Progress

I haven't been in the mood for blogging, so this is quite out of date. So here's a quick update.
As of about three weeks ago I officially passed from the first stage - Freezing into the second stage - Frozen. 

The pain is largely gone thank goodness! And I've made noticeable gain in movement. I've been taking occasional photos of myself from behind, showing the limit of movement - lifting my right arm to the side. 

This shows progress:
9 Sep to 5 Oct I gained 5 degrees
19 Nov (now) another 15 degrees
Another 10 degrees and I'll be able to hold my arm parallel to the floor.

We've been working on the rotator cuff, which is touchy because it's easy to overdo it and go backwards.

Getting there!

Just too bloody bad about my hearing which looks like it's permanently packed up and headed west.

The Downward Spiral

From what I read, the causes of Frozen Shoulder can be hard to pin down, but in my case it started with a rotator cuff injury.


The next step is pain, leading to you deliberately or unconsciously limiting movement. Something also triggers inflammation which adds to the pain, and discourages movement even more.


Restricting movement leads to loss of muscle tone but importantly, also encourages the joint to dry up. There can be a substantial loss of lubricating fluid in the joint leading to.....further inflammation and more pain. So of course you respond by further limiting movement, and down you spiral.

The moral here? Don't give into the temptation to lock your arm by your side.  This doesn't mean exercising to excess. The rule of thumb is that you should not feel pain for more than about 15-30 minutes after exercise. Too much, or too vigorous exercise can cause make the problem worse so it can be a fine line.  More on exercises to come.

Progress hooray!

Last week was bad. This week is much better, which may be helped by the Naproxen.

I just compared a picture of my shoulder back on 9 Sep, and the difference is clear. I have undoubtedly gained a good degree of additional movement.  It also makes a mockery of my attempted system of measurement since that barely shows any improvement.

Meanwhile, check the harsh treatment system used by this practioner!!  I am so not going to him!  It's killing me just looking at it.

Checked my diary, and I'm now about 10 weeks into this. From what I've heard and read, that means I'm actually doing very well.  Some do much worse. 

Yesterday Monique told me how she'd been in hospital for a minor operation and in the next bed was woman writhing in agon she'd been admitted thinking she was having a heart attack, but it turned out she had mega dose of Frozen Shoulder.  Triggered, it seems, by another hospital stay for an ankle treatment which caused her to lie for too long on one side.

15% of people develop FS in both sides.  What an awful thought!  You'd be nearly crippled by such a condition.

Drugs

Feng warned me I'd have good weeks and bad weeks. Last week was a bad week. At my therapy I was feeling good, so we pushed the rotator cuff for the first time. A bit too hard, I think, and then a couple of days later I photographed the body building championships and carrying the heavy lens for a few hours probably didn't help.

Normally I dislike taking drugs. I have to hurt quite a bit to take pain killers, so the fact that I've chewed my way through a jumbo pack of Neurofin plus is a bad sign.  Then last week my father in law gave me a script for some serious anti inflammatory drugs.  I'm now taking Naproxen 500mg twice a day, and after three days, the signs are good.

It doesn't increase your range of movement, but controlling inflamation and therefore pain is a very good thing.  I think this drug is an example of what the call a NSAID.

A Muddle of Therapies

The net is a whirlpool of wackies and gems.

I've just been talking to Jenny, who says she had good experience with a chiropractic treatment called McTimoney. So I thought I ought to start catalogue of the treatments I've found so far. But first, in looking for information and local practitioners here's an example where McTimoney sits beside the crap. If I were selling a therapy, I would not want to be listed near this entry:

Earth Whisperer
I have the ability to see, sense and heal ley lines, underground water, electrical fields, geomantic stress etc, Arrange a reading and healing to assist in improving your health, wealth and happiness.

What is geomantic stress? Hang on - gotta look that up....okay here's a snippet:

Whether your sacred space is a single crystal, a personal altar, a standing stone, medicine wheel, labyrinth, stone circle or something larger; geomancy can help you design, locate, align and activate the space so that it connects with and enhances the natural energies of the earth.

Am I a grumpy old curmudgeon, or is this complete bollocks?

My Top Tips

This is my most important post.

Feng told me I'd have good days and bad days. Today is a good day, very little pain. I could almost fantasise right now it's all but over, but I know, no such luck.  I'm going to do some serious stretching in a minute, and that will certainly bring back the pain, at least for a while.

Tip #1 Stay Positive
Yeah, right, I tell myself. That's what they all say, airhead self help books. Try doing that when your gurgling to the bottom of a day soaked in pain.

Well, no choice. The famous book On Death and Dying some years ago talked about the stages of grieving. That's sort of it.  You go through a phase of denial, followed by anger, and eventually you end up with acceptance (skipped a step or two here).

Frozen Shoulder takes a long time to heal, and eventually you have to accept it. Well I accept it maybe, but I sure as shit am not going to give in to it.

The real point is you must be active.  Do the exercises, do the stretches, get the therapy, and don't give up. Stupid idiot head flippin syndrome is not going to get the better of me.




Tip #2 Manage the Pain
The pain hits, and your reflex is to clam up. Do not do this.  

• Listen to your body. Yeah, it's bloody well winging about being sore here or aching there. So where exactly is it hurting? It may be the shoulder itself, or it may be referred pain. Or, I often find it's actually around my neck or upper back, stresses transmitted because I'm hunching my shoulders.
   
• Don't just sit there, get up and move.  My favourite exercise is the pulley system. I'll spend 10 or 15 minutes gently winching my arm up and down. It loosens things up a treat, and in my book is better than taking drugs.
   
• Use a heat sack.  I have a cloth sack filled with wheat that I put in the microwave.  Sometimes  I back myself up to a wall, and push the hot beads, massaging my back. Does wonders. Many times a day.
   
• Tiger Balm. Or similar. I use the hot stuff. The hotter the better. Hot enough to melt the cloths off my back if I could get it. Makes me smell like I've just come out of the football change room, but who gives a flying fig when it's relieving your pain!
   
• Drugs. Don't like them, but last resort. I've moped my way through a jumbo pack in the last 6 weeks or so

Tip #3 Exercise!!
Don't give in to the urge to go all floppy because you're in pain. More later exercises.


Tip #4 Therapy
I'm still having the weekly acupuncture and manipulation from Feng. However in the course of this melancholy I've found many different types of claimed cure.  I honestly don't know if there's a 'best' one, but in a future posting I'll catalogue them.


Tip #5 Log Your Progress
Since early on I've kept a chart showing my maximum stretch. See here.  The news may not always be good, but being able to measure your progress gives you evidence that it's working.
So far my gains have been marginal, but every so often I achieve a personal best, and that feels good.

Go to it!

 

The Guilty article

Look what I found today, lying near the kitchen at work. This is the offending item.
This is the sponge ball I threw, triggering my Frozen Shoulder.

I HATE this ball.

Now tell me it's only a thing, so how can I hate that. Don't care, not about logic. I HATE this ball.

Zap #2 - Tap Zap

A Zap occurs when you automatically rip your arm in one direction or other because of something you didn't expect.  The high-speed arm yanking manoeuvre causes sudden, severe pain.

Frozen Shoulder has revealed to me surprising opportunities for creative new ways to trigger the Zap. Here's one I'd never have thought of.

The other day I was in the kitchen; arm very sensitive so I asked handy stray person nearby to pull my polyester jacket over my head. Great plan, but also had the effect of charging me up with several thousand volts of static electricity. Next, I reach out and touch the tap.  ZAP goes a great bolt of electricity from my right hand to the tap, YANK goes my arm, and YIKES goes my yell. Followed by a florid stream of colourful words I won't repeat here.

The immediate effect is of course several minutes of woeful moaning and groaning, and the horrified looks on everybody's faces.

The longer term effect is perhaps more serious. It means you begin consciously and unconsciously protecting your arm. You begin holding your arm in close to your body to reduce the possibility of future Zaps. You restrict shoulder movement, and thereby maybe worsen the freezing effect.

One symptom of Frozen Shoulder is the loss of fluid in the joint. This increases inflammation, joint lining damage, and subsequent scaring.

Now I'm actively trying to ensure I use my arm instead of leaving it permanently pinned to my side.
And while doing that I'm now doubly careful when taking off polyester clothing.

More Zap stories to come.

More Needles

There are so many fake medical remedies out there, I'm quite wary about what I would use.

Chiropractic medicine may have benefits but some of the claims about what it can do seem over the top to me.  Reiki and homeopathy are right out in my book, as are iridology and reflexology. Herbal medicine needs to be looked at carefully because of the unregulated doses of the active ingredients and lack of rigorous testing in many cases.

Of the alternative medicines I think I'd be most inclined to accept benefits of acupuncture, but I'm not sure why.  Here is a link to an ABC story about some acupuncture research that says in regard to back pain

After eight weeks, 60% of the patients who received acupuncture of some form reported significant improvement in their ability to function compared 37% of those who got standard medical care alone.

That sounds promising. It also says that in this study there was no significant difference between needles and toothpicks being used.  As far as I can tell science does not yet have a good explanation for acupuncture.

While we're on the ABC, here's a story from them about Frozen Shoulder.

Today I feel I'm making no progress with this condition. I'm about to purchase the electronic version of the book from FrozenShoulder.com. Here's a link to an article by the man behind this, Simeon Niel-Asher.

Pin Cushion

This is a first for me. I never had acupuncture before, but for this I thought I'd give it a try. It's a slightly out of character since I'm fairly conservative with this sort of thing.  Outside my day job I produce a science radio program, and write occasional columns for a national broadsheet newspaper.

I was referred to Feng by someone who recommended him for this condition. The first thing I wanted to see was whether and how he would assess me. Would he just assume Frozen Shoulder, and move straight to the needles? What other treatments would he apply?

The first thing he did was ask me a few basic questions (I was already certain of the diagnosis). Then he held my arm and moved it through its range in each direction: up, forward, backward.

The treatment each time begins with an assessment of my current state. How far can I lift my arm to the front, to the side, and behind me.  Then he loosens things up by swinging it in all directions.

Stretching is next, and this is where the fun starts. He pushes my arm to the limit of movement, and then a bit; sometimes with a rocking motion, sometimes with me squeezing his hand. This hurts.

Then I get the needles, which mostly don't hurt much. But sometimes a particular one hits a sensitive spot, and that's very uncomfortable.

He puts sunglasses on me, and aims a huge laser gun at my joint. It has a red glow coming out of it, but no obvious Star Wars laser beam. To be honest, I can't see how this bit works.

Now all kitted up sitting in a chair with about 10 needles in my neck, shoulder, and elbow, I sit and wait for about 20 minutes. Sometimes he reappears and re-aims the gun--oops, I mean laser.

He takes the needles out, and moves onto more serious stretching and manipulation. This really hurts, and I must breathe deeply and consciously to bear the pain.

Finally it's all over and I'm free to go, relieved that we're done for the week. I generally feel the pain of the treatment for 15-30 minutes.

I really have no idea whether the needles do anything, but I'm in no doubt the manipulation loosens my arm for at least a while.

More on this to come.

Ways to Get Zapped #1

This is the first of an occasional series on how to zap your frozen arm. The zap is triggered by something you don't expect. Something that startles you, and by reflex you whip your arm in one direction or another.

The result is jarring, searing pain that lasts about 5 minutes. Your arm does not like being jerked like this. Not recommended.

Zap #1  The Bouncy Dog
Occurs when you decide to lie on the loungeroom floor to do some exercises, and excitable puppy thinks it'd be fun to jump on your face. Without thinking you yank your injured arm up to protect yourself. Rusty knife jabs let you know immediately this was a bad idea.

Now with Bonus Rotator Cuff!

The evolution of my condition is becoming a little clearer. Apparently I have some rotator cuff damage as well. That's what I did when I threw the sponge ball.

The rotator cuff is a group of four muscles that hold the top bone (humerus) into the joint. It's these that contribute the amazingly flexible mechanism that allows us to swing our arms in all sorts of directions. Rotator cuff injuries seem pretty common, and they can take a while to heal. In my case I think it was the triggering injury for Frozen Shoulder.

Today I also found a web site that rounded shoulders may also increase your risk. By chance, I did have a therapeutic massage a few months ago, and the masseur commented on my rounded shoulders. She said she could tell because my shoulder blades don't sit flat on my back.

The final straw was after my injury I started using free weights. But I think I was a bit too enthusiastic with them, and instead aggravated things.

So the sequence is something like this:

April 2009 - massage, noted rounded shoulders
May - threw sponge ball, damaged rotator cuff
June - desert motorbike trip
July - weights; onset of FS
7 Sep - today, probably end of Freezing stage.

I've just found a web site where they claim to have a therapy that offers rapid healing. I am wary since there are many fakes out there. I will research a bit more, and record here how it pans out. However it looks reasonably promising.

See http://www.frozenshoulder.com/

Cheating

 

This is what Frozen Should does to you. 

The human body is an amazingly intricate device of interconnected parts. When Frozen Shoulder kicks in, you can no longer swing your arm through the full range of movement. To compensate you lift the entire shoulder. Check the height differences of the tip of the shoulder. See the curvature of the spine. Imagine the extra stresses transmitted to the surrounding muscle.

So while the immediate effect is in the shoulder itself, it ripples outwards causing knock on problems.

This photo shows what Feng calls 'cheating'. It shows how you make up for what the joint is supposed to do through contortions in other places.

Bingo Wings

This whole affair is a challenge to my masculinity.  I've always been fit and strong, and never had a chronic physical injury like this. Too bad I didn't get the initial injury tossing the khyber, shot-put, or dwarf. No, it was a flimsy little sponge ball. How girly is that?

My right-arm strength is probably about 50% of what it would be. I've even developed a bingo wing! If you don't know what that means - it's a bit of a cruel joke against old people who play bingo. When they put their hand up, the wing of flesh under their arm flaps ungracefully.

The loose flap of flesh under my arm is testimony to the lack of use it's getting. A similar thing is showing on the tip of my shoulder. The other day I asked Feng if the slight lump there is normal. He tells me it's the tendon revealed as the muscle has shrunk. Don't tell anyone, but I've never been one of those bulky over-muscled types. Still, this is a bit rough!

However at this stage the priorities are to control the pain, and get movement back. Then strength will follow.

Even breaking my collarbone wasn't this bad. That hurt a lot more, but every day I was a little better. With Frozen Shoulder - so far - every day is nearly the same; sometimes better, sometimes worse. But the last to days I've been doing better. Today better still, and the optimist in me says I'm on the road out of this pit.

About 6 weeks in, so I have a way to go, but if the last couple of days continue, I'm optimistic. We'll see!

Night Stalker

There's something about this condition that means it loves the night. You'll feel okay during the day, but at night it hunts you down and inflicts your sleep time with pain.

 Last night was good, and I only woke up once. Other nights, I wake two or three times. I have to sit up, take extra strong pain killers, and wait for it to subside. Extra strong Tiger Balm and an electronic massager also help.

Feng says he thinks I should sleep on my right side, but laying my body weight on top of the sore shoulder seems a bit much. Last night I lay on my back, but angled towards my right rather than fully on it. That seemed okay.

Feng tells me some people take to sleeping in lounge chairs rather than in bed helps.  I don't know I'm that desperate. It's still winter here, and I'm not keen on spending my nights out in the cold living room.

Why is it that chronic diseases seem to target sleep time.

Pulling myself out of a hole

My first 2 or 3 weeks of treatment was with conventional physiotherapy. At this stage (Initial as I described it earlier) I think it was early days, and the Frozen Shoulder was only just begining. I knew something was not right. Lifting my arm was becoming more and more painful, and the range of movement greatly diminishing.

Graeme, my physio could see what was happening. He had me doing simple exercises to try loosening the joint. I'd lie on my back, and raise my right arm from my side up, and over my head (or at least as far as I could). To guide and support my right arm, I'd hold a short rod in both hands, and swing the arms together.

He also showed me a simple pulley device, which I them copied at home. I jam the strap in the top of a door, then use my good left arm to hoist my dud right arm into the air.

I do this several times a day, and I each time I can feel how much it loosens the joint.

More on this to come.

Yikes

After a couple of weeks of physiotherapy I went to the clinic for an ultasound.

I stripped to the waste, and after applying goo, they ran the ultrasound wand thingy to reveal the inner workings of my shoulder. (Same device they use on pregnant women.)

Sure enough, we could see the two layers of muscle on the top of my shoulder. As I lifted my arm we could see them sliding over one another. Then, with my elbow just below shoulder height they stop. Lock. That is the joint seizing.

Just the same, I could still lift it further. However that isn't the joint at work; what I'm doing is shifting the whole structure around the shoulder. It's surprising how much you can move your upper arm without actually rotating at the joint. Looking in the mirror as I do this makes it very obvious. This is what Feng calls cheating.

The referral said 'Cortisone injection if indicated'. It was, so I prepared myself for a needle inserted into the joint. Well it wasn't too bad until I let out a small ooch!

'That was the bone', she said.

Oh. Okay. So she injects cortisone plus anaesthetic. Then followed by 20ml saline fluid, which she tells me helps to loosen the joint. The doctor admits this treatment will not cure my problem, but it ought to relieve the symptoms a little.

$390 poorer and a few minutes later I'm off, moderately confident it's done some good. The saline fluid causes an odd, slightly bloated sensation.

Now, about 6 weeks later I doubt that it did much at all. But at least I'm am now certain of the diagnosis.

Also news is that I appear to have no soft tissue damage. More on that later.

Fall and Rise

Early on in this malady I decided to log my progress. I need to see whether I am improving or declining. So I created this data sheet.  

Front measures the height I am able to lift my elbow directly ahead; Side is how far to my right side I can lift; Back is how far back I can swing my arm. The last column indicates whether I pre-stretched or not prior to measurement. Since filling that sheet I've added a column to rate my current level of pain. Not sure I'll continue with that.




















 






This shot shows how I marked up the edge of my cupboard door.















I'm using the yellow Sign Here sticker to track my best lift to-date.

Measuring the tip of my elbow on the back-swing.


This isn't terribly scientific because it's too easy for me to cheat (as Feng calls it). If I'm really keen, and can bear the pain, I can push a bit further. But mostly I can gain extra stretch by changing my posture, which means I'm not strictly measuring shoulder rotation.  Still, I figure this effect will be much the same each time I try, and the results seem approximately repeatable.

What is Frozen Shoulder?

Frozen Shoulder is a chronic condition causing pain and loss of movement. For some reason the connective tissue in the joint becomes inflamed, and scar tissue forms. It can take 18 months or more to overcome.

There are four phases - initial, freezing, frozen, and thawing. In the first, the shoulder becomes painful with some movements. In the second, the lining of the joint progressively thickens, and there is considerable pain. Third, the pain eases, but shoulder movement is greatly restricted. Finally, the shoulder slowly unfreezes, and movement returns.



 Not only is it painful and depressing, this can take a long time to run its course!
Initial  up to 3 months

Freezing  up to 9 months

Frozen 9 to 15 months

Thawing  up to two years.

There are many good references on the net, and of course you'll look them up. I will recount a lot of this on this blog.

Right now, (29 August 2009), I am probably in the latter part of stage two, freezing. Feng, my accupuncture therapist thinks it's only a couple of weeks away. I live in hope!

In the beginning

In the beginning there was pain, and there was much unhappiness...

This blog is to chart my progress through Frozen Shoulder, aka Adhesive Capsulitis.

I see there's another blogger who started one of these, but unfortunately didn't continue. We'll see if I do. Along the way I'm going to tell you about the various treatments and other information I uncover.

It all began a couple of days before my motorbike trip to central Australia, into some of the most amazing remote desert regions. On my lunchtime walk I picked up a sponge ball, and when I got back to the office I flung it over the partition to Bim.

It hurt straight away, and I knew I'd done some damage. Just before a very physically demanding motorbike trip. Good timing!

As it happened, I was able to do the trip without much impediment from the injury. The only time I noticed it was when I went to pick up a bike after our many prangs. I also recall starting to swim across the Diamentina River, and realising I couldn't properly swing my arm over my head.

Then when I returned I tried to fix my arm by exercising with light weights. Bad news; I wish I hadn't because all that happened was that it triggered the onset of Frozen Shoulder.

Postscript: I now know the damage was to my rotator cuff.