For those who care about buffness

Posts tagged “impingement

new injury! ffs!

yes again.
so this time, torn right triceps. to what extend we just dont know. “not too bad” is what the physio says but obv it needs absolute rest…
to top it up i have a nasty impingement on the right which keeps on getting worse w training (just like my now operated and fixed left shoulder). so my right shoulder is buggered at present.
physio says “NO TRAINING FOR 2 WEEKS AND THEN WE REASSESS”.

i say we shall see about that!

it’s not about being stupid however.
i havent trained the right shoulder since friday. the actual shoulder itself is impinged, no doubt about that, so it doesnt feel much different from last week. but the triceps does feel slightly better i think. so rest seems to be the way. so what will i train you ask?
well how about my left hand side?

here’s the current plan:

training for one arm pulls on left on bar w either negatives or actual 1.5 arm pulls (assisted on bar w other arm, it’s ok not much stress placed there). i will also try australian one arm pulls but working from straps i think.
one arm push up? my left side is really weak so this will be a challenge. am gonna try it semi assisted w a raised right grip on a kettle bell or the like.

AND CORE.

so dish holds, v sits or the like
erector spinae exercises (w weight if i can get hold of the incline bench style machine at the gym, not sure how this will work out at home w free weights but i will try later tonight)
oblique work, i was thinking of doing the usual oblique crunches w weight straps on my ankles. at the gym perhaps some cable crunches will work out. depending on how the shoulder takes it.

oh but apparently i can work my lower arms. errm. i guess i will do some of that too!

as a side note i have been wearing a compression sleeve from 2xu for the past week most of the day. it compresses my triceps and actually seems to have worked really nicely. keep in mind i have to cycle to work too, so my triceps is recruited for daily crap which is the dangerous stuff that you dont watch out for.

IMAG1246

in any case, for any pulled/torn muscle injuries, i can recommend these sleeves. provided you get one your size, and not arnold cat size. or you might experience a major loss of blood in your limb. for triceps, the ideal position is slightly higher than the way you would normally wear a compression sleeve, it goes over the delts basically.



pay peanuts and get monkeys… NHS physio vs private ones

since surgery i have been seen by an NHS physio. i had always been jealous of ppl who got to see them because hey, it’s free (as opposed to the £70 for one hour i paid for the last private sports massage).

but yes. well there is a reason for that. and i am sure the lady is more than competent… for “normal” clients.

i saw a physio straight after surgery who gave me basic “assisted” exercises. i.e. the kind you do using a broomstick to lower and lift your arm behind yr back etc. at that time well in all honesty i wasn’t so sure i would ever be able to lift my arm again.
but i stuck with it and quit wearing the sling very early on to enable my shoulder to move freely (thus avoiding frozen shoulder probs altogether). just before my trip to japan and exactly 11 days after surgery i saw the NHS physio who would be taking care of me for the first time. it was hard to explain what i do on straps, although i thought comparing it to gymnastic rings was the closest we would get, she still seemed puzzled.
she assessed my shoulder movements and deemed my left scapula was winging (and indeed it was, check previous post) so she gave me a lot of rotator cuff exercises to strengthen them and mobilize them.
while in japan, my shoulder got heaps better so i decided to push it and increase the weight (i was told no weights for the cuff exercises but it became remarkably easy).
my next app was due to be today, a good 2 weeks after i came back from japan. since i thought this was too long i went back to my specialized physio.

so last week i had a one hour sesh w the circus physio. he thoroughly checked the range of movements and indeed for 5 weeks, it is very good (and better than pre surgery too). but it’s not that simple. according to him, yes it’s good to mobilize my cuffs, but they are fairly strong already. the problem is more an imbalance, particularly w the pecs and the teres/infraspinatus combo at the back. they are pulling the scapula in the wrong place. so he proceeded and punded the crap out of my poor “mutant” muscle (teres), in the most painful deep tissue massage ever. then moved on to the pec, but as painful as this normally is (elbows blazing!), it felt really relaxing after the previous destruction.

the goal is now to make sure the shoulder starts moving in normal “good” form, as it is badly used to the impingement and i can’t quite make it work the right way atm. so i have a couple of new exercises:
-one involving lifting the arm forward while leaning against a wall and holding the lats down so they do not engage.
-another lying flat on my stomach w arm falling to the side (lying on a coffee table), someone then holds the lat down and pinches the left trap to prevent it from engaging. my left arm must then reach towards the front and extend as much as possible. very painful but very good as “forced” rehabilitation for the left shoulder to stop the big muscles from engaging.

but then today i went to see the NHS lady again. i confessed to seeing the circus physio because i was concerned i was going too long without a checkup. that already did not impress her.
when i reported on the issues the circus physio thought he found, they were more or less ignored and focus was put back on the rotator cuffs.
fine.
but then i was asked “so really, how is this affecting your daily life nowadays?”
“well, i can make myself a cup of tea if that’s what you’re asking?”
“so it doesn’t affect you really?”
“well not my daily life really no i can finally cycle again”
“so what are we trying to achieve then?” *puzzled face
“err i want to be able to train straps again? otherwise why would i have bothered w surgery and the lot?”
“oh right i see”

then yes she tried to help me improve the “hold your shoulder blades back” as i find it hard to disengage the traps while doing that. and then concluded the traps were too tight (uh huh) so said she would massage the left one.
i could have done that better w my right hand. such a weak massage. when i said perhaps she could do acupuncture then, i was told we were out of time. 30 mins gone.

obviously, i am sure if she squeezed an old man’s left trap he would prob scream in pain, but hell lady, i need more of a squeeze than that. i have a knot in there the size of my wrist, stroking it will not help!
i guess it’s all relative and perhaps for mr smith this is great, but i am used to clenching my jaws when i get my back muscles massaged. anything else just doesn’t work. honestly. it doesn’t!!
unless it involves needles. or perhaps cups. but Arnold knows cups best…

apologies for the long post and the lack of pictures…



ouch my rotator cuff

stitches came off this morning. but as it turns out the rotator cuff on the left side isn’t working as it should anymore. the result is an abnormally winged left scapula.
it was bad before but post surgery it’s got even worse.

so let’s explain a little bit what a rotator cuff is and what it does and why you should give a crap about it… esp if you want to do aerial circus!
a couple of pics stolen from the web (first one was stolen from gray’s anatomy!) to show how rotator cuff muscles are structured:

 

 

as you can see it’s not just the one muscle but actually 4 different muscles which can be considered as “rotator cuff”:

– #7 supraspinatus: arm abduction teamed w the delts.
– #8 infraspinatus: external rotation of the shoulder.
– #6 teres minor: teamed w the infraspinatus it holds the humerus in place in relation to the scapular cavity, but also work w the delts to rotate the humerus.
– subscapularis (visible on the pic on the right. sits under the scapula): rotates the humerus medially, w overhead movements of the arm, it draws the humerus forwards and downwards.

all these muscles put together form the rotator cuff, they all have the scapula for origin and insert in the humerus.

the rotator cuff does a lot for shoulder stability. problems occur when there is an imbalance between the “bigger” shoulder muscles (delts, traps, teres major etc) and the rotator cuff. most of us concerned w bulk will pimp the bigger muscles. you can’t really see bulk on the cuff muscles sadly.

which has led me to bulk up a lot on the other muscles at the detriment of the smaller stability providing ones.

check this:

vs an earlier pre injury healthier cuff:

so why is a winged scapula bad?
let’s take a look at the shoulder structure in terms of bones this time:

the gap between the acromion (i.e. the tip of the scapula which fuses w the clavicle) and the humerus (also called the subacromial space) is where the supraspinatus tendon passes to insert into the humeral head. if the shoulder blade is not held properly in its place, this gap becomes more narrow, thus compressing the tendon which then provokes an……. IMPINGEMENT.

and there you have it. why you should care about developing the rotator cuff.

i already had an impingement, presumably caused by the bone spur removed by my recent surgery adventure. now i need to get the rotator cuff active again to prevent more trouble.

how to recover function of the rotator cuff? well then, let’s go onto the physio side of things.

these exercises are the ones i know (done w my good arm!), if anyone cares to add others it would be mighty helpful for injured buff ppl out there! *ArnoldCat?

– these are the 2 basic ones:

lying on yr side just lift your arm back up to your stomach and back down.

same as above but this time the arm you’re working on is on the top, let it drop to your stomach and back up.

 

something a bit more evil now:

lift your elbow to shoulder height and lift a dumbbell up and down keeping the arm bent. it hurts even my good arm… argh.

therabands can be used to improve the health of rotator cuffs, the same 2 exercises can be done with the bands. for now, given my weakened arm, i can only do these w remarkably low weights 🙁



so why and what is a subacromial decompression

shoulders are great joints.

it’s a multiaxial synovial “ball and socket” joint. in other words, it can rotate in all directions more or less, and contains fluid (synovial fluid) which lubricates the joint capsules.

but really, the shoulder joint wasn’t really meant to handle too much overhead action. (as someone said to me once, we aren’t monkeys and thus not meant to be hanging from our shoulders quite that much)

this is where you start talking about an impingement.

an impingement is basically when the soft tissues underneath the acromion bone are pinched and restrained as they move under the acromion itself. pain is felt and that distinct “pinching” sensation, like something is catching in your shoulder and preventing you from moving your arm properly.

to clarify, this is the bone structure (link courtesy of wikipedia), take note that the shoulder blade folds right back to the front onto the clavicle. the little space between that junction and the humeral head beneath is where all the tricky tendons go… bit cramped!

 

the more you try to move and be active/train, the worse the inflammation becomes until eventually, like me, you become utterly unable to lift your arm beyond shoulder level without copious amounts of pain.

before getting to that, i had cortisone injected in both bursas (right and left shoulder, lucky me). which gave me instant yet ephemeral relief (the right hand side took longer to get better but it was a more lasting change, am still feeling an impingement but i have almost 100% mobility).

apparently the fact that cortisone helped was an indication that it was to do w the acromion. my consultant feared slap tear w potential damage to the rotator cuff muscle but luckily this wasn’t the case for me.

this is what we saw originally in november. altho the NHS radiologist ruled out an inflammation of the bursa, everyone disagreed with him, including the head of the shoulder dept at the Whittington Hospital, Mr Hamilton, his colleague Mr Haddo who performed my surgery and my physio James Wellington who deals w all the circus ppl injuries at the Circus Space in London.

by the time the nhs got their rear end in gear, it was already january and i had made it MUCH worse by then.

so i got back to my consultant and we proceeded to booking me in for surgery.

at this stage, without taking a look via arthroscopy, it was impossible to tell what the matter could be. could be as simple as a subacromial decompression but we could also be looking at a torn rotator cuff or a slap tear. it was all a big surprise waiting to be revealed.

the main difference between the above issues is healing time. for subac decompression, you’re looking at 6 months or so. for any of the rest (combined or not), you’re looking at 9 months MINIMUM before you can even consider getting back to training aerials. according to my research and the ppl who were kind enough to tell me about their own surgeries (cirque du soleil artists), it takes about one year to get back to 100%… rough 🙁

so when i woke up and saw my notes saying i had “just” had a subacromial decompression, i was relieved.

here’s the procedure in a nice animation (visit www.shoulderdoc.co.uk for more info, an amazing site):


having said that, it’s not just a walk in the park either. my shoulder aches, like it’s been repeatedly run over by a big truck and bashed w a sledgehammer to finish it off. just now am i beginning to feel more normal in there.

the nerve block they gave me wore off in about 12 hours. cue INTENSE pain. cue codeine. cue coma. i weaned myself off the codeine in a few days as it enabled me to sleep better at night (the discomfort at night is worse, lying down seems to put the humerus in a funny position regardless of whether you’re a back or side sleeper).

but now i am only wearing the sling when i leave the house so ppl know better than to bump into the shoulder.

physio exercises are very basic for now. pendulum, theraband exercises without the theraband and using a stick (or a bike handlebar in my case) to bring your arm up and down and sideways basically. this is to avoid frozen shoulder for lazy ppl who wear the sling all the time, or for those who can’t quite take the pain. my shoulder is free most of the day and constantly in motion (i hope) so the synovial fluid should keep lubing that joint nicely.

in terms of training, i haven’t started doing anything on this arm yet. hell i still have stitches! but i can lift my arm using only its own muscles quite ok (very painful but doable) and do my dishes by myself.

the training for the other arm has however resumed… but more about this in another post…