After a few weeks of progress, I really cut back on doing any of the physical therapy exercises that had been given to me to try at home. I wanted to see if the shoulder would continue improving on its own. I also began lifting weights more regularly, and I've been doing more hiking too. I was surprised at how much the shoulder moves while hiking. When I first started, going for a hike resulted in some pain, especially after the hike. Now it hardly bothers me at all. I'm able to do most of my weightlifting exercises again, but in most cases with reduced weights. I still can't get do shoulder presses or squats with a bar behind my neck.
External rotation continues to improve, about an inch per week. Flexion stopped improving, and actually got slightly worse over the last week. This is a hint that I should work on the stretching exercises more than I've been doing.
Showing posts with label exercise. Show all posts
Showing posts with label exercise. Show all posts
Saturday, May 22, 2010
Sunday, April 18, 2010
leaps and bounds
I have been continuing to do light stretching exercises on my own every day. I do the ones that were prescribed by my physical therapist, and also just try to stretch the shoulder in all directions. For example, I'll reach over to my right shoulder and try to get my hand as far around to my back as possible without causing too much pain. Or I make an effort to reach into my left back pocket and see how much I can stretch while doing that.
My biggest effort has been towards getting more external rotation back, and it seems to be working. I have two exercises for that. I hold a wooden dowel in front of me with my elbows at right angles, as if I were holding a tray in front of me. Then I use my right hand to push at the left hand. I try to keep my left elbow moderately a bit close to my body, and feel the stretch in my shoulder. Another variation of that is just to try to externally rotate my shoulder by keeping my elbow pinned at my side, bent at 90 degrees as if I'm holding a mug in front of me, and then moving my hand out to the side in an arc parallel to the floor, as far out as it will go. It hurts and doesn't get very far. But I've noticed in the last two weeks that it is actually moving more and more over time.
I went away last weekend, and while I was away, my shoulder was kind of acting up. It got a bit painful and weirdly sore. There was a strange pulling sensation somewhere, as if I had a thread coming loose in there. Hard to describe.
Anyway, this evening I was shampooing and suddenly thought "hey, my hand just went farther over my head than it has in a while, I'm sure of it!" So I took another measurement. My last measurement was last Friday. My hand can move an inch farther up the wall, and over an inch more out in external rotation than it could last Friday! Wow, I am very impressed. I have no idea whether this is because I stopped going to the fairly brutal PT sessions, or whether this is just the natural course of the disease. What good progress!
My biggest effort has been towards getting more external rotation back, and it seems to be working. I have two exercises for that. I hold a wooden dowel in front of me with my elbows at right angles, as if I were holding a tray in front of me. Then I use my right hand to push at the left hand. I try to keep my left elbow moderately a bit close to my body, and feel the stretch in my shoulder. Another variation of that is just to try to externally rotate my shoulder by keeping my elbow pinned at my side, bent at 90 degrees as if I'm holding a mug in front of me, and then moving my hand out to the side in an arc parallel to the floor, as far out as it will go. It hurts and doesn't get very far. But I've noticed in the last two weeks that it is actually moving more and more over time.
I went away last weekend, and while I was away, my shoulder was kind of acting up. It got a bit painful and weirdly sore. There was a strange pulling sensation somewhere, as if I had a thread coming loose in there. Hard to describe.
Anyway, this evening I was shampooing and suddenly thought "hey, my hand just went farther over my head than it has in a while, I'm sure of it!" So I took another measurement. My last measurement was last Friday. My hand can move an inch farther up the wall, and over an inch more out in external rotation than it could last Friday! Wow, I am very impressed. I have no idea whether this is because I stopped going to the fairly brutal PT sessions, or whether this is just the natural course of the disease. What good progress!
Saturday, April 17, 2010
another visit to the doctor
I visited the doctor on Tuesday; she had wanted to see how things were going after I'd been doing physical therapy for a while.
I explained that I'd initially had quite a lot of pain with the PT, but that the condition seemed to be slowly improving now. She repeated all the stuff she had told me earlier - it can take two years, etc. But she also said that she didn't think I needed any more physical therapy sessions per se, and that doing the exercises at home should be enough to help. She said that since I'm an active person, she expects that I will challenge the shoulder enough with my usual activities, which will help to reduce the stiffness.
She didn't seem thrilled that the physical therapist had been causing so much pain. She said the condition is associated with inflammation, and forcing the shoulder into painful positions is likely to produce more inflammation. However, she admitted that there's so little known about the condition that you can't really make any absolute statements.
Well, I think I pretty much agree with her. I can't actually tell whether the PT is helping, hurting, or indifferent at this point. I don't know what state I'd be in now without the PT. I'm inclined to think it helped me over the worst of the problem, but it's so hard to tell. But at this point, I have a feeling I'm just as well off doing exercises at home.
I had my 12th PT session on Monday, the day before visiting the doctor. I'd decided to cut back to once a week on the sessions, to see if things continue to improve without so many visits. PT consumes such large chunks of time, and seems to make things so much worse for a couple of days. I want to see what happens if I continue on my own. The visit to the doctor influenced me though, so that I now think I'll stop PT and see how things go. If the improvement slows, I can always go back for more sessions, so far as I know.
In fact there's a perverse incentive for me to continue PT even though it's not clear to me that I need it. There's only a $10 co-pay. I might think "let me just keep going to as many sessions as I can get insurance to pay for. Why not? It's not that expensive and I get more treatment!" The insurance company should give me a reward for saving them money, no? Well, no, I guess that would be asking too much from an insurance company.
I explained that I'd initially had quite a lot of pain with the PT, but that the condition seemed to be slowly improving now. She repeated all the stuff she had told me earlier - it can take two years, etc. But she also said that she didn't think I needed any more physical therapy sessions per se, and that doing the exercises at home should be enough to help. She said that since I'm an active person, she expects that I will challenge the shoulder enough with my usual activities, which will help to reduce the stiffness.
She didn't seem thrilled that the physical therapist had been causing so much pain. She said the condition is associated with inflammation, and forcing the shoulder into painful positions is likely to produce more inflammation. However, she admitted that there's so little known about the condition that you can't really make any absolute statements.
Well, I think I pretty much agree with her. I can't actually tell whether the PT is helping, hurting, or indifferent at this point. I don't know what state I'd be in now without the PT. I'm inclined to think it helped me over the worst of the problem, but it's so hard to tell. But at this point, I have a feeling I'm just as well off doing exercises at home.
I had my 12th PT session on Monday, the day before visiting the doctor. I'd decided to cut back to once a week on the sessions, to see if things continue to improve without so many visits. PT consumes such large chunks of time, and seems to make things so much worse for a couple of days. I want to see what happens if I continue on my own. The visit to the doctor influenced me though, so that I now think I'll stop PT and see how things go. If the improvement slows, I can always go back for more sessions, so far as I know.
In fact there's a perverse incentive for me to continue PT even though it's not clear to me that I need it. There's only a $10 co-pay. I might think "let me just keep going to as many sessions as I can get insurance to pay for. Why not? It's not that expensive and I get more treatment!" The insurance company should give me a reward for saving them money, no? Well, no, I guess that would be asking too much from an insurance company.
Sunday, April 11, 2010
more progress
I went for a hike today. I took a trail which involved some arm work; reaching out to balance, climb, and support my weight in a few places. There wasn't much of that, but enough to test the arm a little.
I had taken this same trail at the beginning of March, and my shoulder bothered me a lot after doing that. Today, it was a pretty big contrast. The shoulder still hurt some, but it felt much more flexible. That's very encouraging!
I had taken this same trail at the beginning of March, and my shoulder bothered me a lot after doing that. Today, it was a pretty big contrast. The shoulder still hurt some, but it felt much more flexible. That's very encouraging!
Saturday, March 20, 2010
stretching the coracohumeral ligament
This afternoon, I finished reading the article Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz. It sounded interesting and simple enough, so I decided to try it. The article can be summed up with one quote:
The article describes pretty clearly the stretching exercise, and also shows a photo of the action (Fig 2). I didn't want to lie down, so I tried to emulate this position while standing. I brought my left arm behind my back as shown in the figure, and used my right arm to help keep it pinned back, meanwhile extending my chest out and focusing on bringing my scapula together in the back. I could feel a decent stretch in the front of the shoulder, and only a very minor amount of pain.
Actually, there's a bodybuilding pose called the side triceps which is quite similar to this move. However, in my case, I kept my hand supinated as described in the article and shown in the figure.
In addition, the article says the stretch is done with ice applied ("cryotherapy"), but I did not try that. The idea is that the cold helps to "contract the tissues in the new lengthened position". Hm, I don't know about that, but I might try that later, if the stretching alone seems to help.
At the moment, though, I'm wondering if this didn't cause me some excess pain later in the evening.
I should probably mention that I'm not a doctor and should you try this yourself, don't blame me if something goes wrong! I encourage you to consult your own physical therapist or doctor before trying it.
The primary purpose of this single-patient case report is to describe outcomes of a positional stretching technique following the anatomical orientation of the two bands of the CHL and rotator interval capsule in a patient with [adhesive capsulitis].Of course, the case study was done on one person, so in some sense it's meaningless. On the other hand, I doubt it could hurt. In fact, my physical therapist has encouraged me to do general stretching exercises, even allowing weight-lifting, as long as I avoid painful movements (although in point of fact, the physical therapy exercises that were prescribed to me always cause the largest degree of pain). I've already been doing an exercise which is very similar to the one described, only I didn't go so far as to bring my affected arm behind my back for additional stretching.
The article describes pretty clearly the stretching exercise, and also shows a photo of the action (Fig 2). I didn't want to lie down, so I tried to emulate this position while standing. I brought my left arm behind my back as shown in the figure, and used my right arm to help keep it pinned back, meanwhile extending my chest out and focusing on bringing my scapula together in the back. I could feel a decent stretch in the front of the shoulder, and only a very minor amount of pain.
Actually, there's a bodybuilding pose called the side triceps which is quite similar to this move. However, in my case, I kept my hand supinated as described in the article and shown in the figure.
In addition, the article says the stretch is done with ice applied ("cryotherapy"), but I did not try that. The idea is that the cold helps to "contract the tissues in the new lengthened position". Hm, I don't know about that, but I might try that later, if the stretching alone seems to help.
At the moment, though, I'm wondering if this didn't cause me some excess pain later in the evening.
I should probably mention that I'm not a doctor and should you try this yourself, don't blame me if something goes wrong! I encourage you to consult your own physical therapist or doctor before trying it.
some improvement
I went for a little hike today. Adhesive capsulitis seems to get irritated by hiking, probably because of the way your arms swing when you walk.
The swing of my left arm is somewhat inhibited compared to my right. I'm not sure if that's an unconscious attempt at avoiding pain, or if the stiffness prevents it from swinging normally. I can force it to swing more if I try, and that does cause some pain.
In any case, the last time I went hiking, I was bothered by pain at the end of the hike, and a clicking feeling when the shoulder moved (bursitis?). Today, it went better. I was out for about 2 hours, and my arm didn't bother me much.
I can't tell if this was a fluke; this disease is quite tricky and sometimes gets worse when you don't expect it, or, on the other hand, the pain lessens for no discernible reason.
Everything was mostly okay today soon after I woke up, and I was feeling pretty good and optimistic, until after I did my physical therapy exercises this afternoon. A while after doing those, the shoulder began to feel clicky and aggravated. Maybe I didn't apply ice long enough after doing the exercises. Right now it's feeling sore, so the ice is back on.
The swing of my left arm is somewhat inhibited compared to my right. I'm not sure if that's an unconscious attempt at avoiding pain, or if the stiffness prevents it from swinging normally. I can force it to swing more if I try, and that does cause some pain.
In any case, the last time I went hiking, I was bothered by pain at the end of the hike, and a clicking feeling when the shoulder moved (bursitis?). Today, it went better. I was out for about 2 hours, and my arm didn't bother me much.
I can't tell if this was a fluke; this disease is quite tricky and sometimes gets worse when you don't expect it, or, on the other hand, the pain lessens for no discernible reason.
Everything was mostly okay today soon after I woke up, and I was feeling pretty good and optimistic, until after I did my physical therapy exercises this afternoon. A while after doing those, the shoulder began to feel clicky and aggravated. Maybe I didn't apply ice long enough after doing the exercises. Right now it's feeling sore, so the ice is back on.
Saturday, March 13, 2010
physical therapy
I've been trying to create my blog posts in an orderly fashion, but I'm skipping ahead with this one.
Yesterday was my fourth physical therapy session. The whole session lasted about two hours.
By now they have me doing a regular series of exercises. In the first one, I spend eight minutes on the "hand cycle", which is essentially a stationary bike which you pedal with your hands. (The machine is way overbuilt for what it does, IMHO). I'm nearly convinced that it's doing more harm than good, since it's impossible to pedal without the feeling that pins are stabbing into my left shoulder.
Since that's first, it sets me up for pain and crackling during the entire session. I try to avoid crackling by easing into and out of positions slowly. Before I developed this condition, it was unusual for me to experience clicking or crackling in my shoulders, and I don't want to develop it in the long-term.
As is often the case with medical offices, my physical therapist was delayed, so I wound up doing all of my exercises, and more, before he could get to me. When he got to me, I was already in quite a lot of pain. Then, as usual, he started with a deep tissue massage, and ended by doing lots of extremely painful manipulations of the arm which are intended to get the shoulder rotating correctly again.
I've been concerned about the manipulations because, in addition to the frozen shoulder, I've also been diagnosed with tendinitis, bursitis, and a partial tear of the infraspinatus. I'm willing to put up with pain, but not if the pain is an indication that I'm doing excessive damage to the other constituents of my shoulder. I want my shoulder back to 100% when this whole episode is over. I fear that excessive pulling and tugging might worsen the existing tear, or produce new injuries in previously healthy tissue. This is speculation, based on a few points that are extremely painful.
I think of my frozen shoulder as if the joint is encased in a ball of cement. The tendons and muscles are coming out of that ball. Usually, they slide around efficiently and cleanly when the shoulder rotates, but my view is that now they are getting stretched with much more force than is natural, and probably in strange directions, too. Surely this is just aggravating the whole joint more?
I'm particularly concerned about the biceps tendon because it inserts into the shoulder capsule and can develop adhesions in frozen shoulder. If the biceps tendon is torn, it won't heal on its own, and I'll need surgery.
I brought up my concerns with the physical therapist once again - I've continued to mention them, because I feel the amount of pain I'm experiencing is unreasonable. Yesterday, he cautiously admitted that the pain I'm feeling may be due to stress on some tendons, in particular the biceps tendon, and suggested that I shouldn't push myself to the point of extreme pain. However, he still seems convinced that it will be necessary to go through a lot of pain to get my shoulder rotating again.
At the end of yesterday's session, he asked me to lift my arm in a couple of directions. He thought that my shoulder had improved marginally - that it was rotating just a little as opposed to being completely stuck. He didn't seem to be saying that to make me feel better, either.
He then offered some ice. I haven't used it so far, but I decided to try it. It seemed to help quite a lot. I kept it on for 30 minutes or so, and after that the pain had subsided quite a lot.
When I got a chance, I took a look in the mirror, and I think he's right. The shoulder does seem to be rotating very slightly now. But it has a lot further to go.
Yesterday was my fourth physical therapy session. The whole session lasted about two hours.
By now they have me doing a regular series of exercises. In the first one, I spend eight minutes on the "hand cycle", which is essentially a stationary bike which you pedal with your hands. (The machine is way overbuilt for what it does, IMHO). I'm nearly convinced that it's doing more harm than good, since it's impossible to pedal without the feeling that pins are stabbing into my left shoulder.
Since that's first, it sets me up for pain and crackling during the entire session. I try to avoid crackling by easing into and out of positions slowly. Before I developed this condition, it was unusual for me to experience clicking or crackling in my shoulders, and I don't want to develop it in the long-term.
As is often the case with medical offices, my physical therapist was delayed, so I wound up doing all of my exercises, and more, before he could get to me. When he got to me, I was already in quite a lot of pain. Then, as usual, he started with a deep tissue massage, and ended by doing lots of extremely painful manipulations of the arm which are intended to get the shoulder rotating correctly again.
I've been concerned about the manipulations because, in addition to the frozen shoulder, I've also been diagnosed with tendinitis, bursitis, and a partial tear of the infraspinatus. I'm willing to put up with pain, but not if the pain is an indication that I'm doing excessive damage to the other constituents of my shoulder. I want my shoulder back to 100% when this whole episode is over. I fear that excessive pulling and tugging might worsen the existing tear, or produce new injuries in previously healthy tissue. This is speculation, based on a few points that are extremely painful.
I think of my frozen shoulder as if the joint is encased in a ball of cement. The tendons and muscles are coming out of that ball. Usually, they slide around efficiently and cleanly when the shoulder rotates, but my view is that now they are getting stretched with much more force than is natural, and probably in strange directions, too. Surely this is just aggravating the whole joint more?
I'm particularly concerned about the biceps tendon because it inserts into the shoulder capsule and can develop adhesions in frozen shoulder. If the biceps tendon is torn, it won't heal on its own, and I'll need surgery.
I brought up my concerns with the physical therapist once again - I've continued to mention them, because I feel the amount of pain I'm experiencing is unreasonable. Yesterday, he cautiously admitted that the pain I'm feeling may be due to stress on some tendons, in particular the biceps tendon, and suggested that I shouldn't push myself to the point of extreme pain. However, he still seems convinced that it will be necessary to go through a lot of pain to get my shoulder rotating again.
At the end of yesterday's session, he asked me to lift my arm in a couple of directions. He thought that my shoulder had improved marginally - that it was rotating just a little as opposed to being completely stuck. He didn't seem to be saying that to make me feel better, either.
He then offered some ice. I haven't used it so far, but I decided to try it. It seemed to help quite a lot. I kept it on for 30 minutes or so, and after that the pain had subsided quite a lot.
When I got a chance, I took a look in the mirror, and I think he's right. The shoulder does seem to be rotating very slightly now. But it has a lot further to go.
Tuesday, March 9, 2010
attempted physical therapy
After getting back from my ski trip, I had to wait three weeks before seeing the orthopedist.
I was sure that she would prescribe physical therapy (PT), so I decided to get a head start, and began doing some rotator cuff exercises that I had found at Yahoo! Health.
It didn't make sense to just do some exercises without testing to see if they were doing any good. So I marked a column of inches on a sheet of paper to use as a ruler, and hung it on the wall. After doing my exercises, I'd reach up against the sheet of paper to see how high I could get, and whether I had progressed at all. To start with, I could reach six inches further with my good side than with my bad.
I did exercises every day for about a week, but found there was basically no improvement in my reach. Further, I felt like the exercises were causing too much pain. I'd get a sharp pain in the front of my shoulder when reaching up. It would get worse the more I did the exercises. I feared I might be aggravating a tendon or doing some form of damage, possibly caused by impingement. I stopped doing any PT exercises, but continued doing weight-lifting pretty regularly, sticking to exercises that didn't hurt.
I was sure that she would prescribe physical therapy (PT), so I decided to get a head start, and began doing some rotator cuff exercises that I had found at Yahoo! Health.
It didn't make sense to just do some exercises without testing to see if they were doing any good. So I marked a column of inches on a sheet of paper to use as a ruler, and hung it on the wall. After doing my exercises, I'd reach up against the sheet of paper to see how high I could get, and whether I had progressed at all. To start with, I could reach six inches further with my good side than with my bad.
I did exercises every day for about a week, but found there was basically no improvement in my reach. Further, I felt like the exercises were causing too much pain. I'd get a sharp pain in the front of my shoulder when reaching up. It would get worse the more I did the exercises. I feared I might be aggravating a tendon or doing some form of damage, possibly caused by impingement. I stopped doing any PT exercises, but continued doing weight-lifting pretty regularly, sticking to exercises that didn't hurt.
Saturday, March 6, 2010
ski trip
I went skiing the second week in January, 2010. I had some trepidations, since I was fearful that I might worsen the problem were I to have a bad fall. However, this was an expensive trip which I was gleefully anticipating, so I decided to take the risk and try to be as careful as possible.
During the trip, I continued to experience moderate pain, on and off. I had some problems pushing myself along with the poles over flat spots. Generally the pain would reduce after I'd been doing it for a while, but then the next day it would feel a little worse.
I also fell a couple of times while skiing, which is quite usual for me. During the last fall on the last day, I twisted my left arm and felt a very bad stabbing pain! The pain eased up pretty soon. I'm glad this happened right at the end, otherwise I might not have enjoyed the trip so much.
It was probably really stupid to go skiing with this condition. OTOH I could easily fall and slip on the ice at home. So I took my chances, and I don't think I actually made things worse despite the fall. It's hard to tell.
increased pain
After visiting the doctor in mid-December, I began to experience more random pain in the shoulder.
Late in December 2009, I began waking up with shoulder pain during the early morning hours! My doctor had predictive powers on that one.
I began to notice it was getting harder to tie up my ponytail without a pinching pain in the front of my shoulder.
Nevertheless, I continued to use my rowing machine and lift weights. At some point in January, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead. Oddly, shoulder shrugs still felt fine.
In addition, I started getting shoulder pain when
Over time, I continued limiting what I'd do, since I thought resting my shoulder was the right thing for it.
Late in December 2009, I began waking up with shoulder pain during the early morning hours! My doctor had predictive powers on that one.
I began to notice it was getting harder to tie up my ponytail without a pinching pain in the front of my shoulder.
Nevertheless, I continued to use my rowing machine and lift weights. At some point in January, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead. Oddly, shoulder shrugs still felt fine.
In addition, I started getting shoulder pain when
- reaching my left hand under my right arm pit while bathing
- bending over and dangling my arms down in front of me (for example when tying shoelaces)
- reaching back to put on my seatbelt with my left hand - I switched to using my right hand
- reaching into my left back jeans pocket
Over time, I continued limiting what I'd do, since I thought resting my shoulder was the right thing for it.
December - the Holiday Challenge
Throughout December 2009, I rowed 200K meters on my Concept II indoor rower for their Holiday Challenge. For about the first half of the Challenge, I usually had some light pain in the shoulder, but it was not a big issue. Towards the end, I began to feel like I was adjusting my natural moment to compensate for shoulder pain, and I began to develop secondary issues in my left arm - pain between the shoulder and the elbow and some pain along the forearm too. But I managed to finish the Challenge before Christmas without too much trouble.
Despite the pain, I continued to do my weight-lifting and rowing workouts when possible. I was sick with a bad cold around Christmas and into January, so I wasn't working out as often as usual.
At some point in January 2010, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead without severe pain. This was worrisome.
Despite the pain, I continued to do my weight-lifting and rowing workouts when possible. I was sick with a bad cold around Christmas and into January, so I wasn't working out as often as usual.
At some point in January 2010, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead without severe pain. This was worrisome.
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