The shoulder is a large and complex joint that is responsible for a lot of movement and mobility. However, the great mobility of the shoulder comes at the cost of stability. As a result, the shoulder joint is prone to injury caused by overuse, sprains, straining, and tears.
Shoulder injuries can be very painful and costly for health plans and employers. For patients, a shoulder injury means mobility issues, weakness, inflammation, and often a drawn-out recovery and missed work. Healing a shoulder—especially if the tear is more than partial—can be as complex as the joint itself.
The most common shoulder procedure is a rotator cuff repair. Rotator cuff (RC) tears account for 20% of all shoulder injuries. Rotator-cuff repair (RCR) is a soft tissue surgery with a high risk of retear. A RCR requires patients to be highly aware of their limitations post-surgery, particularly in the post-op period. In addition, catch-all PreHab and ReHab for shoulder injury can be dangerous as different tears come with distinct protocols, limitations, and timelines.
Rotator-Cuff Repair PreHab + ReHab: Why it Matters
Rotator-cuff (RC) tear is a common shoulder condition and is the leading cause of orthopedic evaluations in the US.
With more than 460,000 rotator cuff surgeries performed annually, RCR is the second most performed orthopedic soft tissue procedure. There are three types of tears that range in severity: partial, medium/large and massive. Each tear type has distinct protocols and recovery timelines. Surgery preparation and recovery should reflect the type of injury, as this will define the patient’s progress and diminish the risk of reinjury.
With the shoulder being a complex joint and center for upper body mobility, there is a high risk of retear. Preoperative education and surgery optimization paired with a custom follow-up ReHab program lowers risk and improves recovery times.
Perioperative education and PreHab followed by a shoulder ReHab program built for the patient’s shoulder injury type fast-tracks healing. With the shoulder being so sensitive to reinjury, recovery without guidance and strict adherence to compliance leads to re-rears and failure—especially in the 6-12 week post-op period.
Read on as we discuss the importance of both a PreHab and ReHab period for shoulder surgery—specifically a rotator cuff repair. Surgery optimization and a structured, daily ReHab program are the ‘peanut butter and jam’ of musculoskeletal recovery—you need both to achieve the greatest results.
7 Reasons to PreHab and ReHab for Shoulder Surgery
When we hear “PreHab” or “ReHab”, we often think of physical therapy. And yes, while PT is a main component, a complete PreHab and ReHab program for musculoskeletal healing and shoulder recovery should be multi-faceted and based on all of the factors that go into healing. At PeerWell, this means that shoulder recovery should be built around the five pillars of health: Physical Therapy; Stress, Sleep & Pain Management; Diet & Nutrition; Health Literacy; and Social & Environmental Preparation.
“Surgery alone is often inadequate to guarantee the satisfactory return of complete shoulder function…Therefore, a correct rehabilitation period, aimed to restore the shoulder function and avoid the risk of retear, is essential.”
Here are a few of the key reasons shoulder surgery patients should use digital PreHab, and follow-up ReHab to recovery from rotator cuff repair.
A Guided Digital Physical Therapy: At the heart of recovery from a musculoskeletal condition, especially one that requires surgery, is physical therapy. Low-impact exercises and range of motion exercises tailored to shoulder repair and surgery is critical for recovery. Designed to carefully follow reduced-mobility protocols, minimize the risk of retears and gradually improve passive and active range of motion, customized shoulder physical therapy reflects partial, medium/large, massive precautions and recovery timelines.
Track Range of Motion and Progress From Home: Being a complex joint with phased recovery for various injury and tear types, it’s important to follow medical direction, and understand what the recovery pace is for each injury. Built-in range of motion tools, like PeerWell’s Shoulder ROM that is able to measure post-op flexion, extension, external rotation, internal rotation and abduction is beneficial for patients and care teams who want to see how their patients are progressing past the immediate post-op period. Other built-in tools, like the Pendulum tool/Codman’s exercise encourage movement, and may even capture results for care teams.
Progressive Patient-Centric Physical Therapy Phases: Patients move through four stages of recovery based on clinical protocol for partial, medium/large and massive repairs. Starting in the “Healing Habits” phase, patients learn about the importance of cryotherapy, the must-follow precautions and restrictions for Phase 1 of their repair. This means starting with gentle, passive shoulder mobilization and active range of motion of nearby muscles. Each of the four phases lines up with the clinical protocol for their surgery to build key health literacy knowledge, and deliver repair-appropriate physical therapy.
Improve Health Literacy: The more you know, the better you do. When it comes to a complex injury and invasive shoulder procedure, it’s important that patients know the do’s and don’ts for their injury. While lengthy pamphlets and online research are daunting, PeerWell’s daily lessons share key information in a consumable way. Preoperative and post-op education is key for understanding precautions and limitations.
Curb Risky Behaviour: Before shoulder surgery (or any surgery for that matter), it’s important that patients lower their risk. Lowering risk going into surgery sets the stage for a better outcome, and even reduces risk of complication. A complete PreHab program will focus on smoking cessation, controlling blood sugar, reducing alcohol intake, and adopting healthier habits. After surgery, during ReHab, understanding the warning signs for complications, preventing muscular inhibition and stiffness, and maintaining the integrity of the repair is pivotal for a safe recovery.
Reduce Stress and Improve Sleep: Surgery is stressful, and also bad for healing and recovery. PreHab helps to control what the patient can, reduce anxiety and keep fear at bay with in-app mindfulness programs, drug-free pain management techniques and emotional support. PreHab introduces relaxation and mindfulness techniques that also improve sleep. After surgery, shoulder ReHab will continue to help manage post-op stress, depression, sleep tips, and pain coping techniques.
“The majority of patients with RC tears had a sleep disturbance, especially before surgery with a general improvement in sleep quality post-operatively. Moreover, sleep quality was correlated with pain as risk factors…”
Food and Nutrition for Added Healing: Small diet changes can promote healing, improve blood sugar control and reduce inflammation. A complete Shoulder PreHab program will include the superfoods, nutrients, and recipes that kick recovery into high-gear. After surgery, maintaining a balanced diet and eating superfoods that boost healing is simplified with easy tips, recipe hacks, and a deeper understanding of the nutritional building blocks.
Social & Environmental Preparation: Before and after surgery, patients will have reduced mobility, and cannot attend to daily tasks normally. They will need to make some adjustments to their life (and environment) in order to recover quickly and comfortably. PeerWell helps patients organize all of the “extras” that they haven’t had time to think about that may delay recovery. Having a safe environment to fully recover in is often overlooked, but makes for more seamless, focused recovery. Patients benefit from videos with tips on how to do essential, everyday activities from occupational and physical therapists.
PeerWell’s new and improved Shoulder PreHab & ReHab programs cover partial, medium/large and massive rotator cuff repair. Care teams are able to select which procedure their patient will be undergoing, and set them down the right stream for their shoulder surgery and injury type. Patients benefit from a PreHab and ReHab specially designed for the severity of their repair, allowing them to go through an experience in line with their surgery’s specific precautions, restrictions, and recommended soft-tissue physical therapy program.
Are you an employer, clinician, health plan administrator or member of the workers’ comp community interested in PeerWell’s NEW shoulder PreHab & ReHab programs? Reach out for a demo or more information.