Rotator cuff Rehabilitation, The New Approach

Enjoy your readings

my regards

This paper claims to have reinvented shoulder rehab, while all the while advocating what has been pushed for decades, the notion that somehow shoulders get pain because of weakness. This completely ignores the much more common and useful prospect that in fact the reverse is more likely to be true. Also ignores the strong likelihood that there will be nothing wrong with the shoulder discretely at all . The most common cause of shoulder pain without injury is referred pain from the upper thoracic and cervical spine. Easily mapped , treated, and eliminated with appropriate manual therapies to the spine and none at all to the shoulder. In my own clinical life , it is such a rare thing to come across a shoulder pain/dysfunction problem that is not referred, I would almost say it is impossible. Nerves govern all function and sensation , to ignore the contribution from central neural structures and the association with spinal facet function is to position oneself, therapeutically , with doctors of medicine , who collectively , are driven by attention to and perceptions of patholgy. Pathology is rarely the cause of idiopathic shoulder pain.
This paper serves to drive the old tired shoulder weakness story still further in the minds of those not yet turned on to referred events as common and fixable phenomena.

Here is evidence based clinical guidelines for diagnosis, assessment and physiotherapy management of shoulder impingement syndrome

This site is like stepping back in time, to about 25 years ago, where understanding of neurodynamics was still fresh and unheard of. Your post sfkashif reflects a paradigm I would have adopted back then, prior to becoming alert to central neural mechanisms and their role in musculoskeletal aetiology.

Here is some useful view on Rotator cuff Aetiology and there has not been found any good emphasis on neural Tension or sensitivity in producing the rotator cuff syndrome.

Etiopathology of impingement syndrome

I would like to hear any evidence based studies or reviews reflecting the role of neural tension in Rotator cuff Syndrome Aetiology.

I can still recall how frustrated I felt when , as a new graduate , working in isolation , I faced up to dealing with numerous "frozen shoulders" or the other common name "rotator cuff syndrome " , with only what I'd been shown at University to guide me. Frustrating because , the best efforts I could manage at the shoulder, proved useless to fix these vexing and common problems. It was only when I discovered a relationship between relevant spinal facet joint dysfunction and the shoulder , that my success in really eliminating these problems began. Over the years since my first discovery , I have found similar relationships to exist between spinal facet dysfunction and the consequence , nerve root irritation , in the cause and better still , the cure for numerous other musculoskeletal conditions.
There are web sites whose principal therapist posters regularly describe and allude to these kinds of neural relationships , should you wish to see an alternative to plodding away at structures which have referred pain.
I can recommend Somasimple for one.
Rehabedge also has rheams of informative material , including my own work on the physiology of spinal and referred pain ( look in the manual therapy section ). Idiopathic shoulder pain is almost always referred pain from spinal joints, but is commonly misdiagnosed , mistreated and confused , in the minds of therapists and MD's alike. Adherance to a pathological model of insight and treatment will only lead you further away from the answer.

hi pal,
This is john, from india. Thats true what u said, being a new graduate, i too know how miserable it is to handle cases. But being a brilliant physio u turned out 2 be a shinning star.i have a questiio for u? I have read an article saying early mobilisation will worsen t symptom of shoulder at adhesive capsulitis stage. But in my case, mobilisation turned to be more successive in early stage or in the later stage of frozen shoulder.
I treated a patient, who is working as a chartered accountant, aged 55 with severe LT. PA shoulder for t past 4 months. He was crying of pain everyday. His ROM was not even 20 degree ABD & FLEX. For t past 4 months he was taking treatment of analgesics and inflamm.drugs. But no improvement. DR. adviced him MUA, he came 2 me i treated him with wax and mobilisation and home exercises, he got relive of pain in t 1st day & improve ROM 60 degree. He was surprised, and he continued 2 months of regular physio everyday and now he is 100%. so what is ur opinion about mobilisation for pa acute or chronic.

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I treated a patient, who is working as a chartered accountant, aged 55 with severe LT. PA shoulder for t past 4 months. He was crying of pain everyday. His ROM was not even 20 degree ABD & FLEX. For t past 4 months he was taking treatment of analgesics and inflamm.drugs. But no improvement.

hi friend
i feel we should think about other diagnostic possibilities and causes for the shoulder pain.dont get carried away by the diagnosis made by somebody else,especially in indian scenario.my personal experience shows that in more than 60% times,the cause will be related to rotator cuff.painful shoulder,periarthritic shoulder etc are vague terminologies which does not give a clue which tissue is at fault.even neural mechanosensitivity also causes similar presentation.
so a detailed assessment and clinical reasoning should be used for an appropriate treatment

for rotator cuff syndrome ther is no reliveing for pain totally by exercises and electical modelities by i notice the patient who given shock wave therapy have amazing results but it depend on the case itself that mean if the patient has another proplems as shoulder OA or cervical spondylosis and sure no tear