Physical Therapy for Torn Labrum

Triathlon Forum
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Hello everyone. I was reading through old posts this morning and I was amazed at the number of posts dealing with labral tears! I had never even heard of this injury until I was diagnosed with a posterior inferior tear in my shoulder last month. Since then, I’ve become extremely frustrated with the amount of conflicting information available on the web and was hoping you all might have some useful advice.

So here’s the story… Back in August, a child on a bike rode directly into me during a training ride. I tried to break and swerve, but he hit me anyway and the impact sent me flying over my handlebars and I slammed into the pavement on my right shoulder. Of course I didn’t see a doctor for months. I stopped swimming and weight lifting, but even running was incredibly painful. I just kept thinking it would get better with rest, but it didn’t. So finally around Thanksgiving I saw a doctor, had the MRI and got the diagnosis. My doctor recommended giving physical therapy a try before resorting to surgery. When I saw the physical therapist last week, she was shocked at how limited my ROM is, especially given that the injury occurred so long ago. Her thought was that given my goals, therapy might be enough to get me biking and running without pain, but she wasn’t very optimistic about the swimming. I basically only like long endurance events. I’ve been focused on half ironman distance, and was hoping to start training for the full IM.

From what I’ve read, it looks like the best I can expect from therapy is that it will help prevent the injury from getting any worse, but therapy won’t heal the tear. Since it’s been almost half a year, it sure doesn’t seem like this is one of those tears that heals itself. If I’m going to need surgery anyway, I don’t want to waste time and money now with the therapy. I’d rather just get it over with so that I only miss one season instead of having a crappy season this year and then needing the surgery later.

Does anyone have any experience with the “just therapy” approach or any advice? Thanks!

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It sounds like your doctor is on the right track. While it is true that if the labrum is torn, it is torn, and it won’t get better without surgery, if your ROM is lousy now and you get surgery your ROM will be lousy after surgery. IMHO with therapy your best case scenario is you avoid surgery, worst case you go into surgery with better ROM and strength than you have now, which will hopefully let you recover quicker after surgery. Good luck!

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I had a type III SLAP tear. No amount of physical therapy will repair your labrum. What they are “trying” is to see if the PT would strengthen your shoulder enough that you could forgo surgery.

It’s a crappy surgery and an even crappier recovery, FWIW. I posted the below a while back

Yeah, I had a SLAP tear (type 3 I think). I had it repaired Jan. 06. Recovery was 10x worse than my knee repair. It was on the upper back portion of the shoulder capsule (picture your arm dislocating up and back the ball of your humerus tears the labrum off of the shoulder capsule).

It will not repair itself. With my tear there was zero chance that PT would fix the issue. My doc basically said if you can live with it, skip surgery. If it hinders what you like to do, i.e. swimming, tennis, baseball, the only way to address it is with surgery. I could not lay on my stomach and push myself up (like out of bed), so it was pretty bad.

They can diagnose with pretty good accuracy with modalities in the office. Depending upon their diagnosis, you would then have an MRI, and then maybe surgery.

It was 3 months with no running, swimming, biking, nothing. It is very difficult to heal, as there is almost no blood flow, and if you fell running, back to square 1. That said, 3 months out I started rehab stuff (stayed ahead of the curve) and was swimming (lightly) shortly there after. I would say that I was close to 100% about a year out, until I fell off of the rollers a few months back. It gave me a scare but I can swim, throw, anything except stretching to my limits without pain. They say for tennis/pitching its 18-24 months and swimming is ~12…

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I had a SLAP tear about 5 years ago. I am a tv sports cameraman and the shoulder that was jacked was the one the camera sits on. I tried that therapy stuff for about about 6 months. It never got any better. After a about a year of “dealing with it” I had the surgery. Not to scare you, but more to give you something to think about. This surgery SUCKED! I have had 2 spinals fusions, emergency appendectomy, few broken bones and this thing was way worse than any of those. The back surgeries were likely a lot more painful but morphine can be your friend. I think I got vicodin for the shoulder and that’s about it.

Now that I did it, I would do it again. It hurt everyday prior to surgery. Now I do whatever I want. I was back to bench pressing close to 300 within that same year. I think if you do the surgery asap you could be back in time for some late season stuff.

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I tore mine 5 years ago crashing 1 mile into a mountain bike race. Then I crashed again a year later on the same course and reinjured it!!!

Anyhoooo, the MRA showed an anterior-superior tear (only had MR after first injury) and I decided I could probably rehab it. I followed most of the exercises my chiro and PT gave me and found others that helped (posterior capsule stretch was the single most important exercise I discovered for my shoulder).

It took around 4 months of OCD determination, but it did improve. To this day, I cannot swim backstroke w/out pain and have to be cautious when pulling up on the bars. But for ME, rehab was great.

Good luck with whatever you choose to do.

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I had the surgery done on Sept 26, 2008. I highly recommend going to surgical route.

Back in 1999, I had a SLAP repair and modified Mumford procedure (they cut off the end of the shoulder blade). I was in the Army and injured it during Army training. It was good experience and I was back to normal in about 6 month.

This summer, the week after IMLP, I took a spill on my bike and landed w/ my arm out stretched. Dislocated the (same) shoulder and tore the labrum. Because I was doing IMWI 10 weeks later, we decided to hold off on surgery. PT was ok and took care of some of the pain, but, did not do much. I was shot up with cortizone for IMWI and did the race. It hurt, but, was manageable.

On Sept 26, 2008, I had a SLAP repair, Bankart procedure, and capsul release (not sure if I spelled those correctly). The found a ton of scar tissue in my shoulder and did not like the way it had healed from the 1999 surgery. He repaired the labrum tear, “loosened” the two tendon attachments in back, and severed the front tendons connected to the pec muscle and re-attached them. My bicep was also torn (again) so, he repaired the tear.

I was expected to be in a sling for 3-6 weeks. I was out of it in 5 days. I start PT immediately and had a passive motion chair delivered to my house. I diligently used the chair and the ice machine daily. They hoped to have 90% ROM by 12 weeks. I got there in 5. They said, with luck, I would be back in the pool by mid-February. I was back in the pool Dec 20.

Today, I am nearly 100% ROM. I am done w/ PT, but, still do some stretching on my own. Strength is at about 85-90%

The labrum will never heal and never get better without surgery. All PT does is manage the pain and the condition. Not worth it.

In addition, the difference b/t the 1999 surgery and teh 2008 surgery is staggering. I spent 3 days in the hospital in 1999. In 2008, I spent 3 hours in a surgical center. The doc advised me that the advances in the last 5-10 years have been huge.

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I went the PT route successfully with a labrum tear. Both docs that I saw were noncommittal as to whether surgery or PT was the way to go, so I decided to give PT a try figuring that the surgery option was always there if needed. My injury was from overuse rather than a sudden traumatic incident. Most of the rehab work that we did was actually posture related, specifically with the re-positioning of the scapula. I have zero problems right now can swim all strokes, use paddles (though I have gone one size down as a precaution), do pullups, and perform all other shoulder-load-bearing activities without any real limitation.

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Another vote for the PT route. I had a slap tear as a result of a hockey accident in November…I fell on my elbow and heard/felt a pop in my shoulder. Was diagnosed with the SLAP tear and began 2x a week PT.
ROM was limited at first, and it hurt even to run. I’ve been diligent with PT and have nearly full ROM…the only tough one right now if reaching my arm up my back as if I were trying to scratch between my shoulder blades. I remember reading a few of the horror stories here on ST and was really fearing the worst.
We are still working on getting my scapula positioned correctly because as a result of hte injury I developed an anterior tilt in my shoulder. I’m now working hard to strengthen those muscles to pull my shoulder blade back in to place.

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In a worst case scenario, the PT won’t be enough, but it will make your shoulder stronger going into surgery, and likely stronger coming out. I don’t think you’re ever “wasting your time” at PT. I think it’s worth the chance to find out. You may not be able to schedule surgery soon anyway, so what better way to spend the time waiting than PT which could potentially help? Makes sense to me.

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Quick answer - I had surgery in Jan 2006 and did IMFL in Nov of 06 and swam 1:05 with pretty good waves. 12-14 weeks you will be swimming and running again. Is my shoulder perfect, NO, can I train pretty hard, Yes.

Get the surgery and get on with training.

11

my 2 cents…

there is lots of info on here …
i am dealing with slap tear for a little over a year. reality is as you start to increase swim distance its just gets tougher.
i went for PT when my ROM was horrible… was border line frozen. the PT will have lots of ext rotation and stretching
i have done extremely well with PT. BUT!!! now that my swim workouts are in the 1700-2500 range it needs a full day of rest sometimes ice.
i am working toward HIM also, however in my case i doubt IM without surgical repair.
it will become what your pain threshold is and what recovery is like after longer workout.
PT cant sew the tear back down.
surgery is about 8 weeks in sling and it will be about 3.5 months before you are in a pool.
definately give the PT a chance…
if you are in south florida i can reco good PT