That’s something I came to understand and appreciate last January while recovering from rotator cuff repair1,2 on my left shoulder. This January (2024), I find myself going through the same process of recovery after rotator cuff repair surgery on my right shoulder.
Last year it was an acute injury. I tripped and fell out my front door, like a tree with its roots yanked out from beneath it. Boom! I saved myself from facial injury–AKA a broken nose, although a near thing if the scratch on the lens of the safety goggles tells you anything–by catching myself with my hands. Unfortunately, that “save” came at the price of a ruptured bicep tendon (torn free from the bone) and a full thickness tear of my rotator cuff. I felt the soft tissue tear away as my weight came down on my hands. Lesser injury, more grievously painful at the time, were broken ribs. This happened in October (2023) but wasn’t accurately diagnose until December. Surgery to repair performed in January– just like this year. 😉
This time, it’s cumulative wear and tear eventually resulting in another full thickness tear on my right shoulder. Additionally, my bicep tendon had “high-grade” tearing and was in danger of rupturing if not surgically detached3,4. On my left shoulder, the surgeon left the ruptured bicep tendon detached. The bicep tenotomy on my right side makes my shoulders and biceps a matching pair again. Now it’s all about the recovery.
As of today, I’m 1 1/2 weeks post surgery. I haven’t had to take pain medication in the past four days and only a couple of doses of regular Tylenol. During my physical therapy appointment yesterday, my DPT told me, based on my range of motion and lack of significant pain, I’m physically, if not actually, at about week four in my recovery progression. He gave me the option of dropping to once a week rather than the two times per week we had originally scheduled. Woohoo!
While very good news, I have to be careful, particularly with the lack of pain, that I resist moving my arm actively, as opposed to passively. The way the PA explained it last year, it’s analogous with pushing and pulling at a paper towel dispenser attached to a wall. Eventually all of that pushing and pulling will wallow out the sheetrock surrounding the anchor points and cause the screws to loosen and\or pull free. Since I literally have anchor screws in my bones, that analogy says it all.
I’m forcing myself to keep my sling on even though I don’t have any pain and even though it’s pressing on nerves and irritating muscles in my neck. This is to deliberately hinder my use of it in automatic responses. Such as, reaching and grabbing for something I’m dropping. Already caused myself pain, if not re-injury, doing that. Also starting awake in bed with that sensation of falling. This unconscious and unintentional use is much more problematic this time because its my dominant arm. I’m right handed! And don’t think that isn’t fun.
Right now I’m using Microsoft’s Speech Recognition on Dad’s old workstation to type this post. It’s a pretty laborious process, but much less uncomfortable and tiring. I dictate slowly, a few words at a time and attempt to enunciate clearly. Speech transcribes “enunciate” as “enough C8,” “enough CA,” and hilariously, “E. Knotts the eight.” This result came about when I sl-ow-ly enunciated the word.
It’s also tricky because Speech is used for program controls. When I say the word “word” as often as not it will open a word command such as word wrap. My sighs get transcribed as the word “if.” Those have to be deleted and to avoid adding more, I have to remember to say “stop listening” if I’m going to be rereading through several sentences or paragraphs.
So, back to the “process” itself. It’s one that cannot be rushed. To rush it is to risk wallowing the screws out of the sheetrock and tearing loose the towel dispenser. 🙂
Based on last year, and previous surgeries, I’ve been gifted with a body that heals quickly. The orthopedic surgeon still comments on how quickly I healed last year. Fingers crossed, it all goes as well second time around with my dominant arm. I just need to keep nurturing the patience I developed last year while going through this same healing and recovery process on my right side.
Something I didn’t do last year was to complete the strengthening and reconditioning of my left shoulder. I am definitely undisciplined, but I hate to call myself lazy because there’s usually a lot more to it than that. Particularly given my history with depression and anxiety. The more I work at it the better I understand some of what’s going on in my brain, but I never know exactly what it might be that’s keeping me from doing a prescribed set of arm exercises on any given day. Laziness? Fear? Fatigue? Depression? All of these? Or none? All I can say is I’ve learned it’s better for me to be compassionate with myself than to be a harsh, strict drill instructor chiding myself and using shame as a motivator. I don’t respond well to that. It’s too much like bullying and pisses me off, even when it’s me doing it to myself.
Learning from my past experiences, I’m going to do better this year. I plan to take full advantage of this recovery process, AKA downtime, to further my training in several areas.
During the fall and early winter, I was working out several issues caused by side effects of some of my medication. I tweaked nutrition and endurance training, felt I was getting back on track around the end of November. I had also returned to physical therapy to finish the strengthening of my left shoulder. Ironically, that’s when the pain and weakness in my right shoulder was so prevalent it prevented me from doing the upper body strengthening exercises I needed. I knew I had partial tears in my right rotator cuff from the 2015 diagnosis and made the appointment with my orthopedic surgeon to get an MRI on my right shoulder.
I was fairly certain it was going to require surgery, however, since it wasn’t an acute injury, I was going to postpone it until end of March after I finished my first 50K. Dr. Gilliam reviewed the MRI results 15 minutes after they were completed and met with me. Not only do I heal quickly, I apparently compensate very well for rotator cuff tears. Both he and my DPT had assessed me for rotator cuff injury and neither felt there was significant injury. Overuse or a muscle strain is what they were thinking. The main thing Dr. Gilliam was concerned with from the MRI results was my inflamed and obviously injured bicep tendon. He was going to have to do surgery on that no matter what to prevent a rupture. He said once he got in there for that, if there was a tear he would repair it. Final results from the radiologist, however, noted a full thickness tear, a 2.6cm retraction, significant fraying, tendonitis/osis, and inflammation. Dr. Gilliam hadn’t wanted me to delay anyway. With the full tear and the retraction, I decided it couldn’t wait.
Unfortunately that meant canceling my January, February, and March races. I was able to get rollover credit on two of them. Not too bad. It took the pressure off of training, but had the usual affect on me of a complete loss of motivation. Meaning my training came to an abrupt halt despite that I could have continued training for another month.
First two weeks of the year, I worked on my training plan to get me to my 50K goal as soon as I could after surgery. As usual I was very excited with planning. I had training mileage on the plan up to surgery day. After which it includes low mileage, easy walks that will keep me conditioning and moving during the first six weeks after surgery. Based on last year and a tear of the same severity, Dr. Gilliam will keep me in the sling for 8 weeks. During that time he’ll release me to walk on pavement or sidewalks, wearing the sling. It will be at least 6 to 8 weeks before he’ll let me hike, much less release me to run on moderately technical trails.
I have it all built into the plan. Barring unforeseen reinjury, it should be realistic enough to let me he hit my training goals. The first being a 10K (6.2M) event on technical trail the second week of April. Training plan for that one begins week four post surgery on February 19. At least that’s my plan. Dr. Gilliam may have other plans.
It shouldn’t be any surprise to you, and it certainly wasn’t to me, that I did not keep to the plan through January. Nor that I haven’t kept to it post surgery. <SIGH> It’s still early yet, though, and no ground has been lost. All of the walks planned for the next three weeks are less than 2 miles with only two being just under 3 miles. The plan doesn’t call for anything over 3 miles until the third week in February. And 3 to 6 miles is very doable for me any day of the week.
Also part of the plan, although not yet formally written down, is to use my PT appointments to bootstrap the strengthening and conditioning part of my training, which I never successfully incorporated last year. Additionally, I plan to leverage the regular schedule of my PT sessions to establish consistency in my training schedule. I’m also going to take advantage of my access to talented therapists, all of whom are willing to help me achieve goals outside of my therapy sessions. I’ll get their help to tailor an exercise program that will maximize gains within my currently restricted physical abilities.
Official start is tomorrow morning. I’m going to drive myself to Lott Fitness Center tomorrow for 30 minutes on the recumbent bike, the same amount of time it takes me to walk 1.5 miles. Bonus goals are to get time on the leg press or the back extension machines. Leg and core work, that’s the name of the game until I can start strengthening upper body.
1. Neat video of comparable arthroscopic surgery. Note: This video doesn’t show the full procedure, which involves anchoring the other end of the suture as well as additional anchors (I have 5 in each shoulder) and sutures to create a mesh over the soft tissue, pressing it firmly against the bloody patch on the bone. As the tissue and bone heal, the soft tissue re-adheres to the bone. Cool, right!
2. Additional detail on the procedure.
3. Basic animation explaining a bicep tenotomy.
4. Additional detail on the bicep tenotomy.
