Posts Tagged ‘physical therapy

11
Feb
14

Carpal Tunnel Syndrome … oh no, not again!

Carpal Tunnel Syndrome … oh no not again!

Carpal Tunnel Syndrome and the Ulnar Nerve

It began this afternoon, a twinge on the inside of my left wrist, and then the sudden awareness that my pinky finger and ring finger were feeling a bit numb. Talk about an “oh no” feeling, I had surgical treatment for the same thing in my right wrist about nine years ago, so the thought of having to repeat is not exactly high on my list. While carpal tunnel syndrome generally entails a narrowing of the sheath where the nerve that feeds the thumb, index and middle finger (medial nerve), it can also cause symptoms in the Ulnar nerve.

Thinking about it and given that I’ve had relative wrist health (with the exception of a ganglion cyst on my wrist as a result of rehab on my shoulder), my first question was what’s different?

procare-imak-smart-glove_2The obvious culprit was a new keyboard at work–slightly smaller, lighter and not as angled as the previous one. I certainly hadn’t given it a thought, but as each new key stroke caused yet a new ache on the top of my wrist, I knew I was probably onto something.

The mechanics of my body position in relation to the keyboard aside (which will have to get dealt with tomorrow), my task now is to immediately reduce the inflammation, which includes taking an anti-inflammatory (ibuprofen or aspirin). Next up will be wearing a wrist brace to keep it angled in a non-stress position for a few days. There are also a series of exercises that can be done to aid in wrist health. The main thing is to address it fairly immediately and if it continues over a few days–to seek out medical attention.

Carpal Tunnel Exercises

For further information here are some links:

National Institute of Health: Carpal Tunnel Fact Sheet

University of Maryland: Carpal Tunnel Syndrome

The main thing is to see if non-invasive treatments can be started to mitigate the problem before it gets to the point of requiring serious medical intervention.

Physical Therapy exercises for Carpal Tunnel:

Yoga exercises for Carpal Tunnel:

24
Nov
12

Off to Gleason’s Gym …

Off to Gleason’s Gym …

 

I’m off to Gleason’s Gym today for the first time in a while. PT has been helpful in bringing back a good portion of my range of motion and strength, but I’m about to put all of it to the test when I work the speed bag for the first time.  Since I’m still only at about 165 degrees (should be well past 180), it’ll be an interesting challenge to say the least.

More than anything, I’m looking forward to seeing my trainer, Lennox Blackmore, who is himself coming back from knee replacement surgery!  Talk about the “blind leading the blind,” but given my state of things slugging s-l-o-w-l-y will be just about my speed.

Coming back from any injury is never easy. If I can use mine as a case in point, I will note first off that as savvy as I thought I was about what the surgery and recovery entailed, I truly underestimated how much it would affect my life and how long the process would take.

Setbacks also happen–thankfully not in all cases, but in when they do, as in mine when my shoulder “froze” it may mean adding months to the recovery process.

Losing the use of one’s dominant arm or other part of the body that is intrinsic to normal functioning for several weeks also takes its toll physically as well as psychologically. If one has been very active, the sight of one’s clipped wing or damaged leg is no fun and no matter how many pep talks one gives oneself, there are those moments.

Mine came when my physical therapist demonstrated an exercise on my body that I literally could not do without his help. It was about 12 weeks into the process and there was something so visceral about not being able to do a movement that had seemed so simple that it released the flood gates of pent-up feelings about the experience.

It was certainly a “first you cry” moment, but in the parlance of my grandmother when it’s all over you wash your face and “do.”

Those cathartic moments are likely a component of any recovery process and if they happen, there’s nothing wrong with giving into it until one can shake it off to go back at it the next time. In my case, I was able to do the movement on my own at the next appointment – and I will say it remains my proudest moment in PT.

Unfortunately, we don’t have Dr. Crusher to wave a magic wand on our limbs to heal our ills.

The fact is as great as orthopedic medicine has become the aftermath to surgery entails a bit of a slog to get back to full physical health.

As experiences go, however, it is certainly far from the worst that life has to “offer,” and each bit of progress brings one that much closer to the goal of regained strength and mobility–all it takes is perseverance, consistency and patience!

01
Jun
12

Moaning and groaning … oh yeah, about that shoulder!

Moaning and groaning … oh yeah, about that shoulder!

Shoulder Anatomy (Credit: Massageitsgoodforyou.wordpress)

Oy … so here’s the story.  Back in December my shoulder started hurting after boxing.  I didn’t think too much of it and let it slide for a while.

By February I noted serious “ows” when I swam–so I stopped doing that, but kept boxing, avoiding things like the right cross.  By March it was still hurting and making “popping” noises so I saw an orthopedist and after getting an MRI got the diagnosis:  A torn labram.  Specifically, I was diagnosed with a SLAP Tear (Superior Labrum from anterior to posterior), a tear where the biceps muscle tendon connects with the labram in the shoulder joint.

Labram Tear (Credit: Healthandfitness101.com)

Here’s a good explanation from About.com: An injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior toPosterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.

The MRI also showed tendonitis of the supraspinatus tendon (the tendon at the top of shoulder) and bits of inflammation in a couple of other places).

Next up was a course of physical therapy — and no more boxing for the duration.

I worked with a terrific therapist name Eddie who patiently took me through a myriad of stretches and strengthening exercises.

Twice a week I  lay on one of the tables while I had a heat pack applied to my shoulder that felt GREAT–for a few minutes. Next up was a massage and gentle manipulation to try to improve my range of motion–and get me out of pain.

After the heat and massage came the hard part: lots of exercises to strengthen the rotator cuff muscles and improve range of motion which I had already begun to lose. The biggest problem was my shoulder was feeling even more unstable–meaning lots of popping when I moved it plus it hurt even more after PT was done.  In other words, not a great sign.

So … back to the orthopedist I went only to learn that I was also developing a frozen shoulder, meaning my shoulder was stiff and losing range of motion big-time.

I’d already known that I hurt when I tried to move my arm up and to the side or across my body–but the shocker was realizing that I couldn’t scratch my back anymore on my right side. I had also started to wake up in the middle of the night in pain, and trying to put on a sweater was becoming a challenge (not to mention hooking a bra!).

In other words my favorite shoulder Yoga pose was a pipe dream and I could no more do the pose than launch into space.

Options??  Well pretty much only one if I want to gain back the use of my right shoulder — arthroscopic surgery to repair the labram tear, clean up the “junk” around it  and to “unfreeze” those parts of the shoulder capsule that are impeding range-of-motion.

Arthroscopic means that the surgery will be performed through 3-4 small incisions around the shoulder using a camera and specialized surgical instruments.  Depending upon the severity of the repair, tiny ceramic screws may also be inserted to help stabilize the shoulder joint.

Surgery typically runs from one to two hours and may also entail repairs to the biceps tendon depending upon the amount of damage.

Recovery is another challenge. Immediately post-op, patients wear an ice-pack on their affected arm for 72-96 hours and pretty much keep the arm immobilized in a sling for upwards of four weeks.  PT starts pretty early though and patients usually start a course of exercise from about the second day or so.

The prospect of surgery is miserable to say the least — but given that I can’t even run because the motion hurts my arm gives some indication of its necessity.  As my surgeon said, if I want to be active at all, I kinda’ have no choice and given that I DESPERATELY want to box again, onward I march into a summer in recovery mode.

My surgery is scheduled for June 20th at NYU/Hospital for Joint Diseases.  I’ll let you know how it goes from the other side.

For further information on Labral tears here are a few good resources.

Johns Hopkins Orthopedic Surgery

NYU – Shoulder Labral Tear

American Academy of Orthopedic Surgeons

28
Apr
12

Missing the gym …

Missing the gym …

Gleason's Gym

Okay, I promise this won’t be a “boo hoo” post or anything, but I’ve got to tell you having a boxing related injury plain s-u-c-k-s!  I mean really, I can’t even put a jacket on these days without a yelp, never mind shadow box!  Even my old shower favorite, slip the water streaming out of the nozzle isn’t exactly cutting it and I’ve got to tell you that attempting a run with one arm pasted to the side of your waist is ridiculous!

When I have gone to Gleason’s Gym over the past three weeks, I’ve been downright wistful.  I mean there were tons of women there last Saturday for the second annual All Female Boxing Clinic — exciting right? — and even saw my friend, wait for it blogger Amy Scheer, who’d come in for the clinic, but was I elated?  The answer is no, I actually felt kind of sad.

Well it seems I am not alone in all of this.  Medical scholars are pursuing research in the psychological effects of sports injuries on Saturday athletes like myself on through elite practitioners.

In a journal article for the Journal of Sport Behavior (1994), authors Nancy Quackenbush and Jane Crossman have written that:

… athletes experience feelings of separation, loneliness, guilt and a loss of identity and independence, because they feel that they are no longer vitally contributing to the team and that they are reliant upon others in the rehabilitative process. 

The fact is that athletes and fitness enthusiasts get injured all the time, when injuries necessitate time away from cherished activities, however, it is important to understand that recovery is not only physical.  There can be a psychological component as well.  And just as it takes a long time to build-up skills to a level of one’s own peak performance, rehabilitation of the injury doesn’t happen overnight either.

If I use my own recovery as a case in point, my shoulder rehabilitation is actually progressing.  During my first week of physical therapy, I could only use one-pound weights for certain of the strengthening exercises, however at the onset of my third week I progressed to three-pound weights.  And sure, it still hurts, and on some days worse than others, but I can actually lift my right arm straight up which I couldn’t do at all in my first week.

My basic four rotator cuff exercises. (Curtesy JumpUSA.com, Topic #474)

And I guess that’s part of the secret. Realizing that progress is relative.  That, and giving yourself a kick in the butt for feeling sad at those points when being in a place like your favorite gym usually brings you nothing but joy!

I also came across a helpful article on coping with sports injuries that may be of interest to anyone going through the same thing.  The link to the article by Elizabeth Quinn is here:  Coping with Sports Injuries: Sports psychology strategies for coping with and recovering from injury.

It is worth the read!

03
Apr
12

Loving boxing and my right shoulder …

Loving boxing and my right shoulder …

Christina Cruz (l.) beats Florina Novac to take record sixth Golden Gloves title. Credit: Ken Goldenfield/NY Daily News

Aside from my absolute joy at the fact that Christina Cruz won her sixth (count ’em) New York Golden Gloves Championship (not to mention that she is the 2012 USA Boxing National Champion at 118 pounds!) boxing has definitely had the better of me lately.

And while I go to bed thinking about my left dig and wake up thinking of how to work in the left hook off the jab,  my body isn’t cooperating in fact it’s in downright rebellion what with a labral tear in my right shoulder socket (that’s along the top, a classic repetitive stress injury from banging) and supraspinatus tendinitis (yep, plus a rotator cuff injury)!

Ssssh…. Talk about the proverbial “bummer.”

To go back a step or two, I’ve had intermittent pain in my shoulder area since about Christmas, mostly when I’d throw a right cross and sometimes on the speed bag.  It wasn’t awful, but if I moved my right arm back, I yelped a definite “ow.”  I was easy on it and figuring to lighten the exercise load tried swimming. It turned out that didn’t work out well either as I could only swim using a Side Stroke because the overhand movements of the American Crawl stroke — and the lateral movements of the Breast Stroke caused even more ows than boxing.

The ouches seemed to subside and I thought, must be a trigger point or something because the discomfort was mostly felt in the back of my arm.  Still, it didn’t go away, and I began thinking it might be a rotator cuff injury which can be more serious.

Rotator cuff injuries up to and including actual tears involve the tendons and muscles outside the shoulder joint where the tendons attach the muscles to the humerus (arm) bone.

According to the Mayo Clinic, “A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a baseball or placing items on overhead shelves.”

In the case of boxing, the constant repetitive motion of throwing punches, not to mention, banging away, hard, on heavy bags, pads, not to mention sparring can certainly cause injuries.

With that in mind I headed over to an orthopedist at NYU/Hospital for Joint Diseases and within about five minutes, some “popping sounds” and several pushes on my right and left arms he was convinced I was suffering a rotator cuff problem and ordered up an MRI to be followed by physical therapy.

It was only after receiving the results from the MRI that it became clear that I had both a labral tear along the top of the labram — also called a SLAP tear (Superior Labrum Anterior-Posterior — aka top of the labram running from front to back), as well as tendinites of the supraspinatus tendon at the top of the shoulder.  In other words, “ouch.”

After talking it over with my doctor, we both agreed that a conservative approach was preferable, so the next will be physical therapy (tomorrow) with a focus on treatment, pain relief and muscle strengthening to give better support to the shoulder area.

Unfortunately, when it comes to SLAP tears, the alternatives after physical therapy can be rather bleak — as in arthroscopic surgery, though my doctor feels strongly that the physical therapy should do the trick, and with your indulgence I’ll likely write another piece about the physical therapy process once it gets going.

The real cautionary tale here is that if you shoulder is starting to “catch” when you pull your arm back, or if you find it aching to the point of an “ow”  after a work out, do get it checked out.  There are, it seems, a lot of things that can go wrong with the shoulder — and a good course of physical strengthening of the muscles in the area, as well as good warm-ups may mean the difference, especially if you are shall we say … older!

For some more information on rotator cuff injuries and SLAP injuries here are some links!

Medline Plus – Shoulder Injuries and Disorders (site has a lot of links for possible disorders)

WEBMD Shoulder Slap Tear (good general discussion)

Lenox Hill Hospital – Rotator Cuff Exercises (tips on strengthening)

Lenox Hill Hospital – Shoulder Pain (general disorders with links)




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© Malissa Smith and Girlboxing, 2010-2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Malissa Smith and Girlboxing with appropriate and specific direction to the original content.

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