Chronic Pain / Rotator Cuff Tears

Understanding Chronic Pain

Many people use the term Chronic to convey just how excruciating a pain is. However, what the term really means is simply that the pain has been there for longer than three months, even if it’s not very bad. The distinction is made after three months because most injuries to tissues, either muscle, bone or joint, has had a chance to heal and resolve by this time.

Why make the distinction?

The difference between pain that has just happened and pain that has been there for a long time has implications for treatment. Chronic pain requires different management and is likely to be caused by more than one thing where as short-term pain (also known as acute pain) often has a distinct cause, such as a fall.

What are some examples of acute conditions?

A sprained ankle, torn muscle, a bruise and even a broken bone are all examples of injuries that occur suddenly and usually follow a typical pattern of healing. They usually go through an inflammatory reaction with the area being red, hot, swollen and painful to touch. This period usually lasts for a few days and is a normal part of the healing process as the body works to remove damaged tissue and repair the affected area. Different tissue types take varying amounts of time to heal. The severity of the injury will also affect healing times.
Some acute injuries can become chronic if something goes wrong in the healing process. Some acute injuries are so bad they won’t heal without medical care. For example, fractures need to be kept as still as possible to allow the broken bones to heal together in the correct position.

Some pain and illnesses develop over time and are chronic in nature, usually starting insidiously and becoming progressively worse. Osteoarthritis, multiple sclerosis and rheumatoid arthritis are all examples of chronic conditions that can cause chronic pain.

For some people, even though their injury has healed and no significant cause can be found, pain persists. This type of pain can be particularly distressing and requires a holistic approach to treatment, particularly addressing the emotional costs that come with suffering from long-term pain.

Certain factors will predispose someone to developing this type of pain including recent or past emotional trauma, anxiety and depression. Unfortunately chronic pain often causes people to adopt a vicious cycle of rest, which causes more stiffness and pain, which then leads to more pain and so on.

Your physiotherapist is well trained to help you cope with chronic pain and get you back to a more functional level and doing the things you love.

Chronic Pain Project

Sometimes the internet can be a confusing place, full of misinformation, particularly from people trying to sell you things. A recent website developed by the Department of Health in Western Australia aims to provide evidence-based support and education to pain sufferers.

Have a look here at painhealth.csse.uwa.edu.au

Rotator Cuff Tears

WHAT IS THE ROTATOR CUFF?

The rotator cuff refers to four small muscles in the shoulder joint that connect the shoulder blade to the upper arm. They stabilize the shoulder joint, and also act to rotate the shoulder inwards and outwards.
The muscles attach at different points around the shoulder blade and attach as four tendons into the top of the humerus (upper arm bone).

HOW DO THEY TEAR?

These tendons are commonly injured through a fall onto an outstretched arm. However, they can tear from seemingly harmless movements of the arm repeated over a long period of time if the tendons are weakened. This is often referred to as ‘repeated microtrauma’. Tears occur most commonly at the point where the muscle turns into tendon, called the musculotendinous junction.

WHAT DOES IT MEAN IF I TEAR MY ROTATOR CUFF?

What to expect after a rotator cuff tear depends on how bad the tear is. It is possible to tear the tendon completely in two, which usually requires a surgical repair and subsequent rehabilitation. Partial tears can heal with rehabilitation and the length of time required will depend on the severity of the tear.
Unfortunately, while many rotator cuff tears are resolving and healing, secondary complications begin to occur. The shoulder girdle is a very complex and flexible part of the body and as such is quite vulnerable to pain caused by poor movement patterns
Many people move differently when they have pain. They might tend to elevate the shoulder blade, move their neck less to that side or simply move that arm less.

A common condition associated with rotator cuff tears is shoulder impingement, which is where, due to poor muscle control, structures within the shoulder joint are compressed and irritated as the arm is moved.

CAN PHYSIOTHERAPY HELP?

Physiotherapy is an important part of the rehabilitation process of rotator cuff tears, those both surgically and naturally repaired. Your physiotherapist will help to prevent secondary neck and shoulder problems and give you a strengthening program to restore you to your previous function. For the best outcomes it’s important to seek treatment as soon as possible and get started on your rehabilitation program.

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