Saturday, February 21, 2015

Ream and run: rehabilitation tips from the super stars #3

We've invited some of the folks who have done a great job of their rehabilitation after a ream and run to share their tips.

Here's #3 who had the procedure on both sides

"Regardless of the reason that the shoulder deteriorated, injury, age, etc., the operation offers a second chance to continue an active lifestyle: thus approach the recovery from a positive perspective. There will be pain, but it can be managed and the objective is to do the exercises necessary to achieve full flexibility and ultimately to regain strength. Patience is important and establishing a routine that achieves success is vital. For me, I took pain meds (Tylenol) if the pain was great enough to make me think twice about doing the exercises. I used my spouse as a "coach" to assure I kept on schedule, to measure my progress, and to assist me as needed. I learned to use the table slide to achieve shoulder/back flexibility and the pulley and prone position to achieve full rotation. If I felt the shoulder tightening up, I would use the pulley to help move it and I found my pain and stiffness would be quickly reduced. Finally, measuring progress was important to seeing real improvement."

Attitude: it is important to enter this process from the positive perspective that you are being offered the opportunity to recover capability (versus the negative of why is this happening to me). If you are positive, I believe that you will proceed to manage the pain to obtain the best results possible. A negative attitude can lead to a minimalist approach, avoiding activity when it hurts.

Pain: It is important to recognize that the process will involve considerable pain and discomfort and the trick is to manage it. The first surgery, I took the narcotic pain meds through the first couple of weeks of recovery and it actually held me back (felt foggy). This second surgery, I quit the narcotics in the hospital and relied on maximum doses of Tylenol for the two weeks. Further, I followed the advice of the discharging nurse, take the Tylenol when the pain was such that I would consider avoiding the exercises.

Exercises: I performed the flexibility exercises prescribed, always starting with the table top slide to loosen my shoulder/back muscles; followed by the pulley and being careful to use the system to pull my arm up with bend in the elbow and then lowering it outstretched. This reduced the levered force on the joint. I then completed the process by laying on the bed flat and rotating the arm back over my head. I used pillows to provide a landing area and then reduced the height of the pillows as my flexibility improved. I had my wife measure and record the amount of flexibility to provide a metric of improvement.

Core Stability: While laying flat to do the shoulder flexibility exercises, I also did a set of leg lifts and crunches to build my core. I got to the point where I would do 40 each, three times a day while doing the shoulder exercises. The effect was to improve my balance and capability to stand up from a sitting position. This gave me confidence. I also walked to improve balance and stamina. When I felt comfortable laying on the floor, I used a styrofoam noodle of 3" diameter (type used in pools) to lay on and to help keep my back and related joints limber. I continued doing the shoulder flexibility exercises, including doing a "snow angel" motion. As I moved into the weight strengthening phase, I did them on the noodle and continue to do my basic core exercises while working on it.

Post 3 months: I use flexible bands to improve strength in my arms and back and a set of weights (working from 1 lb to a max of 9 lbs) to develop arm strength. I allow about one week progression per pound. I am now "pumping" 5 pounds. I follow the rule of 25, in that I do not progress until I am comfortable doing two sets of 25 reps without pain. I am also doing curls with the weights and using exercises to improve flexibility behind the back and across the front (left shoulder to lower right, and left hip to extending the arm up and reaching out to the right). Finally, I am careful to engage the back muscles when appropriate to an exercise to reduce strain and to improve posture. I avoid doing lifts with arms extended because of the leverage effect on the shoulder (with a fly, 5 lbs becomes 10+ on the joint, given arm length multiplier).

I am pleased to continue to be active in my athletic endeavors and believe it would not be possible if I had not been given a "second chance" with my left shoulder at 71 and now the right at 75.


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