Rehabbing after Major Surgery
Dr. Vicky McEvoy, Joan Oeschlager, and Kaysie Smashey
Three NWTO members and players have gone through major surgery and the resulting rehabilitation and are sharing their experience, expertise and advice. Vicky (V) and Kaysie (K) underwent rotator cuff surgery and Joan (J) a hip replacement. They hope you don’t have to experience either one of these, but here’s their shared wisdom if you do!
Rotator Cuff Blues
V: Is there any tennis player who has not suffered bouts of shoulder pain at one time or another? Serving and hitting overheads put the greatest strain on the shoulder, but all the strokes involve the shoulder. The shoulder joint includes the upper arm bone (humerus), the shoulder blade (scapula) and the collar bone (clavicle). The rotator cuff is the group of muscles and tendons that surround the joint to allow the various motions of the shoulder. The main muscles of the rotator cuff are the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. These muscles are attached to the upper arm bone or humerus by tendons. (I am mentioning the anatomy because if you have shoulder pain, you may get an MRI, and the MRI reading will mention these terms which can be confusing.)
In my case, I had on and off shoulder pain over the years, clearly from age and overuse but nothing requiring surgery. After a heated battle at an Addie Cup match, I was suddenly unable to lift my arm. My first MRI showed partial tears of the rotator cuff, but I received a shot of Cortisone which along with rest helped to simmer down the inflammation. The shoulder pain ebbed and flowed but gradually escalated. I continued to play tennis, but serving and hitting overheads became dreaded tasks. Of course, I continued to play, as we all do, but one evening I dropped a bottle and when I caught it, excruciating pain--the tear was complete. An MRI showed a full-thickness tear of the supraspinatus along with other tissue damage.
K: I have had a few major injuries due to the repetitive stress on my body from the intense level of training and competition throughout my tennis career. In college, I discovered that my fifth metatarsal on my right foot was broken (have a screw in my foot); I had tennis elbow to the point I couldn't raise my arm, stress fractures in both shins, labrum tear in my left hip (surgery), pterygiums in my eyes from the sun and wind (had stitches in my eye balls and couldn't see for 3 1/2 days), and the toughest of them all, a total shoulder rehaul due to a torn bicep tendon, torn labrum and rotator cuff! I have always had the mentality of playing through the pain because I wasn't going to give up, and now believe I have really high pain tolerance. lol. No pain, no gain was real in my world. I now understand that soreness and pushing through a workout is way different than the pain I was feeling from my shoulder injury. I was at Intersectionals in Florida with Team Texas when I first experienced my bicep feeling sore, weak, and tired. If you know me, I just thought it was muscular soreness from playing lots of tennis. But the achy feeling did not go away after taking some time off. After about 1 1/2 years of on and off pain and having to serve underhand in a tournament, I finally decided to go to see an orthopedist. He referred me to a physical therapist that specializes with the shoulder, and after testing my strength and flexibility, he was pretty sure that I had a torn rotator at the very least.
Hip Replacement Bummer (Pun Intended!)
J: Osteoarthritis is usually the cause of hip replacements. That was the cause in my case. My hip joint was “stuck”, so my range of motion was limited. I didn’t have much pain, but I was limited in what I could do, especially on the tennis court. I have always been a serve and volleyer and very active net player. I tried to adjust my game to a baseline one, but that wasn’t very successful or satisfying. I gave up playing all together about 4 months before the surgery, mostly so I could be in reasonable shape to help with my grandkids. I started using a cane which helped a lot. I had a presurgical visit to go over procedures 2 weeks before. I had to stop taking certain medications and supplements for that time period and for some time after.
Initial Treatment
V: The rotator cuff damage required surgery. The post-op required a sling 24/7 for 6 weeks unless I was sitting in a chair. Sleep was difficult, even in a chair that moved every which way--a rental that friends insisted upon. The sling itself caused neck issues and made life routines quite difficult. There are lots of different injuries and repairs to the rotator cuff, along with different post-op recommendations, depending on the surgeon. Suffice to say, for me, it was incredibly painful. An ice machine was a lifesaver, along with Advil and Tylenol.
K: The orthopedist sent me to get an MRI, which came back as expected. After scheduling an appointment with a shoulder specialist in Austin, 150 miles away, we started PT with bands and stretches, strengthening my shoulder so that the recovery after surgery would be a little easier. I met with him 2-3 times per week and performed shoulder exercises daily until my surgery day arrived. If you ever need to get surgery, I highly suggest going to a specialist. My doctor performed more than 200 shoulder surgeries per year, so I felt pretty confident in his ability. He was also an athlete and understood my passion and determination to get back to as close to 100%. We spoke about the surgery repair options, knowing that I wanted to continue competing at a high level. My claim to fame is that he repaired my shoulder in the same manner that Brett Favre had done on his!
J: The hip replacement surgery was done with the anterior method, where they go in through the front of the hip. This method is much less invasive, cutting through fewer muscles. If your surgeon says this is appropriate for your situation, definitely take it. Very often, patients go home the same day with this surgery. I went in at 5:30 am and was walking, with a walker, through my front door at 1:30 that same afternoon.
Rehab Therapy/Protocol
V: The initial physical therapy was swinging my arm back and forth and in a circle. The next months were filled with twice-a-week physical therapy which was initially quite painful. In addition, I was religious about doing my home exercises, mostly consisting of band work. The rehab for rotator repair is long. I was told it would be at least 6 months before I could play tennis and probably a year before I felt comfortable on the court. Others have had shorter timelines, depending on their age, type of repair, and diligence with exercises.
K: Post-surgery, my shoulder was in a sling for 5 weeks, and the only time I could take it out was to do table slides, which started on day 3. It was very humbling when I had to use my left arm to put my right hand on the table and could barely slide my hand/arm an inch forward on the table to start. Throughout the first 5 weeks, I slowly progressed on the slides, finally reaching my arm to a full stretch. During this time I met with my physical therapist several times a week, making sure the scar tissue wasn't forming; the PT made me ice regularly to keep inflammation at a minimum. My surgeon also recommended that I get some dry needling to enhance blood flow in my shoulder area within the first few days after surgery.
Once the initial 5 weeks were up, it was time to start strengthening and stretching the shoulder. For the next 6 months, I worked daily on progressing from lifting a one-pound bar (which was almost impossible), raising my arm on a wall, icing daily, massaging around the insertion points to avoid scar tissue build-up, taking vitamins that helped healing and recovery, eating healthy foods, and avoiding foods that would cause inflammation. Towards the end of the 7-month rehab process ("fast" for this kind of surgery), I was spending 20 minutes on my exercises, 5 times per day. I am fortunate that I had a job that I could take this time. Looking back, it was a tough process, but well worth it in the long run!
J: Hip rehab starts in the hospital. As soon as I was out from under the effects of the anesthesia, I walked with the walker to the bathroom and practiced going up a couple of stairs and sitting down in a chair. (It was a good thing my husband was in the recovery room with me. The surgeon came in to talk with me, and I didn’t remember a thing he said even though I was “awake”!!) Icing and elevating the leg for 20-minute periods were the first things I did. My orthopedic group had an online app that checked in with me every morning with exercises to start doing so I did not need to have a physical therapist come to my home. The exercises started simply and all were isometric. Repetitions are used to build strength rather than weight. The app also had a message format so when I needed information, I could just ask online. I was doing the exercises 2 times a day. I used a walker for 10 days. After 7 days of walking around my condo, I had my husband go outside with me. He accompanied me for 3 more days when I felt I could do it myself. I used the cane for one more day and then was walking without any aid, but my gait didn’t feel normal for a couple of weeks. My first check up was 5 weeks after surgery. I was cleared to do simple hitting-- having someone hit right to me. After not hitting for 5 months, it was heaven just to do that much. I did that for about 2 weeks and then had my first doubles game with friends who didn’t care how competitive the tennis was. Now 4-months post surgery, I have been playing league matches, doing drills, and just about all I want to do on the court as well as going to the gym. I plan on playing my first tournament at Intersectionals in Phoenix in November.
Recommendations/Advice
V: For those considering surgery for rotator cuff tears, I have several recommendations. Pick a surgeon who has done many repairs. Rent a chair from a medical supply store for sleep. Take your pain medications as prescribed. Ice, ice, ice! Most important of all is sticking with physical therapy. It is helpful to use a therapist geared to sports medicine, if available, as she is more likely to help you reach your athletic goals. I continue to do my shoulder exercises to keep the muscles strong in hopes of avoiding further injury. We all love our tennis, so do everything you can to prevent injury--listen to your body!
K: The biggest piece of advice that I received was to do neither more NOR less than the PT prescribed on a daily basis; instead, do what is recommended. Four years later, I still use the stretch and strength tool that he gave me to keep my shoulder flexible and strong. The scariest thing is you never know how your body will react to surgery. You have to trust the surgeon to do his/her part, trust the PT, and follow their instructions.
J: My advice is to be sure and do your “prehab”, by which I mean, be in as good a shape as possible before the surgery. Even though I had stopped playing tennis, I continued to be able to ride my bike for exercise as well as use the gym and do leg curls, leg extensions and leg presses to keep my legs reasonably strong . And don’t forget your core. You need a strong core for good balance. You definitely don’t want to fall down!
