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 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.

suddenly, feels better

This morning I woke up around 5 am again, with pain, but managed to get back to sleep till around 7. I wasn't very active today. My shoulder was sore all day, and I didn't feel like doing much. Instead I did a lot of reading and watched some TV. Around 5 pm, I decided I should take advantage of the extra time and attempt a weight-lifting workout.

My workout schedule has been in a shambles since I started physical therapy, which takes too many hours out of my day. So I'm trying to get in two workouts on the weekends, at least. I'm mostly having to lift with very light weights to get around the shoulder handicap.

After lifting, I went through about 40 minutes of PT exercises. The abduction exercises have been particularly difficult since I started. But after just a few tries, it suddenly seemed like things loosened up remarkably. Visually, it doesn't look like much of an improvement, but it is visible. The feeling is much better though. I'm still in mild pain, but I've noticed all evening that the pain has moderated quite a bit. In fact the most pain I feel right now is in my elbow, which I'm pretty sure is secondary, due to excessive twisting while doing PT.

External rotation is still just about zero though. That's where I want to see improvement, next.

Unfortunately, I can't tell whether the improvement is due to the ice that I applied yesterday, or the first few days of PT. The ice seemed to reduce the swelling, and I wonder if that did the trick. I'm going to pick up some ice packs tomorrow and apply them after PT for a while, to see if that helps some more.