New Exercises

On Monday night I had 4 new exercises added to my regime.  The first 2 were new exercises added with the cane and they are pictured below.

In this exercise I hold the cane at waist level then push the cane out with my good hand causing my left shoulder and arm to extend outward.  I do 3 sets of ten each day at therapy and at home on days when I don't have therapy.

In this exercise I hold the cane with bent arms over my chest and bend my arms back and to the left causing the shoulder to stretch.  I do 3 sets of ten each day at therapy and at home on days when I don't have therapy.

In this exercise I stand in front of a wall with the palm of my left hand against the wall and slide the left hand up until all the way extended.  While the arm is extended all the way I lean forward and hold for a few seconds.  I do 2 sets of ten each day at therapy and at home on days when I don't have therapy.

This is called the sleeper stretch.  I lay on the side of my injured shoulder, put my bad arm at a 90 degree angle with the table and with my good arm pull my bad arm forward as far as possible.  I do 3 of these each day and hold each one for 30 seconds.

Monday Morning Update

Happy Monday.  Well, I have survived the weekend but my shoulder has been pretty sore the entire time.  The majority of the soreness has been in the area where the muscle guarding took place at therapy last Thursday so I am hoping it is nothing major.  But I did tweak my shoulder a few times while sleeping this weekend so I am hoping I didn't do any damage.  Have therapy again tonight so we will see what Beth says about the pain then.

Feeling Better Today

Just a quick update here.  The shoulder is pretty much pain free today which is good considering that I thought I would be in pain.  Let's see how it feels after I do my home therapy today. 

Painful Therapy Session and Muscle Guarding

Well, tonight's therapy session was my roughest one by far.  Beth added a new exercise on the pulley system that caused a lot of pain.  Well, not so much pain as soreness.  Instead of pulling my arms straight up I hold my arms out to the side and pull that way.  It was amazing the pressure that it put on my shoulder but no pain no gain I guess.

The stretching session was exceptionally brutal tonight.  I damn near jumped of the table in pain for the first time during one of the stretches but the pain was not in my shoulder which I found weird.  I mentioned this to Beth and told her my pain was in my upper arm instead of my shoulder.  Beth said this is called "muscle guarding". 

Muscle Guarding Explained

Before a foot race, a runner gets into position, poised to take off with a burst of strength and speed the moment the starting pistol fires. The condition of this runner’s muscles at the time following getting into position and preceding the starting pistol firing is a prime example of “muscle guarding”.

Muscles can be held in a position of readiness to act much like when the body experiences the stress response (better known as the “fight or flight” syndrome). When this happens, the muscles are not in a state of relaxation at all, but rather partially contracted in preparation for some action needing to be taken (or, quite often, action that the brain simply perceives as needing to be taken).

Another familiar example is when a person treats a formerly injured but now healed muscle tenderly, even tentatively, out of fear of re-injuring it. This too is muscle guarding.

Because of such physical demands (as for an athlete or performer), fears (as for a patient recovering from an injury), or chronic stresses (as for most of the working class), a muscle can become accustomed to the guarded (semi-contracted) position and remain that way, as though that were its natural state. 

  

What Does Muscle Guarding Feel Like?

When a person’s body is muscle guarding, they experience soreness, tenderness, and pain around the affected area, as well as tension of the tendons. What’s worse, all of these symptoms only end up validating to the brain the appropriateness of the muscle guarding and reinforcing the need to continue doing so. 

Consequences of Continued Muscle Guarding

A common consequence of muscle guarding is muscle fatigue, not only of the muscle in question but those supporting and opposing muscles forced to compensate for the muscle being guarded.

Another possible repercussion of muscle guarding is the inappropriate and potentially harmful hair-trigger firing of some of the body’s reflexes.

The irony about muscle guarding is that the innate intelligence of the body has the muscles in question “believing” that they must be guarded so in order to protect the full body from possible further harm. As it turns out, though, this muscle guarding is more likely to cause further potential harm than that which the body is aiming to prevent by muscle guarding.

At its core, muscle guarding is an effort by the body to defend itself against a perceived threat (whether remembered, anticipated, or actually present). But when no threat is present and the muscle guarding persists, then the behavior has the opposite effect, promoting more problems than it aims to resolve.

Well, it is now 2+ hours after therapy and even though I am still sore it does seem to be getting a little better.  I am going to throw the heating pad on it and take a couple of more pain killers an hope that I am feeling better tomorrow morning.  Keeping my fingers crossed.

*muscle guarding info taken from http://www.rennwellness.com*

Home Exercises

In addition to the exercises and stretching I do at PT 3 days a week there are home exercises I have to do the other 4 days of the week.  They consist of the following:

1.  Bend over and put my right hand (my good arm) on a flat surface and let my injured arm hang straight down.  I then rotate my hips / body in a clockwise motion 20 times and then in a counter-clockwise motion another 20 times.  What this does is loosens up the shoulder without actually using the shoulder to loosen it up...if that makes any sense.  The motion of the rotation of my body is gentle enough to loosen it up.  If I was to just rotate my shoulder it could cause damage to it. (I have found out that this is called the Codman Circumduction Exercise and an actual complete description of the exercise can be found by clicking here.)

2.  Laying on my back, I take a golf club and hold it like I am doing a bench press.  I then push it up until both arms are fully extended and then slowly start moving my arms back towards my head.  I move them until I feel a slight stretching pain in my bad shoulder and hold it there for a few seconds then bring it back forward and then down to my chest.  I do 3 sets of 10 three times a day.

3.  Still laying on my back I take the golf club and grip it like I am bench pressing.  Instead of pushing the golf club up to the point my arms are extended I keep my arms bent (golf club about 2-3" off of my chest) and just move my arms from side to side while keeping my elbows at my side.  I also do 3 sets of 10 three times a day.

For now that is all I do at home but next Thursday starts the more aggressive PT so we will see what gets added to my daily list.

Back To Square One

Well, just as I expected...I had that great night of sleep Thursday night only because I was to the point of physical exhaustion.  Last night I had maybe 2.5 total hours of sleep and tonight (Sat) doesn't look much better.  It is now midnight and I have been trying to fall asleep for an hour with no luck.  Only 1.75 weeks left of this brace.

Finally Got Some Sleep

Yesterday was a breaking point for me.  I had a lot going on personally with my mother who is in a nursing home and that combined with my severe lack of sleep had me at the cusp of a mental / physical break down.  By the time I got back from therapy last night I was a walking corpse.  I took 2 Unisom and was passed out in my recliner before my wife went to bed a 10:00.  She said she woke my up to say good night but I don't even remember that.  I slept solidly until about 3am when I woke up long enough to look at the time and went back to sleep until 6am.  So today I feel great!  My only fear now is that I am rested it is going to start all over again tonight and last until I am to the point of total physical exhaustion again.  Keeping my fingers crossed that this is not the case.