How many ways are there to open a bottle top? As a rule, we hold the bottle and then twist the top, but an equally effective method would be to hold the top and twist the bottle.
And when it comes to treating patients, osteopaths and physiotherapists tend only to use the first method. By this, I mean that when someone comes in complaining of shoulder pain, we move the arm whilst the patient lies still. We don’t often fix the arm and move the body around the shoulder to create motion.
I’ve found this concept of fixing one body part and driving another to be very useful when thinking of how to help my patients. On recovering from shoulder surgery myself, I used it to help speed up recovery to great effect.
Five months ago, when wheeling a bike down my steep drive to put it away, my feet hit a mossy patch and I fell. The bike lifted up into the air, so that all the weight came crashing down onto my left elbow, driving the upper right arm up into the shoulder. Within a few days I realised I had done something serious. I had no strength around the shoulder and it felt like a broken chicken wing.
I let a couple of weeks drift by, hoping by some miracle that the shoulder might improve. It became clear that this wasn’t going to happen, so I decided to pay for a private MRI scan. Fortunately, immediately after the scan I was able to speak to the consultant radiologist who confirmed that I had indeed suffered a massive tear of the rotator cuff. He explained that the shoulder was now unstable and without an operation osteoarthritic changes would quickly follow.
Going Under the Knife
After a four month wait, I finally went under the knife. Shoulder surgery is notoriously painful in the days and weeks following an operation. Concerned, I researched the best possible exercise strategies and how long recovery might reasonably take.
The consensus seemed to be that rehabilitation was going to be extremely painful and I would need to have some strong painkillers lined up. Typically, it would be 12 weeks before I could expect to restore some significant functionality, for example, being able to take my hand up to the back of my head. Being self-employed, I hoped to be back at work within six weeks and my impression was that this was going to be very hard to achieve.
Before leaving the hospital, I was given stern advice not to remove the sling night or day for three weeks, apart from washing gently around the shoulder.
Movement to Stimulate Recovery
This brings me back to the different ways to open a bottle. On arriving home later the same day, I quickly made use of the idea that I could rest the forearm of the operated shoulder, within the sling, on a bannister and move my body around the fixed arm. Furthermore, as I could feel my neck and thoracic spine stiffening up, I put my non-operated hand up onto the door frame above my head and again created motion around the good shoulder and upper back.
The following day, although weak and groggy from the operation, I continued with the movements of the previous evening. I then began to experiment with placing the forearm on a Pilates ball and gently moving back and forth. By the next day, I only needed paracetamol and Ibuprofen for pain relief and felt able to progress the exercises without the sling. I never worked into pain or thought about stretching the joint but simply created movement around the shoulder.
By the third day at home, I felt comfortable without the sling and, nervously that night, I tried to sleep without the support. This proved successful, so from that point on I left the sling off. The next challenge was to pick the Pilates ball up and bounce it like a basketball.
Within a week, I felt confident to go out for a bike ride and for long walks in the hills around the small town I live. I continued to explore movements which ‘switched on’ the shoulder muscles. In the end, it is only movement that matters and it is only movement that stimulates recovery.
Five weeks on from shoulder surgery, I can now gently swim and am ready to return to work. I feel I have learnt an enormous amount from the rehabilitation process and believe I can apply these lessons to patient issues, such as ‘frozen shoulder’ and impingement syndrome.
Watch video highlights of Hugh’s exercises
For more information on shoulder issues or to book an appointment in Bridgnorth or Shrewsbury, please call 01746 761050.