Eight weeks down & we're rockin'!

Since week six I have made a substantial amount of progress in my rehab, but since the milestones are further apart, I'll likely only post updates biweekly, now. Here are some cool things I can do which most people, myself included - at least pre-surgery, probably take for granted.

-I'm sleeping on my repaired side, although I can't tuck my arm in yet. I still leave the arm extended and outwards, away from my body.
-I can now comfortably reach past my left shoulder with my right hand.
-I can dry my back after a shower by holding a towel behind me and pulling back and forth.
-I can reach up with my repaired arm and grab the top of a door frame, unassisted.
-I can throw a frisbee, backhand & forehand, about 5+ yards! (Heather and I tossed this past weekend. I got about 25 throws in before my arm got tired!)
-I am allowed to back squat with the bar (up to this point I wasn't able to even get my arms back behind my head comfortably to hold the bar in place). Worked up to sets of 135 and felt good.
-I am allowed to carry weights in my right arm, now; arm by my side, hanging, only. This is useful for doing weighted lunges and similar lower body exercises.
-My warmups for therapy no longer start with a heating pad, but on the hydraulic arm bike!
-I am doing strengthening exercises with bands and weights now (See more, below)
-I got a parachute for Christmas and am did a kick ass sprint workout with it, last weekend! I'm also getting my cardio fitness back up. I've worked up to eight minutes at ten m.p.h. on the treadmill (~1.3mi).

And now onto the details, if you feel so inclined to read on.

My overhead and external ROM are 80-85%, and that last little bit is in sight. I started this exercise to get over that last hump of stiffness.

In addition, when I get to the top of my ROM I slide over into the door frame forcing my arm up further. By forcing into the door frame, I can also push my lats & teres muscles back into my body, stopping them from (chicken) 'winging'.

As far as ROM, my internal rotation is also getting much better, and I can do this now.

The winging I mentioned above is already much better as I have already gained considerable strength in my teres/scapula from doing weighted table work. From the position in the first image shown, I have worked up to 3 lb. underhand raises (lifting weight in plane with my body, fingers pointing towards my feet), which hits the rhomboids (image 2), and 1 lb. side raises, hitting the deltoids/shoulder and scapula (image 3a). The added motion with the side raises is to get the thumbs pointed as much as possible up towards the ceiling (image 3b), with the idea of helping rotation within the shoulder joint, which I only have about 50% ability to do.

Image 1 - base position

Image 2 - underhand raises, rhomboids

Image 3a - side raises, deltoid, scapula, shoulder etc.

Image 3b - thumbs up!

More scapula work includes Theraband/tube abduction, and rows.

Abduction

Rows

I'm also working on postural strengthening. This exercise requires a tight core, and arms, elbows, shoulders, back, butt, all against the wall. The trouble I'm having is even though my external rotation in a supine position has reached 80-90 degrees, there is still stiffness in the joint, and full ROM requires assistance by pushing the arm out in that plane of motion. Actively moving my arm against the wall isn't yet possible. Note: I haven't started doing wall slides in the way shown below, yet, although my standard wall slides are becoming much easier and I can now almost fully keep my arms parallel as I do them!

Postural strengthening (left image)

Modification with upward wall slides (right image)

Supine external rotation of the shoulder. When I do my postural strengthening against the wall, this is about as far as I can get my arm, so far.

One of the harder things I am now doing is a side bridge to strengthen the teres major which should help immensely with my aforementioned 'winging'.

Side bridge                                        Teres major

Finally, I'm doing, for lack of a better term, what we call a table lean. The image below is actually meant to demonstrate single-armed incline pushups, but it's the closest thing I could find to what I'm doing. Essentially, I start with both arms on the bench/table/chair in front of me, and alternate between balancing in the 'up' position of the incline pushups, which I'm also using to target the teres, stabilizing the shoulder, but also requires pectoralis, core, and even some groin/glute tightening. What the image doesn't show, is that sinking the hips into the table is required, and the closer the feet are together, the harder this gets to hold.

"Table leans"

So the verdict is, after eight weeks, I'm well into phase III (strengthening), again, ahead of schedule. I'm sleeping better. I feel good. I'm doing sprint workouts now! Everything is doing great on this last day of 2014, and I am excited for 2015 to start. 

Happy New Year!

Six weeks in the books

Few new exercises, which I'll get to, but the long and short of it is: I remain ahead of schedule! Here is a great resource with a clear timeline for rotator cuff repair.  I continue to be at or slightly ahead of the earliest described timepoint for all activities.

Day-to-day improvements:
-I can fully reach my right arm across to my left shoulder, which makes showering and dressing nearly thoughtless activities, again. This resulted, I believe, mainly from the progression of passive activities the therapist is putting me through, laying me on my side and stretching the repaired arm across my body (towards the floor).
-I can put the key in the ignition of the car, and put the car into gear all unassisted with my repaired arm.
-I can put weight onto the repaired shoulder, i.e. when shifting in bed at night, or pushing myself out of a chair/off the floor.

This week we moved into isometric activity in several planes of motion, including adduction, abduction, that is, internal and external rotation, both from the wrist (shown below) as well as abduction from the elbow into the wall. I am also pushing my fist straight towards the wall, and my elbow back into the wall. In addition, I'm doing a full cohort of AAROM with a broom stick as a great warm-up.

Isometrics (top two panels)

"wand" exercise (middle panels)

I am also using a lacrosse ball to work out knots in my shoulder (from the front and back), simply by placing the ball between my shoulder and the wall, and leaning into it, massaging around, etc.

As long as all these additions, particularly the isometric work, go on without a hitch, I will be allowed to continue intensity and frequency and move towards resistance band training, soon!

The most important progress yet.

Today, I threw a Frisbee for the first time in six weeks!

It was only about a three-yard backhand, and it involved virtually no arm or shoulder movement at all, just a little flick of the wrist, but it felt so good to have a disc in my hand after so long. I did a killer leg workout and took one toss in between each set. It's not a lot, but I'm thrilled, and starting to feel closer to normal.

Useful manuscript

Rehabilitation after arthroscopic rotator cuff repair: Current concepts review and evidence-based guidelines

The above links to the abstract for a great review article on the current ideas for treatment and recovery from the type of procedure I had. It should be a free article through PMC, but if there is trouble you can try this link, too, which is directly to the .pdf. The actual text includes pictures of many exercises, some of those I've discussed and some others. It also has an appendix table showing more-or-less when different phases of the rehab kick in. The nice thing is that for anyone reading this dealing with a slower recovery, due to age or complications, there is a timetable for a more conservative approach, as well.

Week 5 summary

Really short post, today, as I leave week 5 behind and start week 6 post-op.

Two modifications of old exercises, and a brand new one.
-Supine scapular retraction becomes prone scapular retraction.
-Front pulley raises adds lateral pulley raises. <-- video link!
-New exercise is internal rotation. Note that this image is NOT exactly what I'm doing, but it does illustrate internal rotation of the shoulder. The idea is to get into position as shown in the second image, on the right, and pull with the good arm, stretching the repaired shoulder into the midline of the body. I use a towel held in both hands to do this. Ideally the hand gets to/past the spine. I couldn't find a better picture of this one as the Google searches all came up with towel stretches in the vertical plane.

Prone scapular retraction

Internal rotation

I've made nice progress in my other activities, though I still have tightness and pain when I'm doing them, especially soreness, afterwards. I am now able to lay on my back with my hands folded on my stomach without the need for a pillow under my right elbow.

Generally, it's still pretty hard, perhaps psychologically more so than physically, with moments of self-reflection feeling as if I'd made some mistake by putting myself through all this. I'm sleeping better but not great, I am unable to focus much at work because I'm constantly thinking about rehab, and I get frustrated with myself, often. However, these weekly reflections are helping as I can see the incredible progress that I have made. I am looking forward to shifting into full AROM and strengthening (phase III) soon.

Week 4 update

I continue to remain ahead of the average recovery time. The therapist is being safely aggressive; listening to my body, but always pushing me more.

Now that I'm about a month post-surgery, here are some highlight from week 4:

-All week I was weaning myself off the sling, and I'm now not using it at all, during the day. I only wear it at night, but not to hold up my arm, rather more as a safety net to prevent something stupid from happening.
-Washing, changing, eating continue to get easier. I'm now able to feed myself with my right hand again (surgically repaired side).
-Three new exercises at the start of week 5: Overhead pulleys (it's easy to rig this up yourself w/a quick hardware store trip, or you can just buy a set), forearm wall slides (link is to a great website talking about the usefulness of this activity for anyone doing overhead sports like Ultimate, baseball, and tennis), and hands-behind head scapular retraction. I do this last one laying down, like I'm in the start of a sit up position. In addition to squeezing my shoulder blades together, I am also trying to force my elbows down/in towards my sides. I've got a lot of stiffness in my shoulder and my elbow on all of my exercises stays bowed out because of this stiffness. The new form of scapular retraction is meant to combat this.

Overhead front pulleys

Forearm wall slides (usually done w/both arms parallel)
See video link!

Supine scapular retraction

I'm continuing my lower body & left arm workouts, but it's a little harder to keep up with now that all the shoulder exercises are mounting. It's important to mention how tiring this process is. I woke up from surgery having a repaired shoulder that *will be* better than it was. The problem is getting there. It is an incredible amount of work and very tiring going through all the therapy, even for a serious athlete, like myself. My therapist really put it in perspective for me: Not only am I recovering from the procedure, and the weeks of inactivity in the sling, but I'm also trying to now reprogram my shoulder to use normal mechanisms. For years, before the surgery my body had been compensating for the tears by altering the standard physiological motions, and now, with the new shoulder, I can hit the reset button.