As our active population ages an injury we’re seeing more and more is the rotator cuff tear. The rotator cuff, located in the shoulder, is responsible for holding your arm into your shoulder socket. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder and make ordinary activities like getting dressed or raising your arms above your head painful and difficult to do.
A common reaction to a torn rotator cuff is to rush out and have surgery. However, studies have shown that this may not always be the best remedy.
Most rotator cuff tears won’t increase in size as long as you listen to your body and avoid things that reproduce the shoulder pain. Give your body a chance to heal the tear naturally.
Activities to avoid would include shoulder raises with weights, lifting heavy objects over the head, and working overhead.
Once the shoulder feels better, work with a physical therapist to begin strengthening the rotator cuff muscles. The exercises that your physical therapist will have you do can prompt additional blood flow and healing cells to enter the area using your body’s natural abilities to fix the rotator cuff tear.
If the tear isn’t healing, consider newer autologous biologic approaches like platelet rich plasma commonly called PRP or stem-cell injections. PRP has healing platelets that release growth factors that can ramp up the natural repair process. Stem-cells were recently shown in a 12 year study to dramatically decrease retear rates. Consult with a physician or surgeon that is experienced in PRP and stem-cell injections.
If an activity bothers the shoulder and it takes several days to recover, avoid this activity or try it again after more rotator cuff strengthening. If any activity just makes you sore the next day because you know you haven't tried that activity in awhile, you’re likely fine. So for example, if a certain weight lifting routine gives you pain for four days every time you attempt it, you don't have the rotator cuff strength to tolerate this type of activity. Go back to more rotator cuff strengthening and back down the weights or the intensity and try it again.
There is no substantial scientific evidence that surgery is any more effective than no surgery at all. In fact, in some cases the rate of the rotator cuff not healing is very high. This is because many rotator cuffs tear due to the intrinsic problems with healing in the area which is something the surgery does not solve.
Steroid shots are a common treatment in many family practices and orthopedic clinics, but it can dramatically inhibit natural healing. In general, it will make your shoulder feel better for 1-2 months, but then it will likely feel much worse. Even if it feels better for an extended amount of time, the structure of the rotator cuff and strength of the tissues may be adversely affected.
Using an occasional Tylenol, IBUProfen, Aleve, or Motrin for aches and pains is fine. However, some patients get addicted to these drugs in that they can’t get through a workout without them. These drugs can not only dramatically increase your heart attack risk, but they also generally inhibit healing.
Curcumin was shown to be as effective as Ibuprofen for alleviating pain and helping inflammation. Taking 500mg with Bioperrine (a pepper extract that increases bioavailability) twice a day may help. Fish oil is another alternative as high doses of EPA can help reduce pain and swelling. To get to levels this high, the local store bought brand isn’t likely to help. You need concentrated fish oil that has been converted back to it’s natural triglyceride form. How much? 3,000-5,000 mg of EPA a day is a healthy anti-inflammatory dose.
While many patients believe that an MRI is like the Oracle of Delphi, many studies show that some patients regain normal function and have no pain despite their MRI not looking any better. While an MRI is a helpful guide post about what’s happening, getting too concerned about every spot on that image is ill advised. In addition, a far less expensive and likely just as good approach is seeing a physician who is experienced in using ultrasound imaging in the office to diagnose and follow the status of rotator cuff tears. This quick method takes just a few minutes and is often covered under your office visit co-pay. Be careful, as most orthopedic surgeons have yet to acquire this skill set, while more non-surgeons have mastered this technology.
Unfortunately as we age, rotator cuff tears become more of a reality and a problem - especially to those of us that are active. The muscles of the rotator cuff help to stabilize and move the arm. When torn, the shoulder can lose power, become painful, and very stiff. Contrary to popular thought, surgical repairs of the area aren’t really all that great. Several studies have documented high rates of non-healing on the surgically repaired tear. Many types of rotator cuff tears may be healed with just an injection of the patient’s own stem cells and without the need for invasive and inherently risky surgery.
Consider these non-surgical options before going under the knife in order to protect your body and preserve your original biological equipment. Your body will thank you for it.
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