Rotator cuff tears are extremely pain as Gary, a 40-year-old magazine photographer, who fell and tore his rotator cuff while on assignment in the mountains can testify. He felt intense pain in his shoulder; he could not lift his arm to shake hands.
Like many with this common injury, Gary faced an expensive surgery-- costs can total more than $12,000 -- and up to 18 weeks of physical therapy, often with disappointing results. Fortunately Gary needed none of it. Dr. Loren Fishman, a specialist in physical medicine and rehabilitation who teaches at Columbia Medical School, came to his rescue.
Dr. Fishman has developed a yoga-based maneuver, reported in the peer-reviewed Topics in Geriatric Rehabilitation
, that relieves the pain of rotator cuff tear and restores range of motion during one short office visit. His method trains the subscapularis muscle to take over for the injured supraspinatus muscle in the rotator cuff. Though the rotator cuff has not healed, symptoms usually almost completely disappear.
The method, called the Triangular Forearm Support, is an exercise that can be done against a wall, in a chair or in a yoga headstand. Dr.Fishman studied 49 patients for an average of 30 months to confirm its efficacy.
Immediately after completing the exercise, the average improvement for 46 patients was 150% ; in other words, 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. Their pain relief averaged 82%. Many said that they were pain-free. Three patients did not improve at all.
All 46 patients were satisfied with their outcomes in Dr. Fishman''s longitudinal before-and-after study, and they sustained the initial cure for 30 months or longer. Most patients also received a little physical therapy to solidify their gains -- an average of 5 sessions over a period of a week to ten days.
Those who improved in Dr. Fishman''s clinical trial of the new conservative treatment had results equal to or far exceeding outcomes for participants in published international surgical, arthroscopic and\conservative treatment outcome studies. One study of comparable tears in the Journal of Shoulder and Elbow Surgery
, for example, found a 22% gain
in range of motion for arthroscopic procedures and did not specify pain relief. A paper in Joint, Bone and Spine
reported 55% pain reduction and 25% increase in range of motion. Another trial in Orthopedics that measured results of conservative therapy showed only a 19% improvement in range of motion after six months.
Dr. Fishman''s exciting treatment for rotator cuff tear is particularly well-suited to elderly patients who are poor candidates for surgery. However, rotator cuff tear is one of the most common upper extremity injuries. It is
widespread among people over forty, gym-goers, field athletes, those who have accidents, anyone who makes repeated overhead motions, like taking a suitcase from an airplane storage bin, or forceful pulling or lifting motions.
While there are no definitive statistics, because not all are painful, estimates are that rotator cuff tear affects as many as 30% of all adults.
After suffering a painful injury to his own shoulder that also restricted his ability to lift his arm, Dr. Fishman invented the non-surgical rotator cuff treatment serendipitously.
"Though this paper follows 49 patients for 30 months, I have used this technique on 723 patients over the past ten years,"says Dr. Fishman.
"Of those patients, 680 have reported nearly complete pain relief and essentially full recovery of range of motion."
Several of Dr. Fishman''s patients who have success with his method would be happy to be interviewed.