Physical Therapy and shoulder...

My PT dropped the boom today. While it would be nice if I could afford to just keep seeing him for the foreseeable future, I just can't afford to do that. We are going to devote our last, and longer, session next week to finalizing what I need to do at home. He asked me to send him a list on what I want us to focus on for my last visit, it is obvious he thinks I should continue but my budget can only stretch so far. There is improvement, but there is no doubt the shoulder is just plain jacked from a combination of that broken clavical so long ago, neurological muscle issues from the whiplash mtb injury 2 years ago, and from degeneration. He suggests I consider an MRI and visit an Orthopedist to determine, realistically, how much ROM and increased strength I can expect out of that shoulder. One thing is certain, surgery is off the table unless things get MUCH worse.

I don't know what I expected to come out of all of this - a normal shoulder I suppose. That was a bit unrealistic but there it is! It will be ok, compared to what a lot of people live with every day I've got no complaints. Bill DID stress how much he likes my strong focus on staying active and encouraged me to change nothing - just be kind to my shoulders and listen to any pain that comes with over-head activities. He said he wished that more of his clients had my attitude, which did make me feel a bit better :)

Aw, Catrin, I'm sorry you haven't yet been able to get the improvement you were hoping for.

I know it's not the way either PTs or referring doctors like to work, but could you possibly check back in with him every couple-three months for progress review, maybe a bit of manual work, and tweaks to your home program as you continue to progress?

I thought of you and your shoulder a couple of weeks ago when I was running, and felt my first metatarsal heads on the ground for the very. first. time. (as far back into childhood as I can remember, anyway). I know I've been talking about my feet here for five years at least, longer I think; and while I know I haven't been working on them that entire time as diligently as you've been working on your shoulder, I've been keeping healthy movement patterns in my consciousness, and giving them the shoe space they need to reshape themselves ... and it's continuing to happen. From what you said it really sounds like your PT thinks you will keep making progress, too.

One big takeaway for me from that article I posted the other day was this: "Despite the sales pitches of manufacturers and cure-all gurus, health is not a switch we can easily flip from healthy to injured and back again. Health exists on a continuum with a great deal of gray area between completely healthy and totally immobilized." I'm always on a journey. So are you. Here's hoping that journey takes you where you want to go - maybe not as soon as you wanted, and maybe not even to the destination you envisioned when you started, but on a path you feel good about.

(((((Catrin)))))

I agree with Oak, that maybe a visit every 3 months would be a good thing.
Is there any possibility that an ortho doc could make a case for continuing your pt with your insurance company?
I know you've been working very hard on rehabbing this. But, sometimes you just have to accept a certain amount of chronic stuff and just don't let it stop you from being active.

I KNEW I posted this here for a reason, I almost deleted the post an hour or so after I made it. Crankin and Oakleaf, that is a very good idea about following up with him every 3 months, even I can afford that. I am working on a list of things that I want to cover in my last session with him (at his request) and that will be at the top of it. Health and fitness does indeed exist on a curve, it isn't an on/off thing as much as we would like it to be. It was a bit unrealistic to expect even a talented PT to totally reverse the effects of an improperly healed injury from 40 years ago, muscular/neurological damage and degenerative arthritis - though I didn't know all of THAT was involved. All I knew was that it hurt sometimes, I didn't have full ROM and I couldn't seem to gain strength in the arm.

This certainly won't stop me from being active - and I am actively gaining strength and flexibility in every other way - which does make me feel better :) I appreciate the support and constructive suggestions. I know very few people away from the gym that seems to get why this matters to me, which means I really don't have anyone to discuss it with.

My PT sent a message today saying that Indiana is considering a change of law that would allow direct access to PT without requiring a doctor's order. I had no idea that most states apparently allow this, Indiana is one of the holdouts. This would certainly make it easier for me to see him periodically - which I LIKE the idea of! He told me today, in an email, that in my case we really can't just isolate my left shoulder. It is the entire upper quadrant as a whole because of restrictions in collar bone/scapula junction, shoulder joint and my neck. Yes, I do think this is something that I just have to accept and deal with the best I can. There are worse things to deal with, that is for sure!

The important thing is there IS improvement, and he is going to show me ways to (hopefully) maintain that and increase rotator cuff strength.

Yup, my first rx for pt was for 12 sessions. After like 4 months, I was still there...
I just call and go when I want now. They must have passed that law here sometime in the past 5 years.

I too have rehabbed a shoulder, one that had a broken collarbone one year and then I broke the ball joint into 5 large and lots of small pieces and had a plate and 11 screws inserted a year later.

Some things I found out along the way-

Traditional physio often doesn't work- that is the stuff like walking your fingers up the wall, lifting the arm with a pulley. If your muscles are pretty much frozen or weak, it's going to take years to rehab. I dropped the traditional 1/2 hour physio who made me do exercises and then gave me a massage (and not very good one at that). for a specialist arm physio who worked with golfers to improve their swing. He was also into dry needling- oh the agony but he managed to re-program my muscles to work and respond. I would have 1 hour seassions with him and boy they worked. I didn't need to many sessions in the end.

Sometimes things will not fix themselves- in my case I managed to get my shoulder to lift my arm to shoulder height but couldn't raise it higher myself. My physio could lift my arm higher, but I couldn't. I ended up have an ultrasound on my shoulder (because the MRI wouldn't show anything with all the metal I had in there. BTW it was also much cheaper!) and it showed that the orginal surgeons hadn't done- repair a badly torn tendon. I don't blame them, they were too busy trying to save my shoulder joint and bone. But it meant I wasn't going to get the range of motion back no matter how much I did physio. So it required more surgery. The doctor was also able to check during that exactly how much motion I was going to get out of my poor mis-shapen joint. Yes it is permanently decreased but I now can reach up to put my clothes on, put things on a high shelf and pull the curtains.

I realise money is an issue and I was unemployed during this whole process. But I would suggest trying to make the most of what money you have. I would go and see a doctor to check out what you can realistically achieve. Ask if he can do an ultrasound if he thinks it's muscle/tendon related. Also I would look to see if you can find a specialist arm and shoulder physio (yes I know you have built a relationship) to get as much bang for your buck. And investigate other methods like accupuncture and dry needling.

Good luck and best wishes.

Sounds like quite the journey Kiwi, and thanks for sharing your experiences. Glad to hear that you finally got relief! Bill thinks an MRI and a visit to an Ortho to determine how much improvement is realistic to expect would be a good idea. He doesn't think an ultrasound would show everything in question. I need to think about this, I have to pay a sizeable percentage for an MRI...