New Info on "Frozen" Left Shoulder

Overhead Squat Test

I skipped the pool last Wednesday cos I needed to save my energy for a weekend away. But, I did take full advantage of an opportunity to get free advice from experts at the posh health centre. I wasn't expecting a great deal from it, but came away with some very useful tips/information.

First thing I did was a simple muscle imbalances test: the overhead squat test (see this excellent PDF which gives the details). You perform the exercise shown above and depending on the position your body takes up, various muscle weakness/imbalances can be identified. For me, it's weak upper back (trapezius muscles etc) and tight/short lats and pecs, which I knew about. There was also some tightness/weakness around my calves and mild weakness in the glutes. I was shown some good stretches for the lats/pecs muscles, advised to do more rowing-type strengthening exercises, and told to use a foam roller to stretch out my calves. Seemed good to me, lol.

But, the star of the show was the physiotherapist. He was exceptionally professional, caring and helpful. I asked specifically about my frozen left shoulder. Told him the history (out of action for 8 years, severely traumatised, psych drugs etc and two years of physical rehab). He examined my shoulder thoroughly and told me that he was 100% sure I did not have a frozen shoulder!?! I was too young, I wasn't the right type of person/build/etc, even considering the years of incapacity, a frozen shoulder was extremely unlikely. He explained why I didn't have a frozen shoulder, showing me the positions he could get my arm into whilst it was passive, which would normally be impossible with a frozen shoulder (and had been for me up until a few months ago). He did say that there was clearly a great deal of muscle wasting. He could see there was a significant dysfunction to the use of the shoulder but it needed to be examined and dealt with by an orthopedic shoulder specialist. He talked through some of the things they might want to look at: particularly nerve function through the shoulder, muscle/tendon attachments and so on. He basically thinks it's quite a complex problem to do with the way the nerves/muscles etc are firing and recruited. He also said that significant weaknesses which haven't been addressed/understood yet might be contributing.

If I had health insurance, I could get it all investigated properly. However, he did suggest that if I wanted to go back down the NHS orthopedic route, I should try specifically to see a shoulder specialist (not just a general orthopedic person) and I should try to get to Guys & St Thomas' in London. He gave me the name of a consultant to look out for if I get the opportunity. He thinks there's a great deal more that could be done to restore proper function and strength to the shoulder.

He was like a breath of fresh air. He was clear, very caring and understanding, and everything he said made good sense of the pathology I've experienced. However, I suspect that there must have been some element initially of adhesive capsulitis for it to be diagnosed a 'frozen shoulder'. I did have significant restriction in passive external rotation and abduction for a good 18 months. But, who knows? Anyway, I'm not sure I'll do anything about it just yet. I might simply try to see if the regular swimming and the new stretches begin to make a difference. As he said, I've got bigger things to worry about than a dysfunctional shoulder, but it's great to finally have a better idea of what's going on.

As usual, the manipulation of my shoulder caused me to feel extremely faint. I had to do the whole 'head between my knees' thing, glass of water etc etc, but the physio was very understanding. He said that it wasn't surprising considering the number of nerves through the shoulder.

It took me about half an hour to feel well enough to drive home again but I was very pleased to have made the effort. If I had loads of money, I'd get the shoulder sorted out but, as I don't, I'll just have to pray for a miracle, lol.

Unfortunately, my shoulder still hasn’t recovered from the minimal manipulations the physio did. It’s been very sore, achy and painful to sleep on. I’ve been taking painkillers every night. To be frank, I’m not sure I can handle any treatment because coping alone with the pain for days afterwards requires more resources than I have. I’ve been pretty upset and confused about what to do now. Obviously, I want a shoulder that works! That would be superb! But, achieving that may well be more than I can manage on my own at the moment.

Had a headache for over 3 weeks now, caused (I think) by tight/exhausted neck muscles. Kinda fed up with it!

Tomorrow is the first session at the hospital rehab gym. The last 7 days have been almost free of LHS lower back and left hip pain. I expect that will change tomorrow evening but we shall see….

Swimming - a better recovery (21 Lengths)

The low point this week was after the NHS physio (or not) session on Monday. I'd been shown around the gym machines and had done a few leg extensions and leg presses after a 2.5 min warm-up on the bike. Of course, a few hours later, once I was home, the LHS lower back and left hip pain kicked in and has been a problem all week. I did try to arrange one last physio appointment for the day after the first 'gym' session but the physio isn't at the hospital on that day. It really worries me that just a few of those gym exercises aggravated the pain - I dread to think what it's going to be like with a full hour's work-out!?!

I used another of my 'free swims' at the posh pool on Wednesday. It was bliss. I did a short warm up (10 mins) in the 'baby pool', running through 20 reps of the hydro exercises (the ones that were possible with the facilities anyway). Then I went into the main pool and swam 21 lengths (10 backstroke, 11 breaststroke). I had a lane to myself and thoroughly enjoyed the uninterrupted nature of it all. The swimming felt fantastic. I then immersed myself again in the hot 'baby pool' to warm down, showered and came home for lunch. It was a really enjoyable morning.

Three things I did to try to mitigate the post-exercise crash: I had a large breakfast (bowl of granola/milk, followed by a boiled egg and two slices of toast). During the time in the pool, I tried to actively relax my muscles when not in use and I stopped for 15-30s after every length to breath/relax and recover. Finally, I took an iron tablet with lunch in the hope that it might boost recovery somehow.

I was wiped out for Wednesday afternoon and Thursday but I didn't feel the need to sleep during the daytime on those days. Apart from a bad headache which I've had all week, I feel like I recovered quite well after the swimming. I coped ok with pottery on Friday.

Tired so will leave it there.

NHS "Back to Fitness" Class

One from the archives to cheer me up. A Redwing from last winter in the local park. They've arrived back in the area but I've not had a chance to get any new pictures.

....ok....so I went along to my 3rd physiotherapy appointment this afternoon for my left hip/back problems. Session 1 had been the (rushed) assessment (no treatment); session 2 had been treatment on the tight right adductor muscle. I had hoped that session 3 might be a start on the back/hip treatment.

....mmmm....nope. She never even assessed or examined the LHS lower back and I'm out of the proverbial physiotherapy door. In their defence, I have been referred to the 6 week 'back to fitness' class which is basically an hour's gym session under the watchful eye of a trained physiotherapist. I can't decide whether I'm gutted or pleased although the 'I feel like I'm going to burst into tears' scenario maybe gives it away?!

All I wanted was someone to make my back and hip stop hurting or tell me how I can make it stop hurting. Neither of those things has happened.

I have a horrible feeling that the gym sessions are going leave me in agony. What I wouldn't give for 'normal' muscle soreness. And, I do know what normal, healthy muscle pain feels like and that's not what I experience. However, getting that message across seems to require some kind of special dialect which I don't possess.

Oh well, I can but hope that all of this works out for my benefit. Here's to an optimistic embrace of the NHS 'back to fitness' approach and here's hoping I come out the other side stronger and healthier.....

Drained by Swimming

No birdie pictures today. The weather has been too dull and wet. In keeping with that, I've felt like a soggy lettuce for most of this week! It basically took me a good 7 days to recover from the swimming.

Tuesday, I attempted some DIY (replacing a broken bath tap). I was 99% successful but needed someone who didn't have a frozen left shoulder, and wimpy left arm muscles, to come and maneuver themselves under the bath to tighten up the nut attaching the cold tap to the water pipe (only reachable with the left arm). Thankfully, an old work colleague came to the rescue and that's now sorted out. However, it did nearly finish me off.

Wednesday, I didn't have it me to get up early and head to my normal pool, 17 miles down the motorway. However, I remembered I had "3 free swims" from British Gas which could be used at participating health clubs. I printed off the vouchers, had a large breakfast (in the hope it might reduce the post-exercise crash) and headed to a local health club, late morning. I was very pleased to find that the water in the children's pool was well over 34 degs C. It was like being in a hot bath! I did as much of the hydro exercises as possible and then warmed up with some swimming before trying out the 'big pool'. The main pool was cooler but surprisingly nice to swim in. I didn't push myself too much - I was still feeling very headachy and exhausted. But, I enjoyed the experience.

Thursday, I was completely wiped out, as usual. Slept for an hour in the afternoon. Didn't do anything except watch telly, rest and eat. Friday, I was still tired and a bit headachy but coped ok with pottery, and yesterday managed a short walk.

Muscularly, I think the swimming is doing me a lot of good. I'm still getting the LHS lower back tightness/pain and left glute/hip ache but I can feel my joint stability improving. My core strength and range of motion in my shoulders is also improving gradually. Speaking of shoulders, the left has been quite painful and twingey this week but the DIY antics contributed to that.

Overall, the swimming obviously wipes me out but, for the moment, the benefits outweigh the costs. That might be short lived but we'll see.

20 Lengths & Exercise Intolerance

I keep trying to get decent pictures of the Nuthatch that's visiting the garden but these are the best I've managed so far. Not great quality but there we go. The poor light during winter isn't particularly good for photography at long focal lengths (and small apertures). Maybe in the Spring I'll get a better shot.

Ok, so this week, I reached what I realised was a very significant milestone, which I'll get to later. Generally, I was very tired during last weekend and even into the beginning of the week. I had physio on Monday and I asked her to take a look at the right upper thigh/groin problem. She concluded that the pain might be caused by some friction on the tendons and that loosening up the adductor muscle might help. She massaged the inner thigh muscle and showed me some suitable stretches. She also joked (half seriously) that I really need daily physio treatment [well, yup, tell me something I don't know]. Anyway, I also asked her about the possibility of starting to run. She suggested that I start off extremely carefully - 5 minutes walk, 30 seconds running, 5 mins walk, 30 seconds running etc - and just see how that feels.

Tuesday, I went out for my 45 mins walk and incorporated 2 bursts of running (30s and 1min). I was very pleasantly surprised to find that cardiovascularly, it was easy - it hardly raised my heart rate and I didn't feel puffed out at all. On the other hand, it did seem to aggravate the right upper thigh pain. Anyway, it was a start. I skipped table tennis in the evening - I was still tired and wanted to be as fresh as possible for the pool in the morning.

So, to the milestone: I hit the pool on Wednesday morning, as usual. I did 20 reps of each of the hydro exercises and then started to swim. My hope was to do 20 lengths (500 metres). Overall, the swimming felt good. I continue to be quite careful with the breaststroke leg kick - I did feel some twinges/pain through the pelvis/pelvic floor(?) muscles but nothing that felt 'injurious'. By, 10:15am, I had reached my milestone: 20 lengths (10 on my back, 10 breaststroke)! When I touched the end of the pool on the 20th length I literally cheered! I was so chuffed. I had no idea how significant it would feel but, I suppose, the fact that it has taken me 19 months to get to this point - where I have sufficient joint stability, range of motion and muscle strength to swim 500 metres, is reason enough.

Thursday, I was completely wiped out. Slept for over an hour on the sofa in the afternoon. Didn't do anything except eat and rest. Friday, I still felt pretty drained but I went to pottery and just about managed. Today, I have that exhaustion 'hangover'. I think it'll be another rest and telly day. Hopefully tomorrow, I'll feel better and get out for a little walk.

I've done a fair bit of reading on 'exercise intolerance' since Wednesday. There are a few interesting theories out there (mitochondrial dysfunction, neurally mediated hypotension, etc, see this thread:Link) but nothing that I'm going to try to pursue just yet. I think I simply need to keep going the way I am. Increasing muscle strength (and volume, if possible) and stretching my limits. The swimming obviously absolutely exhausts me for at least 2-3 days but I have to believe that ultimately, it's beneficial.

So, my next aim is to swim 32 lengths (0.5 miles). I guess, for me, I'm looking at a 6 month progression towards that. Incredibly, for 'normal people', it takes just 6 WEEKS to go from zero to swimming 1 mile (see:Link). How I wish that was the case for me! The human body and mind is indeed a complex and delicate bit of kit!!

Edit 15:30: I meant to note that my blood pressure has been doing all sorts of weird things again this week. It's mainly a problem of keeping enough pressure not to faint. I think it's exasperated by tiredness.