Wednesday, September 29, 2010

Physical Therapy -- Is it worth it?

I used to ask myself whether physical therapy actually works. Here is my take on it:

There are a few different reasons for physical therapy (in my case). After chronic bursitis in my shoulders, along with rotator cuff tendinitis, bicep tendinitis, neural tension, dyskinesis, etc. All these issues became extremely painful to deal with. I had been going to a rolfer, acupuncturist, 3 different modalities of chiropractic, massage therapy, gua sha, etc. They seemed to help temporarily. But my quality of life was sorely affected. Finally, I was referred to a physical therapist.

There are many different types of physical therapists. One clinic I saw before, was Physicians Neck and Back Clinic. They used the Med-X (sp?) machines -- isolating your muscles and strengthening them. They have a pretty good success rate. But it wasn't for me. It caused me more pain (as it wasn't treating the problem and only focused on the back -- and they call my upper back "the neck" which bugged me, since in between my shoulder blades is NOT my neck). As it turns out the extreme pain in between my shoulder blades was affected by my rotator cuff -- it is all connected and I don't know how, but I will accept that is the case and move on (I am not in the medical field so I trust them on this).

I then went to a physical therapist's regiment of stretching and strengthening the right muscles... my rotator cuff muscles which are the sub scapularis, teres minor, infraspinadus and supraspinadus. I may have spelled some of those wrong. But strengthening those and stretching really did help my range of motion and my strength. But the pain did not go away, and it was on both shoulders. My right shoulder did have a very good result, it used to be the most painful of the two, but as it healed and consistently ranked on a pain scale, only 3-4 out of 10, it did not stay my biggest problem. My biggest problem was now my left shoulder. (This was also after getting a cortisone shot in both shoulders, it worked for a while, but then wore off).

Since I had been doing physical therapy on my shoulders for over 6 months by this time, and the pain was not gone, THEN, as a last resort, we decided to opt for surgery. By now I was seeing an orthopedic surgeon who specialized in shoulders.

Physical therapy was EXTREMELY important BEFORE surgery for a couple reasons:

1) There was a chance it could have worked -- therefore avoiding surgery!
2) It strengthened my muscles so that recovery AFTER surgery would be a LOT easier.

But, you have to remember that this is homework - - you can't NOT do your exercises and stretches. You have to be consistent and  do them frequently. Sure, it takes time. Right now I am spending about an hour and a half every day, total, on stretches and range of motion. Before my surgery I was spending at least 45 minutes on them.

So, now that we know the importance of trying physical therapy BEFORE surgery, let's talk about AFTER surgery.

This is very important. Even more so than before surgery. You have to be committed to this, or I suggest not even bothering with surgery and sticking with pain pills for the rest of your life.

I will use myself as an example. I had SAD (decompression surgery) and DCE (Distal Clavicle Excision) on both shoulders. Those are pretty simple processes and heal quickly. Basically, they remove your bursa, cut out any bone spurs, and cut off the end of your clavicle. Soreness can remain for months, but on my right shoulder (I am not even 2 weeks post op right now) I have full range of motion, and no "pain" -- just tenderness and soreness as a result of my bone being cut off, and my bursa removed. I expect soreness for the next month or so, going away gradually. Then, I will be 100% better in my right shoulder. Currently I am using my right arm to carry any heavy stuff I have to carry.

Almost seven weeks ago I had the SAD and DCE on my left shoulder (the bad shoulder) but along with that, I had a bicep tenodesis. They removed the longhead bicep tendon, and re-attached the little stub that was left, to my humerous bone. THAT was major surgery. As a result, I was in a sling for 4 weeks. I could only do basic pendulum and isometric exercises, and then the wand exercises a few weeks afterward. (Wand exercises ROCK for range of motion, by the way). Because of this, many of my muscles in this shoulder atrophied, and I lost a LOT of range of motion. Besides, my shoulder is still so weak I cannot hold my arm above my head for any length of time yet. So.. here is where physical therapy comes in. I seriously was afraid of getting a frozen shoulder. So I did my pendulum exercises from day one, although they hurt and weren't the most comfortable to do.

So the first reason why you need to do physical therapy for shoulders after your surgery is to avoid getting a frozen shoulder. The second main reason is that you can heal properly. I was told by my surgeon that the first month at least, after my surgery, would be worse than the pain before my surgery. I am now through that period, and the main pain associated with all this, is the soreness I am getting from my physical therapy. I started doing more stretching exercises, to get my range of motion back. There are some motions where it is SO painful I feel like my bone is breaking. But I am working through that. Every day, as I do my physical therapy, I go to the point of almost wanting to cry. Some days I think I am regressing. But overall, I can see how much farther I am able to stretch, and how much easier it is. Even if it is just a centimeter farther. That is improvement. It is slow going. I was told this would take 3-6 months MINIMUM. And strengthening really doesn't start until after 8 weeks... of course actually living it vs. just being told what to expect, is very different.. I wasn't prepared for the difficulty that physical therapy has become.

And, each time I am given new exercises, to do along with the previous exercises, I wonder where I am going to find time to incorporate it all into my hectic schedule. Luckily I have found that I can do some at work, in my office, while I am on a conference call or on a webinar, or during lunch or break. Sometimes it also feels like I go 3 steps forward just to take 2 steps backward. But I AM coming along.

I also sometimes regret not doing these physical therapy exercises sooner, I look back and figure maybe I didn't really need to be in a sling for 4 weeks... letting my muscles atrophy. But the more I read about a bicep tenodesis I realize that I NEED to allow my bone to heal. There are two screws holding the muscle in place right now. A fall or an accident or me trying to lift something heavy when I am not ready, could ruin the whole surgery and give me a tenotomy (where they just cut the tendon and you end up with a popeye bicep). That would be very bad. I am about 5 weeks away from when I am considered a "successful healing". (It takes 12 weeks for the bone to heal, they told me). I am glad I didn't screw it up.

So, while I am still in physical therapy, and have been for the past 8 months straight, I am very thankful for my decision to continue with it. DON'T GIVE UP. LISTEN TO WHAT THEY SAY. If they tell you to ice your injury 2-3 times per day, then DO it!! Icing sucks in Minnesota in the winter time, for sure. But Thankfully it has been warm this past summer, and by the time winter comes along I plan on being healed :)

My goals are to be fully healed in my right shoulder by the end of October. There is a ligament on the top of your shoulder that attaches the acromium and the clavicle... well, that might be sore for up to 6 months, I was told!! Sore or tender... but I already feel so much better I am thinking that will be completely gone by October. That will be 6 weeks for my right shoulder. Then I can start some strength training for all my shoulder and upper back muscles!!

My goal for my left shoulder is to have complete range of motion back by the end of October. I know that is almost 5 weeks away, and seems so far out, but I have to have goals that I can accomplish. And, since I will be starting some simple strengthening exercises, I think I will be able to do a lot more with it by then as well (i.e. carrying bags of groceries, etc). Then, by December 23rd, I want to be considered fully healed so that I can start strength training, kickboxing if I want, etc. That also is the day that I leave for my Panama vacation, and I want to be able to kayak, etc. That is almost 4 1/2 months from my surgery, and it is 100% do-able!

Yes. Physical therapy is worth it. In just a few more short months, I am going to be pain-free -- a total different quality of life. I am so excited about it. Lots of peaks and valleys throughout the process, but I wouldn't trade it for the world.

Posted via email from rhauptman's posterous

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