title: Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.
abstract: OBJECTIVE
  Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair.
  
  
  METHODS
  A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits.
  
  
  RESULTS
  Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study.
  
  
  CONCLUSIONS
  This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs.
authors.affiliation: C. Burmaster, PT, DPT, OCS, COMT, CSCS, Select Physical Therapy, 2670 Forest Hill Blvd, West Palm Beach, FL 33406 (USA). burmastc@selectmedical.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Burmaster
authors.affiliation: B.J. Eckenrode, PT, DPT, OCS, Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eckenrode
authors.affiliation: M. Stiebel, MD, FRCSC, Palm Beach Sports Medicine, West Palm Beach, Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Stiebel
mesh_terms: D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery*