Elbow Rehab – and some thoughts on pain

The chip can be seen on the right side, the slightly darker area on the small bone on the right (the radius) is the broken area, with the chip and a crack.

It’s been 4 weeks since the fall that ended in a radial head fracture. It’s frustrating having limitations to movement, when you are used to moving. One of the most frustrating things is having to put my hanging practice on hold. Maybe it’s just my imagination but I swear I can feel my shoulders withering and shriveling up and atrophying, my scapula (shoulder blade) drawing in towards my spine.

And this is a window into what my shoulders used to be like BH (before hanging) and pretty much what everyone else’s shoulders are like too. If I could provide one service for mankind during my time on this planet, I think it would be to encourage everyone to get a hanging bar somewhere inside or outside their house and just reach up and grab it now and then. Eventually you can take your feet off the floor and hang from your hands for a few seconds. And then one day you can swing back and forth a few times. You don’t need to be in training for the Olympics or do a gazillion pull ups. Just hang.

My elbow is the injured area, but the joint in the middle of your limb (this goes for knees too) is affected by the movement of the joints nearby (wrist, shoulder) and vice versa. There are muscles that cross both joints. So my rehab includes hand and finger work, wrist work, and shoulder work.

Because everyone benefits from shoulder work, my clients have been enjoying shoulder oriented classes lately, which is kind of stacking my life right? I can get my PT and teach my classes and provide shoulder strength to clients at the same time.

Just the other day I started reaching up and holding my bar again, with my feet on the floor. I need to load the tendons that are in contracture across my elbow and start to lengthen them. I can also start to extend my elbow using a very light weight. I am tentatively adding small amounts of weight bearing on my hands and knees to that arm, although this is the most difficult thing as the weight pushes up into the elbow and that is where the break is, so I’ll be playing it very safe for a few more weeks in this regard. I was told no weight bearing for 6 weeks.

Last week I went for my follow up exam and x-ray – the orthopaedist tested my range of motion, had a look at the new x-rays and left. He had more pressing matters than my little radius. Going to the hospital is always a very interesting adventure. First of all, I walked there, in a snowfall, barefoot. Okay, just kidding about that last part, but I did wear my mukluks with bare feet and no socks. Once I got there, past the parade of taxis and people smoking outside the entrance, I made my way to admitting and got my bracelet. The waiting room actually had No Standing signs, as the area needed to be kept clear for those coming in on gurneys or in wheelchairs (understandably) but there was no area where I could stand, only sit, or stand in front of a chair, thus preventing someone who needed to sit to use that chair. Eventually I waited outside the waiting room in a large hall and they came and called me when it was my turn. I did think it was an interesting observation though, that many, many chairs were provided, but if you were standing, you were in the way.

When I had my x-ray, the technician mentioned that I must be “all healed” because “most people” found the position she had to put me in for the machine very painful. This was just one more person in a line of people (including emergency room nurse, CT tech, doctors, x-ray techs) who mentioned that I didn’t seem to be in as much pain as they would expect. At first I just thought I was stoic, or maybe the break wasn’t as bad as other people’s (which is probably true, as breaks go, it was a lucky one and most of my injuries are soft tissue). But I have been thinking about this. Maybe I’m in less pain because I’m not afraid to move through pain (much), and my movement repertoire is larger than the average person’s. It’s not just the frequency of movement I do, but the fact that I find areas that are less moved, moving in ways that aren’t familiar or even stable for me currently. I know my weaknesses and work on improving them. So having a painful injury is kind of like a slightly ramped up normal day for me. I’m always working in that range where I feel challenged. I feel the need to clarify that this is not about increasing range of motion of joints. As a matter of fact, I’m hypermobile in many areas, I can certainly hyperextend my good elbow. So my work to improve is about relationships of one area to another, and finding other movement strategies I’m not currently utilizing. It involves more than muscles and joints too, as skin can be a limiting factor in hanging and crawling for example. I work on surfaces that are challenging and unfamiliar as much as I can.

So I wonder if that’s why I’m not “most people”?

Maybe it’s because I’ve worked through pain before – acute disc herniation in the lumbar, a broken bone in my foot – not to mention the various injuries and accidents I’ve been in on horseback or in automobiles. I’m also not the kind of person who asks for help. If something needs doing, I do it as usual, and if I can’t do it, I find a way to do it. For example – in the first few days I found I could not twist the lid off a jar, or open a can of cat food (this could have been disastrous!). So I just sat on the floor, grasped the jar between my feet and twisted with the good hand. I grind my coffee by hand and joked that it was my PT – either holding the grinder steady or turning the handle was both difficult at first. When the snow continued to fall I continued to shovel, pushing the shovel with the good hand and using my thigh to lever the shovel off to throw the snow up onto the lawn. One of the first things I tried to do after the injury was to cook dinner one night and find that I couldn’t cut an onion! I could neither press down on a knife or use the arm to steady the onion for the other hand. But I managed through some discomfort to chop it!

Eventually my injured arm was able to take more and more part of these activities. If I had outsourced the activities to someone else, I would have continued to worsen, and when I did do the sweeping or shoveling, I would have been weaker in both arms! Of course, there is a smart and a stupid way to do this, and I would never suggest to most people to just stop their bellyaching and shovel the snow with a broken arm. But then, I’m not most people.





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