My shoulders – ART Treatment & Rehab Log

Hi Everyone,

Firstly I should say that I wasn’t sure where it was best to post this but my hope is that this will eventually evolve from my Treatment Log into my Rehab Log and then into my Workout Log. I will be grateful for any questions, advice or criticism along the way. I already have a copy of The Book and a pair of rings waiting for when I’m ready to use them but I’ll take it slowly. However my main reason for posting this here is a selfish one. I don’t have a lot of faith in my own self-discipline so I hope that keeping track of my recovery here will help me stay “on the straight and narrowâ€. If I can obtain some feed back on what I’m doing, provide information or a warning to other people, or anything else, that will be a bonus. I figure this will also prove to be a valuable source of information to journalists and commentators covering whatever events I decide to take part in at the Olympics next year!

My shoulders - Starting point

I am 31 years old, 178cm tall and I weigh around 75-80kg. I have played rugby union since I was 8 years old and until moving from the UK to Japan 18 months ago spent about 7 years playing rugby union through the winter season and rugby league through the summer season (basically rugby 12 months a year). I also do some climbing and have dabbled in martial arts since being in Japan.

Both of my shoulders are injured through a mixture of bad luck and ignorance about proper prehab, injury care and rehab. My right was initially injured nearly two years ago playing rugby league and I now have a partially ‘Frozen Shoulder’ (adhesive capsulitis). The range of motion is quite limited and many movements are painful. My left was injured about 8 months ago doing some Judo training (trying to resist getting thrown when I was probably better off accepting that the other guy was better than me and falling properly). My shoulder was sore afterwards and I couldn’t lift my arm very far initially but it didn’t seem swollen and it started to get better after a week or so. The range of motion has remained poor though and it is more painful than my right. When it is cold at night I am woken up by the pain. I have had several sessions of acupuncture, which initially helped the right shoulder, but the progress seemed to stop.

I have continued playing rugby occasionally (there’s so much social pressure to participate when it comes to team sports) and I have done quite a lot of bouldering in the misguided belief that this might be beneficial. My attitude always used to be “keep doing what you can doâ€.

I was looking around for shoulder stretches that I could do to try to regain some of the lost range of motion and hopefully alleviate pain. That’s what led me to the GB forum and THAT has played a huge part in me gaining a much better understanding of what I should be doing, so a HUGE thanks for all of your help so far.

I spent some time reading this forum and gathering some more information. I tried some of the shoulder stretches: Wall Extensions on the floor, for which I needed a small dumbbell in my left hand just to get it down to the floor, shoulder dislocates and the stretches from Slizzardman’s ‘Fix Your Shoulder Pain’. These felt really good but weren’t really getting me better. So I continued to read around here and some other sources and decided to find an ART Practitioner in the belief that I had a partial ‘Frozen Shoulder’ on both sides.

Chiropractic and ART Treatment

There are only a few ART Practitioners in Japan but I am now going here: http://homepage2.nifty.com/advancedhealthcare/en/main.html It’s a practice run by a father and daughter. They seem well qualified, reasonably priced and most importantly the daughter, Dr. Abe, speaks excellent English (my Japanese is definitely not good enough for dealing with this!).

First session on June 18th:

Diagnosis:

The diagnosis was partial ‘Frozen Shoulder’ on the right but the left is more severe. I had a type 2 Separation – a torn Acromioclavicular (AC) Ligament and damage to the Coracoclavicular Ligament. So obviously a much bigger problem than I had thought. :oops: What makes it worse is that about 10 years ago I broke my left clavicle (playing rugby). It healed with a small overlap; I did minimal rehab at the time and basically haven’t thought anything of it since. Now there is a lot of scar tissue under the clavicle and the biomechanics on the left side are permanently altered. This is not the cause of the problems I have now but it left my shoulder more susceptible to injury. Basically the left shoulder is kind of a mess right now.

Treatment:

Dr. Abe worked on both shoulders, told me to ice afterwards and gave me stretches for the right. Also told me NO stretching back movements with the left which conflicts with the stretches I had been doing to try to improve RoM.

When I got home I followed a hot/cold shower protocol. I am trying to take around 6 grams of fish oil a day and will steadily up this. I am also increasing my Vitamin C intake. I will rest completely until Dr. Abe says otherwise. My shoulders felt tired and sore for 2 days after this first session.

Second Session - June 21st:

Right:

Already feeling improvement! During this session I felt my shoulder moving in ways I had forgotten it was supposed to be able to! Part of the treatment was movements similar to wall extensions but keeping the elbow joint at a right angle and with Dr. Abe pinching hard at a specific point in my arm pit. This was VERY uncomfortable but I felt good after it.

Left:

Can’t feel improvement this side yet. Dr. Abe worked on it including some work on stretching out my traps, which I didn’t realize were so tight. Then used ultrasound to stimulate fibers to settle in correct form. Taped my shoulder up to provide some additional support.

I told Dr. Abe I had followed a hot/cold shower protocol. She said that in my case this wasn’t going to be of any extra benefit and that I should just ice it after treatment. Alternating hot and cold is better if there is swelling but just a normal shower and then ice is fine for me. Also asked her about fish oil as mine is from the local drug store and I’m not sure about the quality. She said she wasn’t in a position to recommend a particular brand but told me to also consider flax oil and shiso oil.

Dr. Abe told me her Dad had suffered a severe shoulder dislocation from Judo a few years back. He’s a 70 year old, seventh dan, who still goes to the Kodokan regularly to train! I asked him how it was now and he said no problem at all.

My shoulders felt tired and sore again after this session. My left shoulder is currently more painful than when I started the treatment but I guess this is a necessary part of the process. I will confirm this with the Dr. in my next session.

Thanks for taking the time to read through. I’m sorry, this is a really long post. But this brings anyone who is interested in hearing about my progress (or otherwise) with this kind of treatment up to date. I will have my third session later today (23rd) and I will try to keep this log up to date. Believe it or not I have tried to keep this post fairly short so there are inevitably details I've left out. If you feel like asking me about anything, please ask away.

Welcome, Yorkie!

Dr. Abe sounds like she knows what she's doing if she got her 70 year old dad back to daily Judo practice! Best of luck to you in your rehab. Keep us updated!

Interesting.

I have heard in the old days in Japan, it was the senior judoka that often were bodyworkers of some sort. Here in the states, it tends to be those in aikido instead from what I have seen.

That is awesome to be helped by a nana-dan.

Thanks for commenting guys.

Dr. Abe sounds like she knows what she's doing if she got her 70 year old dad back to daily Judo practice! Best of luck to you in your rehab. Keep us updated!

It’s pretty humbling (and inspiring) to look at a seventy-year-old guy and know for a fact that he’s in better shape than me! I don’t think Fujii-sensei trains every day but he certainly trains pretty frequently. There are plenty of guys of this age and higher at the Kodokan. They tend to stick to ne-waza and kata practice to reduce the risk of falls and injuries.

I have heard in the old days in Japan, it was the senior judoka that often were bodyworkers of some sort. Here in the states, it tends to be those in aikido instead from what I have seen.

That’s absolutely right. In fact this is from the website of the clinic I am going to:

Judo Therapy is known as an osteopathic medicine or traditionally known as " bonesetting "in Japan. Since the beginning of the 17th century, Judo instructors (masters) have provided first-aid and care for various acute Judo injuries. Judo Therapists have treatment techniques for various closed fractures, dislocations, sprains, and strains and also are able to perform evaluation, reduction, immobilization, and rehabilitation techniques for those conditions.

A Judo therapist holds a national license that grants the ability to treat injuries to bones, joints, muscles and other soft tissues through the conservative therapy (without operation) based on Japanese traditional medicine or Judo therapy skills (which have been utilized and trusted by people for many centuries) and Western medical knowledge.

I did a little Aikido (I have to admit I got bored with it though). One Sensei at the Dojo was a healer (sorry, I can't remember the name of the type of healing right now). I never saw this first hand, but friends told me that in a class they had occasionally seen him go up to someone and ask if they had any pain. When the student had pain in a certain place he would put his hand on them for a while and that was enough to make them feel better. :? He was a really lovely guy but there were some very far-fetched seeming stories about him. On the other hand I've only scratched the surface of Martial Arts training and understanding of the body, so what do I know?

I think that between Fujii-sensei and Dr. Abe there's a great blend of traditional and cutting edge knowledge of healing though.

Third Session - June 23rd:

Right:

RoM has definitely improved on this side. Dr. Abe said that it is almost normal now. There is still pain (faint even while the shoulder is neutral) but there is less pain at the extremes of the movements. Dr. Abe and Fujii-sensei worked together on it. The Dr. pinching my arm pit or sticking her thumb hard into the back of my pec while her dad manipulated my arm into various positions. This was only part of the treatment but it seems to be the most beneficial thing at the moment.

Left:

Difficult to say if this side has improved or not. The Dr. will ask which positions/movements are the most painful and focus most of the work there. The position causing the most pain in this session were different to the ones causing the most pain last time. So maybe the work on what was my most painful area last time has had some success and now a different area is the new worst. In this case I guess it is starting to improve.

I had some more ultrasound and felt really good after that but that might be largely the effect of the cooling gel!

Lastly the Dr. took a good look at my scapula movement and then gave me my first rehab exercise:

'Push-up plus' - 15 slow reps x2 daily

This is earlier than I expected to start rehab and its surprisingly exciting to be told to start doing this one simple exercise – I'm back in the game!!! And she said I might get some theraband exercises next time!

I asked the Dr. whether it was expected that my left had been more painful after the first couple of sessions than before starting treatment. She said yes but to make sure I’m doing plenty of icing (I have been). Today, after the third session the left has been in less pain (she’s put more tape on this time so that might be helping).

My next appointment is on Saturday. I asked if it was worth me booking a double appointment (as there are two injuries). Dr. said it won’t really help. The longer she works on the shoulders in one session the more inflamed they will get and they are getting enough work each in a single session. Actually, one session is supposed to last 45mins but each one I’ve had so far has been over an hour.

Holy crap batman, you hit the jackpot with treatment! That is so cool! I'm glad things are improving so quickly, I hope that continues!

To note, Judo has only been around since the late 19th century. It's father, jujutsu often had bone setting and joint relocation incorporated in some systems.

From what I know, chiropractics is considering very new in Japan compared to bonesetting/osteopaths.

Also bare in mind, from what I know the Americas don't have any system of bonesetting. Other cultures from the Old World did though but it never seemed to take root here.

That's part of Osteopathic medicine. They are the AMA's bonesetters. To be honest, the techniques of Osteopathy and Chiropractic are essentially the same these days, which is why a lot of people think there should be a merging of the fields.

I think the AMA reluctance to recognize the true importance of complementary medical approaches will greatly delay that, but I think that in the end it is inevitable, barring some sort of disaster that wipes out current knowledge.

Osteopathic techniques almost certainly came from the various immigrant bonesetters and were probably compiled over time.

Holy crap batman, you hit the jackpot with treatment! That is so cool! I'm glad things are improving so quickly, I hope that continues!

Thanks Slizzardman. I’m really happy with the situation after the first week of going there. I wouldn’t have found the place if I hadn’t been specifically looking for ART practitioners following the recommendations made by yourself and others so thanks very much.

I’m glad you commented here as I wanted to ask you about Jin Gu Die Shang Wan. You mentioned it in this thread:

http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=4876&hilit=jin+gu+die+shang+wa&start=15

I hope you’ve been injury free since then and not had to try it, but if you have I’d love to know what you think. I asked my wife to quiz the acupuncturist that we've both used about it (he’s recommended Chinese meds to her in the past). He said he had not heard of it but recommended we speak to the Chinese medicine people he deals with. My wife called them and interestingly they said that they didn’t think it was an authentic traditional Chinese medicine as such but was kind of a newly blended thing. That’s not to say it’s no good of course and the ingredients are nothing new. They recommended something called (in Japanese, don’t know the Chinese or English) Shintsutsuiootou which is for blood circulation and joint pain relief. I’ll ask at the clinic if they have any thoughts about either of these when I’m next there.

To note, Judo has only been around since the late 19th century.

Ha ha, I wondered about that. I guess they didn’t want to get into the history of judo itself on the website but still wanted to convey that the practices were that old. Maybe a little bit of a Lost in Translation effect.

Fourth Session - June 25th:

Right:

More of the same. Fujii-sensei wasn’t there today so I didn’t have both of them working it together this time though.

Left:

Dr. Abe focussed a lot more on this side today. There’s still plenty of work to be done. It can be quite frustrating as I’ll identify a movement that is causing pain and then I’ll do what feels like exactly the same movement again and there will be no pain. :? I think generally speaking though the Dr. is gaining more understanding of the detail of my particular issues. The tape that was put on last time has started causing a skin rash so the Dr. didn’t put any on this time to give the skin a rest. I don’t know if it was the tape that meant I had little pain in the left side after the last treatment so it will be interesting to see if no tape means there is more pain this time.

No ultrasound today.

got a Theraband and a program to complete with it. So currently my daily rehab program is:

Theraband-work:

Abductor (front of body & behind).

Adductor (front of body & behind).

Extensions

Depressions

Flexions

External Rotations

Internal Rotations

All of the above to be quick reps over small RoM, each for 45-60 secs.

'Push-up plus' - 15 slow reps x2

I can only make an appointment either Tues or Thurs next week. Dr. Abe said Thurs would be better to give me a few days to test out the exercises and let my skin rest.

Interesting. I wonder what her reasoning is for the phasic exercises. Shouldn't be bad, I'm just curious. Could you ask next time and let me know?

I have not gotten the Great Mender yet. Realistically, anything that improves circulation in the connective tissue or in general is going to help tendon healing. Even something as simple as long periods of moderate direct heat application, whether it's from infrared lamps or a simple heating blanket, can dramatically speed up healing.

I recommended this to Dillon and it helped him immensely. Perhaps he can share his personal experience.

Edit: The tendon soaks from Suigetsu Shop should work quite well. I have used their medicated patches and had great results.

Interesting. I wonder what her reasoning is for the phasic exercises. Shouldn't be bad, I'm just curious. Could you ask next time and let me know?

Yeah, I’ll ask when I go on Thurs and let you know the answer in my log for that day.

I’ve found that doing these exercises for a full 60 secs can be pretty tiring on the muscles being used. I think I’ll keep at least the Internal & External Rotations to 45 secs for now. Does anyone have any thoughts on the difference in effect between doing this type of exercise over 45 and 60 secs?

Realistically, anything that improves circulation in the connective tissue or in general is going to help tendon healing. Even something as simple as long periods of moderate direct heat application, whether it's from infrared lamps or a simple heating blanket, can dramatically speed up healing.

Yesterday I checked out a couple of local drug stores to try to pick up something to use short term. I was thinking of the little pads you can buy to keep your hands warm on chilly days. I found some little chinese med patches which said they were for blood circulation, warming and easing old injuries – Perfect!

These are only about 3cmx3cm but they are potent! I put 4 on my left shoulder and after about 5mins my shoulder was getting so red and warm I thought I would have to take some off! The reaction started to calm down soon after and they felt great for a few hours. I’ll post the name and what I can tell about what's in them later.

If these work as well as they feel like they might they will be a very cost effective and easy addition to my treatment. A pack which should last about a month cost me less than 800yen (so less than $10). The recommendation from the chinese med place that I mentioned above would cost more than ten times that and would take me half an hour twice a day to brew!

I've been reading through Slizz's Log and I'm starting to think there must be some truth in the rumour that Superman wears Slizzardman pyjamas!

It seems like the patches I have are very similar to something he has used:

Chinese medicine is awesome. I have medicated plasters, which are flexible highly adhesive band-aid-like patches infused with certain combinations of herbs along with menthol and camphor.

Anyway, the attached pic shows what I'm using. I don't know the name in Chinese but in Japanese they are called "Tenunkou" which simply translates to "Point Healing Plasters". They contain: DL-Camphor, L-Menthol, cinnamon oil and various acids. I also picked up some Shiso oil at the supermarket today.

The information in Slizz's log re. "extended duration iso's" has been very interesting reading. I'm sure I'll have plenty of time to read through it again :roll: and might plan to have a period focussing on this before getting into much else when I'm ready. Some CNS reprogramming might be just what the Doctor (the metaphorical Doctor, not Dr. Abe) ordered.

Fifth Session - June 30th:

I asked Dr Abe about the reasoning for the phasic exercises. She said that these muscles are the first to shut down after injury. I've been injured for some months so these have become very weak so I need to rebuild them to help stabilize the joint. If I do these exercises with a full range of movement it is easier for the big muscles to get involved and compensate for the weakness of the phasic muscles. Actually I was feeling some of these exercises in my pecs yesterday so I really need to remember to set my shoulders back and down before I start each one. Hope this answers your question sufficiently Slizz, but if not, or if your curious about anything else, just ask.

I had been noticing that during the Pushup plus as I come from the top of the movement down through neutral I have to make a small adjustment in my left shoulder or I get some pain in the bottom part of the movement as I squeeze my scapula in together. Dr. Abe has told me just to do the top part now.

Right:

More of the same. Still pain present in certain movements but slowly improving.

Left:

Very small differences in positions can cause a big difference in pain level and apart from the worst offenders there seem to be different movements causing pain each time I have a session. There is a range of possible problems complicating the main issue so 2 weeks from now if there is no significant improvement on RoM or level of pain Dr will do an MRI scan.

I can get a lot more movement if I relax my arm completely and allow it to be moved for me. As soon as I engage my muscles they pull or put pressure on the AC joint and cause pain and stiffness.

Dr Abe and Fujii Sensei together used a highly adapted version of the procedure I've had a several times on the right side. Its difficult to put this into words but I'll try. The starting position is my shoulder out to my side at 90 degrees to my torso and my forearm pointing up to the ceiling (I'm lying down on my back) elbow joint at 90 degrees also. Sensei then slowly rotates my arm down so that my forearm is parallel to my torso palm up (like the 'surrender' position at the start of a wall extension). Then, rotating at the shoulder, my arm is moved in a horizontal arc until my thumb is almost touching the top of my head (like a wall extension motion but keeping the elbow at 90 degrees) then Sensei pushes down slightly on my elbow. Throughout this the Dr is pinching hard at a specific point in my armpit. My left isn't capable of these movements but if I relax my arm and Sensei moves it in slight a waving motion instead of a flat arc we get as close as possible. I feel this has helped the right shoulder a lot so I'm hoping it can start to do the same on the left.

Finished with ultrasound.

Left shoulder has been taped up again. Baby tape this time to protect my delicate skin.

Daily rehab:

Theraband-work:

Abductor (front of body & behind).

Adductor (front of body & behind).

Extensions

Depressions

Flexions

External Rotations

Internal Rotations

All of the above to be quick reps over small RoM, 2 x 30secs or a short rest holding the band in the tensed position is OK if a full 60 is too fatiguing

'Push-up plus' modified - just top part now, 10 slow reps x 3

Next appointment is Saturday.

Sixth Session - July 2nd:

This was Saturday morning so I might not have been paying as much attention as I usually try to.

Right:

This side seems to be getting much closer. Mobility wise there is almost no problem now. There is still some pain and some clicking. I noticed as I walked to the clinic that the swinging motion of my arm causes a soft click each time my arm comes forward. I guess this has been happening for a long time. Maybe as other symptoms have faded, this one is now more obvious.

Dr. Abe worked more on the top of my bicep than she has previously.

Left:

Dr Abe was pushing back on the front of my shoulder more than previously during this session. The GH joint is damaged as well as the AC joint and the "ball" of the humorus has shifted forward and up.

Finished with ultrasound and the tape hadn't caused any skin irritation so it's been taped up again.

The rehab Theraband exercises are feeling more positive now that I'm being very cautious about setting my shoulders properly first.

I've also started to work through the mobilityWODs from the beginning, doing one or two a day.

Next appointment is Thursday.

I'll buy that. I played with the idea and found that to be very true. It takes a lot more concentration to focus on the small muscles during large movements.

Glad to hear you're still making progress! Take care of those shoulders!

Seventh Session – July 7th:

Right:

Dr. Abe focused more on right than left today. She’s keen to clear up the remaining pain from the movements. If I have my arm up behind my back with my hand between my shoulder blades I feel some pain in the front of the shoulder. Before this session, this pain was significantly increased if my elbow was pushed in towards my back but it has improved a lot after today. There are still some other movements where I am feeling pain and I’m still feeling the soft clicks.

Left:

The pain in some movements on this side has been reduced for sure. The worst movement however is an external rotation, bringing my hand up in front of my chest as though taking off a T-Shirt. This is not noticeably better than before I started treatment. Often, certain other movements will be painful the first time I do them and then the joint will adjust slightly and they’ll feel fine. Then as the Dr. returns my arm to a neutral position it’ll be painful, the joint kind of needs to adjust back into that position. This indicates hypermobility in the joint, the ligaments being stretched. I asked the Dr to what extent this can be fixed without surgery. She said it won’t be the same but by encouraging the formation of ‘good scar tissue’ and by properly traning the muscles to stabilize the joint it can function properly again.

She told me that in the past her Dad, Fujii Sensei, had completely or almost completely ruptured both of his achilles tendons. He had surgery on one but chose to treat himself on the other. According to him the one he treated himself is now significantly healthier than the one he had surgery on!

Next appointment Saturday.

Eighth Session – July 9th:

Right:

Dr. Abe continued to focus on making getting my hand up behind my back easier/less painful.

Left:

Dr. was more focused on this side again today. The external rotation/bringing my hand up in front of my chest movement described in the last post is still the most obvious problem. This is apparently a movement that should involve the GH rather than the AC joint. However when the Dr. pressed on the AC joint during this session the pain caused by the movement was significantly reduced. At the next appointment the Dr. will decide if she needs me to get an MRI scan done.

Daily rehab:

I feel like I’ve made some progress but its taken some time to get used to the exercises and honestly I may have only just have started doing some of them with the correct form. For example: I had been doing the external rotation with the band doubled up over the door handle. Now I’ve discovered that by shutting one end of the fridge door I can do it with the band at single thickness and am able to do it for a full 60secs this way instead of barely managing 45secs.

Dr. says that once I have made some sustained progress with these she might have me start using a BodyBlade.

Next appointment Saturday (Tues & Thurs were already fully booked this week).

Hey if you can do things with proper form that's major progress!

Hey if you can do things with proper form that's major progress!

Yeah, true.

I have to admit I'm looking forward to being given something new to do though! I have to remind myself that it has only been 4 weeks since I started treatment and maybe only a week since I started doing these rehab exercises properly.

I have been "enjoying" doing some of the stuff from the MobilityWOD site. Most days I've been doing one or two of the WODs from the very first one onwards. Not the shoulder ones (yet) but mainly focussing on trying to improve my hip and hamstring flexibility. I've not got as far as a lower back one yet but I think I'll look specifically for one today. I currently have a really crappy chair at work, which I try to get up out of as much as possible but I think its the cause of some lower back pain.

On another note: I'm taking an enforced break from using the Chinese Medicine patches. It's ridiculously hot and humid around Tokyo at the moment - 90°F most days and not much cooler at night. Being from the UK I'm not used to this kind of temp. I haven't stopped sweating for about the last 3 weeks. The last thing I want to do is to put warming plasters on my skin!

I've been busy and have had 2 ART sessions and a hospital appointment since my last post, so this is a general update.

At my appointment on Saturday 16th Dr. Abe asked me to get an MRI. In Japan this isn't something physios are able to do themselves at their clinic so you have to go to a hospital.

At the hospital the Doctor initially didn't think an MRI was necessary. His opinion at first was that I had a separated AC joint and suggested that the options for this would be either to just leave it or to get surgery. I was pushing him to do an MRI (as that's really all I was there for) but he said an X-Ray would probably be enough to confirm what he thought. From the X-Ray he found that the AC is slightly separated but relatively speaking not too bad. He couldn’t really tell anything about the GH joint and after some more inspection said that what might be more significant is damage to the muscle tissue in the supraspinatus. He also thought the fact that I get night pain supports this. He said that an MRI would be necessary in order to get more detail on the muscle tissue damage but that the MRI equipment at that facility was outdated and would not give sufficient resolution. He has referred me to a sports and shoulder specialist at Nihon Daigaku Hospital (the national university hospital) where the MRI equipment should be more up to date. He concluded by saying that, if this tissue damage is confirmed, it was likely that the treatment that would be recommended to me would be a course of injections (which I’m assuming would be corticosteroids).

10th Session - 21st July:

Dr. Abe looked at X-rays taken at the hospital. Focussed on supraspinatus and AC joint in left shoulder and continued to work on improving mobility in right shoulder.

I mentioned to her that the hospital Dr. had said that it was likely I would be prescribed injections. She says that in her opinion, in Japan steroids and antibiotics are used as default "magic-medicine" options by Doctors even more than in the US or Europe.

I have a new Theraband exercise targeting building up the supraspinatus:

Loop band around both hands. Hold hands out in front palms facing each other, push scapula down and keep fingers spread as wide as possible, keeping elbows on side of body as fulcrum, slowly open up hands out to the side then slowly return.

Keeping the fingers spread is apparently important as it creates a reflex reaction which puts the shoulders back in the correct position. Doing it with fists clenched would be very different. This exercise is replacing the 'Depressions" which were causing some pain.

I don't know if there's a name for these so for now I'll refer to them as 'Separations'.

EDIT: The Dr. told me today that tese are a called "Bragards" although I've tried Googling that and can only find information about a "Bragard's Test" which seems to be nothing to do with shoulders.

My daily rehab routine is now:

Theraband-work:

Abductor (front of body & behind).

Adductor (front of body & behind).

Flexion

Above are 1 x 60secs

Extension

External Rotations

Internal Rotations

Above are now 2 x 60secs

All of the above to be quick reps over small RoM

"Bragards" (Described above)

1 x 40secs

'Push-up plus' modified - just top part, 15 slow reps x 2

I have another physio appointment on 26th July and an appointment at Nihon Daigaku Hospital on the 29th.

I've had two treatment sessions since my last post. One on the 26th and one earlier today.

Dr. Abe is very happy with the progress on my right shoulder. Its not 100% fixed yet but if she was just treating this side would lower the frequency of my appointments now. Apparently some of my left shoulder movements are "Gliding" better now too. I have my hospital appointment tomorrow an will hopefully get an MRI done.

She said that I can start doing the entire rehab routine twice a day! I also asked her if I could do L-Sit and she said that she thought it would be good! Wooo!

I've already been doing arch & hollow holds ( 3 x 20secs for each) daily and now I can throw in L-Sit too!

Regarding the other beginner/warm-up holds:

Plank - For now, I think doing a total of 60 Push-up plus a day is sufficient without doing plank too.

Reverse Plank - I'm not sure if this will be good for my left shoulder, I'll check with the Dr. soon though.

Dead Hang - Same as above. But I'm more dubious about this one.

PB Support - Should be OK if L-Sit is OK, but I'm not sure where in my appartment I can do it. I don't even have any chairs, only a sofa and a bean bag. Only place I can think of is maybe with my hands on either side of the bath tub They're shorter but deeper here in Japan so it might work if I tuck my legs up a bit! I'll test it out but otherwise I'd have to go down the road to the kids play park, which would really break up my workout.

All in all, I'm feeling really optimistic that with a clearer diagnosis from the MRI, the extra rehab and more focus on my left now that my right side is much better I should be able to make more good progress over the next few weeks.

I have my appointment at Nihon Daigaku Hospital tomorrow and my next ART session on August 2nd.

I had my appointment at the hospital on the 29th and was expecting to get an MRI on that day but it was actually some sort of preliminary appointment. I went back to actually have the MRI on the 1st. I was pleased to see there were a lot of sports people around at this hospital including some pro Sumo guys (I'm not just assuming they were Sumo guys because they were big and er... heavy looking They dress a certain way when they are out and about and even wear a traditional fragrance to make sure they don't smell of sweat).

The doctor said that the MRI showed I had Impingement Syndrome, I've heard of this before of course but didn't really know what it was. I specifically asked if there was any damage to the AC or GH joint and he said he didn't think there was a problem. This is good news I guess, but a bit confusing as Dr Abe's diagnosis initially was AC separartion and perhaps also GH damage and the doctor who took the X-Ray a couple of weeks ago said he thought the AC was separated. Anyway, the recommended treatment was Hyaluronic Acid injections along with rehab.

It's my understanding that Hyaluronic Acid injections are not damaging (I checked with Dr Abe and with the Dr at the hospital but if anyone knows of evidence which differs please let me know). I had one injection and have an appointment for another on the 22nd. The Dr also said I could come to the hospital to do rehab, but I'd much rather do it at home.

The injection itself was painful but since my shoulder has felt significantly better. Its certainly not fixed yet though.

For some reason I have to wait until tomorrow to get a copy of the MRI so that I can let Dr. Abe see it. That's fine as I was able to change my next appointment with her from the 2nd to tomorrow (4th).

Sweet! Hyaluronic acid is what is in the joints anyways, it is a major part of synovial fluid. It won't hurt anything.

Slizzardman wrote:

Sweet! Hyaluronic acid is what is in the joints anyways, it is a major part of synovial fluid. It won't hurt anything.

Reassuring. Thanks! The first injection really has made a lot of difference. I haven't been woken up by pain in my shoulder since and am looking forward to the second one!

Again I've had 2 ART sessions since my last post and, as I hoped, I feel like some really good progress has been made.

13th Session - 4th Aug:

I finally got the MRI on a CD but Dr Abe can't check it at the clinic so she took it home to look at before my next appointment on 11th. The left shoulder is definately a little more flexible as well as having less pain since the injection. I'd say it's stiffness rather than pain that is restricting movements now. The right shoulder actually is the more painful now and there is still some clicking at the top of the bicep. The left is still noticeably less flexible though and is also weaker. Recently I have added side-plank into my daily work out. Two sets of 30seconds is relatively easy to hold but I get some shaking in my shoulder on the left side so I'm guessing this shows that the stabilising muscles still need some strengthening this side. Today's session was focussed on improving flexibility in left.

Dr. Abe suggested a couple of new swiss ball exercises:

1) Lie on back holding ball above chest, hands on each side of ball at 3 & 9 o'clock. Keeping arms straight, twist as far as possible one way then the other.

2) Lie on back and throw ball straight up high and catch. This is for proprioceptive rehabilitation.

I don't have a swiss ball at home but I can do number 1 with a pole and number 2 with a rolled up pair of jeans tied up with a belt. :wink:

14th Session - 11th Aug:

This was a really good session. Having looked at the MRI, Dr. Abe agrees that some inflammation or scarring of the Supraspinatus muscle is leading to impingement. The AC joint is not damaged according to the MRI but there remains more space in the left AC joint than right. I think that the ART work has essentially fixed this joint as it was definately hypermobile when I began and is much more stable now. I guess the space in the joint is consistant with what Dr. Abe told me about not being able to put the shoulder back to the way it was as such (i.e. shorten the stretched ligament) but being able to restore function by encouraging "good scar tissue". On the right side Dr. Abe worked on the remaining painful movements and is trying to reduce the clicking. For the first time I had ultrasound on the right side not left.

On the left side this session resulted in some really good progress in flexibility. I think that now Dr. Abe is more confident that the AC joint is better she is able to work harder on this. I've noticed a big improvement in the couple of days since. For example, I can do stick dislocates with my hands 10-15cm closer together now!

Dr. Abe has asked me to continue doing 1 daily set of the small RoM theraband exercises as before but to replace the second set with the same exercises with full RoM.

I also spoke to her about the 'Overhead Straight Arm Pull Down' and 'The Whippet' from Ido Portal's scapula mobilization routine video. She agreed that these would be great for me and suggested also doing a 'Reverse Whippet' with the band in front, like a chest expander exercise. Something I've since noticed that Slizz has a great Youtube video on, he calls this movement a "Standing Reverse Fly" though:

Hahaha, we all have names for everything. First off, congrats on the progress! I'm feeling better too from Gua Sha, which accomplishes similar goals through a different means. I feel your joy my friend!

I think you will continue to have slow, steady progress for quite some time. It feels good to become something of a functional human being again, eh?

Yorkie, please continue to share your experiences with rehab. It's great to read