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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'health'

For those following my rehab journey, this entry will recap days 8-14 after surgery. At this point, I had been off pain meds for 4 days. However, I will admit I took one pain pill prior to my first PT session exactly one week out from surgery. For two decades I have listened to patients recount stories of their own or friends who report how painful therapy is after this surgery. Oddly enough, most of my patients over the years said it was not so bad. Perhaps, there is great variability in the intensity of the passive stretching among therapists.

Research Nuggets

The literature offers support and caution for early motion after rotator cuff repair. While ROM is generally better early on with early motion, there is some concern about higher re-tear rates. I am in the camp that gentle early passive range of motion (PROM) is okay given the proper regimen and patient compliance. Early active range of motion (AROM) or too vigorous PROM is likely to be more detrimental to the repair. Ultimately, these decisions are made based on the size of the tear, tear configuration, patient’s health and age, MD preference and whether or not this is a primary or revision repair.

The article abstract below is a great reference for activities and activation of the rotator cuff as measured by surface EMG to provide some insight for patients and clinicians regarding safe movement and exercise in the rehab process:

https://pubmed.ncbi.nlm.nih.gov/28704624/

In addition, here is another article that outlines post-op rehab (you can download the entire article for free)

https://pubmed.ncbi.nlm.nih.gov/29399735/

My First PT Visit

So, I would be lying if I said I was not nervous. I mean I was always the guy stretching the fresh post-op shoulders, and suddenly I am the one laying on the table a week out from surgery about to let someone move my stiff, sore shoulder. Fear of the unknown is probably the worst in that moment. My therapist is a colleague in my own clinic who actually reports to me. No pressure on him, right? LOL

He and I agreed to co-pilot my rehab and map everything out through constant dialogue and feedback. He has done a good job thus far. That first day the shoulder felt like a cement block to me. It seemed like super glue was preventing it from moving much. The focus was on gentle external rotation and flexion range of motion. Both hurt, but the flexion was by far the worst for me.

After doing pendulums and the PROM with him, my routine consisted of:

  • Seated passive external rotation using a cane on my own – 2 sets of 15
  • Scapular retraction (gentle squeezing of the shoulder blades together) – 2 sets of 15
  • Seated table slides with a towel – 2 sets of 15
  • Game Ready x 15 minutes with low compression


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Last week I began sharing my story about my left arthroscopic rotator cuff repair. As reminder, I had surgery on May 20. In this post, I will share more about the first week. I get many common questions like: How bad does it hurt? When can you get rid of the sling? How long is the total recovery?

The entire outpatient procedure went well. I barely remember getting an interscalene block (kudos to the anesthesiologist) and the entire operation lasted about 45 minutes. The  oldest feeling is not feeling the left arm and having no control of the arm until the block wears off. The entire arm is essentially paralyzed and numb. Great for pain management to be sure, but not even being able to use the hand is inconvenient for small prehensile tasks.

I was fortunate that I did not have any adverse reaction to the anesthesia itself. I was a bit tired and groggy for the first 4-6 ours after surgery. The biggest adjustment is getting used to the sling and abduction pillow (see below)

Learning how to sit, adjust and take this off/put it on takes some getting used to. However, I quickly learned how valuable and supportive it was once the block wore off. My surgery was at 8:45 AM on a Thursday. The block wore off about 18 hours later at 3 AM. Let’s just say that aha moment was enough to get my attention.

Pain 

I would say pain level was 7/10 for me. The doctor and his staff had advised me to start taking pain pills ahead of the block wearing off and I had initiated that about 8 hours after surgery. I was alternating ibuprofen every 2 hours while taking oxycodone every 4 hours. I can only imagine how much more it would have hurt if I had waited for the block to wear off.

Cryotherapy

The first 3-4 days afterward were the worst in terms of pain. Generally, pain at rest was probably 3-4/10, occasionally spiking to 9/10 if I moved the wrong way. Aside from the meds, I used cryotherapy, specifically a Game Ready, extensively (20 minutes on, 40 minutes off) 8-10 times per day the first week. I cannot say enough about how helpful this is in managing pain and inflammation.

This unit provides cold and compression, however, I would recommend low or no compression initially as your incisions will be tender, especially once the surgical dressing is removed at day 3 post-op. I sat upright in a chair and supported the elbow while using this machine. The hospital or outpatient facility will offer a polar care unit for $250, but I opted for this unit as I have used it for years in the clinic, while hearing countless patients tell me how much better it is. A 3-week rental will cost you $300, but it is well worth it.


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The idea behind this exercise is applying progressive gradients of resistance that encourage the faulty motion (pulling the leg into adduction and internal rotation) to facilitate increased activation of the gluteus medius/minimus and small lateral rotators to create an anti-adduction/internal rotation force by forcing the brain to work against the unwanted motion (better central nervous system activation). Decreasing such moments at the knee will reduce IT Band issues, patellofemoral pain, ACL injury risk and overuse problems often seen in running.

The video below from my online column for PFP magazine demonstrates how to execute this exercise. It is a great corrective and prehab training activity.

At times, athletes I work with have shoulder or low back pain that is related to restrictions in the thoracic spine. Rotational sports rely upon adequate mobility in the thoracic spine to ensure proper force transmission throughout the body’s kinetic chain. This exercise featured in one of my recent PFP online columns is a nice corrective exercise or mobility drill that can be used to optimize t-spine mobility and resolve any asymmetries.

Keep in mind that forcing through pain or stiffness is not advisable. This exercise can be done daily or as part of the warm-up routine.

As 2020 draws to a close and no holiday travel due to COVID, I found myself spending extra time scanning Twitter, IG and some various blogs related to training and rehab last week. I remember starting my blog many years ago prior to the birth of Twitter and IG (I am feeling old typing that lol). My purpose with this blog has always been to freely share information with clients, the general public and practitioners.

Now, more than ever, there is a plethora of opinions, videos, posts and methods on multiple platforms out there on the web. Many people seek clicks, followers, validation, attention, ad revenue or internet fame. It becomes easy to quickly go down a rabbit hole and become consumed with back and forth convos, online debates about the best exercise techniques/methodology, sales pitches for training programs, and in general what I deem to be excessive or over the top ‘look at me’ promotional posts by certain people. On one hand, the internet is a gift that gives us all a bigger platform and voice, including me. On the other hand, it can also muddy the water, create division among the ranks, and propagate consumer confusion as to what is best for him/her in rehab and training circles.

The spirit and purpose of this year-end blog post is one of a cautionary tale for consumers and young professionals. As someone more seasoned with 24 years of experience rehabbing and training clients, I feel it is important to step back and remember a few important things in this era of instant gratification and access to countless online videos, programs and opinions just a few clicks away.


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