The everyday blog of Richard Bartle.
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11:21am on Friday, 7th July, 2006:
I went to see the physiotherapist today.
Oh, you didn't think my bad shoulder was cured, did you? It's not. I can do almost everything now that I can do with my good shoulder, except for put my hand behind my back.
Here's the way I see it. When I first went for physiotherapy, my shoulder was in a very bad state. Something had happened (maybe an injury, maybe some awkward movement, maybe just the mysterious, cause-free "frozen shoulder") and my body over-compensated for it. This left me unable to do a lot of things, eg. throwing was agony. Through a series of exercises, the physiotherapist managed to undo all these knock-on effects, until now my arm is almost back to normal. Except, that's still almost. The follow-on problems have all gone, but the original problem that sparked them all remains. If it's not cured, I'm looking at having to do daily exercises for the rest of my life to stop the secondary effects coming back, and ten years from now I'll have awful arthritis from all that graunching of muscle and bone.
The physiotherapist doesn't see it that way. She says that most people would be happy being able to do what I can do, and functionally there's nothing I need to be able to do that my shoulder prevents me from doing (the key test being "can you wipe your bum?"). I pointed out that this is like an optician saying you don't need glasses because you can always hold the book further away and stand in a bright light. Yes, you can get by, but that's not the point! My shoulder has a mechanical problem. It ought to work like my left shoulder, not like a generic person's right shoulder, and it doesn't.
I'd have been signed off now and sent home with a "speak to your GP, I can't do anything more" if it weren't for four things different about me.
Firstly, I actually do the exercises I'm set. By this stage in their treatment, most people have lost patience and don't. Last month, I had to throw a ball at a wall 100 times a day, and except for the day when I was in Portsmouth, I did.
Secondly, I have (apparently) exceptional muscle control. I can switch a muscle off when told to. Thus, if asked to do something but "don't use your pecs", I can do it. This means she can try unusual exercises on me that would be tricky to for other people. In particular, she can invent new exercises she's never tried before, knowing that I'll be able to do them (and, as I said, will actually do them, too).
Thirdly, I can articulate my problem. Not only can I say that something hurts, but I can say where it hurts and (importantly) how it hurts. It's uncommon for patients to be able to describe how their muscles feel like they're moving, and how they feel they ought to be moving, and for them to have any kind of mechanical model of what their body does. It's a lot of help to the physiotherapist if a patient can do that, and I can.
Fourthly, I moan and complain and get grumpy when she tries to suggest that maybe we should just leave it. I didn't pay good money to have my shoulder fixed only for it not to be ... I admit ... but if I had then I wouldn't consider how it is now as an acceptable result. There's an outstanding mechanical failure and I think there's a mechanical solution.
So today we had a discussion of what the problem felt like to me, in which I used my left fist to represent my shoulder capsule and my right hand to represent a band of muscle over the top of it, my right fingers slotting into grooves except for the middle one which was on top of the left middle finger instead of in the slot between middle and ring finger. The middle finger was like where my shoulder hurt, because it wasn't in the right place. The physiotherapist said that this looked a lot like the way the biceps attach to the shoulder, and although there's no earthly reason why that should stop me from being able to move my arm behind my back, she had no other ideas left as to what to do. Thus, I have to do some biceps work for the next month, standing on one end of a theraband with the other in my right fist and pulling while my elbow remains behind the plane of my body. It's supposed to stretch some tendons, which may make them loose enough to click back into place. If that doesn't work, she's out of ideas and I'm out of luck.
Whatever, I still apparently have my uses. There was a student physiotherapist in the hospital today, and I was the patient she was asked to come and observe. Maybe it was the equivalent of the sick-bag test they do for air pilots: if you can stand to look at a lump of sticky, white, flabby, pock-marked skin and still perform your duties, you're made of the right stuff to be a physiotherapist.
I've left my body to medical science when I die. I wonder if the physiotherapist will call dibs on my shoulder, just so she can find out what was really wrong it after all?
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Copyright © 2006 Richard Bartle (firstname.lastname@example.org).