Sebastien Ruiz

Après le succès  et les 38 commentaires de l’article « La rééducation après acromioplastie simple de l’épaule. »

http://osteopathe-montpellier.com/la-reeducation-apres-acromioplastie-de-l%e2%80%99epaule

voici la traduction en anglais : Rehabilitation after acromioplasty of the shoulder.
· By Sébastien Ruiz
· September 12th 2006

Rehabilitation after simple acromioplasty of the shoulder.

Hospitalization lasts 2 to 5 days.
This is rehabilitation with no particular difficulty as no movements are prohibited.
Only the active work must be carried out in moderation at the beginning to avoid triggering tendonitis or reactive capsulitis.
An « elbow-to-body» type sling will be worn for 3 days to 3 weeks depending on the severity of surgery and the thus surgeon’s judgment.

At the surgery, the first sessions consist of  recovering the fullest passive amplitude possible with minimum pain.
To make it easier to relax, the patient must be in the decubitus position (lying flat on his back) while the physiotherapist carries out passive mobilization.
The physiotherapist will gently slide and pull on the gleno-humeral joint in order to avoid conflicts between joints and therefore decrease the risk of pain.

The aim of  passive amplitude varies from one patient to another (age, quality of movement before the intervention, motivation…to go back to work and take up physical and sports activities again), hand-to-forehead amplitude should be aimed at quickly, with the humerus in the axis of the scapula.

Physiotherapeutic means must be complementary to manual mobilization, Electrotherapy and ultrasound might be a good indication.
Electrotherapy helps combat pain with endorphinic programs, and the early contraction of the muscular fibers of the supra and infra-spinal deltoid can also be obtained, this contraction favors the sliding of the fascias and thus limits the formation of fibrosis.
When maximum amplitude has been achieved  without pain in passive mobilization and auto-passive mobilization (the use of pulley-therapy with which one limb can be raised passively with the other upper limb active, or direct mobilization of one limb with the other limb), active work on the lowering muscles of the shoulder becomes primordial.

Work must be done on the corporal perception of the shoulder-lowering movement before raising the upper limp, and likewise the endurance and strength of the latissimus dorsi and pectoralis major muscles.
This muscle work may be carried out manually or with the help of a simple pulley-therapy system. You simply have to slow down the arm-lowering movement and thus at the same time do the active work helped by the elevation.
 

In, The stability of the shoulder will be worked on progressively in an open and closed chain by gradually increasing the intensity of destabilization.

Massage (a cream containing an active or neutral principle) must not be forgotten by the physiotherapist because it remains a precious aid, the contracted areas can be softened, and any eventual areas of skin adherence.

In case of  persistent pain upon actively raising the upper limb, the  patient will have to use the ways of raising his arm as taught by the physiotherapist in order to avoid the area where it blocks
In general, surgeons prefer prescribing a certain amount of physiotherapy before the surgical intervention in order to make the painful shoulder more supple and strengthen it a little.
With experience, we have noticed that those patients who have begun physiotherapy before their intervention recover better and faster than the others.
Sometimes even in the case of slight damage to bone tissues, the surgical intervention is cancelled or put off because the patient has learned to optimize the use of his shoulder…

Ruiz Sébastien, Physiotherapist, Osteopath, CHU Lapeyronie (orthopedic surgery, surgery of the hand and the upper limb) and freelance, Montpellier.

Suite au nombre important d’anglais et d’étrangers qui débarquent à Montpellier, ou dans mon cabinet de kiné ostéo.
J’ai décidé de faire traduire quelques articles de mon blog.
De plus la coupe du Monde de rugby 2007, approchant à grand pas, les échanges en anglais vont être nécessaires pour communiquer avec les touristes du Monde Entier venus supporter leur équipe favorite.
Ces articles seront classés dans la catégorie articles en anglais,” In English “.
Avec le tag: Hand Surgery and Rehabilitation.
Je remercie Mme Sawyers T. pour ses traductions du français vers l’anglais.
Voici : la traduction de l’ “electrotherapy muscle”

http://osteopathe-montpellier.com/llectrothrapie-muscle
Does electrotherapy really help build muscle? Can we really obtain bulging abdominals ?
And why does electrotherapy relieve backache?

And here’s the question I am most often asked. People want to know whether  they can really develop bulging abdominals whilst reading the newspaper by simply placing electric currents on their muscles.
I always used to tell them : bulging abdominals, certainly not  (with this method alone) but gain a bit of muscle strength, yes, probably …
Today I would say to them :” I know you’ll gain a bit of muscle strength …if you use the right equipment and the right dosage…”
Indeed, two months ago whilst testing the biceps strength of a  patient in hospital, I had the idea of testing my own  biceps, because I had not done any sport for over 10 months ( apart from physiotherapy and osteopathy ), to find out what my strength was without any training (like judo), and to my great disappointment, I only had 7 kg more than a patient who was going to have an operation on the rotator cuffs.
So I decided to work out a  simple electrotherapy protocol for my biceps over several weeks …and to regularly measure its strength.( for the last two months I’ve been talking about this to patients who are partly treated by electrotherapy at my surgery and here are the results at last!)

Electrotherapy  protocol:
- 60 minutes a week  (if possible split into three 20-minute sessions) jolts or bursts (low frequency ) 10 seconds and visible muscle contractions provoking elbow supination and flexion for 10 seconds (voluntary muscle contraction is not used)
-1 muscular test of the right and left biceps and right and left triceps.( agonist/antagonist muscles)
Position to adopt for measuring strength: subject upright, elbow-to-body, 90 ° elbow flexion, supination for the biceps (flexion strength measurement ) and pronation for the triceps (extension strength measurement).
Strength is measured using an electronic dynamometer.
(only one test per week to avoid the test becoming a strengthening exercise in itself if done every day ).

http://osteopathe-montpellier.com/llectrothrapie-muscle
The right biceps had increased its strength by 6.5 kg  in 7 weeks.
That is to say an increase of 28.26 %.
The left biceps had increased its strength by 4.4 kg  in 7 weeks.
That is to say an increase of 19.38 %

The right triceps had increased its strength by 1.65 kg in 7 weeks.
That is to say an increase of 8.6 %
The left triceps had increased its strength by 4.35 kg  in 7 weeks.
That is to say an increase of 23.2 %
The triceps had not undergone any electrotherapy so its increase in strength may be due to automatic re-balancing of the agonist/ antagonist forces, or quite simply to contracting the triceps muscle to its maximum, once a week (during the test).
Furthermore this measurement on myself was reliable as I hadn’t been doing any sports activities or muscle reinforcement (apart from my 50 hours (approx.) per week of physiotherapy or osteopathy work)
In conclusion it is easier to understand why out-of-condition back pain sufferers who have not done any sport for a long time feel better after a few sessions of electrotherapy with their physiotherapist, their para-vertebral muscles must be stronger and the stability of the joints in the spine as well as muscular endurance will probably have increased.
If  biceps strength can increase by about  25 % in 7 weeks then the back muscles must also improve !!!
The release of endorphin by low-frequency electrical stimulation must play a large role  ….in relieving pain.

Your comments and complementary research will be most welcome.