Week 5 post fracture – elbow flexion focus
The Physio Monkey has been beaten!
Just to clarify the Physio Monkey is bit you you that says “You can’t, it hurts, it’s too much effort”. Defeating the Physio Monkey has been my weekly challenge of late. Along with managing to keep up doing 30min Zwift spins….
Elbow flexion physiotherapy
Today has been good, after a rather bad week. 9 days ago, and in a previous post, something went “click” in my arm during pool physiotherapy. Since then, there has been a constant dull ache, increasing to a pain when moving my right elbow. This had given the Physio Monkey plenty of ammunition and I’d reduced the amount of physiotherapy I was doing. Not out of being a total lazy-bones, but due to a worry over the discomfort.
Easing off the physiotherapy has subsequently lead to a slight reduction in the movement of my arm. It’s all been a bit of a negative spiral. Honestly, this has probably been my lowest week since the accident happened. Not that I’ve been described as being grumping around the house like a bear with a sore head/elbow.
Communication vital to patient relationship
Discussing my elbow with the physiotherapist, who has been marvellous fielding my never ending barrage of questions, he advised if the pain hadn’t improved within another 2 days we’d get an X-ray to see if anything had moved. He knew it hadn’t. I knew it hadn’t. But sometimes the patient needs to SEE they are not dying for themselves!
So yesterday, the day before I was due to have the X-ray, there was still no improvement I had to attend a prebooked course. I managed to get my grump, and pain under control as this GP training day had been booked months before. Improving my mood for this wasn’t too hard too be fair. I was on the course with my best friend and some mates, getting free food (with extra desserts as “everyone is on a diet”) and the course was on weird and wonderful endocrine problems, which is right up my street. Basically a good day – oh and did I mention the free food? – some medical students traits can never be over come!!
iPad of pain!
At the mid point of the afternoon, I moved a little too quickly, and reached a little too far to pick up my iPad of the desk. Obviously using my RIGHT arm without thinking. As I lifted the iPad there was a very large crack from the elbow, and a flash of pain!
I did say things had been good didn’t I – I am getting there – honestly!”
The pain flashed…and VANISHED!!. Taking the general discomfort with it. Just like that!!
The elbow felt slightly sore, but suddenly I was able to move the arm much further again, now with only mild discomfort at the extremes of movement.
Bad news was that the Dr Brain woke up again.
- Is there a small piece of bone in the joint floating around?
- Is the dreaded articular step actually there?
- I was told the joint surface smooth? Maybe there is a lip of cartilage which keeps getting caught and folding back on itself?
All relative complications which are not uncommon.
However as the physiotherapist commented today, unless it’s a bone fragment, which is astonishingly unlikely, i)given the surgeon, ii) no new injuries had happened and iii) we’d have seen it when we poured over the X-rays, there is nothing to do. Anything else sinister would basically have the joint locking so it won’t move, or too much pain to move at all. As its none of those things, even if it is a flap, a bump, or any of the things I’m worried about, there’s not really any simple or effective treatment, so I’d just have to live with it!
This is certainly proving to be a difficult concept for someone with a type A, perfectionist, personality. It’s not 100% perfect!! How can you expect me to just “live” with it!!
Long term complications
Another way of viewing this is potential long term complications… There aren’t really any – I checked! Even people with a visible step in the cartilage, which is what I’m worried most about! Of those who don’t have a smooth joint surface, 58% go on to develop RADIOLOGICALLY VISIBLE deterioration of the joint, OVER 10yrs after the injury. Of that 58%, less than 10% of those people are even aware of that change! So ultimately I’m worried about FUNCTIONALLY irrelevant, medical minutae! So nothing new there!
So the real good news:
After a 1 hour session of physio, focusing only on flexion stretches, extension stretches, and deep tissue massage, I was tired. But had an excellent outcome. Without any major discomfort I was able to flex my arm all the way up to normal!! Yes it felt good. In taking an hour to get to that stages, it also left me shattered, but smiling. WE, the physiotherapist and I, achieved it!!!
Full elbow flexion
Full elbow flexion meaning able to touch the back of my neck!
I’m so glad I’ve actually seen real progress and now have the knowledge that to get back to full flexion is going to be possible.
As I have said before, being unable to get to full extension, ie. A straight arm, isn’t actually massively important to life. There are very few activities actually need a fully straight arm, maybe some sports like polo, but since I’m not really a fan of horses, that shouldn’t really be an issue. Any loss in ability to flex an arm however will have a noticeable impact, even if it’s minor. So fir the first time, to get back to full flexion, is a major mile stone, and a real mental boost,
Ok the the effect of the physiotherapy only lasted for about an hour, BUT I NOW KNOW ITS POSSIBLE. Meaning that from a flexion perspective, 100% recovery should not only be possible, but is probably likely.
One thing that has surprised both the physiotherapist and myself is one of the ways I’ve found to help stretch the arm – On the Wahoo KICKR Turbo trainer!
I found that using the turbo was an option because I was unable to perform one of the stretches – specifically bicep stretch. Due to the fracture, there has been quite a change in the carrying angle of my arm.
Due to this new angle, I can’t actually straighten the arm sufficiently to do the reverse bicep stretch. It feels like my arm will collapse back on itself.
However we realised that when sitting on a bike, and pushing against the handlebar, this allows a controlled stretch of the arm. As I can determine how much force to push against the bar, this control means a limited risk of pushing too far.
It also allows me to put my unaffected right hand on the handle bars and see what the difference is. Crucially this allows me to adjust the angles and the forces going through my right arm, to help me assume the “normal” position of the arm again. Plus I can ensure that I’m not compensating by putting my back, or shoulder in strange positions.
Personally I think this is quite a definitive post for me. You can use a turbo trainer to perform effective upper body physiotherapy. One of the most unexpected benefits is how it works as a distraction technique. By hold the bar, and concentrating on the whole arm and not just a joint, I’m actually able to get more of the muscles in the arm to relax, and get a greater flex. Plus using the turbo keeps my heart rate up, moving the waste products from the arm, and helps me keep my legs spinning
Plus a having assess to the Zwift beta has helped make the Physio turbo sessions much more enjoyable! I really want to start getting a full lean over the bars and putting some pressure through the fracture – its coming, but just not yet – patience was never my strong suit!