This is a follow-up to my Clavicle Injury – Part 1 post describing my bicycle accident that led to the surgical repair of my collarbone fracture. The point of this post is to provide access to the secret photos to basic physical rehabilitation movements to maintain your range of motion.
Collarbone Fracture Rehabilitation Begins
The doctor’s appointment was standard fare: We took an x-ray and discussed my progress with the physician’s assistant. News Flash: The Bone is Healing. When bones heal they become gelatinous and begin to reconnect, eventually hardening until the bone is healed. We discussed the metal bug stiffness I am experiencing and the prospect of getting relief by removing the screws and plate. The physician’s assistant says no problem on removing the screws and plate once the bone is healed, but we agree to see if the stiffness and pain goes away with time. Our plan is to begin rehabilitation with a therapist and meet again in early December for another x-ray. If by December I still want the plate out, we will schedule surgery to take it out.
My first meeting with my physical therapist was informative as to the physiology of why does my shoulder hurt so much? And what is with the metal bug? The therapist explained that when you break your bones, the tissue surrounding the area will begin to stiffen all around the affected area attempting to “splint” the injury. Think of a webbing of fascia tissue that shrinkwraps over the entire area. This fascia tissue is chalked full of lactic acid which gives it stiffness. The objective of therapy is to get this tissue to moving again, which he explained is akin to getting taffy to move. When you attempt to get taffy to move, you move it very slowly, and if you attempt to move taffy quickly it will resist and not move. So movement begins – the goal is to get to 90% range of motion!
And now, for the first time ever on the internet… are the TOP SECRET photographs that I was able to sneak out of a heavily guarded physical therapy vault at great risk to my person. (NOTE: Even though a collarbone fracture is one of the most common bone breaks, and there is tons of information on the web covering the subject matter, I could not find any pictures or instructions on the web regarding the recommended rehabilitation exercises.) So I am now going to publish the pictures and unlock the top-secret rehabilitation exercises you are to do if you have a collar bone fracture. Hopefully, others will find these pictures and instructions on the internet and start moving their shoulder correctly without having to travel and see someone to tell you how to complete these not-so-complicated exercises.
(NOTE: All the exercises I was doing prior to learning these were useless – these are the exercises you need to do to begin to get a range of motion back.)
(NOTE: I started these exercises approximately two-three weeks post-surgery, when you could start these without surgery is an open question – I imagine you will not want to start these exercises until your bone begins to reattach naturally.)
(NOTE: We shot new pictures of these secret exercises, and that is me!)
Standing or laying down. Obtain a long broom handle and push with your injured arm out to the side. Push your arm up to, and then into of pain. Keep your shoulder blade tucked back and down, and keep your arm as straight as possible at the elbow. Push and hold into the pain threshold until you can no longer stand it. Rinse and repeat. You can do this one standing up, or lying down. I prefer an x-ski pole whereby you can strap your hand into the grip – this allows you to put additional pressure into the pain zone and extend the reach. Remember, the range of motion is the name of the game, and getting that taffy moving is the goal.
Laying down. Take your broom handle or x-ski pole in both hands, and with your good arm, push your injured arm straight up over your head and back. Let gravity help pull the injured arm down over your head. Hold your arm in the pain threshold as long as you can. Rinse and repeat.
Laying down. Take your broom handle and push the arm back at the elbow forcing the arm back and down. As the arm rotates, it will begin to feel tight and painful. Push into the pain threshold and hold. As you get the arm to move further and further back down towards the floor, slide the elbow up further out to a 90’ degree angle from the body. Rinse and repeat.
Standing up. Take your broom handle in both hands behind your back. Your good arm to raise the broom handle into a harm-lock type position. Push the injured arm up into the pain threshold and hold. Get the arm to be able to move higher and higher. Rinse and repeat.
Standing up. Pull your shoulder blades back and down.
Standing up. Place your injured arm on a table outstretched in front of you. Lean forward from the waist, pushing the arm forward at the shoulder and extending the arm. Rinse and repeat.
The physiology of the stiffness occurring in the tissue is the result of lactic acid flooding the surrounding area. Some people recommend rubbing the tissue (use some coconut oil) to get this acid to unlock from the tissue. Personally, I don’t like anything touching the surrounding area, the nerves are raw and uncomfortable.
At this point in my recovery, I changed therapists in order to be closer to my office. This therapist more castigated me for not more aggressively attending physical therapy and doing my exercises. He also explained the ramifications for not getting after physical therapy. He reaffirmed the stiffness and metal bug were caused by hardening tissue – but he had a new name for the condition which he called “Frozen Shoulder.”
Frozen Shoulder is a condition associated with shoulder injuries where the webbed tissue shrink wraps the injured area to the point of freezing it in place – THIS IS BAD!!! Strangely, middle-aged women get frozen shoulder for no reason. Frozen Shoulder, I was told by the therapist is a terribly painful condition and his least favorite to treat. He said that if frozen shoulder is not treated aggressively it results in a permanent range of motion loss. Finally, my therapist said that unlocking a Frozen Shoulder if not dealt with through aggressive therapy involves sedated manipulation! Sedated Manipulation!!! That is exactly what it sounds like – they put you out under general anesthesia and move your arm to places that you cannot bear while being conscious.
After several weeks of visiting the physical therapy torture chamber – this what I called therapy because its a place where my injured shoulder goes deep into my pain threshold. My regime was two times a week to begin seeing some “thawing” of my frozen shoulder. After several weeks of “hell” I began to experience gains in my range of motion on internal and external abduction (Exercises #3, #4, & #5) but continued to struggle with lateral and vertical range of motion (Exercises #1 & #2). So we continued to focus on the gains and avoiding the necessity of sedated manipulation. He certainly gained my attention with those words – plus, I want to swim again!!!
After learning to swim and I have come to enjoy open water swimming over most other forms of outdoor exercise and activity (RIP-Terry Locklin your Total Immersion swimming technique changed my life). So the thought of looking like a wounded duck in the water vs. Shinji is a real bummer. So I am on it, with a goal to maintain a high elbow stroke!
Notably, at this point in the therapy, my therapist thinks that further gains may be inhibited by the implanted plate. After all, the hardware is designed to be stiff and the seven screws are biting deep into the collar bone. My guess and intuition is, the plate, representing the metal bug, will need to come out in order to get a full range of motion. In December I will return to the surgeon for my x-ray, and if the range of motion is not improving, schedule the plate removal in mid-January.
The picture at the top of this post represents the x-ray in January 2018. You can see the bone is beginning to heal, and soon the collar bone will be almost good as new. In terms of the range of motion, I have stopped going to physical therapy, and I have successfully thawed most of my frozen shoulder. I even have a decent swim stroke again. However, I still really feel the stiffness from the plate and screws. So, at this point, I expect to get the plate and screws removed in April 2018. The doctor said that the surgery to remove the plate and screws is very simple, and will take less than 50 minutes and the trauma of the surgery will be 1/10th of what I experienced when I had the plate and screws installed. DEAL! I am in!!!
Read Clavicle Hardware Removal – Part 3 to find out how my recovery went after I had the plate and screws removed! Madison IM 2018!