An Alternative Therapy for Rotator Cuff Injury

The painful rotator cuff syndrome is caused by inflammation or tears in one or other of the rotator cuff muscles.  One of the most common causes in older people is a tear in the supraspinatus muscle.  The usual treatment involves lengthy physical therapy  or expensive surgery.  These options may not always be acceptable, so Dr. Loren Fishman, a specialist in physical medicine and rehabilitation who teaches at Columbia Medical School, New York, has developed a Yoga-inspired alterative.  He’s published his method in the journal Topic in Geriatric Rehabilitation.    

Dr Fishman treated 50 consecutive outpatients with partial or full-thickness supraspinatus tears confirmed on magnetic resonance imaging (MRI).  In a single outpatient session he taught the patient a partial weight-bearing exercise involving triangular forearm support (TFS).  The purpose of the exercise is to train the subscapularis muscle to take over the function of the supraspinatus muscle.  The exercise can be done against a wall, in a chair, or in a full yoga headstand. Twenty-three patients were taught the chair-assisted headstand (Urdhva Dandâsana) version; 27 were taught the against-the-wall maneuver.  To train the subscapularis, the TFS maneuvers were repeated in physical therapy sessions; the average number of sessions for these patients was 5.

Immediately after the TFS procedure patients more than doubled the pain-free range of abduction (i.e. sideways away from the body) and flexion (i.e. raising the arms forwards) movements.  Pain-free range of movements were maintained or improved slightly more after 30 months.  Questionnaire-based pain scores improved 80% over pretreatment scores.  Three patients failed to improve.  Dr Fishman points out that although the rotator cuff has not healed, symptoms usually almost completely disappear.  He claims the results compare favorably with outcomes for participants in published international surgical, arthroscopic and\conservative treatment outcome studies.  He has records of a total of 723 patients collected over the past 10 years.  Of these, 680 reported nearly complete pain relief and almost full recovery of range of motion.

This is essentially a pilot study, as it was totally uncontrolled, in clinical research terms.  However, the results are apparently so encouraging it should not be long before other rehabilitation physicians take up the challenge of a rigidly-designed controlled study.  In the meantime, you can read more about the TFS method in the original publication; but think twice before you try it, if you are not 100% fit and healthy (apart from your rotator cuff syndrome).