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I have a rotator cuff tear in my throwing arm that is keeping me off the baseball mound. The surgeon wants me to go through a physical therapy program instead of (or maybe before) having surgery. I would rather just have it operated on and get back in the game. Why can't they do that?
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Our understanding of how the very complex structures of the shoulder work has improved tremendously as a result of motion studies of throwing actions. Being able to see (and analyze) movements in slow motion has expanded the understanding of normal and abnormal shoulder function during throwing activities. This information has helped shape today's injury prevention and rehab programs.
Surgery is not always advised as it is invasive and further disrupts the already damaged soft tissues. Complications from surgery can add to the delay in recovery. Whenever possible, conservative care is advised first. If there's been no improvement after three months, the athlete is re-evaluated. Further testing may be needed to determine what is wrong and what to do about it. Failure of nonoperative care to restore the athlete may point to the need for surgical repair or reconstruction.
Physical therapy for injuries such as a rotator cuff tear (as well as shoulder laxity and instability, impingement, or ligament tears) is broken down into four phases. The first phase takes place when the injury is new or fresh. This is called the acute phase. The therapist helps the athlete understand the importance of activity modification and giving the injured tissues a chance to heal. Various treatment methods such as neuromuscular facilitation, lymphatic drainage, and rhythmic stabilization exercises are used by the therapist to help promote healing.
Phase two begins when the pain and inflammation of the acute phase have decreased. In this phase, the therapist uses specific exercises to strengthen and re-tune the muscles. Other exercises are used when there's too much motion or not enough motion in any part of the arc of shoulder movement. The therapist must carefully examine each throwing athlete to identify exactly which soft tissues are affected, why, and what to do about it.
When tests show that the athlete's shoulder is stable with only a mild loss of motion and no pain, then the program can be stepped up to the third phase. Here the training becomes more intensive with endurance drills, plyometric training for speed, and an interval throwing program. Interval throwing progresses pitches through various distances, speeds, and intensities on and off the baseball mound with plenty of rest periods in between. The player is taught how to regain speed without overtraining before moving to the final phase.
Phase four continues to advance the pitcher through a series of advanced interval throwing exercises, strengthening and conditioning exercises, and a maintenance program at the pre-injury level of performance and play. If all goes well, the athlete is returned to the game. If there has been no improvement (or not enough improvement), then surgery may be advised.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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