Unbork my shoulder
August 16, 2020 4:01 PM Subscribe
What other therapies might I consider for my totally messed up shoulder? I have been in PT twice a week for months and have gone from 60% range of motion to 85% but now I'm stuck. (Therapist is quite good, I've used her for years.) Primary issue is a SLAP tear, but I also have rotator cuff wear and arthritis. Surgeon says inoperable (and regardless, I would try everything else first anyway). A big part of the problem is chronic tightness everywhere--in pec, bicep, teres minor, etc. Who can help?
Have you tried deep tissue massage?
posted by little mouth at 4:56 PM on August 16, 2020 [2 favorites]
posted by little mouth at 4:56 PM on August 16, 2020 [2 favorites]
More specifically, I would look into neuromuscular therapy. I've had rotator cuff issues for years and while PT does wonders, occasionally I've added in NMT to help with tightness and it makes a difference. If you do go the deep tissue massage route (which I consider NMT to fall under), I would expect a therapist to be working not just the muscles with the presenting issues, but also opposing muscles or others that get recruited with your shoulder issues.
posted by cocoagirl at 5:54 PM on August 16, 2020
posted by cocoagirl at 5:54 PM on August 16, 2020
Response by poster: Well the PT does a lot of massage although I’m not sure what all the different techniques are but it’s deep and often painful. She also does stretching/mobilization, ultrasound, and has me do stretches and strengthening exercises. I’m wondering if something like Feldenkrais might help me figure out how to move without pain again. Acupuncture? I don’t want to throw money away but this is my number one priority and I’m willing to try some things.
posted by HotToddy at 6:17 PM on August 16, 2020
posted by HotToddy at 6:17 PM on August 16, 2020
Primary issue is a SLAP tear, but I also have rotator cuff wear and arthritis. Surgeon says inoperable (and regardless, I would try everything else first anyway). A big part of the problem is chronic tightness everywhere--in pec, bicep, teres minor, etc. Who can help?
I think all the tightness you describe is your body's attempt to immobilize things in your shoulder enough to allow the SLAP tear to have a chance of healing up.
It's funny that we splint bones and use casts to immobilize breaks sufficiently to heal, and sew cuts in skin and muscle together so that the edges can't pull away from each other as they heal together, but when it comes to connective tissue tears, we ignore the fact that the immediate physiological response is inflammation, pain and stiffness, and do everything we can to preserve range of motion and eliminate the stiffness which acts functionally like casts and stitches, and attempt to get rid of the inflammation which attracts immune cells such as macrophages which can remodel and also lay down new collagen, which is the only way acellular tissue such as collagen can actually heal, since it doesn't have cells which divide, fill gaps, and bind things together. I think this is most easily seen in the case of frozen shoulder, which I mentioned and provided links to justify in an old comment.
So I believe you should aid and abet what your body is clearly trying to do anyway, and take external measures to further immobilize that shoulder as much as you can for as long as you can get away with.
posted by jamjam at 1:03 AM on August 17, 2020 [1 favorite]
I think all the tightness you describe is your body's attempt to immobilize things in your shoulder enough to allow the SLAP tear to have a chance of healing up.
It's funny that we splint bones and use casts to immobilize breaks sufficiently to heal, and sew cuts in skin and muscle together so that the edges can't pull away from each other as they heal together, but when it comes to connective tissue tears, we ignore the fact that the immediate physiological response is inflammation, pain and stiffness, and do everything we can to preserve range of motion and eliminate the stiffness which acts functionally like casts and stitches, and attempt to get rid of the inflammation which attracts immune cells such as macrophages which can remodel and also lay down new collagen, which is the only way acellular tissue such as collagen can actually heal, since it doesn't have cells which divide, fill gaps, and bind things together. I think this is most easily seen in the case of frozen shoulder, which I mentioned and provided links to justify in an old comment.
So I believe you should aid and abet what your body is clearly trying to do anyway, and take external measures to further immobilize that shoulder as much as you can for as long as you can get away with.
posted by jamjam at 1:03 AM on August 17, 2020 [1 favorite]
A few months of dry needling, combined with maintenance PT exercises, solved 20+ years of chronic shoulder pain for me.
posted by veery at 4:30 AM on August 17, 2020
posted by veery at 4:30 AM on August 17, 2020
Came here to say dry needling.
posted by Medieval Maven at 5:16 AM on August 17, 2020
posted by Medieval Maven at 5:16 AM on August 17, 2020
Not sure how old you are - but I have started to pay WAY more attention to my bed and pillows AND how I sleep.
At one stage, I was setting an alarm for 3am so that I would get up, stretch, and reposition my pillow, to get another four hours sleep in a good position.
I also pay attention to any tingling sensation - fingers, elbow, ankles, whatever - time to reposition to improve blood flow/ nerve angle / muscle tension
posted by Barbara Spitzer at 5:40 AM on August 17, 2020
At one stage, I was setting an alarm for 3am so that I would get up, stretch, and reposition my pillow, to get another four hours sleep in a good position.
I also pay attention to any tingling sensation - fingers, elbow, ankles, whatever - time to reposition to improve blood flow/ nerve angle / muscle tension
posted by Barbara Spitzer at 5:40 AM on August 17, 2020
I do a workout much like the one listed above. In pre-COVID times had a lot of massage therapy, Three things not mentioned thus far - icing - daily for 20 minutes at a time, CBD and being very careful and specific with your pillow set-up for sleeping to support your shoulder. That said I live with chronic pain from my shoulder - varies from minor to significant from day-to-day and I've had all the surgery that will help. So at some point looking at mindfulness in living with chronic pain may be useful.
posted by leslies at 5:43 AM on August 17, 2020
posted by leslies at 5:43 AM on August 17, 2020
My wife had a rotator cuff tear and the only thing, PT-wise, that helped her was a Feldenkrais practictioner. (At least until the tear fully healed; after that, PT has been a godsend in strengthening the area to protect it from reinjury.)
posted by restless_nomad at 8:03 AM on August 17, 2020
posted by restless_nomad at 8:03 AM on August 17, 2020
Response by poster: Okay well I made an appointment for a Feldenkrais session and then went to the pot shop and got some Dragon Balm (CBD balm) and some tincture. The balm is fabulous. The rest, TBD.
posted by HotToddy at 7:03 PM on August 17, 2020
posted by HotToddy at 7:03 PM on August 17, 2020
Seconding dry needling. I've had a type of dry needling called IMS (intramuscular stimulation), and it unknots tightness that massage/stretching alone can't touch.
Some physiotherapists are certified to do dry needling — they take a course to learn it. It's best if you can find one who specializes in chronic pain and can provide stretching and maintenance exercises to support the needling.
Best of luck!
posted by fire, water, earth, air at 8:37 PM on August 17, 2020
Some physiotherapists are certified to do dry needling — they take a course to learn it. It's best if you can find one who specializes in chronic pain and can provide stretching and maintenance exercises to support the needling.
Best of luck!
posted by fire, water, earth, air at 8:37 PM on August 17, 2020
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posted by selfmedicating at 4:23 PM on August 16, 2020 [3 favorites]