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. It is known that rotator cuff healing occurs in 3 stages: inflammation, repair, and remodeling.
In the inflammatory stage, inflammatory cells migrate into the repair site guided by chemotactic factors followed by an influx of blood vessels and fibroblasts.
In the repair phase, several growth factors are unregulated that induce cellular proliferation and matrix deposition.
Finally, this tissue undergoes remodeling due to extracellular matrix turnover.
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. 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 moreover complete healing is not assured.
Ayurveda has natural methods for the treatment for joint injuries, especially rotator cuff injuries which offer long term solutions, taking into account the recuperative capacity. Ayurveda’s system has an inherent advantage in bone and joint medicine and the treatment of bone and joint related injuries owing to its experience of having been largely developed to treat injuries caused due to battlefield combat in ancient times. In effect, Ayurveda’s approach can be said as a predecessor of modern age sports medicine.
Ayurveda Therapies offered for Rotator Cuff injuries include:
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 (postures associated with the sport of archery) 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, utilizing either the hands or feet of the practitioner. The medicated oils used for Pizhichil depend upon the physical nature and disease condition of the person. Pizhichil is a highly effective treatment method for 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 also increases mental acuity. During the treatment period the client is required to adhere to protocols in matters of food and activities.
b. Kizhi is an herbal steam application involving specially prepared herbs and leafs that are bundled in a cloth bag which then is immersed into a medicated oil. Based on the physique of the client and the nature of their complaint the temperature of the Kizhi needs to be different for different cases. The formulation of the oil also changes depending on the nature of the disorder. It is critical that the Kizhi is applied with the correct amount of pressure on the body where there is pain. Owing to the combined effect of the medicated Kizhi and the warmth, it is highly effective in treating joint injuries especially rotator cuff injuries.
c. Navarakizhi is a method of treatment based on fomentation in which four boluses of a type of paddy (called Navara, hence the name Navarakizhi) is cooked in milk and an herbal decoction from Sida rhombifolia. Usually there are two masseurs who apply the fomentation in an identical manner, one from each of the client’s sides. Navarakizhi is used in the treatment of rotator cuff injuries, rheumatism, arthritis and other neuromuscular disorders as well as for general rejuvenation of the body’s musculature.