Shoulder Archives - Bacci & Glinn Physical Therapy

Must Read About Rotator Cuff Tear Treatment in Visalia

Do Steroid Injections Increase Risk For Rotator Cuff Tears In The Long Term?

If you are Googling “rotator cuff tear treatment in Visalia,” here’s some research you need to know about. It’s important for patients to be well informed. New information could save you time, money, and help you avoid prolonged shoulder pain.

A Quick Rotator Cuff Anatomy Review

The rotator cuff is a crucial component of the shoulder that allows it to function. It connects the upper arm bone (humerus) to the shoulder blade (scapula) with four muscles, each of which has a tendon that attaches to different parts of the scapula. These tendons form a “cuff” around the head of the humerus, and all the muscles work together to control and stabilize the shoulder.

But when any of the tendons of the rotator cuff becomes injured or torn, the tendon becomes detached from the head of the humerus, and the injury is called a rotator cuff tear. Some rotator cuff tears occur after sudden injuries like falling on an outstretched arm or lifting a heavy object, but most develop gradually over time after the tendon gradually loses its strength. Athletes involved in overhead sports like baseball, tennis, and weightlifting, and those who are older than 40 are at a greater risk for rotator cuff tears.

Highly Recommended – Physical Therapy for Rotator Cuff Problems (We Treat This Condition in Hanford & Visalia)

Physical therapy is recommended for most patients with rotator cuff tears and treatment typically includes:

manual (hands-on) therapy,
strengthening and stretching exercises,
deep tissue laser therapy,
patient education, and
passive modalities like ice/heat and taping.

Nonetheless, many patients decide to have steroid injections either in addition to or instead of physical therapy because injections can provide short-term pain relief; however, some experts (these are medical doctors as well as physical therapists) are concerned that injections might have negative effects on tendon health over time.

Thankfully, There’s a Research Study About This

Therefore, a study was conducted to evaluate the effect of steroid injections on the risk for rotator cuff tears. The study’s authors collected data on patients who were diagnosed with shoulder disease and divided them into one group for those who received a steroid injection and another group for those who did not.

This search led to 1,025 patients being included, 205 of whom received a steroid injection and 820 of whom did not. The rate of rotator cuff tears was 9.8% in patients who received steroid injections versus only 1.2% in patients who did not, which indicated that steroid injections increased the risk for a rotator cuff tear by 7.44 times. The average time to a rotator cuff tear from the date of the steroid injection was 39 months.

These findings suggest that although steroid injections can effectively alleviate pain in the short-term, they appear to increase the risk for rotator cuff tears over time. Therefore, healthcare providers and patients with shoulder pain should consider these findings and carefully weigh the risks and benefits of steroid injections when determining the best course of treatment.

In addition, we encourage patients that are looking for rotator cuff tear treatment in Visalia or Hanford to contact us for a detailed initial evaluation, and you’ll receive a comprehensive treatment program for your shoulder pain.

Contact Bacci & Glinn Physical Therapy at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) for more information or to schedule an appointment today.

Physical Therapy for a Frozen Shoulder in Visalia and Hanford

Are you searching for a specialist that treats frozen shoulder treatment in Visalia or Hanford? You may not know, but our physical therapy treatment for frozen shoulders is some of the best you’ll find in the area.

Understanding a frozen shoulder/adhesive capsulitis diagnosis is important, so we wrote this article below to help those in need.

Comprehensive Review Finds That Several Types Of Exercise
Lead To Improvements For Patients With Frozen Shoulder

Adhesive capsulitis, or frozen shoulder, occurs when scar tissue forms within the shoulder. This causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room to move the shoulder normally. Although frozen shoulder affects up to 5% of the population, the reasons why it develops have not yet been clearly established. It is generally believed that not moving the shoulder normally for long periods is a leading factor, as most people who get frozen shoulder have kept their shoulder immobilized due to a recent injury, surgery, or pain. People between the ages of 40–60, women, and patients with arthritis, diabetes, cardiovascular disease, and other health conditions are also more likely to develop frozen shoulder.

Frozen shoulder usually develops slowly and gets progressively worse over time with more pain and loss of motion. It is typically divided into the following four stages:

Stage 1: consists of the onset of symptoms, which gradually get worse over 1–3 months
Stage 2: the “freezing” stage, which generally occurs 3–9 months after symptoms begin and is very painful
Stage 3: the “frozen” stage, which involves the shoulder becoming even more stiff and difficult to move
Stage 4: the “thawing” stage, which occurs within 12–15 months and involves pain decreasing significantly and range of motion starting to improve

Adhesive Capsulitis Treatment in Visalia & Hanford – Clinical Research Supports Physical Therapy

Physical therapy is commonly used and often recommended for frozen shoulder because it’s effective for addressing symptoms at every stage; however, there are some questions about the exercises used in physical therapy that have not yet been clearly answered. Therefore, a comprehensive study called a systematic review and meta-analysis was conducted to 1) compare the effectiveness of exercises alone and exercises in combination with other interventions and no exercises and 2) determine what kind of exercises are most effective for frozen shoulder.

Researchers review 33 studies on exercise therapy for frozen shoulder

To conduct the study, researchers performed a search of three medical databases for relevant studies about exercise therapy for frozen shoulder. This led to 33 studies being accepted into the review, which saw patients treated with a variety of exercises, some prescribed individually, and others prescribed as part of a comprehensive treatment program. The findings of all included studies were then reviewed and compared to one another with the goal of answering the two main research questions.

Results showed that exercises—both on their own and as part of a program—improved range of motion (ROM), function, disability, and pain, and the type of exercise performed had little to no impact on these improvements. Also, adding physical modalities to exercises did not provide any benefits to treatment outcomes, and programs that included exercises resulted in larger active ROM gains than programs that did not.

Frozen Shoulder Physical Therapy Visalia & Hanford – Physical Rehab is the Key

These findings support the effectiveness of physical therapy for frozen shoulder and suggest that the type of exercises performed and whether they are completed alone or combined with other interventions may not be important, so long as they are featured in a rehabilitation program.

Therefore, if you’re currently dealing with symptoms that may suggest the presence of frozen shoulder, Bacci & Glinn Physical Therapy can help.

Call us at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to learn more or schedule an appointment today.

PT vs Surgery for SIS – Research Says Try Conservative First

Are you searching for a specialist that treats shoulder impingement in Visalia or Hanford? You may not know, but our physical therapy care for shoulder impingement is some of the best you’ll find in the area.

Understanding rotator cuff problems and shoulder impingement is important, so we wrote this article below to help those in need.

Physical Therapy Is Just As Effective As Surgery In The Long Term For A Common Shoulder Condition

Most shoulder conditions—about 85%—involve the rotator cuff, which is a group of muscles and tendons that keeps the shoulder stable. Among these common shoulder conditions is shoulder impingement syndrome (SIS), in which rotator cuff tendons become compressed—or “impinged”—as they pass through a small bone on top off the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, and will lead to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement, and pain.

SIS is most common in individuals that regularly perform lots of overhead activities like golfers, swimmers, and baseball and tennis players, as well as painters and construction workers. The condition can also result from an injury that compresses the structures of the shoulder—like a fall—or from frequently sleeping on your side. Sleeping in this position regularly can strain the shoulder and cause impingement over time.

SIS is closely related to rotator cuff tendinitis and subacromial pain, and in some cases, the terms may be used interchangeably. When any of these conditions develop, the best course of action is a comprehensive physical therapy program, which helps patients work through their pain to regain strength, flexibility, and physical function; however, many patients undergo a surgical procedure called arthroscopic subacromial decompression (ASD) to treat their shoulder pain. An abundance of research has shown that this procedure does not lead to any significant benefits, but it remains one of the most frequently performed procedures in the world, and some professionals still advocate for it. Therefore, a study was conducted to compare the return-to-work rates for patients with subacromial pain who underwent different interventions.

More than 200 patients are monitored periodically for 5 years in this research study

A total of 210 patients with subacromial pain for more than 3 months were enrolled in the study and randomly assigned to one of three treatment groups: exercise therapy, diagnostic arthroscopy, or ASD.

Patients in the exercise therapy group underwent a supervised, individually designed physical therapy program that included daily home exercises and 15 visits to the physical therapy clinic. Patients in the diagnostic arthroscopy group underwent a “sham” procedure in which an examination of the shoulder was performed with a small camera inserted surgically, but no repairs were made to the shoulder. Patients in the ASD group were treated surgically with the ASD procedure, which involved the careful removal of some portions of bone and a structure called the bursa. Patients in the diagnostic arthroscopy and ASD groups also participated in a postoperative physical therapy program. All patients were assessed at the beginning of the study and then again 2 years and 5 years later.

Two years after the interventions, 78% of patients in the exercise group, 80% of patients in the diagnostic arthroscopy group, and 82% of patients in the ASD group were actively working.

Five years after the intervention, these figures were 66% for the exercise group, 69% for the diagnostic arthroscopy group, and 67% for the ASD group.

These results show that there were NOT significant differences between the three groups 2 years and 5 years after the intervention. Therefore, based on these findings, physical therapy can be considered just as effective as ASD for helping patients with subacromial pain recover and maintain their improvements in the long term.

Subacromial Impingement Pain Treatment is Something We Specialize In…

At Bacci & Glinn Physical Therapy, we frequently see patients with subacromial pain and related shoulder conditions and help them regain their abilities in a safe and cost-effective manner.

Therefore, if you’re currently dealing with any type of shoulder pain, we recommend giving us a call.

You can reach us at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to learn more or schedule an appointment today.

Shoulder Impingement Syndrome

Sore Shoulders Are Common In Swimming,
But Physical Therapy Can Get You Back In Line

Swimming is a great form of exercise because it strengthens multiple regions of the body and improves both flexibility and endurance. In addition, the lack of impact on joints makes it a safe choice for avoiding lower-body injuries that are common with land-based exercises. Water polo, which involves swimming, passing a ball, and other active movements, features many of the same attractive characteristics as swimming and is commonly regarded as an excellent workout. However, neither sport is risk-free, and an injury called shoulder impingement is quite common in both.

A Quick Review of the Anatomy

The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The humerus and scapula are surrounded and connected by the rotator cuff, a group of muscles and tendons that keeps the shoulder stable and allows the ball-and-socket movements of the joint. There is also a fluid-filled sac called the bursa between the rotator cuff and a bony prominence on the top of the scapula (acromion), and this bursa provides a cushion during movement.

What Exactly is Impingement?

In shoulder impingement syndrome (SIS), the tendons of the rotator cuff become compressed—or “impinged”—as they pass through the narrow space beneath the acromion. Over time, this causes the tendons to become irritated and inflamed, eventually leading to bothersome symptoms like swelling, tenderness, loss of strength, restricted shoulder movement and pain that’s most common at rest, when moving the shoulder overhead, and when sleeping.

If You Use Your Shoulder, You Might Get SIS

SIS is most common in individuals that regularly perform lots of overhead activities like golfers, swimmers, and baseball and tennis players, as well as painters and construction workers. Competitive swimmers are at a particularly high risk for shoulder impingement syndrome because of the repetitive overhead motions involved in most strokes, which can cause continuous wear and tear on the structures of the shoulder. It’s estimated that year-round competitive swimmers cover 10,000–24,000 meters per day, and more than half of these athletes suffer from shoulder pain.

Water polo players also swim large distances on a regular basis, while also passing and shooting a ball, which are overhead motions. As a result, these players are frequently affected by SIS and other shoulder problems, with one study finding that the rate of shoulder pain is about 80% in these athletes.

Physical therapy for swimmers and water polo players with SIS
If SIS develops, physical therapy is strongly recommended as the safest and fastest route to recovery. Physical therapy for SIS typically consists of the following:

Activity modification/functional training
Stretching exercises
Strengthening exercises
Hands-on (manual) therapy
Posture education

The effectiveness of physical therapy for SIS has been consistently confirmed through published research, including a recent study called a systematic review and meta-analysis. This study reviewed the findings of 11 high-quality studies called randomized-controlled trials that compared physical therapy to surgery for patients with SIS. Results showed that there were no significant differences between patients in measures of pain or function up to 10 years later, which suggests that physical therapy can lead to comparable outcomes to surgery while also avoiding the high costs and potential risks of a surgical procedure.

Whether you’re a swimmer or water polo playing dealing with shoulder pain, or if your shoulder is bothering you for some other reason, Bacci & Glinn Physical Therapy can help you get back on track.

Contact us at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to learn more or to schedule an appointment today.

Surgery vs. Physical Therapy for Shoulder Pain

Surgery And Physical Therapy Lead To Very Similar Outcomes
For Older Patients With A Rotator Cuff Tear

The shoulder is one of the most common sites for pain in the body, ranking only behind the back and knee in overall prevalence. Shoulder pain becomes even more common later in life, with many older adults complaining of restricted shoulder mobility that interferes with their ability to complete overhead tasks as they age.

Tears of the rotator cuff—a group of four muscles and tendons that wrap around the shoulder—are particularly common in this population, with about 30% of adults over the age of 60 experiencing this injury. Rotator cuff tears are associated with significant disability, and many patients therefore turn to surgery to alleviate pain and help them regain physical function. However, it’s unclear whether surgery leads to better outcomes than a nonsurgical approach such as physical therapy.

Physical therapy versus two surgical procedures

With this in mind, researchers performed a study to compare patients with a rotator cuff tear who had physical therapy to those who underwent one of two types of surgery. All 150 patients included were older than 55 years and had a confirmed, full-thickness tear of a rotator cuff tendon called the supraspinatus. Patients were then randomly assigned to one of three treatment groups: 1) physical therapy, 2) acromioplasty and physical therapy, or 3) rotator cuff repair, acromioplasty, and physical therapy.

Patients in the physical therapy treatment group were guided by a physical therapist through a standardized exercise training program that was to be completed at home. The first six weeks of the program aimed to increase the range of motion of the shoulder and then progressed to focus on muscle stability and function until the 12-week mark. Patients then increased the intensity of their strength training further for up to six months and participated in 10 in-person sessions with the physical therapist as a supplement to the at-home program.

The acromioplasty and physical therapy group underwent a procedure in which the acromion—a bony protrusion of the shoulder blade—is made smoother with surgical instruments. Afterwards, patients completed the same physical therapy program as the first group. The third group underwent a repair of the torn rotator cuff, plus the acromioplasty procedure, and then finally completed the physical therapy program. All patients were assessed before the interventions and then at regular intervals over five years for various outcome measures.

Patients should take into account these findings when considering surgery

After five years, there were no significant differences between patients in either of the three treatment groups, and surgically repairing the supraspinatus did not lead to any notable improvements, as researchers had expected. Therefore, according to these findings, it does not appear that surgery is any more effective for treating rotator cuff tears than physical therapy.

Seeing One of Our Physical Therapists is the Best First Choice

So if you’re dealing with shoulder pain and surgery is suggested as a possible avenue forward, we strongly recommend considering these findings and the limitations of a surgical approach when making your decision.

And for a hands-on, evidence-based, and personalized physical therapy treatment program for your shoulder pain, contact Bacci & Glinn Physical Therapy at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to schedule an appointment today.

Why a Shoulder MRI Often Isn’t That Useful

MRIs Of Both Painful And Non-Painful Shoulders Are Similar,
Which Questions The Usefulness Of These Tests

Shoulder pain is the third most common musculoskeletal condition, as up to 67% of individuals will experience it at least once in their lifetime. When pain in the shoulder occurs, the traditional approach is to identify its source through diagnostic testing and then treat the injury appropriately. MRI scans are frequently used during this process because they provide highly detailed images of shoulder structures, but more recently, some experts have questioned whether these tests are helpful or even necessary.

The primary reason is that abnormal findings from MRIs do not always correlate with pain, and some patients with no signs of pain display so-called “abnormal” MRI results. This has led researchers to take a closer look at MRIs of individuals both with and without shoulder pain to help determine the reliability of these tests when making a diagnosis or treatment decisions.

Comparing both shoulders in patients with pain in one shoulder

One study took a unique approach by comparing MRI scans of both shoulders in patients with shoulder pain in only one shoulder. For the study, 123 individuals with chronic shoulder pain for an average of three years were recruited and accepted to participate. The average age of participants was 39.4 years, with 15 individuals being aged 60 years or older. All patients underwent an MRI of both shoulders, and two healthcare professionals—a radiologist and a shoulder surgeon—interpreted the findings from these scans independently.

Results showed there was a high prevalence of structural abnormalities in both shoulders of these patients. For example, the radiologist identified complications with the rotator cuff and one of the major shoulder joints in both shoulders for about 90% of patients, while the surgeon found these issues in about 75% of patients. In addition, no significant differences were detected in the prevalence of abnormal MRI findings between the painful and non-painful shoulder, except for one type of injury.

The source of your pain may be something else

These findings suggest that MRI results may not always indicate the source of pain in many patients with shoulder pain, since abnormal findings were also found to be very common in shoulders with no symptoms. Therefore, despite the frequent use of MRI for shoulder pain, it may not be the most effective way to diagnose these injuries. Of particular concern is that focusing exclusively on MRI findings can lead to costly and risky interventions like surgery being performed unnecessarily, even if the pain is not related to these findings.

Try conservative, natural care first

Physical therapists, on the other hand, treat most cases of shoulder pain from the first visit and rarely order MRIs unless it’s deemed completely necessary. This saves patients time and money, which allows them to start their path towards improvement immediately rather than being held back by MRI findings that may not truly reveal the reason behind their shoulder pain. So if you’re dealing with shoulder pain, we strongly recommend seeing a physical therapist at Bacci & Glinn Physical Therapy before having an MRI.

Call us today at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to schedule an appointment.

Overuse and Repetitive Strain Injuries

Repeatedly performing certain motions can produce pain and dysfunction over time

Most injuries will fall into one of two categories: acute and overuse. Acute injuries usually result from a single, traumatic event, such as a fall, slip, or collision with another athlete or object. Some common examples of acute injuries include wrist fractures, ankle sprains, shoulder dislocations, and hamstring strains.

Overuse injuries, on the other hand, occur gradually over time rather than on the spot. They are more common than acute injuries but are also more subtle, which makes them more challenging to diagnose and treat. Overuse injuries may result from training too hard and pushing your body past its limits, or simply by moving incorrectly or with bad posture on a repeated basis. Another term used is repetitive strain injuries, which shows how repeating the same movements can result in small trauma—or microtrauma—to tendons, bones and joints. Eventually, the damage gets so bad that symptoms begin to arise, in which cases treatment is usually needed.

Here at our practice, we treat a variety of sprains & strains. Below, we offer a brief overview of the mechanisms responsible for 5 common overuse injuries:

Shoulder Impingement – Consider Physical Therapy for Shoulder Impingement Syndrome in Visalia
Shoulder impingement syndrome (SIS) is a condition that involves the rotator cuff, a group of muscles and tendons that keeps the shoulder stable. In SIS, rotator cuff tendons become compressed—or “impinged”—as they pass through a small bone on top off the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, and will lead to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement and pain that occurs at rest, when moving the shoulder overhead and/or when sleeping.

Plantar Fasciitis – We Provide Effective Physical Therapy for Plantar Fasciitis in Visalia
The plantar fascia is a thick, connective band of tissue that runs across the bottom of the foot and connects the heel to the toes. It’s a tough structure designed to absorb the regular stresses that are placed on the foot, but can become damaged when these forces are excessive. When this occurs, the resulting condition is plantar fasciitis.

Plantar fasciitis is a stubborn overuse injury and the most common cause of heel pain.
It occurs most frequently in runners—especially long-distance runners—due to the repetitive strain they place on their feet. People who have flat feet or high arches, are overweight or regularly perform any other weight-bearing activity are also at increased risk. The most common symptom of plantar fasciitis is a stabbing pain near the heel that’s most noticeable upon waking up and after standing for long periods.

Carpal Tunnel Syndrome – Relief for Those Searching for Physical Therapy for Carpal Tunnel Syndrome in Visalia
The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to the fingers. If these tendons thicken or any other swelling occurs in the area, this tunnel narrows, which puts pressure on the median nerve and leads to a condition called carpal tunnel syndrome.

Carpal tunnel syndrome is extremely common, as it affects about 5% of the population.
The greatest risk factor is any task that requires repetitive hand motion, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. As a result, individuals who work on an assembly line—like manufacturing and meatpacking industries—are at the highest risk. The risk if also high in office workers. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness and/or numbness develop in the hand and wrist, and then radiate up the arm.

Golfers Elbow – Choose Physical Therapy for Golfer’s Elbow in Visalia
Golfer’s elbow is a condition that results from the repeated bending of the wrist that is necessary in a golf swing. This damages the muscles and tendons of the medial epicondyle—a piece of bone on the inside of the elbow that allows the forearm, wrist and hand to bend and move in several different ways—and eventually leads to inflammation. It is especially common in golfers because gripping or swinging clubs incorrectly or with too much force can take a toll on the structures within the elbow over time.

Common symptoms include pain, tenderness, swelling, weakened grip strength and a burning sensation on either the inside or outside of the elbow. These symptoms often develop gradually and are worsened by activities that involve the forearm, and if left unchecked, can go on to make many basic activities that require gripping or grasping a major challenge.

Lower Back Pain – Natural Physical Therapy for Back Muscle Strain in Visalia
Back pain is the most common musculoskeletal injury, and a significant number of cases are due to a strain of one or more back muscles. This condition—also known as a pulled muscle—is the result of muscle fibers tearing from being overstretched or overused, which can occur from repeatedly bending your back or using improper posture.

The most common symptom is pain in the lower back that is often most intense during the first few hours of the day. Pain also tends to get exacerbated with certain movements or positions that strain the muscles of the spine, like standing for long periods of time. Tenderness and stiffness of the spine is also likely.

Physical therapy for all types of overuse injuries
In addition to being the product of overuse or repetitive strain, another feature that all of these conditions share in common is responding to physical therapy. Our physical therapists can help by identifying the behaviors or habits that are responsible for your pain, and then recommending adjustments to your movements along with a personalized treatment program to help you move with less pain.

Contact Us for More Information About How We can Help

Physical Therapy After Shoulder Surgery in Visalia or Hanford

Searching for physical therapy after shoulder surgery in Visalia or Hanford? We can help – read more below.

If you decide to have shoulder surgery, physical therapy is an integral part of the recovery process

The shoulder is an incredible joint. As the only joint in the body that can rotate a full 360°, the shoulder is the most mobile and flexible joint in the body, and this wide range of motion is the reason you can move your arm in so many directions. There is, however, one downside to all this mobility: it makes the shoulder particularly vulnerable to injury.

The Shoulder Joint is Complex – Therefore, There are All Kinds of Potential Problems

Although the shoulder is typically referred to as a single joint, it is technically more complex and consists of four joints, with the acromioclavicular and glenohumeral joints being the most important for movement. Bones of the shoulders are connected by several ligaments, while muscles connect to bones through various tendons. Other important structures of the shoulder include the rotator cuff, a group of four muscles that form a “cuff” around the upper arm bone, a ring of protective cartilage (the labrum), a fluid-filled sac that provides cushioning (the bursa), and the joint capsule, which encloses all the components of the shoulder.

Any of these structures can become damaged and lead to shoulder-related disability. The rotator cuff is one of the most commonly injured areas of the shoulder, with a condition called rotator cuff tendinitis being the most prevalent cause of shoulder pain. Tears of the rotator cuff also occur frequently, and these injuries can occur either traumatically from a single incident, or gradually over time, which is usually the case in older patients.

Physical Therapy After Rotator Cuff Surgery – We Can Help Both Visalia and Hanford Residents

In the event of shoulder pain from injury to the rotator cuff or any other structure of the shoulder, the patient will decide with a doctor whether surgery is needed or a conservative (non-surgical) approach—which primarily involves physical therapy—can be taken. Most shoulder injuries can be effectively treated with a conservative plan, but if this approach fails to produce significant improvements or the patient has suffered a severe injury like a high-grade, sudden rotator cuff tear, surgery may be needed. Surgery is also more likely to be selected by active athletes involved in overhead sports. If you’d like additional resources, the American Physical Therapy Association also has some details – click here.

Physical therapy also essential after surgery

If you have a shoulder injury and decide to have surgery, physical therapy will still serve as a fundamental component of the recovery process. Through a movement-based, individualized strategy, physical therapy will help to bring you back to full strength and function with targeted exercises and other interventions. A typical treatment program for patients recovering from shoulder surgery will likely include the following:

Stretching and strengthening exercises: weakness and reduced flexibility/mobility are two major consequences of surgery, so the bulk of rehabilitation will aim to address these impairments; key exercises include:

- External rotation: using a resistance band or dumbbell, keep your elbow bent at a 90° angle and slowly move your hand out from the body
- Internal rotation: same as external rotation, but move your hand towards your body
- Forward flexion shoulder raise: holding a dumbbell, keep your arm straight and lift it directly in front of you until it’s at eye level
- Pendulum exercises: holding a dumbbell, let your arm hang loose and swing it around in a circle; then try swinging it back and forth
- Scapular squeezes: lie on your stomach with arms at your sides, draw your shoulder blades together and down back as far as possible; ease about halfway off from position and hold it

Passive treatments: ice, heat, ultrasound, and other interventions will likely be utilized to alleviate shoulder pain
Activity modification: your therapist will teach you how to avoid positions and movements that can aggravate pain and make the condition worse, like sleeping on your side and carrying heavy loads

Contact Us Today if You are in Need of Physical Therapy After Shoulder Surgery

Remember that you always have options after a shoulder injury of any sort, and surgery is not necessary for many patients. But if you do opt to go the surgical route, keep in mind that physical therapy will play a major role in your recovery, and that better adherence to your treatment will lead to improved outcomes. Contact us to learn more about how we manage patients recovering from shoulder surgery or to schedule an appointment today.

Call Us in Visalia at (559) 733-2478 or Hanford at (559) 582-1027 for More Information

Specialists for Swimming Injuries

Year-round swimmers can reduce their risk for shoulder pain
by taking time off and seeing a physical therapist

For the hardcore swimmers out there, training is a year-round affair. Over one million Americans are involved in recreational or competitive swimming, and more than one-third of these individuals practice and compete throughout the entire year. Competitive swimming is certainly a great way to stay fit all year, but it also carries with it a risk for shoulder pain that can be managed with certain precautions and staying conditioned.

Swimming is a great form of physical activity that strengthens multiple regions of the body and improves flexibility and endurance. The lack of impact helps swimmers avoid lower-body injuries, but its intense involvement of upper-body muscles increases the chances for overuse injuries.

Overuse injuries occur gradually over time and primarily result from fatigue and failure to adhere to proper stroke techniques. About 90% of swimmers’ complaints relate to their shoulders, and the most common injury overall is swimmer’s shoulder, which is a general term to describe any type of shoulder pain. Swimmer’s shoulder is usually due to tendinitis of the rotator cuff—a group of muscles and tendons that surround and stabilize the shoulder—and if left untreated, it can cause more pain and other injuries.

Other swimming-related injuries include foot and ankle issues, hip pain, breaststroker’s knee (knee pain related to ligament or tendon damage), and back pain. As with shoulder injuries, most of these problems occur when swimmers push their bodies too hard without enough time to recover. The best way to reduce the risk for shoulder pain and other swimming-related injuries is to ensure that you’re practicing and competing with the proper technique. While it’s best to consult with a swim trainer, here are some general tips to keep in mind:

Warm up and stretch thoroughly before entering the water
Avoid overuse injuries by mixing up strokes and spending less time practicing those that are causing pain; also be to take enough time to rest and recover
Practice good communication between coaches, swimmers and sports trainers
Perform core strengthening and cross-training exercises

Physical Therapists can Help Prevent and Treat Swimming Injuries

Another effective way to both prevent and treat swimming-related injuries is physical therapy. Physical therapists can create sport-specific training programs that will keep swimmers properly conditioned throughout the year and reduce their risk for enduring an injury to the shoulder or elsewhere in the body. If any injury does occur, they can also provide patients with an individualized treatment program that addresses their symptoms and focuses on the mechanics and muscles involved in swimming. The benefits of physical therapy for swimming injuries are highlighted in a published study in 2017, which evaluated whether surgery or non-surgical (conservative treatment) was better for tears of the rotator cuff. The conclusion states the following:

There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality.

This shows that swimmers and any other patients with suspected rotator cuff injuries should see a physical therapist first before considering surgery. Doing so can help them reduce their pain levels and regain shoulder function with significantly lower costs and less risk for complications compared to surgical interventions.

Contact Us if You Have Questions or Need Help

Shoulder Impingement & Labral Tears – Do You Really Need Surgery?

Reference for image https://www.bmj.com/content/364/bmj.l294 .

Physical therapy should be your first choice for shoulder pain, regardless of what’s causing it because it’s conservative, there are little to no side effects, and recent research suggests surgery is no better.

The shoulder is an incredible joint. As a ball-and-socket joint, it allows for an extremely wide range of motion and is the only type of joint that can rotate in a full circle around its axis. But as a result of its design, it’s vulnerable to injury. The rotator cuff can be pinched between the ball and a bone above the ball called the acromion. Also since the shoulder ball is much bigger than the socket, it makes the cartilage labrum around the socket also vulnerable to injury.

The issue is that the ball of the joint (the end of the upper arm bone, or humerus) is much larger than the socket (a structure called the glenoid fossa). Due to the major difference in size, the shoulder is considered an unstable joint, and the ball can slip out of the socket to cause pain and dysfunction. The good news is the rotator cuff helps actively hold the ball and socket together. One other feature of the shoulder that helps prevent dislocation is the labrum, which is a band of cartilage around the edge of the socket that adds depth and keeps the humerus in place. But despite this added protection, shoulder injuries are still quite common.

Two Diagnoses that Might (Yes, We Said “Might”) Cause Pain

Shoulder impingement occurs when the rotator cuff tendons, primarily the supraspinatus tendon, is pinched between the humerus, subacromial bursa, and the acromion. See the above image to try to orient yourself. Imagine what could happen if the arm bone (the humerus) was raised overhead and pinched the rotator cuff and blue bursa that’s below the acromion bone. That’s what happens with shoulder impingement. It’s common but as indicated in the main image of this article at the top, recent research suggests that surgery isn’t better than conservative care.

While we agree that conservative care, especially provided by one of our professionally trained and licensed musculoskeletal experts, is the best thing to do first, we’ve also seen a number of patients that have had surgery and good outcomes as well. Bottom line, research often doesn’t adequately summarize all possible outcomes. Nevertheless, we agree with the research – you should first try conservative care before you have any surgical procedures.

Similar Research Suggests Conservative Care First for SLAP Lesions Too

A SLAP (superior labrum, anterior to posterior) tear is an injury to top of the labrum (or superior), from its front to back (anterior to posterior). SLAP tears can come about from a single incident, such as falling on an outstretched arm or shoulder, or from doing lots of overhead activities on a regular basis. Participation in overhead sports like baseball or tennis, or lifting heavy objects repeatedly can all increase the likelihood of experiencing a SLAP tear. In other cases, they result from the labrum gradually losing strength over time as a natural part of the aging process.

Typical symptoms of a SLAP tear include pain when moving the shoulder, a sensation of locking, popping, or catching, a decrease in shoulder strength and flexibility, and a feeling that the shoulder will suddenly “pop out.” If you’ve been experiencing these symptoms, a SLAP tear my be possible, and some medical professionals might recommend getting an MRI to confirm the diagnosis. While MRIs can be helpful, they should not be relied upon too heavily in these types of situations. Research has shown that the MRIs of many patients—particularly older individuals—with no shoulder pain will actually reveal the presence of a SLAP tear. For example, one study of 53 individuals between the ages of 45-60 concluded:

There is a high prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people. These findings suggest that superior labral tears noted by MRI may not be the cause of symptoms in this patient group with shoulder pain.

Regardless of whether a SLAP tear is responsible for your shoulder pain, physical therapy is the best first step to address it in nearly all situations. A physical therapist will work with you to identify the specific ways your condition is limiting you, and then create a personalized treatment program to address these impairments. Every program is different, but most will include the following:

Flexibility exercises to stretch the shoulder capsule that surrounds the joint
Strengthening exercises for the muscles that support your shoulder
Manual therapy from the physical therapist to increase shoulder range of motion
An analysis of your movement patterns and correction of any overhead faults
Heat, ice, and/or electrical stimulation

Before you get an MRI of your shoulder in order to find out exactly what’s wrong, see a physical therapist. While specific diagnoses are helpful in some cases, they can also be distracting and take away from time that can be better spent getting treated and working your way back to full strength.