This week I finally got my stitches (aka sutures) out on Tuesday. When the Dr. first walked in I was leaning back on the exam table with my arms just resting on my waist. As he is getting things ready he is explaining that he wants me to start getting my shoulder moving and possibly go to a pool and start with a breast stroke. I then showed him that I could already do that along with rotate my shoulder in other ways. He was quite impressed and didn’t realize my shoulder was already so mobile. He said I either had a really high pain tolerance or that I waited way too long to get my shoulder fixed in the first place for it to be moving so much so soon. I’d have to go with the latter on that one as I’m probably a wimp when it comes to pain. He also said I had what they call an “active shoulder,” which means there was a lot going on in there, which I think is a bad thing. Anyways, he removed the stitches and gave me a prescription to go start seeing a Physical Therapist, and also asked that I come back and see him in a month. I was somewhat disappointed to have to come back again given my $25 co-pay, but as I went to schedule it they didn’t collect my co-pay for the current visit and said any visit within 90 days of surgery is considered a post-op meeting and co-pays are not required…Sweet!

So, on Thursday I went to Physical Therapy at a place close to work. I wanted to go back to the same place I went last year b/c there was a full workout gym and pool, but given that I can’t take Kyle, it is much easier to do my therapy close to work. Looking at the website of the PT place I was somewhat skeptical as there was an older guy who was the therapist. Sure enough, when I got there the place just seemed older…almost as if it had been there with the same furniture and equipment for 20+ years. When the guy came in I was somewhat short with him as I expected to hear some crazy old ideas, but as we got to talking and he began explaining in detail what the surgery had done and what the reason for it was, I became absolutely convinced he knew what he was doing. In about 5 minutes he gave me a better understanding of what my injury was, what the surgeon had done, and how we were going to go about making sure it didn’t occur again. What helped tremendously is that he had one of this mini skeletal shoulders (similar to the image here) and he could show me the muscles, their purpose, and what was going to happen.

To give you the brief summary, the rotator cuff muscles are there to keep your shoulder within the socket, somewhat suspended. As you raise, lower, etc., the muscles work to make sure the bones don’t touch. However, sometimes the muscles get weak due to age and/or lifestyle, and then they are not strong enough to hold the shoulder centered. So, this was my problem…mainly due to age and computer use and slouching. Then, when the rotator cuff muscles weaken, and you throw a ball for instance, the rotator cuff muscle begins to hit the Acromion bone and Clavicle (collar bone) above it, and that begins to irritate the muscles, thus weakening them even more. Basically, it become a vicious cycle until you get to where you can’t do it anymore without serious pain.

To combat this with surgery, they “raise the roof” of your shoulder by sawing the bottom part of your AC and Collar bone thus allowing more room for your shoulder to operate. Once surgery is done and you have your motion back, you have to begin working on strengthening your rotator cuff muscles so that they are strong enough to keep your shoulder centered. The other thing that is needed, and something I didn’t know or understand after 4 weeks at the first PT place is that your shoulder blade muscle also helps to “raise the roof” of your shoulder. He basically showed me that if you stand in front of mirror, and push on your shoulder blade, your shoulder will actually move up slightly, which means it is allowing more room for the shoulder to rotate. I spent 4-6 weeks at the last place working out this muscle and I had no idea why, and with a 10 second demonstration by this guy I could completely understand and see why this would work. He said a lot of people, especially computer users who are always leaning forward, feel that muscle getting tight b/c it is constantly being stretched forward as you type or work. Since it is so tight, people feel they need to stretch it by pulling their arm across their chest or something, but this actually isn’t good for you. Once stretched, it is now weaker/looser and you will lean more forward and slouch more. So, what you need to do is strengthen it, which will actually tone and tighten the muscle, and thus cause you to slouch less. Basically, it is the same thing as demonstration he gave me. Tighten the muscle, which pulls your shoulder blade closer to your back, which thus pulls and/or lifts your shoulder for more room for the rotator cuff. Simple.

Needless to say I was thoroughly impressed with this guy by now. Then, to top things off he says I don’t need to come twice a week, but come as often as I want or need. My prescription says to come twice a week for 4 weeks, but I am going to go once a week and do the exercises at home. Each week he will see where I am and give me harder exercises to do. The amazing thing about the exercises is that he doesn’t want me to have any pain during them. He wants the top of the rotator cuff to heal first. If we try to work it out while it is healing, it won’t get better. So, we are working on the other rotator cuff muscles, and then will get to other one. The exercises are not what I would call tough, but I understand them and what they are doing, and I do get tired, which he says is the key. Get tired, but no pain. So, I go back next week, and hopefully I’ll be a little stronger and be able to do a few more of the exercises.

Finally, the name of the place is Milpitas Phycisal Therapy (http://www.milpitaspt.com), and the physical therapist name is David Severson.