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Patient Case Study – Full Rotator Cuff Avulsion Rehabilitation

Mar 29, 2021

Patient details: 65yr old male, Obese, Hypertension, no other comorbidities

Occupation: Heavy haulage truck driver

Injury Details: Fell between two truck trailers onto the right arm causing major rotator cuff tearing. Right shoulder arthroscopic subacromial decompression, excision of the AC joint and open repair of a massive avulsion of the entire rotator cuff on the 24/08/2020.

Critical Physical Demands of the job role: Ingress/Egress from large trucks and heavy machinery requiring 3 points of contact and ladder climbing. Lifting to 30kg from floor to shoulder height, forceful manoeuvring of items weighing up to 30kg at chest height, occasional heavy lifting above head height up to 30kg, repetitive upper limb use when tying downloads. Physical tasks can be completed for periods of up to 4 hours on a repetitive basis.

Rehab Timeline: The patient commenced physiotherapy immediately post-op and completed this for the first 6-weeks, he then transitioned to an exercise rehabilitation programme under my supervision at the request of the surgeon. From weeks 6-12 post-operatively, the focus of the exercise rehabilitation programme was to restore pain-free shoulder passive and then active ROM and begin isometric rotator cuff activation exercises and basic Theraband exercises in preparation for moving into the strengthening phase of the programme after week 12.

On review with the treating surgeon at 12-weeks post-operatively, the surgeon was happy with progress given the complexity of the injury, and clearance was provided to commence gentle strengthening exercises. From week 12 onwards, strengthening exercises were gradually introduced whilst also keeping focused on further building and maintaining the patient’s active ROM and rotator cuff function. Overhead exercises were not introduced until 5-months post-operatively when the patient was able to demonstrate good scapulothoracic control into overhead positions. The patient made steady progress over a period of 3-months (see graph below), with weekly reviews to ensure he remained on track with his exercises and they were appropriate for his presentation and abilities.

At the 6-month post-operative review, the patient was able to demonstrate normal pain-free shoulder range of motion (symmetrical to his non-injured arm), excellent power and strength with all rotator cuff integrity testing, and had reached the appropriate milestones to facilitate a graduated return to work programme. Using the evidence from the supervised exercise programme, the surgeon was able to provide clearance for the patient to return to modified duties with a 15kg lifting restriction below shoulder height only.

The patient is due to review with the surgeon again at the 9-month post-operative mark, the goal prior to this review is to further build the patient’s strength and tolerance for work-specific physical tasks and gradually build strength and capacity for overhead movements. The exercise programme will be suitably modified to begin to replicate the critical physical demands of the job role to ensure the patient is exposed to these tasks in a controlled environment, where a focus on correct manual handling and sound technique can we implemented. The ideal scenario would be for the patient to return to his full pre-injury duties at the 9-month mark, with some possible permanent restrictions in places for overhead lifting, due to the nature of the injury and surgery completed.

Keep an eye out for further updates on the patient’s journey over the coming months!

Alixe Marion (BSc – Exercise Physiology)

Workers Compensation Specialist

Senior Accredited Exercise Physiologist

By Alison Absolute Balance 24 Apr, 2024
The human body is designed to move in a three-dimensional plane divided into the following segments: Sagittal Plane: Cuts the body into left and right halves. Forward and backward movements. Frontal Plane: Cuts the body into front and back halves. Side to side movements. Transverse Plane: Cuts the body into top and bottom halves. Twisting/rotational movements. Too often we get caught training mostly in a sagittal plane, think running, squats, bicep curls etc. While these are all good exercises, in day-to-day life we don’t only move along a sagittal plane. What happens when you need to quickly get out of the way of the e-scooter flying towards you on the foot path or make a quick sidestep to avoid a pothole – these movements are along the frontal plane. While movements such as turning to check your blind spot while driving or turning to talk to the person next to us are in the transverse plane. When it comes to injury prevention and movement efficiency it is important to incorporate exercises from all planes of movement into training programs. Sagittal If a line ran down the middle of the body splitting it from left to right, movements parallel to this line are within the sagittal plane of movement. The sagittal plane is the most common plane of movement and is trained overwhelming more than the frontal and transverse planes of movement. Movements/exercises considered to be in the sagittal plane include running, squats, deadlifts and bicep curls. Now while all these exercises are good, with the way our lives having evolved into many desk sitting roles, driving from place to place etc, to then go to the gym and focus heavily on movements that are predominantly up – down, and forwards – backwards we can end up reinforcing these pathways and becoming somewhat robotic, heavily limiting our natural movements. Frontal If a line ran down the middle of the body splitting it into front and back, movements parallel to this line would be within the frontal plane of movement – essentially any movement that involves moving away from or towards the midline. Often neglected in strength programs, frontal plane exercises include Cossack squats, lateral lunges, and side raises. Transverse If a line split the body in half separating it into top and bottom with the pelvis being the point of division, any movement parallel to this line would be considered to be in the transverse plane of movement. Movement along/through a transverse plane is generally more rotational such as a Russian twist or trunk twist. By focussing largely on sagittal plane movements, we are risking developing muscle imbalances, limited mobility and uncoordinated movements in the neglected planes. Our body is designed to move on a 3-dimensional plane so make sure to train in a way that will allow it to move the way it’s supposed to. Katie McGrath Injury Prevention Specialist Injury Prevention Services
18 Apr, 2024
Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
05 Apr, 2024
Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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