Rotator cuff repair surgeries are one of the most common procedures
performed by orthopedic surgeons, with over 250,000 performed annually
in the United States alone. Despite its prevalence, there is concern
regarding the ability of the rotator cuff to heal back to the insertion
site on the humerus following repair. Clinical studies have shown
radiographic failures at the repair site at 2 years in anywhere from 11%
to 95% of patients, depending on the size and chronicity of the tear,
presence of fatty infiltration, and the age and general health status of
the patient. Although patients with re-tears or failed healing may have
pain relief, these studies show that they have inferior functional
results when compared with patients with healed repairs. An
understanding of the histology and biology that occur during the healing
process may lead to therapies that can improve the healing rate and
improve the functional results of patients following repair.
Our understanding of tendon healing is largely based on animal studies because there is little histological information on healing rotator cuff tendons in human beings. From this animal data, it is known that rotator cuff healing occurs in 3 stages: inflammation, repair, and remodeling.
a. In the inflammatory stage, inflammatory cells migrate into the repair site guided by chemo tactic factors followed by an influx of blood vessels and fibroblasts.
b. In the repair phase, several growth factors are unregulated that induce cellular proliferation and matrix deposition.
c. Finally, this tissue undergoes remodeling due to extracellular matrix turnover mediated by matrix metalloproteinases (MMPs)
At the conclusion of the healing process, a normal rotator cuff insertion site is not regenerated. Normally, the rotator cuff inserts into bone through 4 distinct transition zones: tendon, unmineralized fibro-cartilage, mineralized fibro-cartilage, and bone. After repair, the tendon heals to bone with an interposed layer of fibro-vascular scar tissue that persists. The mechanical properties of this fibrous tissue are weaker than the native insertion site and may render repairs prone to failure.
The stages of rotator cuff healing involve inflammation, repair, and remodeling. Growth factors are expressed during the repair phase, because they promote cell proliferation and matrix production. This timeline must be kept in mind in growth factor therapies, because the addition of growth factors too early or late in the healing process may decrease their effectiveness. In an effort to limit failures, researchers have focused on ways to minimize the formation of scar tissue at the interface, while at the same time promoting the regeneration of the fibro-cartilaginous insertion zones. Initial studies have focused on improving the biomechanical strength of the repair through stronger sutures and by recreating the surface area of the footprint through double-row repairs or their equivalent. Even with these techniques, re-tears or failed healing still occur in up to 12% of patients.4 Although improved biomechanics may modestly improve healing, it appears that biologic augmentation of the healing process is needed to further reduce failure rates. Biologic therapies that can limit the amount of scar tissue formation at the repair site, and help regenerate a normal fibro-cartilaginous transition zone, may theoretically improve the strength of repairs.
How Ayurveda can help?
In many cases, these types of injuries are due to overuse of a part of the body when participating in a certain activity. Rotator cuff injuries require special care while treatments. Modern treatment methods might require that surgeries be carried out, which shall prevent the person from actively pursuing the activities and more over complete healing is not promised.
Ayurveda has natural methods for treatment for joint injuries, especially rotator cuff injuries which offer long term solutions, taking into account of health and healing conditions. Ayurveda system has an inherent advantage in bone and joint medicine and treatment of bone and joint related injuries because it was primarily developed to treat injuries caused due to martial arts in ancient times. In effect, the Ayurveda system can be said as a predecessor of modern age sports medicine.
Therapies offered for Rotator Cuff injuries
a. Pizhichil is a complete Ayurveda massage which rejuvenates the nervous and muscular system of the body and stimulates blood circulation. This method of treatment is a result of the blend of Dhanurveda and Ayurveda. Pizhichil is the systematic application of pressure on the muscles according to their structure, at the same time stimulating the nervous system and the circulatory system. This is done by oiling and massaging the various parts of the body. It can also enhance the general fitness of an average man. The oil used for Pizhichil depends upon the physical nature and disease condition of the person. In Pizhichil the masseur has to have exact knowledge of the vital spots and the energetic channels of the human body. Pizhichil is of two types: 1. Using hands, 2.Using feet. Hand type is applied on children, old and people of light build while Feet type is used to treat young and healthy persons. Pizhichil is always done so as to minimize the pressure on the heart and on the nerves to the heart. This is achieved by massaging from the waist downwards and upwards to the upper parts of the body. The pressure and the force of the massage is increased day by day till the 4th and then reduced so as to reach the minimum again on the 7th day. The massage is also done for the face and the head. Pizhichil is a highly effective treatment method for even rotator cuff injuries and back pain and as a supplementary form of treatment which increases vitality and strength. By stimulating the normal energy flow in the body it increases mental sharpness. During the treatment period the patient is required to strictly follow the instructions especially in matters of food.
b. Herbal steam application, method which involves specially prepared herbs and leaves are bundled in a cloth bag known as Kizhi which then is dipped into a Medicated Oil. Based on the physique or body nature of the patient and the nature of his complaint the temperature of the Kizhi needs to be different for different cases. The combination of the oil also changes depending on the nature of the bruise or the disorder. It is very important that the Kizhi is applied with the right amount of pressure on the body where there is pain and swelling and with the right kind of medicated oil. Owing to the combined effect of the medicated Kizhi and the warmth, it is highly effective in treating joint injuries especially rotator cuff injuries. This is also useful to treat old bruises and other disorders.
c. Navarakizhi -It is a method of treatment based on fomentation in which four boluses of a type of paddy (called Navara, hence the name Navarakizhi) with medicinal value is cooked in milk and a herbal decoction from Sida rhombifolia. Usually there are two masseurs who start fomentation in an identical manner one from each side. The movement of hands has to be always from upward downwards and the Kizhi has to be kept always at a constant temperature. There are mainly 7 positions in which the patient has to be during the fomentation process. Once the procedure has been carried out for the required amount of time, the medicinal paste is wiped off with palm leaf scrapers and the patient can bathe after applying oil on the body. Navarakizhi is used in the treatment of rotator cuff injuries, rheumatism, arthritis and other neuro-muscular disorders as well as for general rejuvenation of the body.
For a personalized Rotator Cuff healing plan visit rVita Ayurveda center, No.2, Krishnamacharya avenue, Adyar, Chennai 600020. For appointments Call 1800 425 4325 / 044 42187226
Click rVita personalized consultation tab for online Rotator cuff healing plan with Ayurveda, Yoga and Diet.
References
1. Fealy S, Adler RS, Drakos MC, et al. Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med 2006;34(1):120–7.
2. Galatz LM, Ball CM, Teefey SA, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86A(2):219–24.
3. Harryman DT 2nd, Mack LA, Wang KY, et al. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991; 73(7):982–9.
4. Lafosse L, Brozska R, Toussaint B, et al. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 2007;89(7):1533–41.
Call 9940079511/ drkgowthaman@gmail.com for a FREE CONSULTATION with Dr Gowthaman for Shoulder pain, neck pain, rotator cuff injury etc
Our understanding of tendon healing is largely based on animal studies because there is little histological information on healing rotator cuff tendons in human beings. From this animal data, it is known that rotator cuff healing occurs in 3 stages: inflammation, repair, and remodeling.
a. In the inflammatory stage, inflammatory cells migrate into the repair site guided by chemo tactic factors followed by an influx of blood vessels and fibroblasts.
b. In the repair phase, several growth factors are unregulated that induce cellular proliferation and matrix deposition.
c. Finally, this tissue undergoes remodeling due to extracellular matrix turnover mediated by matrix metalloproteinases (MMPs)
At the conclusion of the healing process, a normal rotator cuff insertion site is not regenerated. Normally, the rotator cuff inserts into bone through 4 distinct transition zones: tendon, unmineralized fibro-cartilage, mineralized fibro-cartilage, and bone. After repair, the tendon heals to bone with an interposed layer of fibro-vascular scar tissue that persists. The mechanical properties of this fibrous tissue are weaker than the native insertion site and may render repairs prone to failure.
The stages of rotator cuff healing involve inflammation, repair, and remodeling. Growth factors are expressed during the repair phase, because they promote cell proliferation and matrix production. This timeline must be kept in mind in growth factor therapies, because the addition of growth factors too early or late in the healing process may decrease their effectiveness. In an effort to limit failures, researchers have focused on ways to minimize the formation of scar tissue at the interface, while at the same time promoting the regeneration of the fibro-cartilaginous insertion zones. Initial studies have focused on improving the biomechanical strength of the repair through stronger sutures and by recreating the surface area of the footprint through double-row repairs or their equivalent. Even with these techniques, re-tears or failed healing still occur in up to 12% of patients.4 Although improved biomechanics may modestly improve healing, it appears that biologic augmentation of the healing process is needed to further reduce failure rates. Biologic therapies that can limit the amount of scar tissue formation at the repair site, and help regenerate a normal fibro-cartilaginous transition zone, may theoretically improve the strength of repairs.
How Ayurveda can help?
In many cases, these types of injuries are due to overuse of a part of the body when participating in a certain activity. Rotator cuff injuries require special care while treatments. Modern treatment methods might require that surgeries be carried out, which shall prevent the person from actively pursuing the activities and more over complete healing is not promised.
Ayurveda has natural methods for treatment for joint injuries, especially rotator cuff injuries which offer long term solutions, taking into account of health and healing conditions. Ayurveda system has an inherent advantage in bone and joint medicine and treatment of bone and joint related injuries because it was primarily developed to treat injuries caused due to martial arts in ancient times. In effect, the Ayurveda system can be said as a predecessor of modern age sports medicine.
Therapies offered for Rotator Cuff injuries
a. Pizhichil is a complete Ayurveda massage which rejuvenates the nervous and muscular system of the body and stimulates blood circulation. This method of treatment is a result of the blend of Dhanurveda and Ayurveda. Pizhichil is the systematic application of pressure on the muscles according to their structure, at the same time stimulating the nervous system and the circulatory system. This is done by oiling and massaging the various parts of the body. It can also enhance the general fitness of an average man. The oil used for Pizhichil depends upon the physical nature and disease condition of the person. In Pizhichil the masseur has to have exact knowledge of the vital spots and the energetic channels of the human body. Pizhichil is of two types: 1. Using hands, 2.Using feet. Hand type is applied on children, old and people of light build while Feet type is used to treat young and healthy persons. Pizhichil is always done so as to minimize the pressure on the heart and on the nerves to the heart. This is achieved by massaging from the waist downwards and upwards to the upper parts of the body. The pressure and the force of the massage is increased day by day till the 4th and then reduced so as to reach the minimum again on the 7th day. The massage is also done for the face and the head. Pizhichil is a highly effective treatment method for even rotator cuff injuries and back pain and as a supplementary form of treatment which increases vitality and strength. By stimulating the normal energy flow in the body it increases mental sharpness. During the treatment period the patient is required to strictly follow the instructions especially in matters of food.
b. Herbal steam application, method which involves specially prepared herbs and leaves are bundled in a cloth bag known as Kizhi which then is dipped into a Medicated Oil. Based on the physique or body nature of the patient and the nature of his complaint the temperature of the Kizhi needs to be different for different cases. The combination of the oil also changes depending on the nature of the bruise or the disorder. It is very important that the Kizhi is applied with the right amount of pressure on the body where there is pain and swelling and with the right kind of medicated oil. Owing to the combined effect of the medicated Kizhi and the warmth, it is highly effective in treating joint injuries especially rotator cuff injuries. This is also useful to treat old bruises and other disorders.
c. Navarakizhi -It is a method of treatment based on fomentation in which four boluses of a type of paddy (called Navara, hence the name Navarakizhi) with medicinal value is cooked in milk and a herbal decoction from Sida rhombifolia. Usually there are two masseurs who start fomentation in an identical manner one from each side. The movement of hands has to be always from upward downwards and the Kizhi has to be kept always at a constant temperature. There are mainly 7 positions in which the patient has to be during the fomentation process. Once the procedure has been carried out for the required amount of time, the medicinal paste is wiped off with palm leaf scrapers and the patient can bathe after applying oil on the body. Navarakizhi is used in the treatment of rotator cuff injuries, rheumatism, arthritis and other neuro-muscular disorders as well as for general rejuvenation of the body.
For a personalized Rotator Cuff healing plan visit rVita Ayurveda center, No.2, Krishnamacharya avenue, Adyar, Chennai 600020. For appointments Call 1800 425 4325 / 044 42187226
Click rVita personalized consultation tab for online Rotator cuff healing plan with Ayurveda, Yoga and Diet.
References
1. Fealy S, Adler RS, Drakos MC, et al. Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med 2006;34(1):120–7.
2. Galatz LM, Ball CM, Teefey SA, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86A(2):219–24.
3. Harryman DT 2nd, Mack LA, Wang KY, et al. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991; 73(7):982–9.
4. Lafosse L, Brozska R, Toussaint B, et al. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 2007;89(7):1533–41.
Call 9940079511/ drkgowthaman@gmail.com for a FREE CONSULTATION with Dr Gowthaman for Shoulder pain, neck pain, rotator cuff injury etc
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