Physical Therapy is Super Fun


Adhesive capsulitis, also known as frozen shoulder syndrome is really weird. The tissues in my shoulder became tight and inflamed. Scar tissue and adhesions that are not supposed to be there formed making it hard to move my arm. The manipulation under anesthesia (MUA) is meant to break that tissue with aggressive movement and manipulation of my arm. It might also include a scope with tiny scissors through an incision in my shoulder, if the adhesions could not be sufficiently broken. The anesthesia team came by before hand and told me I would be given a nerve block shot prior to being put under anesthesia, but that I'd get a little something in my IV to relax me.

Bummer. I was hoping that the whole thing would happen while I was completely knocked out.

I still didn't know exactly where the shot would be given, nor would I look at it. I preferred not to see or know. Well, the good news is that "little something to relax me" was plenty. They brought my husband back to see me off before they wheeled me back, but I have no recollection whatsoever of seeing him prior to surgery. They put something in my IV, and the next thing I remember is waking up in recovery. I found the spot on my neck where they put in the needle the next day.

According to MJ, he came by after the nerve block. I spoke to him and everything, but I don't remember. He says my surgeon came by to see me in recovery, gave him some follow up instructions, and even demonstrated the newfound mobility of my freshly manipulated arm, but I don't remember. I do remember waking up a few times, babbling a bit, and being so tired that I just drifted off back to sleep. It took me about two and a half hours to officially wake up, and the first thing I wanted to know, is if I had any incisions. I had none! The doctor was able to break my scar tissue by moving my arm.  At my two week appointment my doctor told me the manipulation was loud. As in snap, crackle, pop, coming from my shoulder while it was being manipulated. Sounds awful, and I was definitely cut up on the inside, but I'm glad I didn't have to get cut on the outside too.

I don't remember most of the drive home, so apparently, I wasn't quite as awake as I thought. I hadn't eaten all day, so MJ decided on Peanut Butter shake and french fries for lunch. Then I went to sleep. They never told me my arm would be completely paralyzed. It was about as floppy as a fish out of water, and would fall out of the sling if I didn't hold onto it with my other hand. It was the oddest sensation to have MJ hold my hand, or poke my arm without me having any idea he was doing it. My arm felt like it belonged to someone else, but it didn't last.

The next morning, is when the pain and the reality of the trauma my shoulder went through despite not having any actual incisions really hit. I most definitely had a wth did I do moment of regret. Once my shoulder froze, the amount of pain I experienced on a day to day basis decreased, but now I was back to barely being able to lift my arm without pain. Reaching my right arm across to shave my left arm pit was way worse than it had ever been before. I had to hold the razor with the very very tip of my fingertips and even then I could barely reach. The short lived mobility of paralysis was gone. My shoulder was super stiff and extremely tender. Just the weight of my arm hanging at my side hurt, but I wasn't allowed to use the sling the next day. I was inclined to use my left arm to hold my right arm or not to use it at all, but the doctors want you using and moving it right away. In fact. I had physical therapy that very day. Not a moment to waste.

I had no idea how I was going to make it through physical therapy when hitting bumps in the road on the way there made me cringe. Needless to say, even with vicodin in my system, physical therapy was not fun. I gritted my teeth, and sweated my way through that first session. I did all the exercises I was asked to do as best I could, and I'd have to do them four times every. single day. Physical therapy must be immediate and consistent or else the scar tissue will lay right back down and freeze the shoulder all over again.

I couldn't let that happen.
  
Four days post surgery I was really discouraged, because physical therapy is really painful, and I knew I had a really long way to go before my shoulder mobility would be even close to normal. One particular exercise where I have to hold a pole in both hands palms up and move it to the right, was so uncomfortable, that it made me feel nauseous every time I had to do it. I asked MJ move my arm the night before while it was still paralyzed, so I knew what it was capable of, but that was all gone. I had visions of waking up with full mobility, but that's not the way it works. My tissues underwent severe trauma, and the only way to heal that trauma is essentially by inflicting more pain.

My second physical therapy appointment just one week out was pretty bad. The woman was brutal. I was whimpering on that table, pretty much the whole time. She manhandled my arm, moving it in directions I didn't know it was allowed to go, but that helped me to see what was possible with assistance, and made me unafraid to push the limits harder in physical therapy at home. It became pretty clear that pushing those tissues and freeing up my shoulder capsule would require me to go past my comfort levels.

I took two weeks off from work. As I became more mobile and less in pain, I started to convince myself that I could go back sooner, but I'm glad I didn't because sitting at a desk is a lot harder than anyone thinks it is. My shoulder wasn't as "recovered" as I thought because my first day at work was pretty rough. I made it through the day, but definitely experienced an uptick in pain and discomfort, and it felt like a setback at my therapy appointment the next day. I'm really glad I took those two weeks at home so I could focus on that critical therapy four times a day, because once I went back to work, not only was I in more pain for a few weeks, but I also had much less time. I remember sitting at my desk that first week back, thinking that there was no way my shoulder would ever be normal. It was still so stiff. The scar tissue was supposedly cut, so why can't I stretch my arm over my head without wanting to scream? I switched over to prescription motrin at that point, because feeling buzzed and then sleeping half the day was no longer an option when I went back to work.

I can't talk about this recovery without mentioning just how sweet my husband was through all of it. That man does not know how to braid hair, but he tried and he did a pretty good job of it when I couldn't do it myself. He made sure I took my painkillers, and iced. He helped me get dressed, fixed my plate, took me to my doctor's appointments, and was there to lean on when I thought I'd pass out from the pain or the vicatin or whatever it was that made me feel so sick the day after surgery. I appreciate him so much.

I have a weekly in office physical therapy appointment and therapy on my own at home (or work) four times per day. Even though it seemed impossible at first, slowly but surely it's been getting better. I was honestly really happy when I quit PT after my shoulder froze. I was pretty much over it, and I would have been glad not to ever have to use that darn over the door pulley system again, but that was one of the first exercises I had to start doing again. At first my back arched and I had to tug really hard on the left side to get my right arm to lift over my head, but after two weeks it got less painful. Then I started focusing on pressing my back against the door, and stretching higher. It got painful all over again with better form, but by week three it was less painful. And so it goes.

I was too scared initially, but after three weeks, I asked MJ to help. I'd look at what my good shoulder could to compared to my bad shoulder, and I wanted more. If I quit when it hurt, how was I ever going to get it to move any higher? The scar tissue was broken, my arm was capable of more movement, but I had to move it! My shoulder is so stiff that sometimes he has to push pretty hard to get it to move past my "comfort" level. I let him push as far and as long as I can stand, and then when I can't take it anymore, I'm practically yelling at him to stop. It sounds harsh, but I think it's really been helping me along.

I get a new exercise almost every time I go, and those new exercises hurt a lot at first, which is frustrating, but then it gets better. I do make progress every week when they measure my range of motion, but it wasn't until week five that I started to feel more optimistic. I got more range of motion and less pain on one of the external rotation exercises I got on day one. Some of the other exercises were becoming easier, and pain at work was going down. That was also the week I graduated to therabands to build some strength. My muscles were so weak that my arm trembled just from the effort of holding it out from my body, and that has already gotten much better.

I'm currently seven weeks out. Physical therapy this week (and the week before) was extra tough because I got a therapist who really works my shoulder hard. There was definitely some popping going on when she rotated my arm, and each time it happened she wanted me to go a little bit further. I kicked my legs in protest, because it hurt so bad, but I let her do it, because I really really want my shoulder to get better. I'm glad I've been scheduled with her three weeks in a row because, she pushes my shoulder to the limit. It really sucks at the time, but I understand that I have to do it anyway, to get my mobility to the next level. I was really sore afterwards, but when I did my next set of exercises that night I was thrilled to be able to move my arm a little bit further, with a little bit less pain. She wanted to add an exercise where I raise a 2 lb weight above my head, but I felt a painful pinch when I tried to do it. She wants me to wait on that one, but I'm hoping that eventually I'll be able to do it.

I was most discouraged four days out because I felt worse off after the surgery than I did before. Then I got discouraged after my two week post op appointment because I felt like everyone lied to me about how I could benefit from MUA. That was just me being impatient, and anxious, because nobody ever promised me 100% mobility and I have to be realistic. I haven't had full range of motion in that shoulder for a long time. They literally had to break up all that stuff inside my arm, so I can't expect the effects of that to disappear overnight. Also, they said it could be a fix, not a quick fix. I knew going in that if I wasn't willing to do at least six to eight weeks of therapy I shouldn't even bother with the surgery.

Some days I feel as though I'm making progress, and other days it feels like I've taken a few steps back. Over the 4th of July my family was in town. There was a lot going on, so I went longer periods of time between my daily therapy sessions even missing a few. The day we went to the fair, it was hurting, and I could feel some stiffness setting in. I took a week off work, and when I went back, my shoulder was painful and stiff for most of the day. Two steps back. Three days ago I was super excited to gain some additional mobility after therapy. Two steps forward. The very next day my shoulder was really achy for no real reason at all. I was just sitting there. Two steps back. Later on that day I did burpees. Very slow, and very cautiously, but it was a pretty big deal because I haven't been able to experience the joy of burpees since 2016! Yay Progress!!! That night, I was discouraged when MJ pushed on my arm stretched over my head while I was laying down, and I couldn't get it to go very far. It barely budged. I can't. Stop. One step back. I felt a little defeated, but it hurt too much, and I can tell the difference between when it's okay to push and when it's not.

Progress is absolutely, not linear, but it's happening. My mobility is much better than it was before surgery, and I have no regrets about my decision to do the MUA. Will I ever do a handstand again? A month ago, I told myself I needed to accept that it would probably never happen, but now...I don't know. Maybe. That's my ultimate goal, but most important is having a fully functional pain free shoulder again. I'm not there yet, but I'm getting closer. Fitting therapy in throughout my day is truly a pain in my butt, but it's helping the pain in my shoulder so I'll stick with it.

I'm not giving up.

3 comments

Nylse Esahc said...

consistent not aggressive - that's my PTs mantra as I go through PT. I'm glad they said that because I really want to be aggressive but I have to listen to my body and work with it. When I started I had such limited mobility but it made me more determined. I'm doing pretty well. The hardest movement is putting my hand behind my back; that still hurts but it's getting.

Hang in there. Where? There.

Faith said...

You got this! I can't wait for the picture of you doing a handstand!

Rachel ¦¦ A Nesting Nomad said...

Wow, you've really been through it. Sorry things have been so rough. That sounds just as tough mentally as it is physically, I think I'd be a right wimp about it. I hope the PT keeps going well and you keep seeing results!