Friday, 25 March, 2005

Rehabilitating an injured shoulder

The shoulder is an incredibly complex joint. Three or four bones and ten or more muscles all work together to give the shoulder a wider range of motion than any other joint in the body. When it's working, it works quite well. But injure any one of the muscles and you begin to lose strength and flexibility. If an injury is left untreated, the other muscles--especially the four muscles and tendons that make up the rotator cuff --will compensate, further reducing strength and flexibility. The problem often gets progressively worse, causing other muscle groups to stiffen and resulting in chronic back and neck pain.

I suffered an AC separation of the left shoulder in 1994. The emergency room physician gave me a sling and some painkillers, and referred me to an orthopedic surgeon. The orthopedist told me to take it easy and let the shoulder heal. So I did. I injured the shoulder a couple more times less seriously in the late 90s while mountain biking. I began to lose flexibility and strength, and I had to sell my trampoline because I couldn't tolerate the pain that jumping on it induced in my shoulder.

My doctor sent me to an orthopedist who took X-rays and told me that I was getting old. He explained that the AC joint injury was getting worse and the only way to fix it would be through surgery. With no guarantee of making things better, and the possibility of making it worse, I declined and grudgingly accepted the idea that my body's starting to wear out. In the five or six years since then, two other doctors have said pretty much the same thing.

About three months ago I began experiencing upper back and neck pain. I put it off to long hours on the bike at first, but it got to the point where I couldn't sit still for more than five minutes, and the only time I wasn't in pain was when I was sleeping. At the same time, my shoulder was becoming even less flexible to the point where trying to raise my hand over my head would cause excruciating pain. Figuring that I could at least take care of the back and neck pain, I made appointments with a massage therapist and a chiropractor.

If you've never had a professional massage, you don't know what you're missing. I'm not talking about some scantily-clad lovely lady rubbing her hands over my body--I can get that at home. No, the massage that I received last Tuesday wasn't even comfortable. Forget arousing. Kathy combines massage with trigger point therapy, and the results were nothing short of miraculous. My muscles were a little bit sore the next day, but the pain in my back and neck had reduced, and my shoulder was noticeably more flexible than it had been in years.

The chiropractor has been using some electrical therapy to help loosen my shoulder. He places an electrode on the muscle near my shoulder blade and turns on the juice. Every five seconds, a slowly building electric charge causes the shoulder muscles to flex, and then relax slowly as the charge is reduced. Each visit also includes a spinal adjustment--something I'm not entirely convinced is required, but it seems to help.

I've always been suspicious of massage and chiropractic therapies, but I can't argue with the results.  In the last two weeks I've visited the chiropractor four times and the massage therapist twice. The back pain is almost completely gone and I'm actually using my left arm. I've been learning more about the shoulder joint and how to stretch and strengthen the muscles. It's almost certain that my AC separation 10 years ago also included a rotator cuff injury that has worsened over the years as it's gone untreated. It will take time--maybe a year--to rehabilitate my shoulder, but I should regain full use of it.

In retrospect, it's my own darned fault for letting things go this long.  I didn't even research the injury, but instead trusted that my doctors would give me complete information.  I know better than that.  I've actively participated with my family doctor on a number of other issues recently, and with the cardiologist in developing a diet, exercise, and medication regimen to address my family history of heart disease.  Perhaps those recent experiences lead me to re-examine the shoulder injury.  Whatever the case, I got another reminder that my health and well being is up to me.  Doctors and other health professionals are there to help and advise, but it's up to me to research and approve the appropriate therapies.