Hard to believe I am 365 days removed from surgery. At this time a year ago I was trying to struggling to eat dinner, my nerve blocker had not worked off, so I couldn't feel my fingers in my right hand, and I was woozy from the anesthesia. That night was one of the worst of my life, particularly the gap between surgery pain killers and the oral opioids that had not kicked in, yet. The following weeks were no easier.
My last entry was four months post surgery, in early March. I was released from physical therapy rather quickly to home exercises. It turned out to be a mistake. What most of you do not know is that in the months following I did continue to make progress in strength and range of motion, but most of my technique was sub par. I was compensating with my trap for my scapular controllers. My supraspinatus still wasn't firing correctly. As a result I started putting more strain on my triceps and developed bad elbow pain that I initially thought was some sort of lateral or medial epicondylitis (golfers or tennis elbow). By the 4th of July I could barely throw a backhand without terrible sharp pain. I was terrified I had torn something in my elbow because of compensation issues. I had to do something about it, or risk long-term health issues, and ruining my Club Ultimate season. On July 16th I went back to physical therapy.
Though I tried to return to the same office that was involved in my procedure, they made it difficult to do so based on their silly policies and lack of available appointments. I went to a different office that took me almost immediately. Physiotherapy Associates (Rockville office) has taken incredibly good care of me in the past nearly four months. From the front desk (Cindy), to the therapy assistants (Erika and Brian), to my therapist (Anastasia Rukavyshnykova, yes, Nastia, I did it without checking your business card), I received nothing but the highest standard of care, met with a willingness to work with me closely, and a true empathy for my situation.
I will post a scanned image of all the exercises I have been doing in the past four months, but until then I simply want to share the diagnosis. Turns out I have substantial joint hypermobility, including at the elbow. Essentially, I am able to extend knees/elbows beyond 180 degrees, I can bend my fingers back to abnormal degrees, etc. As a result of this, and combined with substantial weakness in the external rotation of my shoulder the problem with my elbow developed. With external rotation of the shoulder, primary muscles involved are teres minor, deltoid, and infraspinatus, that later of which was the other tendon that was (50%) torn. Scapular control (muscles in the mid/upper back around the spine) is also incredibly important to stabilize many shoulder motions, and this was one of the muscle groups most affected by atrophy during the 6 weeks of non-use post-surgery.
At my four month update I wrote that I thought I was close despite the average recovery time taking about one year. I laughed when I looked back and read that. I set high standards for myself, but I also really believed that I was close. I never appreciated just how complex the shoulder is, nor did I understand how severe the initial damage in my shoulder was, or the fact that the tendons probably were torn and getting worse for the better part of two years before the surgery. The weeks of immobility and passive motion post-op were a big delay and not only was I not getting stronger during this time, but I was getting weaker from non use. When you consider all these things and add on my hypermobility, plus my quick return to Ultimate and lifting, it is much less surprising what happened to me in July.
So where am I now? For real? I hesitate to say "close", as I did with folly 8 months ago, but I'm in much better shape now. I have more strength and range of motion in all directions. Everything I do now is easier. I think about my shoulder less, though it is still a constant presence in my day-to-day life. The work I did with Anastasia has been remarkably effective, though. The elbow pain went away within a few visit. My strength, particularly external rotation, is finally improving as I stay as diligent as possible with my at home therapy. My scapula on the right side actually feels like it is activating, when I felt like I could not will it to 'go' for months after the surgery. It feels like a real muscle again! More great news is I'm back to lifting heavy. Last week I hit 205# on my squat and 365# on my deadlift for the first time since my surgery. Most importantly I can bench press (flat and incline) safely, comfortably, and without and searing pain in my shoulder. My next goal is to hit 1000# on these combined lifts. Ultimate is good, too. My pulls and deep throws feel good. The mechanics on my hammer are returning. I have not returned to climbing, and I'm not sure when I will, but that is currently less pressing that making sure everything with my shoulder and elbow is totally fine. For now, everything is moving forward, and I feel good about that.
The plan going forward to is to keep working hard; remaining diligent; remaining mentally tough. I had a lot of moments of psychological and emotional struggle in the past year. There were many times that no one is aware of, until the moment I publish this blog post, where I completely broke down. It always happened during a shoulder workout. I would be stretching in the doorway, working on front raises, or my scapular control, and looking in the mirror I could see my form was awful. I would get frustrated. "It's nearly a year since my surgery, why can't I do this? What is wrong with me? Will I ever be ok?". I'd feel my elbow pain come and go, occasionally. I would often feel completely helpless. I would hang my head, or even lay no the ground in a crumpled mass of frustration and cry.
So, this year was hard. While I wouldn't wish this experience on anyone for many reasons, I can appreciate the character building that has come from my struggles, and I am sure in the months and years to come I will look back on this time much differently. For now, I am happy to be nearly through the muck.
grt
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