On a Sunday morning in 2006, Cecilia Wu was mugged after leaving church.
“I was at a small shopping center, and a guy came up from behind and grabbed my purse,” said Wu, who recently turned 70. “I instinctively held on; he pulled again and sent me flying.”
When she hit the ground, she broke her right clavicle. Although she’s not sure when the tear took place — she felt pain while performing everyday tasks — the injury eventually caused damage to her rotator cuff.
“I was living with pain off and on for years, and I thought it was related to the clavicle,” she said. “A couple of years ago, the pain became unbearable.”
Discouraging treatment options
In 2016, Wu underwent a round of rehab at Casa Colina Hospital in Pomona, but the treatment only agitated her injury. A series of scans later revealed a full-thickness rotator cuff tear.
Wu contacted orthopaedic surgeons to research options to fix the tear: One recommended surgery, which would entail a painful recovery, while another prescribed a topical anti-inflammatory to possibly ease her pain.
“That [medication] was almost $3,000; it was outrageous,” she said, adding there was no guarantee of long-term improvement.
Discouraged with her treatment options, Wu opted to participate in a pilot study at the Clinical Biomechanics Orthopedics and Sports Outcome Research Lab.
“It was better than surgery or the ointment,” Wu said.
Funded by a $463,000 donation from Barbara Fried, who experienced a similar injury, the lab conducts revolutionary research for patients with full-thickness rotator cuff tears.
The “unheard-of” treatment
Rehab for this type of injury typically involves non-weight bearing, open-chain exercises — for instance, holding a band and rotating the arm, while the end of the limb is free.
The concept behind USC’s research protocol involves closed-chain exercises often using the patient’s body weight — including push-ups, pull-ups, dips and reverse rows — while the end of the limb is braced.
“It’s a not a new type of exercise, but it’s new as it applies to people with full-thickness rotator cuff tears,” said Lori Michener, PhD, PT, lab director and professor of clinical physical therapy at the USC Division of Biokinesiology and Physical Therapy. “Our idea was that using this approach would facilitate less pain for the patient and better muscle activation.”
This treatment is “unheard of” for this type injury, said Jonathan Sum, PT, DPT, assistant professor of clinical physical therapy. “To my knowledge, there have only been one or two studies looking at the efficacy of doing these traditionally more difficult exercises,” he added.
Goal: sleeping without pain
In phase one, patients go through the study’s exercise protocol as part of their comprehensive physical therapy treatment, which could entail other interventions based on the injury. In the second phase, patients progress to a gym program with intermittent supervision.
In the summer of 2016, Wu started the study’s first phase, undergoing 30-minute therapy sessions twice a week for 12 weeks.
“When we started, she had difficulty raising her arm, lifting anything, and she wasn’t able to exercise,” said Sum, Wu’s primary physical therapist. “One of her big goals was to sleep through the night.”
Now in the second phase of rehab, Wu said her shoulder has completely recovered.
“Before therapy, I couldn’t even wash my back in the shower. Now, I forget I’ve ever had an injury,” she said. “I exercise; I do Zumba. The only reason I’m not playing tennis is because I can’t find a group to take me — I’m not that good.”
A potential gamechanger
The study, which started with 15 participants in 2015, has shown improvement in patients’ function and pain “dramatically,” Sum said.
“I can’t think of a patient who didn’t show improvement,” he continued. “In my opinion, this is one of these game-changers that could alter the standard of care for people with full-thickness rotator cuff tears.”
Surgery is often the protocol for this injury, which becomes more common as people age.
“By the time you reach 70, there’s a 50 to 70 percent chance you have some degree of full-thickness rotator cuff tear,” Michener said.
Through the work at USC, Michener hopes more patients can recover non-operatively.
“Many people who have surgery end up tearing their cuff again for a whole host of reasons,” she explained. “Some statistics are as high as 50 percent; others are as low as 15 percent, depending on the injury and the procedure.”
This new approach could provide clinicians, including physical therapists and surgeons, with a non-surgical option.
Your own physical therapy team
“If we can prolong someone’s natural anatomy as long as possible, they’ll do better overall,” Sum said. “We want patients to have an alternative to surgery that returns them to better function and pain control.”
Michener and her team continue to examine the outcome of these exercises and are applying for a grant to investigate the short- and long-term impacts of the protocol.
Wu wants to spread the message to other patients.
“This is a very good alternative to surgery and the painful recovery,” she said. “The coaching atmosphere made it feel like you had your own team. I saw that I was improving, and that made me actually want to go to therapy.”
— Jamie Wetherbe