It’s a reasonable question. Your shoulder has been sore for a while, you’ve had a scan (MRI or ultrasound, most likely) and you’ve been told the dreaded news…
You have a rotator cuff tear!
Life suddenly flashes before your eyes the room spins and you can feel your dreams of a huge bench press, playing sport or even lifting up your kids or grandkids slowly disappear.
Hopefully you’ve kept reading for the good part. A rotator cuff tear is not the end of the road, nor does it mean a swift trip to the orthopaedic surgeon.
Many studies have shown that conservative treatment, AKA physiotherapy, is effective at improving shoulder pain and more specifically rotator cuff tears.
Two such studies looked at the comparison between physiotherapy treatment and surgical intervention in people with full thickness rotator cuff tears.
The first study looked at why people fail conservative rehabilitation. The definition of ‘failing’ physiotherapy treatment was electing to have surgery. Of the 433 participants only 87 (roughly 20%) elected to have surgery. The kicker here is, why did they fail? The primary reason identified by the researchers was the patient’s expectations of physiotherapy. So those who went in with a low expectation that physiotherapy didn’t work, surprise, surprise, didn’t get better.
The second study looked specifically at the effectiveness of physiotherapy. Patients were provided an evidence based exercise plan and then asked if they were cured, getting better or no better at 6 and 12 weeks. 75% of the patients were ‘cured’ with physiotherapy.
Furthermore, it is cost-effective. A 2009 study looked at the cost of four different shoulder surgeries. The results showed an average of $9444, $8675, $7246 and, hold onto your hats, a whopping $16, 323! A Swedish study conducted in 2012 looking at the cost of physiotherapy in people with shoulder pain determined the average cost of physiotherapy was a measly $288. So not only is physiotherapy physically effective, but it is cost effective too.
The important thing to remember is that physiotherapy treatment can take time. The best results are seen between the 6 and 12 week mark. This is not the ‘quick fix’ we all want, however physiotherapy is proven to work and ultimately saves a significant hole in your back pocket!
The take home message, ‘damaged’ structure does not always equal pain or dysfunction. Consider giving physiotherapy a try, persevere with your treatment plan for 6 to 12 weeks and reap the rewards of evidence-based, cost-effective treatment!
Dunn, W. R., Kuhn, J. E., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., … & Jones, G. L. (2016). 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery, 25(8), 1303-1311.
Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., … & Ma, C. B. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 22(10), 1371-1379. Milne, J. C., & Gartsman, G. M. (1994). Cost of shoulder surgery. Journal of Shoulder and Elbow Surgery, 3(5), 295-298.
Virta, L., Joranger, P., Brox, J. I., & Eriksson, R. (2012). Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC musculoskeletal disorders, 13(1), 1.
You’re having a terrible nightmare where, every time you train, the ‘strength gains’ literally melt off you. You awake in a pool of sweat and struggle to get back to sleep through the stress of it all. It is this moment where the ‘gains’ actually start to diminish.
We become so concerned with training hard and moving toward our goals, whether they are performance, health or physique based, that at times we neglect the other side – Sleep and recovery.
Most will know that sleep is important, but how important?
In combination with this, the negative impacts from a lack of sleep are abundant;
How do you know if you’re getting enough sleep? Try these three easy questions;
The answer to these should dictate quite clearly if you’re getting enough quality sleep.
If you find yourself in the ‘poor sleep’ category, how do you fix it? Firstly, the true cause of poor sleep must be sought.
By no means am I suggesting not training hard over the short and long term. If you’ve read anything written by me, you’ll know I have a significant researcher/man-crush on Tim Gabbett and subsequently his catch-cry “train harder AND smarter”. A considerable part of training smarter is promoting adequate recovery strategies.
This is all the more important during heavy training cycles. Heavy training increases the stress on the body, which elevates cortisol levels. This can create a situation of reduced immune function. Sound familiar? It’s the same situation when you don’t have sufficient sleep, now compounded! This leaves you more likely to succumb to illness and lose valuable time training.
In short, poor sleep and inadequate recovery has the capacity to reduce long term adaptation which is arguably THE key principle of strength and conditioning. By not allowing yourself adequate recovery the body is unprepared for the next round of training, meaning you are compounding fatigue and limiting performance.
In summary… stop reading this and get some sleep if you want to maintain those sweet, sweet ‘gainz’!
(Image Credit: YLMSportScience)
Please see this directory page for further information on stress: https://www.betterhelp.com/advice/stress/
Posture can be a tricky beast for most people to grasp, though it’s seemingly simple. I could safely say that each and every day in my clinic a patient will mention,
“I think [insert various ache or pain here] is because of my posture”
That, or, they’ll blame the scape goat of the muscular system, their hip flexors. If I’m really lucky, they may even blame both!
Posture seems to be really important and placed in a high regard. I don’t blame you for thinking this way either. It’s been drilled into us from our earliest days. Teacher’s telling you to sit up straight, and grandparents or parents telling you to fix your posture and if you don’t fix your ‘bad’ posture, you’ll end up with pain and dysfunction.
If you’re like me and The Simpsons taught you everything you will ever know and hold dear, this quote from Principal Skinner will resonate with you;
‘Mother always said, “a curvy spine is the devil’s roller coaster”’
So, today I am here to clarify some key points and free you from the shackles of our oppressive posture overlords.
Research published by Karen Richards in 2016 helps to clarify why our previous understanding of posture isn’t so straight up and down (see what I did there?).
Karen and her colleagues took a lot of young people (over 1,100) took photos of their sitting posture and divided them into groups depending on the angles between their head, neck and upper back. From this they identified four distinct groups.
From our traditional understanding of posture, we look at the above images and say a prayer for the slumped group, because, with posture like that, you’re destined for a life of back and neck pain.
The researchers found no significant difference in the odds of developing neck pain (or headaches, for that matter) between the groups! This strongly challenges our beliefs about posture and their relationship with pain.
What is really interesting though, is that our slumped group did have higher odds of depression. Which, as a therapist who has a strong belief in holistic (whole person) care, gets me really thinking…
Perhaps, a more important question to ask isn’t ‘what’s your posture like?’ but rather ‘how are you feeling?’. Just a thought!
So, when someone tells you posture is the problem, consider this…
In summary, here are Roar Physiotherapy’s Key Postural Points:
As always, leave any comments or questions below and I’d be happy to answer them!
P.S. Just to clarify, I do assess posture, but I do so in the right context
Richards, K. V., Beales, D. J., Smith, A. J., O’Sullivan, P. B., & Straker, L. M. (2016). Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents.
I couldn’t come up with a snappier title because, quite frankly, that’s as direct as it gets.
If you’re putting in the hard yards with your training, but you’re disregarding your recovery, it’s a critical error. Research has shown that sleep (AKA recovery) is just as important as physical conditioning AND nutrition to maximising performance.
If you’re prioritising everything except sleep, it may lead to partial sleep deprivation and this is what you’re potentially doing to your performance;
Furthermore, sleep loss reduces muscle protein synthesis (muscle recovery & repair) whilst also increasing muscle degradation (muscle damage). Not to mention it also reduces glycogen stores (available energy supply)!!!
In my opinion, if you’re sleeping on sleep, you’re doing TWICE the work for HALF the results. Prioritising sleep and working on optimising sleep hygiene provides the EASIEST and MOST EFFECTIVE recovery strategy.
The easiest way to optimise recovery and reap performance benefits is simply to sleep more. Some of us find that easy, others not so much. So, here’s some tips from the research!
If you’re pushing the limits and squeezing in two (or more…) training sessions daily, then you may also benefit from napping. A quick kip, approximately two hours following training, has been shown to improve preparedness to train in subsequent sessions.
As always, thanks for reading!