Sep 21, 2016Post-Op Shoulder: Using End Feel to Gauge Progression Speed
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By Lenny Macrina, MSPT, SCS, CSCS
Therapists are challenged on a daily basis to get their patients back to normal function. Think about it: someone comes to you in pain, just out of surgery or unable to do a daily task, and they’re relying on you to get back to their normal life. Talk about stressful! That is what makes our profession so excitingly special and rewarding.
Post-op shoulder rehabilitation
One aspect of therapy that I have much experience in is post-operative care, particularly of the shoulder. I see these patients as a challenge because there’s no guarantee that their motion, strength, and function will return to the expected levels. However, it is so rewarding to see these people show up in pain and completely debilitated but leave a few months later with most of their function. Our job is to nurture the process, not force it, and to slowly progress patients back to normal activities.
I frequently hear therapists complaining about the limitations of protocols and the speed by which they can progress a patient. This really frustrates me because we are the true professionals that understand the anatomy and biomechanics of the shoulder joint and how it all influences the rehabilitation process. If you truly understand the mechanics of the joint and tissue healing, you can get any patient back to normal in no time.
Use End Feel as Your Gauge
So, what is the one factor that I think is the most important in rehabilitating a patient safely and gradually after a surgery? In my opinion, end feel is the single most important aspect of rehab progression a therapist needs to consider.
If a post-op rotator cuff is having painful guarding, which is very common, then the therapist must figure out a way to get through this without the negative effects of further spasm, disuse, and capsular contraction.
On the flip side, a Bankart repair in a young athlete should be progressed at a speed where the tissue is not ‘stretched’ out and a nice, capsular end point is maintained. Should they begin to feel tight, don’t panic! Young adults, say up to 25-30 years old, very rarely get too tight. Let the process happen, progress appropriately knowing that excessive ROM gains may preclude the patient to further issues down the road if their instability returns.
Take Your Time
Remember: tissues need to reach a level of homeostasis, and this takes a lot longer than we think. Some would say many months to years, although a therapist may only see a patient for a few weeks or months because of insurance limits.
So, respect the process, think long term, and use the patient’s end-feel as your gauge. I’ve been spot on with this thinking for many years and have had numerous patients thank me for it.
Below, Lenny Macrina discusses a case where he was rehabilitating a teenage ballet dancer after a Bankart repair in a short video from his course, Rotator Cuff and Labral Pathology: Presentation and Post-Operative Rehabilitation.
About Lenny Macrina, MSPT, SCS, CSCS
Leonard (Lenny) Macrina, MSPT, SCS, CSCS, is the Co-Founder and Director of Physical Therapy at Champion Physical Therapy and Performance in Waltham, MA. He received his Master’s Degree in Physical Therapy from Boston University. He has been teaching continuing education courses on shoulder rehabilitation, and presenting at conferences around the United States since 2006.
Lenny’s work has been published in the Journal of Orthopaedic and Sports Physical Therapy, the North American Journal of Sports Physical Therapy, the Sports Health Journal, and many more. His professional memberships include the APTA Massachusetts Chapter, APTA Sports Physical Therapy Section, American Sports Medicine Institute, and National Strength and Conditioning Association.