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Woo hoo! I'm done with PT! I had my last appointment today and they declared me well enough recovered that I don't have to go back. Actually it was rather fun to go there but it's also expensive at $25 a visit.
My abs/rib injury has been healing nicely. While not 100%, I'm able to do most anything I want without problems. My shoulder is actually progressing more slowly but still making progress. It's not quite strong enough to do "step-ups" (in a push-up stance, walk my hands up and down a stairstep) - I can do it, but it causes pain in the front of my shoulder. I'll have to keep working on that.
The coolest part of PT today was when the PT handed me a baseball and a mitt and said "Let's go see how well you can throw!" Yes! He grabbed a catchers' mitt and we went out into a wide hallway at the fitness club to play catch. Bringing my elbow back and up caused a slight click in my shoulder, but the actual throw posed no trouble. That's good, because softball practice will start next week!
I haven't written about rehab in a while, but it's been going well. My shoulder is getting much stronger and doesn't click nearly as bad as it used to. I can actually put my hands in my back pockets and then take them out again without a loud popping noise in my right shoulder. My exercises now consist of higher strength stuff - my favorite (and most difficult) is the "step-up" where I get into a push-up position, arms extended, and then walk my hands up one stairstep and back down again, over and over. Walk up, walk down. Very tiring but my shoulder is quite stable while I do it, so that's a good sign.
I'm also rehabbing my rib cage injury. The PT discovered that it's not costocondritis (rib cartilage inflammation) as my primary care doc thought; rather, it's a strained abdominal muscle. I did some stretches for a week and it felt noticeably better very quickly. Now for this week I have to do planks. Those are also tiring, but also quite fun, especially the ones you do on your side, kinda like a sideways push-up.
A cool tidbit - one of the patients that I've seen frequently at rehab is a basketball player for Western Michigan University (I'm not sure if he's current, or recently graduated). He's only about 6'0" (short for basketball) but this guy is RIPPED. Watching him do some exercises, he's as strong as he looks - I would describe his movements as "explosive". He tore his calf muscle a while ago and he's getting it back to full strength. The way he was exercising, I'd say his injured calf is stronger than my healthy one! He's a pretty nice guy, too.
Another PT session today and it went pretty well as my shoulder rarely clicked during the stretching exercises. Nothing really feels different, but apparently progress is happening. Today I was the only person there most of the time so the trainer and I were talking a bit.
He told me about how he gets lots of wannabe bodybuilders who have lots of back and neck pain because they only work the "mirror muscles", i.e. only the muscles they can see in the mirror! As a result they don't work their back and everything gets out of whack.
I commented about all of the PT "toys" laying around and he said that his kids love to visit him at work and play with the equipment: giant rubber bands, medicine balls, balance balls, blocks of foam in various shapes. A friend going through some PT of her own recommended that I ask about the "ballistic squat machine". Unfortunately my trainer didn't recognize the term, and asked how she described it. Since I didn't actually talk to her about it, I replied "that's all her email said" to which he replied "Tell her to send a picture!"
My curious trainer isn't done; he asks why my friend is in PT. I tell him they think it's compartment syndrome in her leg and he responds "Oh, that's why she's doing that squat whatever thingy, to make it worse so they can confirm it." He's pretty sharp! He then describes the painful aspect of needles and possibly cutting the fascia, and adds that most people don't like to watch that stuff. I explain how I actually prefer to watch procedures being done to me so I know what's going on (e.g. when drawing blood). He agrees, but then casually states out of the blue:
"Except when I had my vasectomy! I couldn't bear to watch that, you know." I didn't quite know what to say; I was trying figure out how the conversation went from compartment syndrome to vasectomy so quickly!
Maybe I shouldn't be so surprised - apparently there's no place for modesty during therapy. One time I asked a female PT where a certain tendon was on the front of my shoulder. She replies "Here, feel where mine is" and she guides my hand to the spot, but first has to move her bra strap out of the way. Ack! It's really no big deal but I wasn't quite prepared for such an open environment. After all, this isn't the kind of stuff you'd do at the office!
Awkwardness aside, my PT is impressed with the progress on my shoulder so whatever they do, it really woks.
Another session of PT today and it went pretty well, probably in part because I was one of just two patients being seen by the two PTs, so my work was one-on-one today. My PT was a lot more talkative, although as a result I learned that he just started here in November and used to be a back and neck specialist rather than a sports specialist. Still, he's done a good job so far.
Lots of exercises today, including one where he said "do this to exhaustion". I clarified "you mean until I can't lift the weight anymore?" and he replied yes. After about 50 reps my hand started shaking but I was still getting the weight up and down, so he finally took it away from me, saying "uhh, I think you're done now!" I'll be sore tomorrow.
There was also an exercise where an elastic strap attached to the wall was placed around my shoulder; I then walked forward to put backwards tension on the shoulder joint and then proceeded to raise and lower my arm about 40 times. It was supposed to hold my joint further back in the socket to prevent the clicking whenever I raise and lower the arm, but it didn't work today. Perhaps I need more tension, or maybe I just need stronger muscles that will improve over time.
The PT also worked out yet another knot in my infraspinatus muscle (it attaches to the shoulder blade ridge and runs to the shoulder, under the trapezius). However, the pain in the front of my shoulder he thought was my biceps tendon. I'm not so sure about that since working my biceps has never caused pain, but doing pushups or pullups does cause the front side of my shoulder some pain. The frustrating thing about all of this is that it's gonna take time to see some change since I have to wait for those muscles to develop!
Last week I forgot to write about my second PT session, which didn't go so well. Session 1 was run by a PT assistant (not a full PT) and one who was just a contractor substituting for the regular guy, Doug. For session 2, Doug was still on vacation so I saw another PTA substitute and she was rather clueless. She hadn't read my file by the time I showed up and didn't know what was wrong with my shoulder. She was about to ultrasound the outside of my shoulder (the deltoid?) when I informed her that it was a different muscle, one on the shoulder blade. So we did the ultrasound and then she worked the front of my shoulder, which was rather painful. Actually, it hurt for three days afterward! I don't know if it's supposed to do that but it feels OK now. At least she was friendly and willing to explain all that she could.
Yesterday, session 3, went much better since Doug was finally there. He's very knowledgeable but rather distractable, too. It didn't help that there were only two PTs on staff there and I was one of five patients in the room! Nevertheless, Doug did some good detective work trying to figure out my shoulder. I raised my arm, and it clicked going up and down as usual. Then he would hold my shoulder in different positions within the socket while I moved my arms again, trying to see if there was a place where the clicking would stop.
He found it, too - it turns out my shoulder has kind of drooped forward against the front of the socket. The injured muscle(s) on my shoulder blade are so weak now that they don't hold the shoulder tight. After loosening up the muscles a bit, he had me do some exercises that were different than what I'd done before. Boy can I really feel it today! My shoulder blade muscles feel sore, the good kind of sore. My next session is tomorrow.
Next time I have PT, I'm going to ensure that the regular PT is the one to see me for my first appointment because after yesterday, I feel like the first two sessions were pointless and a waste of $25 copays. Speaking of which... I elected the best health insurance offered by my employer just for reasons like this and I figured that $25 (for a maximum 30 sessions per year) must be good. While I'm in line waiting to pay, two college students in front of me discuss their coverage, which is $15 copays and 60 visits per year! What?! Why doesn't my company offer that?
I went to my PT appointment this morning and if it weren't for the fact that I'm there due to an injury, I'd love to go more often! Seriously, it felt like I went to a museum or something - it was a lot of fun and I learned a lot. They even had all kinds of sports items - posters, pennants, even mock lockers for Steve Yzerman, Derek Jeter and Mia Hamm! My exam room had an autographed Jeter photo, photos of Tony Clark and Alan Trammell in action, and a "timeline of baseball history" poster. Awesome!
FYI, I have two injuries - a bad right shoulder that's been bothering me for a few years, and also a strained rib cage that I hurt six weeks ago. This PT appointment addressed the shoulder; there's not much that can be done for the rib cage aside from rest.
The therapist started by asking a ton of questions, then started prodding me all over on my back. She did mention that my back appears to be unaffected from my rib cage strain, so that's good. Then she hits my right shoulder and says "Whoa, there's quite a knot back there!" That was news to me; I'd never noticed anything like that. Next I had to move my arms around in various directions with the palm of my hand facing one way, then another, etc. Some of those motions caused a clicking sound in my shoulder, which I expected - it happens quite frequently. The last step in her diagnosis was for me to push against her hand with my arms in various orientations, e.g. push outwards one way, push down another way, push up yet another way, etc. One such configuration resulting in my arm shaking as I pushed up with very little force, although I didn't feel any pain.
At last, a diagnosis. We walked over to a wall chart depicting all of the muscle groups and she pointed out one in particular - the infraspinatus. That's the one that was all knotted up. She concluded that I don't have any tearing or significant damage to the muscle - sweet! The problem is that the muscle is quite inflamed, especially around that knot and especially where it connects to my upper arm bone (the humerus), which is where I can actually feel some pain if I push on that area.
The problem is that the inflamed muscle doesn't behave properly - when flexing the inflammation apparently weakens it and disrupts some of the nerves trying to control it. See how many muscles connect to the shoulder? It's a complex joint, so when one is out of whack and the shoulder moves, certain motions can be rather uncoordinated and cause the clicks that I sometimes feel.
The solution? Ultrasound! Seriously, the therapist wheeled an ultrasound machine into the room, set the timer to eight minutes, and proceed to rub the wand around on the back of my shoulder. She explained that the ultrasound warms up and relaxes the tissue. It worked! After the eight minutes she confirmed that the knot in my shoulder was gone. Wow.
Next I had to sit in a chair parallel to a table and rest my right elbow on the table next to me with my hand raised as if I were doing a casual wave. She then pressed her fingertips into that infraspinatus muscle and leaned into it so hard that she nearly pushed me out of my chair! While she's doing that, she asks me to raise and lower my hand a dozen times... dang did that hurt! Not sharp pain, but rather it felt like my shoulder was full of lactic acid. After I'd completed the dozen reps my hand was all tingly and pale white - it felt really weird. And I was done!
I'm scheduled to go back next week, and then 2-3 times per week after that for 3-4 weeks. I don't know exactly what they're going to do, but I assuming something similar to today. I was also given a few simple exercises to do daily. Amazingly, the entire day my shoulder has felt all limber! I guess I never realized such tightness had formed but boy that ultrasound must've done something. I still get the clicking, so I need to build that muscle back up to strength before that will go away.
How did this injury happen, anyway? Well, I used to be a fairly serious tennis player back in high school - the strongest aspects to my game were my uncanny quickness (rarely is the tallest guy on the team also the quickest, but somehow I did it) and my booming serve. I loved serving and practiced it often, even throughout college as a way to burn some energy. I also played rec softball in college. Needless to say, my right shoulder must've been pretty well developed.
Then I stopped. For several years I played neither tennis nor softball, then a couple years ago I started playing softball again. My mind remembered how to throw a ball hard, but my muscles didn't and over time my now under-developed shoulder muscles couldn't keep up with the expectations I was putting on them, and one became inflamed. Hopefully after all of this PT has run its course my arm will be strong enough again to hurl a softball a couple hundred feet again, without injury!