A question that arises frequently is whether or not a torn rotator cuff should be surgically repaired.  Many factors will play into the ultimate decision: age of the patient, overall health status, partial or full rotator cuff tear, time needed for rehabilitation.

Let’s look closer at some of these variables: 

Age of the patient: As we age, the common tendency of the rotator cuff is to become weak, stretched, hypovascular (poor blood supply) and possibly torn already as a result of fraying over the years.  Many surgeons have told me the rotator cuff in the elderly looks similar to tissue paper, making a surgical repair not possible.  In many of my elderly patients, conservative management is the only choice.

Overall health:  In patients with compromised cardiac function, surgery may not be a viable reason for additional health reasons. 

Partial or full thickness tears:  As the name implies, a partial tear indicates that the muscle is not torn all the way through and conservative rehab may be a stronger choice.  A full tear of the muscle leaves no chance of spontaneous reattachment without surgical intervention.  If you do have a full  thickness tear and choose not to have it repaired, then expect to have residual strength deficiencies . The residual arm weakness may not be an issue for your particular lifestyle or you may learn to live with it.

Time needed for rehabilitation:  Many patients do not realize that you will probably be in a sling for 4-6 weeks after surgery and will not be allowed to use your arm except for passive range of motion exercises.  For many clients that have other obligations (child care, work duties, etc) this may not be an option and they may try a more conservative approach (assuming no full thickness tear of the rotator cuff)

Many factors must be considered when surgery is an option.  The more information you have, the greater capacity for making a sound decision.  Good luck!

Ed Deboo, Physical Therapist

Bellingham, Washington

What can cause this and what do I need to do to help treat it? There are two main types of frozen shoulder:

1. Insidious onset- no injury, just a natural tendency for the shoulder muscles and capsule to get tight. The most commonly effected with this type of frozen shoulder are women with diabetes and it is also common to experience this in both shoulders.

2. Secondary frozen shoulder:  The second, more common type of frozen shoulder is a secondary complication as a result of some type of shoulder injury.  For example, you hurt your shoulder while lifting something heavy or playing tennis and you get diagnosed with a rotator cuff injury.  Well, your arm hurts to you stop using it for many daily activities while you rest it.  However, if you don’t perform the correct range of motion exercises during this “rest period”, your shoulder joint and capsule could freeze up resulting in a much longer rehabilitation period.

The literature states that from the onset of shoulder pain or arm pain from a frozen shoulder, it will take about 24 months to completely heal and regain all lost function.  What can you do to speed up the recovery time?  Focused and specific range of motion and strengthening exercises will help tremendously.  Be smart and take charge of your health!

Ed Deboo, Physical Therapist, Bellingham, Washington.

As a manual structural therapist, I have always had a  different take on carpal tunnel syndrome.  First, let’s talk about the make up of the median nerve:  the median nerve is made up of nerve roots that exit the spinal column at the levels of C5-T1 that pass just under the clavicle and then travel down the arm (see picture below, courtesy of Grant’s Anatomy).   You can see the thick, canvas like tissue at the wrist.  This is what is “released” in surgery.

Since the median nerve roots come out of the middle and lower neck, it makes good sense to first look at the mobility of the cervical spine to determine if there is any segmental vertebral joint restrictions that may be playing a role in the arm symptoms.  I just read a research article from some Physiotherapists in Spain that give this treatment approach some scientific credibility.  To summarize the article:

71 women with diagnosed CTS had their cervical (neck) range of motion tested to see if they also demonstrated restrictions proximally (the area that the median nerve is formed from).

Conclusion:  Women with mild to severe CTS all exhibited less cervical spine range of motion compared to women of the same age without CTS.

My take home message is this:  if you have CTS and are being treated, make sure your practitioner is also addressing your cervical spine, clavicle, and explaining the role of the neck in your hand symptoms.  Good luck!

Ed Deboo, Physical Therapist

Bellingham, Washington

Nerve: median nerve
Diagram from Gray’s anatomy

Summary of the study:  67 women diagnosed with Fibromyalgia where placed in to two groups:

Group 1:  low intensity walking without walking sticks only once a week for 20 minutes.

Group 2:  Nordic walking (used two walking sticks/hiking poles).  This group started each session with low intensity walking followed by a series of 2 minute intervals of higher intensity walking including both flat and hilly surfaces for a total of 20 minutes 2 times per week.

According to the researchers “after 15 weeks, the women in the Nordic walking group experienced improved function, decreased activity   limitation, and improvements in fatigue levels compared with the control group”.

This is promising on many levels.  You have often heard me preach the importance of daily exercise and walking is something that we can all do, anywhere we are at, without the use of expensive gear or equipement. A quick search for hiking poles on Amazon.com showed multiple pairs for about $25, not a big investment. 

 The results of this study are preliminary and we cannot make vast, sweeping judgements.  However,  I will be recommending this program to my Fibromyalgia patients as an alternative to steady state walking to get them to exercise and hopefully improve their quality of life. Good luck!

Ed Deboo, PT,

 Bellingham, Washington

He asked me what I thought and my first question to him was whether or not he still enjoyed playing basketball.  His response was a resounding “yes, I love playing but I’m afraid I’ll never be able to play again”.  In response to his Eyore like answer, I gave him my suggestions:

1. Get your hip and back looked at by someone who will do a comprehensive bio-mechanical analysis of his gait and running technique, not just give you hip stretches that you can find on the internet. (FYI: upon evaluation, we found that his ankle on the opposite side of his painful hip was severely restricted, placing more stress on the opposite hip with running, jumping, etc)

2. Tell yourself everyday in the mirror that you will return to basketball, you must believe it.

3. Until you can do it on land, take up deep water running to keep the movement strong without the gravitational impact.

4. Get some body work done either by your Physical Therapist, massage therapist, or local Rolfer.  In addition, try a course of acupuncture.

5.  Start a strengthening program with body weight resistance and free weights, no machines.

6. Lose weight, no excuses, just do it.

7. Try Glucosamine/Chondroiton for 6 weeks

The results?  He’s had to limit the number of days in a week that he can play, but he’s BACK, doing something he loves, how great is that?

Sobering stats:

• According the the American Arthritis Foundation, 27  million Americans have osteoarthritis that effects their quality of life. 
• 632,000 joint replacements are performed each year in the US.
• obesity is one of the main culprits of advancing osteoarthritis.

The mainstream medical community is finally understanding that the best thing for arthritis is to get moving!  Gone is the old attitude of rest and medication.  Studies have shown that reducing weight, starting a strength training program, and performing range motion/stretching exercises can significantly improve your quality of life as compared to medication alone.  Good luck!

Ed Deboo, Physical Therapist, Bellingham Washington

Cheers, Ed

However, I read an interesting article by John M Cissik, MBA, PT from the Texas Women’s University in Denton, Texas, who checked on the actual evidence of these claims in the literature.  What he found was that the evidence to support these claims is “lacking, contradictory, or taken out of context”. 

Let’s look at the 3 main areas of “benefit” from core training and then take a critical look at the literature:

Performance Improvement:  Research review in this area has, at best, produced “mixed results” with some studies showing improvement in field tests and others not.

Injury prevention:  Most of the literature in this area deals with core training and the prevention of lower back pain.  The nature of lower back is too complex to conclusively say that core training can actually “prevent” lower back pain. 

Injury treatment:  Again, most of the research is with lower back pain and it’s response to exercises including core training.  Several studies have found a positive correlation between strength training and the reduction of lower back pain.  However, the studies have many detractors who disagree with the methodology and therefore, do not take stock in the results.

So what does this all mean and how has it changed my approach to core training for myself and my patients?  The results of this literature review highlight the difficulty of studying exercises and directly relating them to performance and injury prevention/treatment.  To take performance and injury treatment and reduce them down to a simple series of exercises is far too simplistic as there are a multitude of factors that play a role in each. 

Remember, in the human developmental process, movement came first, then stability and strength! Babies are born with great flexibility, but almost no strength as even lifting their heads is difficult.  How does that translate to injury prevention/treatment and performance?  If you have ever been a patient at our clinic, you would know that finding the movement loss first is critical since you cannot strengthen tissue that is in “guarding” or “protective” mode.  Bottom line, continue with the core strengthening exercises, remembering that they are only a component of the entire fitness plan and look for areas of immobility or asymmetry and get them corrected!  Good luck and keep moving.

“Ed Deboo, PT, doesn’t want to fix people. He wants them to fix themselves. ‘I don’t want you to come in and watch you ride my bike,’ he says.‘I help to facilitate the healing process and remove roadblocks, but you own your own health.’

To read the entire article and view the pictures, please click here to download the NW Health PDF

What’s new in the literature?

I will often come across an article that I think my patients would be interested in. I have included a short summary and then cited the source if someone was interested in the entire article. Enjoy!

For those who do not know what Statin drugs are or what they do, they help to reduce cholersterol  (LDL’s) by blocking a crucial enzyme the liver needs to produce cholesterol.  Common names for statin drugs include: Lipitor, Lescol, Mevacor, and Zocor.  There are many documented benefits to statin drugs, besides just lowering cholesterol: they help to reduce cholesterol build up on artery walls that may lower the risk of a heart attack, they  have anti-inflammatory effects, and may also prevent certain forms of cancer (although the research still isn’t complete).

However, about 1%-5% of those taking statin drugs have side effects that include muscle pain and weakness.  The muscle pain and weakness can be  potentially dangerous  and needs to be discussed with your physician immediately.  Another side effected noted is memory loss.  The drug companies have added  this warning with  statin drug advertising  “Unexplained muscle pain and weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away.”

Since my patient had no other reasons for his sudden onset of increased muscle pain, he was sent back to his physician who then took him off of the statin drug.  Although many of you reading this who are on statin drugs may already be aware of this rare, but potentially dangerous side effect, I felt it warranted a blog entry.

In summary, if you are on any form of statin drugs and feel as though you have an increase in muscle pain or weakness, please contact your physician immediately.

In my search for credible information on the web, I came across this website, Healthnewsreview.org.  This is an an award winning U.S. website devoted to objective, evidence based reviews of medical articles and studies.  It is headed by Gary Schwitzer, long time medical journalist and professor at the University of Minnesota.

The mission of the website is to improve the accuracy of news stories about medical treatments, tests, products, and procedures, and help consumers evaluate the evidence for and against new ideas in healthcare.

It is then up to the consumer to make an educated decision, weighing both the pros and cons.  Healthnewsreview.org.  uses 10 criteria for evaluating medical news  and then rates them on a scale from 1-5 stars.  

The internet is a wealth of information and  Healthnewsreview.org  will help bring clarity to a sometimes confusing barrage of information so you may make the best possible decision for you and your family.