NHS Physio - 1/3 of the way through

I started with the NHS physio last week for my left shoulder (private physio is on hold until that's completed). As far as I know, the NHS only offer a course of 6 sessions(!).

This morning was my 2nd appt. Still no ultrasound, manipulation or massage. Just a series of test/assessment exercises and recommendations for new physio exercises to strengthen the lower trapezius muscles to stabilise the scapular. I came home and iced my shoulder.

Discovered this morning that my intercostal muscles through my rib cage are stiff/strained. And, judging by how they feel since the physio appointment, I know the cause, lol. The trouble with engaging/strengthening new muscles, is that these inevitably pull on shortened (and invariably) weakened opposing muscles which are then pulled taut and risk strain and continued stiffness. I think this is the problem with the structures around my shoulder. By continually retracting and stabilising the scapular, I've introduced a level of tension through the opposing muscles/tendons/nerves and they are struggling to accommodate and adapt to this. I suspect that the whole of the front of my shoulders and chest will take a long time to stretch out, adapt and become elastic at the longer lengths. In the meantime, I just have to put up with the pain and be careful not to induce injury.

Feeling kinda despondent. It's the complete lack of muscle which is depressing really and knowing that rebuilding the back muscles is going to take years, with all the associated pain etc. I've probably written this a million times already, but the major obstacle with severe deconditioning is this critical lack of muscle to begin with. It's so much easier to build muscles once you have the capacity to move the joints in a stable, controlled, pain-free way. If you don't have the strength and joint stability to even lift your arm above your head you've got a heck of a lot of ground work to do before even thinking about 'bigger muscles'!

Ah well....what's a few more years of rehab in the grand scheme of things....!

Bike work

Well, having worked my way up to coping with 25 minutes on the exercise bike, the private physio suggested that I could now split the time over 2 sessions (say 12 mins and 13 mins), and then build up each of those 2 blocks. My schedule had been Wed: Hydro, Saturday: Arms/shoulders, Sunday: Bike. This worked well because it took my hips/back/legs at least 3 days to recover from the hydro workout. I tried adding in another bike session on Fridays but my left hip just hadn't recovered enough to cope. Then, I started a pottery class on Fridays and that is a workout in itself - absolutely exhausting, lol. So, I tried shifting the bike sessions to Saturday and Monday but that doesn't work either. Mondays are therapy days and I'm just too rung out from that.

Soooo...after a lot of failed experiments, I shall get back to the way it was to begin with, lol. I think that the addition of the pottery class is enough of a step up in terms of stretching my rehab.

At the moment, my left hip stabiliser is going through a tired, achy phase with pain on foot strike. I guess I overdid it one way or another last week and it's not quite recovered. I iced it yesterday but that hasn't reduced the pain. Today, I skipped the second bike session of the week to give it a chance to heal before Wednesday's pool work.

ONE YEAR

Yup, it's a year today since I started physiotherapy/rehab for my hips/back/core. One year down, a few more to go I guess. Progress has been slow and painful. I'm still getting strains or pain through my groins, outer hips and lower back. I know I'd be feeling a whole lot more depressed about the lack of progress if it hadn't been for the reduction in hip and back pain after the last 3 hydrotherapy sessions. That has felt like a major milestone.

This morning, my left hip and lower back are achy/tight. *sigh*

At the moment, I keep experiencing overwhelming tiredness through the afternoon/evening and it's only relieved by sleep. I don't know really what's causing it - could be any number of things including the severe deconditioning/effects of rehab.

Too tired.

Shoulders

I had my 3rd physio session this morning. I mentioned that the shoulders and arms had been pretty tender and restricted since the last session and that I actually don't have the muscle strength to do as many assessment exercises as last time. The physio took all that on board and seemed to mostly do muscle and nerve mobilisation. At the time it didn't feel particularly painful or aggressive but since coming home my left shoulder and arm has ached/hurt badly and my right shoulder/arm hasn't been happy either.

I dosed up on painkillers and went to sleep for an hour this afternoon! I was completely wiped out. Not sure why - perhaps a combination of yesterday's pool work and this morning's physio. Who knows.

The physio mentioned that I have lost significant muscle definition on my left shoulder and arm and it'll take a while to rebuild. The deltoid muscles of both shoulders are still small and weak. Standard delt exercises are too advanced so I think I need to stick to pool assisted movements and perhaps some 'static deltoid contractions' as demonstrated by the chappy below (Link)

I picked up a mild RHS hamstring/back of the knee strain yesterday from the pool work. Iced it this morning and put on a support bandage. It shouldn't take too long to heal. Other minor injuries at the moment are trunk strains, mostly just below my rib cage on the sides/back. Again, no idea how I did them but they're there.

My mind is mostly preoccupied with how I'll get full range of movement and muscle function back in my shoulders and arms. It's the usual problem of there being so little muscle that it's hard to find exercises that don't cause strains or overuse but do promote growth. Scapula stabilisation is a key component but.....how....? Mmmm.....I'm sure it'll come with time and perseverance. But, it could take years before my shoulders and arms function healthily and strongly. *sigh*

....it's a long, hard slog. Just as I feel optimistic, I suddenly get a dose of reality and have to accept that the progress I envisage is a long way off.

Anyone else out there been through this rehab process....?

25 Minutes and No Pain!

It's been a beautiful, sunny October day. I headed out to go bird watching this morning and spent a few hours over at Amwell and Rye Meads Nature reserves. Walking felt ok - no sharp, left hip pain on foot strike and the LHS of my lower back wasn't too tight/painful.

This afternoon, I did the usual Sunday bike work. Today, I hit the 25 minutes mark AND I didn't experience any hip stabiliser aching or LHS lower back tightness and pain! It's the first time in the 8 months that I've been using the bike that I've not had any pain! I daren't celebrate too soon but I'm really hoping this is another sign of improving muscle/joint condition and a step towards real fitness.

On the downside, my shoulders/arms are aching and painful. I think the tendonitis in the left shoulder is playing up again but, hey, I can cope with that so long as it will eventually settle.

....25 minutes on the bike and no pain - hurrah!

Note added 07/10/09: Post-cycling, there was some aching/tightness in LHS lower back and mild groin strain/tiredness on RHS. However, relatively speaking, it's still significant progress.

Ongoing tiredness

Getting back to doing the daily physio exercises for my hips/core seems to be wearing me out big time. For the past 3-4 days I've either need to sleep in the afternoon or at least rest completely. My shoulders/arms have remained problematic/painful since the physio session last week.

...just tired out from all the rehab.