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 rot
ator cuff to heal back to the insertion site on the humerus following repair. Cl
inical 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 t
he tear, presence of fatty infiltration, and the age and general health status o
f the patient. Although patients with re-tears or failed healing may have pain r
elief, these studies show that they have inferior functional results when compar
ed with patients with healed repairs. An understanding of the histology and biol
ogy that occur during the healing process may lead to therapies that can improve
the healing rate and improve the functional results of patients following repai
r.
Our understanding of tendon healing is largely based on animal studies because t
here is little histological information on healing rotator cuff tendons in human
beings. From this animal data, it is known that rotator cuff healing occurs in
3 stages: inflammation, repair, and remodeling.
a. In the inflammatory stage, inflammatory cells migrate into the repair
site guided by chemo tactic factors followed by an influx of blood vessels and f
ibroblasts.
b. In the repair phase, several growth factors are unregulated that induce
cellular proliferation and matrix deposition.
c. Finally, this tissue undergoes remodeling due to extracellular matrix t
urnover mediated by matrix metalloproteinases (MMPs)
At the conclusion of the healing process, a normal rotator cuff insertion site i
s not regenerated. Normally, the rotator cuff inserts into bone through 4 distin
ct transition zones: tendon, unmineralized fibro-cartilage, mineralized fibro-ca
rtilage, and bone. After repair, the tendon heals to bone with an interposed lay
er of fibro-vascular scar tissue that persists. The mechanical properties of thi
s fibrous tissue are weaker than the native insertion site and may render repair
s prone to failure.
The stages of rotator cuff healing involve inflammation, repair, and remodeling.
Growth factors are expressed during the repair phase, because they promote cell
proliferation and matrix production. This timeline must be kept in mind in grow
th factor therapies, because the addition of growth factors too early or late in
the healing process may decrease their effectiveness. In an effort to limit fai
lures, 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 fibr
o-cartilaginous insertion zones. Initial studies have focused on improving the b
iomechanical strength of the repair through stronger sutures and by recreating t
he 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.4 Although improved biomechanics may modestly improve healing, it a
ppears that biologic augmentation of the healing process is needed to further re
duce failure rates. Biologic therapies that can limit the amount of scar tissue
formation at the repair site, and help regenerate a normal fibro-cartilaginous t
ransition 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 activiti
es and more over complete healing is not promised.
Ayurveda has natural methods for treatment for joint injuries, especially rotato
r cuff injuries which offer long term solutions, taking into account of health a
nd healing conditions. Ayurveda system has an inherent advantage in bone and joi
nt medicine and treatment of bone and joint related injuries because it was prim
arily developed to treat injuries caused due to martial arts in ancient times. I
n effect, the Ayurveda system can be said as a predecessor of modern age sports
medicine.

Ayurveda Therapies offered for Rotator Cuff injuries

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 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. Thi
s is done by oiling and massaging the various parts of the body. It can also enh
ance the general fitness of an average man. The oil used for Pizhichil depends u
pon the physical nature and disease condition of the person. In Pizhichil the
masseur has to have exact knowledge of the vital spots and the energetic channel
s of the human body. Pizhichil is of two types: 1. Using hands, 2.Using feet. Ha
nd type is applied on children, old and people of light build while Feet type is
used to treat young and healthy persons. Pizhichil is always done so as to mini
mize the pressure on the heart and on the nerves to the heart. This is achieved
by massaging from the waist downwards and upwards to the upper parts of the body
. The pressure and the force of the massage is increased day by day till the 4th
and then reduced so as to reach the minimum again on the 7th day. The massage i
s also done for the face and the head. Pizhichil is a highly effective treatment
method for even rotator cuff injuries and back pain and as a supplementary form
of treatment which increases vitality and strength. By stimulating the normal e
nergy flow in the body it increases mental sharpness. During the treatment perio
d the patient is required to strictly follow the instructions especially in matt
ers of food.
b. Herbal steam application, method which involves specially prepared herbs
and leaves are bundled in a cloth bag known as Kizhi which then is dipped into
a Medicated Oil. Based on the physique or body nature of the patient and the na
ture of his complaint the temperature of the Kizhi needs to be different for dif
ferent cases. The combination of the oil also changes depending on the nature of
the bruise or the disorder. It is very important that the Kizhi is applied with
the right amount of pressure on the body where there is pain and swelling and w
ith the right kind of medicated oil. Owing to the combined effect of the medicat
ed Kizhi and the warmth, it is highly effective in treating joint injuries espec
ially rotator cuff injuries. This is also useful to treat old bruises and other
disorders.
c. Navarakizhi -It is a method of treatment based on fomentation in which
four boluses of a type of paddy (called Navara, hence the name Navarakizhi) with
medicinal value is cooked in milk and a herbal decoction from Sida rhombifolia.
Usually there are two masseurs who start fomentation in an identical manner one
from each side. The movement of hands has to be always from upward downwards an
d the Kizhi has to be kept always at a constant temperature. There are mainly 7
positions in which the patient has to be during the fomentation process. Once th
e procedure has been carried out for the required amount of time, the medicinal
paste is wiped off with palm leaf scrapers and the patient can bathe after apply
ing oil on the body. Navarakizhi is used in the treatment of rotator cuff injuri
es, rheumatism, arthritis and other neuro-muscular disorders as well as for gene
ral rejuvenation of the body.
For a personalized Rotator Cuff healing plan visit rVita Ayurveda center , No.2,
Krishnamacharya avenue, Adyar, Chennai 600020. For appointments Call 1800 425 4
325 / 044 42187226
Click www.rVita.com personalized consultation tab for online Rotator cuff healin
g plan with Ayurveda, Yoga and Diet.