PT Update 3 - POD 70

PT on Wednesday went well. Although I've seen and felt progress the whole time I've been going for therapy, this week is the first week I've really begun to feel like myself again. I was able to put some boxes up on a shelf at work and reached over my head like I haven't ben able to do in years. Since I'm also in the process of packing to move I'm doing a lot of physical activity that I haven't done to this point. I'm trying to be careful with what I'm lifting since there is no getting away from this work needing to be done.

David added two more exercises to my routine on Wednesday. The first was the plank. I had to 3 planks for at least 30 seconds each. I think I held them for a little longer since I couldn't see the clock while I was doing them.  This is a great exercise for anyone who is looking to strengthen their core and I felt it in my abs for a few days after PT.

 Plank

The second addition was a stabilization exercise. David had me get on my hands and knees on the table, lock my elbows and he tried to push me from different points on the sides of my body and I had to resist him so I did not move. He then increased both speed and pressure as we progressed so that I had to react more quickly. I have to say, it was kind of fun.

Since the PT routine is ever expanding I'm going to recap the routine in a table below which is current as of POD 70.  Also, a note on therabands: I keep talking about the different colors and ,for those of you who haven't been lucky enough to use them, I wanted to mention that the different colors equate to different levels of resistance. The progression from, least to greatest, is tan, yellow, red, green, blue, black, silver and gold.  All of the exercises listed below are for three sets of 10 unless otherwise noted.

Exercise	Weight/Color/Time
Heat	15 minutes
Hand Bike	Level 4, 4 minutes each direction
Pulleys	30 reps
Codman's Exercises	30 reps each direction
Front Raise	1 lb
Shrugs	4 lb
Biceps Curls	4 lb
Scapular Retraction	Green
Internal Rotation	Green
Rear Extension	Green
Adduction	Red
Wall Climb	n/a
Ball Stabilization	30 seconds, 5 times
Front Flexion, Wand	n/a
External Rotation, Wand	n/a
Plank	3 x 30 seconds
Kneeling Stabilization	n/a
Manipulation/Massage	n/a
Ice/Electric Stim	15 Minutes

It's Always Fun...

...when you can shock your doctor. I went to see Dr. Hershon for my 4th post-op visit on Tuesday (POD 69) and he was amazed by my progress.

He asked me to take off my shirt and move my arm and I mimicked his motion. Then he asked me to lift my arms straight up in front of me to observe my front flexion and when I threw both my hands up in the air, his eyes bugged out of his head!!! Then he tested me further and asked me to put my left hand behind my back to test my internal rotation. Again, he was shocked that I was able to almost get my thumb up to my scapula.  "That's the one most people have trouble with." he said. He told me he was very pleased and that he was not so happy with my progress the last time I was there. I told him that the external rotation was the thing that still needed the most work and he assured me it would get there. He also told me that high end athletes (obviously, not me) have a really hard time with this injury because it takes a long time to get back to full function and most of them are unwilling or unable to wait.

He gave me another prescription to extend my PT, shook my hand, told me to keep up the good work and go back to see him in 6-8 weeks.

PT Update 2 - Post Op Week 5

Well, the PT train is running is running fast and furious. I'm at least one entry behind where I should be but only one exercise was added the last time around so it is not really that bad but things have been moving so quickly that I've kind of lost track of dates so you'll have to forgive my lack of time frames. I'll try to take better notes going forward.

So, the last time I mentioned that they had added the hand bike,front raises, scapular retraction and shrugs to our routine. About a week later David, once again, threw some more exercises at me. The list has gotten so long that I had to put a note on my Blackberry so I could keep track of what I was doing during my sessions.

This time around the following exercises were added: biceps curls, internal rotation, rear extensions, wall climbs and ball stabilization. That's 5 new exercises on top of my already lengthy schedule at the clinic so that has kicked my time there up to almost two hours there!!!!

Biceps curls are a pretty standard exercise that most people have done at some point but most people don't realize that the biceps play a part in the shoulder anatomy. The biceps tendon anchors right near the glenohumeral complex and can become dislodged or damaged by dislocations. According to my surgical report my biceps tendon was healthy and undamaged but I still need to build strength in it to aid in the rehabilitation of my shoulder. That is happening in the form of 4 pound dumbbells and, while I won't be winning Mr. Universe any time soon, it is helping the arm.

The faithful readers will know the difference between internal rotation and external rotation. The internal rotation exercises consists of my taking a red thera-band in my left hand and while holding a rolled up towel under my arm rotate my arm internally away from where the thera-band is tied to a piece of equipment. Like all my exercises the routine is 3 sets of 10 reps.

 

 

 

 

 

 

I also added rear extensions to the fray. That consists of standing with my arm by my side and holding a yellow thera-band in my hand while anchored to a fixed point. I then move my hand backward past the plane of my body from the shoulder joint. This helps to strengthen the anterior deltoid. Again, three sets of 10.

Wall climbs are a pretty standard range of motion exercise for shoulder recovery. It is, quite literally, what it's name implies. In this case, I use a towel to reduce friction against the wall and I slide my hand up the wall in front of me to help front flexion and stretch out those tight tendons.

The last thing that was added this time around was the ball stabilizations. This exercise is getting to be one of my favorites because I really feel it. I hold a small, weighted ball that looks like a dodge ball but is about the size of a cantaloupe against the wall at shoulder level against the wall. I then make small rotations from the shoulder and do that for about 30 seconds. It is supposed to help loosen the shoulder capsule and aid range of motion. I just think it's fun.

Two visits after those 5 exercises were added I had one more thrown at me. This one is shoulder adduction and I use the yellow thera-band for this. I hold the band in my left hand out to my side at shoulder level and then bring it across so my hand is out in front of me with my elbow held straight. I always confuse adduction with abduction but Dana (Physical Therapy Assistant) told me that she remembers it by thinking that adduction comes toward your body like you're adding something to your body. So far, that seems to be helping me remember. The adduction is going to help build strength in the pectorals major muscle, which also has a part in the shoulder function.

One last note...I have a follow up appointment with Dr. Hershon I'm curious to hear what he'll have to say about my progress. The progress notes David gave me indicate that I'm doing "very well." I'll post again after my appointment to fill you in.

PT Update 1

It's been a while since I've written. There are a bunch of reasons/excuses. I came down with a cold shortly after my last post and did not feel like doing anything but eating and sleeping for about a week. There was also the fact that there was not much to say until last Wednesday and I was not going to write for the sake of writing. Then my PT schedule changed, the sessions became longer and it was just wiping me out. But now I'm buckling down again to do some writing.

So my PT routine had remained what I described in my last post until last Wednesday, which also happened to be the 2 month anniversary of my surgery. Last week David, my therapist, added 4 exercises to my routine. David added the hand bike, scapular retraction, shrugs, and front raises to my exercises.

The Hand bike is just what it sounds like. It is a stationary bike but, instead of using your feet to turn the mechanism, you use your hands. The bike was set for 6 minutes on level two and I was told to do three minutes going forward and three minutes back. It felt okay going forward but after about a minute of going back the shoulder started protesting. So I finished tha last 2 minutes forward and moved on. It wasn't terrible, it just didn't feel right.

Scapular retraction is probably the most mysterious sounding thing in the list of new exercises.OOOOOOOOHHHHHHHHH!! Well let me end the wonder. It is similar to a rowing type exercise. While in a standing position I hold a Thera-band in my hands, while my elbows are at 90 degrees and pull back so that I feel the squeeze between my shoulder blades. It is supposed to assist with strengthening the rhomboids and aid good posture. It felt good. I quickly moved up two levels of resistance so that I'm using the green bands for that exercise now.

The dumbbell shrugs are a pretty basic weight lifting exercise. I just stand with 2lb. dumbbells in my hands and I raise my shoulders up as high as I can and repeat for 3 sets of ten. This helps to build the trapezius muscles.

The final exercise was the front raise. Standing with a 1 lb. dumbbell in my left hand and 2 lb in my right I lifted the weights straight out in front of me and kept my elbow straight. Once I reached the 90 degree mark I lowered them and repeated for 3 sets of 10. It wasn't much but it's the most exercise I'd gotten in a quite a while so it wore me out.

In addition to the exercise it is just the time I'm putting in. The addition of these exercises to the routine I was already doing pushed the time I was spending at the PT clinic to 1 1/2 hours. After a full day of work and doing PT exercises and stretches through the day and then putting that kind of time in after work was taking it out of me. On the up side, I've been sleeping really well.

People keep asking if I'm in pain or if the PT hurts. Maybe I have a high tolerance for pain but it has not really been bothering me all that much. Yes, I'm sore and yes, I've winced while Dave is digging his thumbs into my trap but there hasn't been any overwhelming, incapacitating pain during PT. The worse thing is on the days I don't go that I'm really dreading doing the last set of external rotation exercises because I'm just so sore. Overall, I feel better when I leave the clinic and I've noticed a marked improvement in my range of motion and my ability to do every day tasks.

The greatest testament to what I've accomplished so far is the things I do with realizing them. I was driving around over the weekend and I propped my elbow up on the door without realizing I had even done it. This was my normal driving pose before the surgery and I just went back to it without any pain. I was shocked because as little as two weeks ago I could not do it.

The other thing was that I tucked in my pants in the back with my left arm. It's the kind of motion you make every day and don't think twice about. I've been thinking about it a lot lately since every time I went to do it my shoulder let me know it was a bad idea. Then one day last week I just got dressed and didn't even realize I had done it until I had gotten half way to work.

The bottom line is this: I'm putting the time in and I'm seeing results and I'm excited.

PT Update 2 coming soon.