8 July 2009

Thought it was about time for an update  after about 17 months!

 

Things are much better now.  Sometime over the last year or six months I found I could do more and more without aggravating my shoulder.  I started the side-lying bent arm raise (rotator cuff exercise) and found it wasn’t a problem anymore.  I started on 3 x 15 with 1 kg, and I’m now on 3 x 12 with 2 kgs (shortly to up reps to 15).  Shoulders are feeling much stronger and sturdier.  I’ve also been doing some curls and overhead triceps extensions (abt 3 x10-12 with 4.6kg), and even did 10 pressups yesterday, which felt great!  First time in 3years and 3 months!!

 

And I’m back playing again. Nearly.  Been practising an hour a day playing left-handed for the last few months, and just started a little on the right too.  Sat in a couple of times in town – it’s gonna take me a while to get my feel and ‘ears’ back!  But everything’s looking good.

 

And in the meantime I’ve learned to play piano – maybe the whole experience wasn’t so terrible after all.   I’ve certainly learnt a lot.

New philosophy

I’ve now had 4 sessions with C the masseur. The effects haven’t been quite as spectacularly positive as the last post would suggest. Sometimes I’ve even come away feeling slightly more achey in the region where the elephant is. But overall, I think the results are definitely positive: releasing tense muscles, breaking down toxins, and slowly slowly bringing the bones and muscles back where they should be. This process will of course be slow as things may have been going the wrong way for years.

When I’ve felt slightly better, I’ve made the same mistake and charged out doing things I really should think twice about. I recently played agogo in the street for some visiting Brazilians making a tv documentary, then spent 11 hours over 1-and-a-half days running intensive ‘drum circle/jams’ (which I’ve never even done before), and then finally did my day at Renaissance college. Things didn’t feel too good after that I can tell you.

But everything seems to settle down again fairly quickly, which I remember from my recovery last year, so this is a good sign.

Anyway, onto my ‘new philosophy’. The pain from my shoulder has been ruling my life. When it doesn’t hurt, I feel good. But when it is making it’s presence felt – which is most of the time – I get depressed, worry about the future, and can’t concentrate on anything else, so usually end up doing not very much. A couple of days ago, I thought “what if I disassociate my mood from my elephant?”. So now I’m disempowering it. It’s had too much control for too long, and it’s time for it to take a backseat. If nothing else I’ll get my life back.

finding the key?

I think I may have finally discovered why all the $30,000hk worth of treatment I’ve had generally didn’t have much long-term effect.

But before I get there, a recap on what I’ve done since last post:

I’ve been doing the exercises listed below fairly consistently, and also went back to see R, the ‘electro’ acupuncturist I saw last year. In my review of last year I discovered I was back doing physical things and even a gid within a few weeks of my two sessions with her, though my immediate reaction after the second session was that it had made things worse, as the biceps tendon was once again sore to the touch.

This time around, I was apparently much more resistant to the pain of the needles, but she did both sessions (I had two again: 3rd and 5th of October) with me sitting down. As a result I couldn’t really relax properly, and as I felt like I was going to be in pain if I moved my head, my neck and shoulders actually become incredibly stiff.

My right shoulder had been aching a bit before I saw R, but after these two sessions, it was aching quite a lot. I also had a strange twinge on the edge of my left scapula (she’d put a needle in my left shoulder too).

Then I went to see C, who does therapeutic ‘deep-tissue’ massage, and had been recommended by a friend.

The session was incredibly excruciating, but in a good way! Afterwards as I peeled myself off the table, I noticed that my shoulders seemed further back, I had better posture, and the ache in the bad shoulder had lessened somewhat.

C had found a lot of scar tissue in the right arm just below the shoulder and concentrated on a couple of areas there, which were very sore. She said it felt as if all the tendons and muscles were matted together and stuck to the bone.

The next day, I had a healthy-feeling ache across both shoulders, and in my back muscles, as if I’d had a good workout at the gym the day before! And the spot with the scar tissue (about 3.5 inches below the ‘injury’ in the tendon on the ball of the shoulder joint) was very painful to the touch, and a little lumpy, but didn’t hurt when I moved my arm…

Suddenly I had a revelation (which I hope doesn’t prove to be a red herring): when I’d injured my arm at the start of March 2006, it wasn’t in the place where I’ve had all the pain, it was down there, 3.5 inches below! That was why I figured I’d injured the muscle, and I didn’t have much pain from it so carried on doing very physical things with it in the fateful month that followed. When I got a pain in the actual shoulder a month later, I figured I must have injured there as well, but just couldn’t feel it before.

So, I’m guessing that the injury further down the arm had a knock-on effect on the tendons in the shoulder as it healed, perhaps not very well. This would explain why the MRI scan (from August 2006) showed no damage to the tendons there, and it didn’t extend far enough down the arm to pick up where the actual injury was. You might think an ‘orthapaedic specialist’ would think laterally at that point and figure the pain must be referred or the result of some other injury. Hmmm. Anyway, it seems that most of the treatment I’ve had was in the wrong place!

Right now – three days after the massage – my shoulder feels much more limber and relaxed. I’ve got a good range of movement, with apparently less clicking. But it still starts to ache when I do things like sit at my computer typing alot as I am now. I know it’s capable of changing completely from one day to the next, and this whole experience has driven me slightly insane, so I may just be clutching at a false hope. But I really feel like I may have found the key to this!

4 months later…

and I’m still not back to normal. Last year I was playing gigs about 6 months after the injury. This time around, it’s now at least 7 months since the last ill-advised gig, and the tendon still hasn’t settled down.

I had 6 or 7 sessions of acupuncture with a new guy (new to me) from Shanghai, recommended by a French bass-player. Also did acupressure, and this was very painful – the first session really seemed to mess up my shoulder and I couldn’t even lift my arm, though this faded quickly over the next 36 hours. The only effect of the treatment seemed to be to make the shoulder less aggravated from the treatment itself. The acupuncuturist felt there should have been more improvement than there was, so as he wasn’t confident I stopped seeing him.

Been back on MSM, Glucosamine & Chondroitin for the last few weeks. Recently did some more internet research and came across the condition ‘tendonosis’, which seems to better reflect my situation, though it’s strange that none of the ‘experts’ I’ve spoken to have come up with this. Basically ‘tendonitis’ means inflammation of the tendon, but when you have really chronic tendon pain, the tendon has probably healed, just badly, and probably with the ‘wrong’ sort of cartilage.

Also doing some exercises, stretches and icing most days. Exercises –

- twisting arm through 180 degrees and back hanging straight down, 3 sets of 50, with 2.5kg weight.
- scapula clench w. theraband on doorknob, 3 sets of 20 at 127cms (toes from door)
- back arm lift, lying face down on bed. arms straight, with 0.5kg each hand (water bottle)

also just started isometric ‘thor’ handpress (1 x 30 secs each way), and back-hand-press (standing against doorframe, hand just above arse, pressing with palm against doorframe, 5 x 5 secs, v. difficult).

7 weeks later…

So, it’s been a while since I wrote this. To summarize:

1. I’ve been having regular sessions with physio H, at least 5 visits. H was away for a couple of weeks, so had a 3 week gap, and recently went back again. Now down to 1 session/week. In last session did:

Ultrasound
Manipulation/massage
Exercises (focussing on scapula), including use of swiss ball.
Interferential treatment

I feel that the interferential may be quite good for it.

2. Diet – have been eating and drinking as normal.

3. Exercise – I’ve been hiking a couple of times, and have tried to get down the beach for an exercise session in the sea regularly. Probably been about 4 times in the last couple of weeks.

4. Stress on shoulder – I’ve been through a lot which isn’t good for the old thing: Nearly moving house, and then having to move everything back again, for example. Now living in a small flat which is stacked like a warehouse, but I can’t get it organized as I can’t move anything heavy on my own.

Summary: Looking back on my last post, things definitely seem to have improved. Over the last couple of weeks I’ve started to having that inkling again that I may be turning/about to turn the corner. This is always very transient, as one day is commonly worse than the one before, but I seem to have had a few more good days recently.

Having said that, today it seems rather aggravated, and unsettled.

regression?

Yesterday evening I was just doing something innocuous – moving a teatowel or somesuch – when I felt a sharp pain in the front of my right shoulder. What was unusual this time was that it didn’t go away when I moved the arm back to a neutral position (though it was hardly contorted at the time). The pain only died away slowly over the next couple of hours.

It wasn’t a severe pain, but was pretty uncomfortable, and seemed indicative of something not good happening. Hopefully this is wrong. It followed my first day of the week at school, and I had to be back there today. Drifted through a golden period mid-afternoon where I didn’t seem to be aggravating things at all, just by keeping my shoulder blades back, but this passed unfortunately.

Then it was off to the physio (H), for session 3. This was similar to the last sessions, but with the addition of a ‘new’ exercise: the scapula clench, while holding theraband ends (theraband wrapped around door handle). It was good to get some more direction on how to do this exercise properly though.

During the massage/manipulation, H concentrated on a point of knotted muscle, kind of between the shoulder blade and armpit on the right back. She was amazed at the solid state of this muscle, and the pain when she massaged it was excruciating. It also seemed to trigger intense pain in the point where I’d experienced renewed discomfort the previous evening. H managed to get rid of a lot of the tension, but there was still a ‘knot’ there.

Returning home, I found that the pain from last night seemed to have returned, so took nurofen 400mg.

experiments in success

I had my second session with physio H yesterday. After some thorough massage and manipulation (though more manipulation of the flesh, rather than moving the arm about) on both shoulders/arms, I had a bout of ultrasound. Then it was off to the ‘physio-gym’ to be (re)introduced to two exercises:

- Lying face down, with arms up resting on bed, elbows at right angles (upper arm in line with shoulders, fingers pointing towards head). Carefully focus on muscle below scapula and use to lower shoulders for counts of 5 seconds. First each side individually, for 5 repeats, then both together for 5 repeats. Repeat whole set twice.

- Lying on back on rubberized tube about 4/5 inches in diameter (running between shoulder blades parallel with spine). Legs bent to avoid rolling off, arms splayed out to sides, palms up. Just relaxing in that position for a minute or two, to stretch out pecs and tendons from chest to shoulders.

Followed the exercises with some more focussed icing (using frozen paper cup of water).

Today I carried on with the exercises this morning, and in the early evening finally returned to the Gym near where I live. As usual, I stretched, then did 15 mins on bike, some leg weights (on machines), 15 mins on ski machine (without using poles) and then warmed down.

I felt good, and particularly on the ski machine, which – by keeping an upright but relaxed position – really seemed to exercise the scapula muscles which the physio is intended to target. I iced both shoulders on returning home (with frozen cup of water method).

Other treatments over the last few days:

- detox pills (continuing for another 9 days or so), together with plenty of water, nature’s tea etc…

- ‘anti-inflam’ smoothie every day: carrot, pineapple, celery, cucumber & ginger.

- MSM+Glucosomine creme (though this doesn’t seem to absorb very well: always a film left on surface even a day later).

drifting up and down

The day after I saw physio H, the muscles along the top of the shoulders/back (Trapezius?) were insanely sore. But this felt slightly more akin to exercise soreness than strain from the messed up mechanics of the shoulder. H couldn’t believe how hard and knotted those muscles were, so it’s to be expected that there’d be some reaction to them being kneaded and manipulated vigorously.

Yesterday though, they’d relaxed considerably. The troublesome tendons also felt relatively at peace, and all seemed well with the world. It’s these times that I have to be very careful to rest them, as it’s easy to start picking up things without proper care and attention, and the next thing you know – there’s tears, as more damage is done.

The next few weeks are going to be challenging. I’m having to move into a larger flat, because I have stuff being shipped from the UK arriving soon. But this large flat is more expensive, so I’m having to find some more work, which doesn’t aggravate my tendons. So, the question is: should I give up the school job, and try to get fulltime work for conventional hours? I’m certainly gonna need a lot more money, as the new flat is unfurnished, but the school job does pay well, even if for only two days a week. Against this is that it may really slow the healing of my shoulders, or even not allow them to heal at all!

So, some difficult choices ahead. At least in 10 days my self-imposed ascetic life will be over, and I can finally relieve the stress with a few beers. (Though I’m going to try to keep everything on a moderate and brown-rice-type keel to avoid losing any benefits from my fast).

a new day, a new physio

Having listed out the treatments I received, gigs I played, and other events of last year – chronologically – it seemed to me that I’d made the most progress from mid-July to the start of September, when I was having regular treatments with another physio (‘H’). So I decided to return to her today for some regular (twice weekly) treatment.

I’d just finished my two days/week at the school, and my thinking was quite logical: even if I spend half my income on treatment, if that means I can keep the job at the school, it will be worth it. H gave me ultrasound, some thorough massage and manipulation, and some very localized icing, before suggesting stretching exercises for the neck into the tops of the shoulders (which have become more tense than ever as I’ve been on the computer too much recently).

I’d ended up having a couple of 400mg Nurofen during the day, to stave off deterioration while I was working, but this made it difficult to see exactly what the status of my shoulders was, as it really seemed to kick in just as I got to the physio.

I left the clinic with the usual rosy glow which comes with believing you’ve found the holy grail of treatment for your ailment – again. I know I’ve felt like this before, so don’t want to be disappointed again, but I don’t think there’s any harm in basking in the mental warmth that this feeling brings, even if it’s only temporary.

Another change to my treatment is that I’ve started using another topical creme I found in a shop yesterday: ‘Natrol – MSM with Glucosamine’. It’s the first topical form of these supplements which I’ve seen in HK, and I’ve read that topical application can get much more of the active ingredients to the sites where you need them. I’m using it extensively to see if this is true.

…and it’s not so bad again

My shoulders were painful this morning, and even seemed to produce some sharpish pain when lying on my side this morning. But they settled quite quickly, and were much better today than yesterday (thank god).

I noticed however that they became worse – less flexible – when I was typing at my computer all morning. Also the weather has become much colder here in the last 36 hours, so that could have had a bearing on the degeneracy yesterday. When I went out for a swift 30 minute walk that really seemed to help, and with those benefits seemed to remain all day afterwards.

I iced them this morning, but in this weather, it makes them feel cramped and inflexible. The only thing I’ve been doing differently today is that I resumed taking Omega 3 and Glucosamine Sulphate supplements. It’s probably just the natural cycle that this thing seems to have – I remember something similar from last year, and that slowly improved. Very slowly. Anyway, it’s welcome to feel a little respite just before I start my two days at school tomorrow.