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After an athroscopic SAD procedure ten weeks ago, despite disturbed sleep virtually every night, I did feel that the daytime pain was improving a bit. However, at my last (final) physio appointment, it was felt that I could move on to strengthening exercises as my ROM was pretty good. I have tried to push through with these, which consist of the use of a theraband, but it seems to be a backward step. I have even cut back on the amount of reps for each movement but it appears to have really aggravated my shoulder joint and I feel I have pretty much gone backwards and had a couple of really horrific nights with regard to pain.
Now I'm not sure if I should hold fire on this and let things settle or continue. I should add that I am using the affected side as much as possible, filling the kettle, opening doors, reaching into high cupboards etc. but I guess these movements in themselves will not necessarily strengthen the shoulder particularly. Anyone have any thoughts on this?
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Its all quite normal, I got told by my physio to ease off all of the movements I was putting my shoulder through, but she noted that in the long run if I can handle the pain il get better use of my shoulder.
Like you the horrific nights with no sleep etc were awful, added to the fact the tramodol gave me insomnia, sweats... Biting my lips and tongue!
I skate, go to the gym etc and I really put my shoulder through some situations I wouldn't advise... I'm 14weeks post op I think and it hurts with certain movements but I can use it pretty freely now... I can't hold my weight yet... But I can lift weights at the gym and do most things.
Just stick with the movements, don't add heavy weights to those movements... But the ROM will be massively improved in the long run if you battle on. You will find in a couple weeks tht you are use to those new movements.
Hi Nathan. Thank you for the reassurance. To be honest, the new exercises didn't seem that strenuous so I was a bit surprised at the amount of reaction I had. I've been very conservative with regards to what I am doing in the gym and sticking mostly to a routine that doesn't tax my shoulder much. I think you are probably right and I should persevere. You are a little further on than me so your post is encouraging, thank you.
Honestly they never quite tell you just how painful any shoulder surgery can be. I was absolute in thought, that they knackered my shoulder in the op because it hurt so much... Then felt OK, to hurting the worse it's ever felt.
But honestly we're all different, I'm 32 and I'm active... So fairly fit. I have always felt my pain threshold to be very good. I could always take more pain than my friends growing up... Had hospital Injuries thst I never got seen to... I had my shoulder popping out regularly, I couldn't put any weight on it... Couldnt hold my baby properly for over year until I thought, right let's get the op.
But damn, this shoulder pain post op had me close to tears at times!
I rest assure, it gets better and better and when you feel it's hurting more than yesterday, it's more than likely muscle fatigue from using it more.
Please post back in a few weeks so I know how it feels then.
Im currently doing strength rebuilding now.. My whole rear deltoid and scapula area has severe muscle wastage... Funnily enough it doesn't hurt... I just can't place my arm at angles though lack of strength.
On a side note... I do get pain on the front of my shoulder still... Down to my bicep, very sore if I rub it... But I believe tht is where most the anchors were placed.
I agree about the warning of pain severity. I think your procedure was more complex than mine. I read your last post around 3 a.m. this morning as generally that's around my most difficult time for sleeping and reading is a good distraction from the pain. I tend to agree that muscle fatigue comes into play and like you I get pain on the front of my shoulder down to the bicep which has remained quite lumpy ever since the original injury a year ago. Its encouraging to read your age. Although I am fairly active, go to the gym, cycle (when I'm not re-habbing shoulder) etc. I am almost twice your age so on reflection maybe I'm not doing too badly. I know age plays a big part in recovery so maybe I need to be a bit more patient. Yes, will post again, hopefully with a slightly more positive take on things.
Sounds like something you should be discussing with your surgeon and therapist? It also seems like there should be close communication between your surgeon and therapist for you to have the best outcome.
If you google 'protocol following su bacromial decompression' you'll come up with a lot of hits, usually in the form of pdf's outlining various surgical center's pt recovery regimen following a SAD. The protocols may range anywhere from 2-9 months or perhaps a year. Most of them will stress that it is up to the discretion of the therapist as to what rate and timeframe to follow. You'll also note restriction advisements as to lifting especially overhead and to the side with the affected arm. Also there are usually notes that if you do experience pain you should curb your exercises and activities giving your shoulder a chance to transition more gently. You're 10 weeks out and lifting overhead already? Your therapist okayed this?
With such difficulty and pain as you are experiencing (and it's something that usually registers in the patient's face and body and attitude in front of the therapist while you exericise even if you don't directly tell the therapist) I'm wondering why they haven't adopted a slower rate of progression in your protocol.
I suppose they do suggest ice and pain creams like biofreeze, and perhaps a tens unit? There's lots of things you didn't mention. Remember you are not alone, recovery depends a lot on you especially your interaction with your surgeon and therapist. It's a team effort, it should feel like a team effort with your surgeon and therapist being the leaders who are trying to transition you to becoming fully independent on your own for your final phases and the rest of your life with your recovery.
Maybe time to have a serious talk with them, expressing your fears and pain or switch therapists?
Hi Mike. Thank you for your response. I have actually been signed off by my physiotherapist, although advised to go back should I feel the need to. Hence my post as I didn't want to immediately press the panic button. I haven't seen the surgeon since my procedure (last week's appointment was postponed and I am due to see him in two week's time). Both the physio and the surgeon told me to expect 4 - 6 months recovery so I guess I am being a little impatient. It's just that I was surprised to have an increase in pain as soon as I upped the exercise routine, even though I understand this does happen. I think as my ROM was very good, the physio felt it was appropriate to introduce some strengthening exercises. I'm not actually lifting overhead. It is just using therabands with no weights involved. I take your point about adopting a slower rate and this is what I have done over the last couple of days. I guess I am just keen to get back to pre-surgery state and maybe need to have a bit more patience. I haven't really used pain relief other than ice since day 5 post surgery so I think my expectation was a gradual improvement, not fits and starts such as I have experienced.
I am now about 16 months post surgery on a rotator cuff tendon reattachment surgery. I am now also about 97% recovered. Without getting into all the pedantic details of the pain and challenges I went though to get to where I am now, I can offer a few bits of overall information.
Shoulder surgeries can be extremely painful during recovery, and, until you are about 10 months post surgery, I think it is common for heavy pain to return at times from overuse or from movements that cause minor setbacks, even when at times you may feel like you have made a lot of progress on reduced pain. This is all normal and part of the recovery process. And in those situations my surgeon had me return to icing it again and taking anti-inflammatory medications for a couple of weeks. And in all instances, this way of treating the setbacks got me be back to where I was in my recovery before the heavier pain started reoccurring.
Another thing to keep in mind is that pain is often compounded by muscle atrophy, stiffness, and weakness. So one of the best things you can do is to continue with internal and external movements to try and increase ROM, even in times of pain. I also found at times of pain, that if I do some very simple repetitive movements (with no resistance) until my shoulder muscles start to burn a bit that this would relieve pain. This is an indication that stiffness can easily set back in after a couple of days and start causing pain again. So the movements increases blood flow to the area, warms up the muscles, and reduce stiffness. It’s something I still even need to do now if am inactive for a few days.
So the sooner you get nearly full ROM back then the sooner the stiffness and pain will go away for the most part. External rotation is the hardest movement to regain (hand behind the back and being able to touch the middle of your shoulder blade). So good to continue to work in that. I still work on that now as part of my warm up to my regular exercise routine.
So the best thing I think you can do is be patient. Give it time. You are still very early in your recovery. Go back to icing multiple times per day in times of heavy pain and maybe take some anti-inflammatory medications for a couple of weeks when setbacks occur until things get back on track again.
As I said, I am about 97% recovered and still get small amounts of temporary pain from certain movements, but that may still get better over the next 6 months or it may not. What I focus on though is the 97% I got back and not the 3% I didn’t. So overall I am quite positive about my recovery, even though there were many times I had my doubts along the way.
Best wishes with your recovery.
Thank you for your very reassuring and informative post. It's good to know I am on the right track regarding rehab. I have indeed felt that I have had setbacks and had to pull back a bit on exercise, which as you correctly point out, leads to stiffness so it's a bit of a catch 22 situation. I have slowly built up the regime again and this time it hasn't hit me as hard as it did before. I guess in the big scheme of things you are right in that I am still in the early stages of recovery. There are quite a few days now whereby I forget about my shoulder although I am quickly reminded of it at night. I don't believe I have slept for more than a couple of hours without being awoken and reminded to move. Once I get up and move about for a few minutes it calms down again. It would be nice to think I might one day manage a half decent night's sleep.
Your welcome. Understanding a bit more about how the recovery process will go I think also helps put the mind at ease. I wish I was able to understand things better myself when I was going through it. I had weeks lying in bed in pain in the beginning, not even wanting to move, and thinking it would never get better, and then depression also set in. In the beginning I was only able to sleep a few hours a night because of the pain. And I think I could only sleep in one position on my back for the first 2-3 months. Anyway, that has all thankfully passed now for me and you will soon be able to get a full nights sleep without waking up too I’m sure. You just got to hang in there. It was hard for me to see the light at the end of the tunnel at times too, but it’s there, trust me.
But what you said about a catch 22 is spot on. If you stop exercising it helps with reducing the pain caused by the inflammation, but if you don’t keep moving enough then the stiffness increases and adds to more weakness, which adds to the pain in other ways. So you got to keep fighting it and find the right balance between rest and movement.
I think in the beginning, if I better understood the relationship between inflammation, stiffness, weakness, and pain, then perhaps I might have tried to do more to keep moving the shoulder more in the beginning. Or perhaps I did all is was really able to do anyway. It’s hard to say. Just try and find your rhythm is the best approach though I think. You can always work through the stiffness later once the pain starts to go away.
Glad to hear you're almost all the way home with recovery!
You might be glad to hear that a nurse told me it may take up to 3 years for some to fully recovery depending on age and extent of injury they are recovering from. That's actually good news because it means you can still keep progressing.
I'm at 2 year 3 month on my left shoulder and it has still been recovering. Little things, like a tiny bit of extra strength and ROM improvements. And yes, there have still been days when I get stiffness and pain but not as much as during the 1st and 2nd year.
On my right arm I'm at the 1 year 3 month mark and it seems to be recovering faster than the left arm. Maybe that's because the extent of damage isn't as much and also it is my dominant arm so I use it more and maybe that's what helps it recover its strength and ROM faster as well. But again, even at the 1 year 3 month mark it is still improving week by week and yes I still do have a little stiffness at the end range and still some pain sometimes but it just keeps improving.
It sounds as if you are doing really well with recovery. My first shoulder surgery - which like yours was a bigger procedure than the right one - is really good now and was probably pretty good by 18 months. I was in considerable pain for at least a year so I am hoping that this one will be a bit quicker. It's good to know that your strength and ROM is improving still as it's something to strive for. I have a consultant visit next week (first and I suspect only one) so hopefully he will also think that things are going well. I hope you continue to progress.
Thanks jay...same to you!
The head therapist I had who was also a high school classmate, told me his mentor stressed: "Range of Motion! Range of Motion! Range of Motion!"
I'd urge all rotator cuff patients recovering from surgery to always concentrate on that. It's why I still do EVERY ROM exercise I learned EVERYDAY. And I even try and imitate the manipulation they did on my shoulder while I laid on the table.
I'll just lay on a mat on the ground and put my arm all the way back above my head and press down against it with the other hand, then shake it out. Repeat a couple of times. I hold these for 30-60 seconds. I'll put it up against a pole forwards and sideways, same hold time. I do these stretching exercises till I feel it almost but not to the point of pain. Heck I still do my peek-a-boo and cradle rock exercises still along with codman and pendulum exercises, wand exercises, and of course the pulley exercises and the finger ladder exercises on a wall or chainlink fence.
My therapist said it's a sawtooth progression cycle: stiffness, increased range of motion, stiffness, maybe even loss of ROM and pain, increased range of motion, etc. etc. But if you keep at it, you make progress gradually. And so it's been for these last 2 years. The therapist died, but I still hear his words of advice as I do my exercises.
Just as I thought things were moving forward well (still waking up every couple of hours in pain through the night) and hardly a twinge during the day; exercises stepped up a bit and a pretty good ROM, I feel I have now taken several steps backwards and instead of 14 weeks out of surgery I am feeling more like 6!
For no apparent reason - no heavy lifting - actually that's a lie - I lifted a box of five packs of A4 paper in a shop before I remembered it was my surgery side - but it was fine for a week after that, and a few days ago, the bicep and front of shoulder area suddenly became very stiff and painful to move.
However, I have read back over the replies to my original post and taking on board the advice and I am hopeful I will get back there. I am pushing through the ROM without overdoing the exercises and crossing fingers I get back on track. What a journey this is!
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