered to you, but maybe think about which ones you really need to have, and which ones you can skip in advance. It makes saying “no thanks” to that third slice of fruitcake easier.

Modify

We’re realistic. We understand that life isn’t the same during the holidays as it is during the rest of the year. That’s part of what makes this time of year special! With that in mind, our next set of tips focuses on making modifications to help you get through the holidays successfully.

Your PT Plan

When you planned your PT appointments out well in advance, you might have run into some challenges. Talk to your therapist about how you might be able to modify your plan of care through the holidays to make it all work. Maybe you’re going to PT three times a week and you can only come twice a week for a week or two. Plan this sort of thing in advance with your PT and you can work together to come up with the best plan.

Your exercise

Exercise is so important, it made our list twice. Now that you know when you’ll exercise, you might have to modify your routine to make it fit. Again, we recommend talking with your PT to see what you can do. Maybe your home exercise program can be modified so you can do everything in the kitchen during downtime when you’re cooking up your holiday feast. Maybe you can reduce the number of exercises to focus on maintaining the gains you’ve made until things settle down.

Your schedule

In your planning in advance (see how important it is?) you might have found that your normal routine wasn’t going to work. If your PT appointments or exercise time is usually right after work and you’ve now got commitments during that time, maybe you can move them to the morning before work. If you’ve been exercising outside, the shortened days may move you into the gym. Be flexible and consider temporarily modifying your schedule and your routine to make it work better during the holiday season. You can always go back to your previous routine after.

The holidays are a special time of year. Keeping up with your health and your physical therapy can be challenging during this time. But you don’t have to fall behind. With some planning and flexibility, you can stay healthy, survive the holidays and head into next year with good momentum!

referenced with permission from APTA PPS

Rehab for your Rotator Cuff

December 13, 2022

Shoulders are such an important part of our daily function. Without them, we wouldn’t be able to eat, drive, write, dress—complete any activity involving our arms! What helps the shoulder act as a key player in the majority of our daily activities is the rotator cuff. The rotator cuff is a term used to describe a group of four muscles within the shoulder that work together to move the joint in all different directions. Because the shoulder is a ball-and-socket joint, the movability is much greater than most other joints in the body, and thus requires more coordination between muscles. With the rotator cuff making up nearly half the muscles of the shoulder joint, you can about imagine the amount of wear-and-tear these muscles experience over the years. With this wearing-down of tissue comes injury, and even surgery. According to IData Research, over 400,000 rotator cuff repairs are completed each year in the United States. But how do you know if you need surgery? And what does the recovery process look like?

The decision for rotator cuff repair surgery always depends on a couple factors. The size of the tear is the first consideration. The only way to know the amount of damage in the shoulder joint is imaging from a doctor’s office or hospital. An MRI will be able to show a clear picture of the tendons and muscles, defining the degree of tear in the shoulder. A partial-thickness tear describes a tear within a rotator cuff tendon that does not cut all the way through the tendon. Some partial-thickness tears require surgical intervention, but some patients are able to continue functioning without surgery. Full-thickness tears describe those that do happen to cut all the way through the tendon. In this case, patients almost always require surgery in order for the arm to be functional again.

The second consideration is the severity of symptoms with the injury. Some patients, despite the grade of tear, can press on and continue about their daily activities without too much pain or dysfunction. With more conservative treatment methods, they may be able to return nearly to their prior level of function. Others presenting with damage to the rotator cuff tendons may lose quite a bit of motion and experience pain that is difficult to manage. Excess pain makes it hard to move a joint, and a greater loss of motion is a possibility. In this instance, it is likely surgery will be the best option. Despite progress that can be made in therapy as far as pain management and range of motion, it isn’t always enough to justify bypassing surgery.

If you and your doctor decide to proceed with surgery, you will be expected to complete physical therapy in order to fully heal. A typical protocol for a rotator cuff repair consists of about 14 weeks of gradual exercise progressions. Immediately after surgery, the doctor will place you in a sling that positions your shoulder in optimal position for proper healing. You can expect to wear the sling for the initial phase of the recovery process (approximately 6 weeks).  This initial phase places a sole focus on passive range of motion. This means the therapist stretches your shoulder for you. You will be discouraged to complete any sort of movement with the shoulder on your own as that will strain the repair sight and put you at risk for re-tear.

Once the passive motion has improved and you are at least 7 weeks post-op, the active motion then comes into play. This means you are able to move the arm on your own, without therapist assistance. This is when we work on the quality of movement, decreasing any compensatory patterns that may develop as a result of weakness in the shoulder. Strengthening typically begins within this phase as well. Light resistance bands and dumbbells are used to initiate strength within all muscles in the arm that have been affected. Progressing the strength will depend on the rate of healing, the quality of movement, and the muscle response to the new routine.

In an average case, you can expect to be close to your prior level of function after 12-14 weeks of rehab. However, in order for tissues and joints to fully heal from a traumatic event, such as a surgery, time is needed. It is said that true, full healing will take up to one year. For this reason, it is pertinent to keep stretching and exercising even after you’ve finished your bout in physical therapy.

If you aren’t sure whether or not surgery is in your future, discuss your options with your doctor and local physical therapist. They will be able to accurately diagnose the grade of injury and determine the appropriate interventions for your specific injury. In any case, therapy is always a beneficial route to take. Your therapist will be able to create a plan of care based on how you present and help get you on the right track. Whether you are trying to avoid surgery, have decided you need surgery, or are just coming out of surgery, therapy can prepare you for that next step.