A New Yoga-Inspired Technique To Help Your Shoulder Injury

A painful surgery with a long recovery time and often disappointing results costing in excess of $12,000 is the standard treatment for rotator cuff tear, an upper extremity injury so common it showed up in almost 61 percent of shoulders in one study. Many patients with rotator cuff tear have come to me for help after playing golf or tennis, going to the gym, taking a suitcase from an overhead airplane bin, lifting and pulling activities or experiencing an accident. As a specialist in physical medicine and rehabilitation, and as someone who had gone through the surgery himself, I wished I could do more to help many of them avoid surgery.

I never thought I would come upon a non-surgical solution. Then, 10 years ago I tore my other rotator cuff while trying to avoid an automobile accident. This time the surgeons said the tear was so severe they couldn't fix it. The pain and inability to raise my arm even to shake hands were a nightmare, but I tried to go on with my daily life, including my yoga practice.

One morning, despite some apprehension, I got down on all fours, placed my arms on the floor and raised my legs until I was standing on my head. Amazingly, when I came down from that headstand, my shoulder didn't hurt any more. My arm moved as well as it did before my accident.

That serendipitous incident inspired the clinical trial and the peer-reviewed paper, "Yoga-Based Maneuver Effectively Treats Rotator Cuff Syndrome,"on research for which I won a prize at the 1st International Conference on Yoga for Health and Social Transformation in India this past January.

TFS Keeps Working

The longitudinal before-and-after paper follows a group of 50 patients from the original large cohort. I kept track of them for more than two years to make sure their shoulders stayed pain free and they retained their range of motion.

Immediately after completing the exercise, the average improvement for 46 patients was 150 percent. In other words, these patients more than doubled their range of motion and could lift their arms normally. Much of their pain disappeared. Patients reported their pain reduction on a questionnaire.

The average was 82 percent. Many said that they were pain-free. Only three patients reported no improvement. (One patient dropped out of the trial.) Nevertheless, 46 patients were satisfied with their outcomes, and they sustained the initial results for 30 months or longer. Most patients also received just enough physical therapy to solidify their gains -- an average of five sessions over a period of one week to 10 days.

Outcomes for TFS Exceed Those for Surgery

Those who improved in my clinical trial of the new, conservative treatment had results equal to or exceeding outcomes for participants in published international surgical, arthroscopic and conservative treatment studies. One study of comparable tears in the Journal of Shoulder and Elbow
Surgery, for example, found a 22 percent gain in range of motion for arthroscopic procedures and did not specify pain reduction. A paper in Joint Bone Spine reported 55 percent pain reduction and 25 percent increase in range of motion. A 2007 trial in the Journal of Bone and Joint Surgery that measured results of conservative therapy showed only a 19 percent improvement in range of motion after six months.

The following slideshow demonstrates the triangular forearm support (TFS) exercise. Amy and Pete both hurt their rotator cuffs doing yard work, golfing and playing with their their 4-year-old. They decided to try to figure out what they could do for themselves, and they're interested in yoga. We were a perfect fit.

Speak to your doctor before deciding on the safest treatment for you.

 

Comments

[robert horwitz]

09:09 AM on 09/26/2011

OK maybe standing on your head will relieve shoulder pain but what do you do for that broken neck you get while curing your shoulder? You think shoulder surgery is expensive. You haven't seen anything until you get the bill from a Neurological Surgical Team. Don't forget to figure in the four month stay in the hospital in traction. Be sure you ask for a room with a TV that swivels because you sure won't be able to move your head.

[Drmhp]

02:09 PM on 09/24/2011

Just get DMSO and put it on once a day. It will heal the injury. Works for all soft tissue damage. Cured my chronic knee pain.

[Loren Fishman, MD]

07:15 PM on 09/24/2011

It's a wonderful solvent, but that's also the drawback: it will dissolve and therefore contain just about anything it's been in contact with before it's in contact with you!

[Jacob Rozbruch]

12:41 PM on 09/24/2011

Loren,
In my experience, full thickness tears of the rotator cuff don't do well with conservative Rx. Without removing the causative factor, healing of torn tendons cannot occur without recurrent breakdown, assuming that it heals at all. Most, get worse over time.
Surgically eliminating the source of impingement leads to elimination of the pain in better than 95% of patients, regardless of the severity or duration of the tear. Recovery of motion and strength is as good if the tendon and muscle have not degenerated and atrophied. The key to such good results is early intervention.
I think that it is misleading to suggest that strengthing the subscapularis alone will lead to a good functional and pain free result in the majority of patients. I suggest similar exercises but also include the infraspinatus and biceps to help lower the humerus away from the impinging acromium, plus strengthing the upper 1/3 of the trapezius to lift the acromium off of the rotator cuff. This can help only during the early tendonitis stage, once the bursitis resolves enough for the patient to exercise without pain. It will not, in my opinion, resolve the problems of a large supraspinatus and or infraspinatus tear or even tendonosis related to chronicity of injury. Realize that I often see the results of failed conservative treatment, which gives me another perspective.
Jacob D. Rozbruch MD
Orthopaedic Surgeoon
www.jacobrozbruchmd.com

[Loren Fishman, MD]

07:14 PM on 09/24/2011

Dear Jake,

Your may or may not remember, but we published a paper together in 2002! This time, I don't think I've gotten across to you the actual mechanism by which this maneuver works. It activates the subscapularis to pull down the head of the humerus as the deltoid acts like a fulcrum, holding the bone firmly. Lowering the head of the humerus as the bone is approaches 90 degrees actually raises the shaft like a see-saw, cantilevering the shaft higher. Once the shaft gets to 120 degrees or so, the deltoid has a vertical component again, and can take the bone the rest of the way up.

I've tested this with over 700 patients (more than 650 of whom have improved, usually right on the spot), using serial MRI, CT and eight channel EMG to figure out this mechanism and then validate it. This is not strengthening, it's neuromuscular retraining: getting a pair of muscles to act differently, to cooperate in a new, beneficial and painless way.

If you look at our last publication, at topicsingeriatric.com, you can download (for free) my paper in the May 2011 issue to get into the details of the study. You'll see it actually compares favorably in just about every parameter to open surgical and arthroscopic studies with 2 to 5 year followups, including both American and European studies.

Hey, consider something new!
-Loren

[sunshineshines]

08:54 AM on 09/23/2011

it's been four thousand years, which is not a bad track record.

[maab76]

08:56 AM on 09/22/2011

As one who suffered a severe tear, I find this article difficult to believe, let alone practice. After many months of physical therapy at two different locations, I called the orthopaedic department of my favorite teaching hospital and requested a second opinion. The doctor whom I consulted performed my surgery as well as that on many others in an attempt to determine if us "old folks" would improve quality of life WITH the surgery. Four months of intensive physical therapy to restore all of the muscles which pass through that shoulder, I had regained nearly 100% of the movement plus a lot more strength.

The results of Dr. Verma's study can be found at Rush University Medical Center's website. I will speak for his skill, his knowledge, his courage, and his ability to interpret study results.

[Loren Fishman, MD]

10:11 PM on 09/22/2011

It IS difficult to believe. I had surgery on my right shoulder for a moderate tear about 15 years ago, but did this maneuver on my left after a massive tear ten years ago. I have full painless range of motion on both sides. Strength is undiminished. Puzzled about it myself, I've used MRI, CT, ultrasound and eight channel EMG to figure it out. What happens is that the TFS maneuver activates another muscle, (the subscapularis) that works to elevate the arm through a cantilever type of action, so you do not need to use the injured supraspinatus. BTW, I went to Rush Medical School. - Loren Fishman, MD

[maab76]

10:30 AM on 09/23/2011

I do trust that you are a lot younger than I am. But how encouraging to read that there are options to choose. When doing the PT, I was putting in at least 5-6 hours per day on a selection of @ 20 specific maneuvers. We old folks do heal more slowly, and probably therefore need more time in which to work at retrieval. I will also speculate that my age slowed the development you were able to achieve. I was approaching 75 at the time of the surgery.

Have you been back to Rush lately? The new building is due to open in just a few months, and it is a major mark on the horizon. And I have encouraged a grand nephew to submit his test scores to Rush in the hopes of being accepted there. I have great respect for all who have their MD from there. Were you there when Ralph Spaeth taught pediatrics there? He was our Ped, and absolutely uncanny in the field of diagnosis.

And my hubby retires as biomedical engineer with experience at U of C, IL Masonic and Jesse Brown (formerly Westside) VAMC. Only one week to go.

Thanks for replying - good information.

[asfarasimconcerned]

08:54 PM on 09/23/2011

My son injured his shoulder in a HS football game last weekend. I also have a bad shoulder(broke in 1993 and injured again a few weeks ago loading our camper). We will both try these maneuvers tomorrow. Praying it gives us both relief.