Blog written by Chris Dohrmann, DPT
“Rotator cuff disorders are the most frequent group of pathologies affecting the shoulder and represent 50-85% of shoulder conditions treated by health professionals”1. These disorders are by far one of the more frequent diagnoses and presentations that we encounter on a daily basis in the clinic. Without appropriate care, disorders that are so prevalent may be subject to becoming persistent and impacting quality of life and the ability to lead a healthy, active lifestyle. Good news though…it seems that activity is really the best medicine for rotator cuff related pain!
According to a Systematic review of 9 current clinical practice guidelines across the healthcare landscape (this includes the American Academy of Orthopedic Surgeons (AAOS) and American College of Radiology(ACR)), exercise therapy is universally recommended in treatment of these disorders. Motion is lotion rings true here and the evidence is here to back it. Now exercise can vary in what we do, what our intent is, what our dose is, etc. This is where a clinical examination that is unique to you, the patient, is important to understand how we can leverage movement in helping you achieve your goals.
The same systematic review also supported the use of manual therapy with 7 of the 9 studies. Now admittedly we’re biased here, and have a strong belief that manual therapy is a helpful tool to provide a window of symptom relief, improved confidence with movement, and reducing the threat of painful stimuli.
Now a few of the final recommendations pertaining to imaging and surgery were quite mixed actually. The general rule of thumb though was that a course of conservative care is recommended prior to even considering this. From the literature we know about soft tissue related and tendon related pain, patience is required throughout the rehabilitation process. The duration of conservative care recommendations ranged from 3 to 6 months in this review. In other reviews of tendon related pain, the prognosis can last even longer than that. That’s not to say that folks don’t improve during this time. Measuring progress through strength assessments, range of motion assessments, and most importantly making treatment measurable and goal oriented for your unique limitations is how we develop and refine plans to help patients along the way.