It turns out that my insurance company will probably allow more than 8 days of PT. I misunderstood the letter that I got. Apparently the physical therapy practice requests 8 days of treatment at a time, and it was the letter approving the first 8 days which confused me.
My eighth session was a couple of days ago, and it looks like I'll get more next week.
Friday, March 26, 2010
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.
another insurance snafu
I opened some mail from my insurance company today. Turns out they'll pay for no more than 8 physical therapy sessions (and according to the verbiage in the notice, they may not even pay for that - thanks for the warning, guys!). So my next one may be my last.
There's certainly been some progress, but it's a mixed bag. I might be willing to pay for a couple more sessions on my own, but it won't be more than one a week. If I'd known beforehand, I probably would have rationed out the sessions more slowly. Bummer.
The next time I hear someone complain about how the government will decide whether or not I get medical care under the public option, I'm going to bop them. There's already a large, bureaucratic, money-grubbing institution standing between me and my medical treatment - my insurance company.
There's certainly been some progress, but it's a mixed bag. I might be willing to pay for a couple more sessions on my own, but it won't be more than one a week. If I'd known beforehand, I probably would have rationed out the sessions more slowly. Bummer.
The next time I hear someone complain about how the government will decide whether or not I get medical care under the public option, I'm going to bop them. There's already a large, bureaucratic, money-grubbing institution standing between me and my medical treatment - my insurance company.
Friday, March 19, 2010
PNF
Today was my 7th physical therapy session for a total of 3 weeks. It was more of the usual: start by applying moist heat to the shoulder for about 10 minutes, then do some exercises, and finally the massage and mobilization techniques applied by the physical therapist himself.
Almost every time I go, they throw something new into the mix, though. This time, the physical therapist asked an assistant to work with me on some PNF. I was intrigued, because I had just seen this acronym in an article last night but hadn't had time to look into it.
In this particular case, it was a rather lame exercise. I lay down on my back, and moved my arm straight up in an arc as far past 90 degrees as possible (which is not much), with my thumb pointing in the direction of travel. Then I rotated my hand so the thumb was pointing towards my feet and moved my arm back down to my side. While doing this, the assistant applied a very small resistive force against the motion of my arm. This really felt completely useless, but in any case didn't go on for long.
It's a mixed bag in the area of pain. With so little sleep yesterday, I fell asleep pretty easily. I still woke up a couple of times with pain in the middle of the night, but fell back to sleep without much trouble.
When I awoke this morning, the pain was pretty bad, and I kept debating whether I should go to physical therapy, scheduled for midday. I went anyway. The mobilization techniques were still agonizing, but it was more bearable, similar to what was done last time. The therapist has been easing up a little, and I think that is helping.
Since I did 1.5 hours of physical therapy today, I opted to do my weight-lifting workout tonight. For any exercises involving my left shoulder, I use very light weights and try to stay away from anything that causes the least bit of pain... I feel pretty good right now, no pain at all. This disease is strange, the way you can be in fierce pain in the morning and then feel normal just hours later.
I still don't have any ibuprofen so I wonder how I'll sleep tonight.
Almost every time I go, they throw something new into the mix, though. This time, the physical therapist asked an assistant to work with me on some PNF. I was intrigued, because I had just seen this acronym in an article last night but hadn't had time to look into it.
In this particular case, it was a rather lame exercise. I lay down on my back, and moved my arm straight up in an arc as far past 90 degrees as possible (which is not much), with my thumb pointing in the direction of travel. Then I rotated my hand so the thumb was pointing towards my feet and moved my arm back down to my side. While doing this, the assistant applied a very small resistive force against the motion of my arm. This really felt completely useless, but in any case didn't go on for long.
It's a mixed bag in the area of pain. With so little sleep yesterday, I fell asleep pretty easily. I still woke up a couple of times with pain in the middle of the night, but fell back to sleep without much trouble.
When I awoke this morning, the pain was pretty bad, and I kept debating whether I should go to physical therapy, scheduled for midday. I went anyway. The mobilization techniques were still agonizing, but it was more bearable, similar to what was done last time. The therapist has been easing up a little, and I think that is helping.
Since I did 1.5 hours of physical therapy today, I opted to do my weight-lifting workout tonight. For any exercises involving my left shoulder, I use very light weights and try to stay away from anything that causes the least bit of pain... I feel pretty good right now, no pain at all. This disease is strange, the way you can be in fierce pain in the morning and then feel normal just hours later.
I still don't have any ibuprofen so I wonder how I'll sleep tonight.
Thursday, March 18, 2010
articles
I had asked my physical therapist for resources or articles to gain more insight into my condition. Yesterday, he gave me a couple of sites where I could look into frozen shoulder further. He pointed me to the article on adhesive capsulitis at the Professional Baseball Athletic Trainers Society. The article is okay, but it's mostly a rehash of the same information that I've found elsewhere online. There's quite a lot of discussion about surgical treatments, if you're into that kind of thing. The illustrations for the site are the best thing about it, although you wonder how correct they are. My preference is usually to go to wiki for general information like this.
In addition, he had told me to search PubMed for the terms "shoulder adhesive capsulitis". I'd actually already tried PubMed, but the first result I got was about shoulder pain in Nigerians, which didn't sound very relevant, and I had quickly decided to look elsewhere.
In fact, PubMed seems to be a good resource after all. Since he suggested I try it, I returned and immediately struck gold. I found a single case report1 and a more extensive study2.
I'm still in the process of reading the articles, and I'll write about them more if I find anything notable.
1 Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz
2 Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, by Henricus M Vermeulen et al.
In addition, he had told me to search PubMed for the terms "shoulder adhesive capsulitis". I'd actually already tried PubMed, but the first result I got was about shoulder pain in Nigerians, which didn't sound very relevant, and I had quickly decided to look elsewhere.
In fact, PubMed seems to be a good resource after all. Since he suggested I try it, I returned and immediately struck gold. I found a single case report1 and a more extensive study2.
I'm still in the process of reading the articles, and I'll write about them more if I find anything notable.
1 Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz
2 Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, by Henricus M Vermeulen et al.
more problems sleeping
I had a physical therapy session yesterday evening at 6. It lasted just a little over an hour. It was still plenty painful, but less so than usual. The physical therapist told me that he's trying to be more gentle, so as to avoid aggravating the tendinitis.
I woke up at 2:30 this morning, and felt too awake to get back to sleep. After lying in bed for an hour, I finally got up.
There was some pain in my shoulder that was bothering me, but I had pain in my forearm - extreme soreness - which was worse. This is new. I think it's due to the physical therapy. My elbow has been giving me trouble too.
I've been sleeping worse since I started PT. Previously, I might wake up at 5, but I'd be able to get back to sleep. Now I'm waking up at all hours between midnight and 7. Tonight I'm going to try some ibuprofen. The only thing I've tried so far is naproxen sodium, and that doesn't seem to help much.
Maybe I should avoid doing PT in the evening; that might help with the sleep.
I woke up at 2:30 this morning, and felt too awake to get back to sleep. After lying in bed for an hour, I finally got up.
There was some pain in my shoulder that was bothering me, but I had pain in my forearm - extreme soreness - which was worse. This is new. I think it's due to the physical therapy. My elbow has been giving me trouble too.
I've been sleeping worse since I started PT. Previously, I might wake up at 5, but I'd be able to get back to sleep. Now I'm waking up at all hours between midnight and 7. Tonight I'm going to try some ibuprofen. The only thing I've tried so far is naproxen sodium, and that doesn't seem to help much.
Maybe I should avoid doing PT in the evening; that might help with the sleep.
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