7 weeks 3 days post op…
The last 4 weeks post op – crucially out of plaster – have been very interesting. Particularly so as the movement in my RIGHT arm has improved significantly. Almost more pleasingly is that the power in my RIGHT arm, both triceps, and biceps have begun to return.
Returning to work
I’m not entirely sure what has lead to the improvement though! especially as physiotherapy hasn’t actually started to look at adding weight yet! Certainly the static resistance stretches on the Wahoo KICKR will have been beneficial. What is most likely is that my improvement has been a combination of many factors, all enhanced by my continued healing. The progress I’ve experienced so far, is likely to accelerate further, as I have passed the 6 weeks post fracture point. During the healing process, week 6 is always the the “safety” point, where patients are advised they are able to undertake more normal activities. The shift from protection to activity is allowed as the tissue at the fracture callus will have changed from a soft callus, to complicated beginning to remodel.
As has the risk of damaging the newly healing bone diminished, although not gone, by 6 weeks, I’ve finally been able to get back to work!
Back to work
My first week back in practice has been somewhat tiring, mainly as I’m not 100% pain free 100% of the time. The tiredness is largely connected to that fact I’m not able to move and stretch the arm as much as I would like whilst sitting at the desk typing away. As a happy coincidence, my first week returning to work corresponded with a University course booked some time before the accident. Although still lecture room, and desk and computer based, I did have a little more ability to stretch than when back in the surgery!
Too much enthusiasm
Unfortunately the week long course wasn’t entirely without incident. Part of the course required me to give a presentation – and I’m relatively dynamic with my public speaking – lots of hand waving. It shows how well things have been progressing that I could present in my usual style, although maybe with slightly less arm waving than would be usual. I say unfortunately without incident, as on one slide I stretched to gesticulate at a diagram in the top corner of the projection, and there was a resounding CRACK.
Previously when this happened, I’d had a stiff arm before, which the “crack” seemed to resolve after than pain settled. On this occasion, there was no soreness, thankfully there was no deterioration in the ability to move the arm. I’m not quite sure what happened, but the discomfort has was enough to have me restarting co-codamol for the rest of the day. Thankfully within 24hrs, the soreness had completely resolved, this time frame confirmed that whatever had caused the crack wasn’t any cause for concern.
I’ve found, mentally, that the return of a small amount of strength to my triceps has been a massive boost. Previously, even with clear physiotherapy instructions, aimed at over coming the difficulty I’m having straightening my arm, I’d been unable to generate anything more than slight a flicker in my triceps muscle.
Yes the power in triceps is still no where near as strong as it was before my accident, but now I can see contraction rather than simple twitches to the muscle, i know i’m finally improving.
Initial run – postponed
I’d aimed to try my first run at the 6 week mark, but have found there has still be a nagging discomfort in the arm, so Ive decided still to hold off the run, and aim to keep my fitness up using the turbo trainer, and the Zwift Cycling software beta (which is brilliant).
The one change I have put in place this week is to move from sitting up most of the time whilst on the turbo, to trying to hold the bars throughout the riding sessions. In moving to doing this on the turbo, I’m also trying to balance my position. The Zwift simulation is helping me keep a focus as if I were biking, whilst very carefully holding the bars with both hands and trying to begin to equalise the pressure I’m putting through both arms.
I think one of the reasons that the turbo trainer has been so effective for the rehabilitation of an upper limb injury is it allows me to perform “real world” stretches, allowing me to try and get to a position that I need. A position I use. Well, hope to use when I finally feel able to get out on the bike again.
There is of course an increase in discomfort stretching and holding the bars of the bike. The physiotherapist is not concerned about this, as long as the pain/discomfort remains on a personal scale of no more than 5/10. A lesson I sorely learnt a few weeks ago on the first pool physiotherapy session.
One issue that has come to the fore with the physiotherapist is some discomfort to the RIGHT shoulder. As I cant fully straighten my arm still, I can reach as far. I’ve been compensating unconsciously by stretching forwards with my shoulder hence the discomfort. It was suggested that I would be able to improve this with the focused rotator cuff muscles stretches as advised initially, but add in addition:
- Turning my head, holding the stretch for 30secs on each side. 3 reps
- Shoulder extension, both free, and pushing back against a wall for isomeric contraction 10 reps
- To be repeated every hour
Certainly the shoulder extension exercises have been difficult/odd depending on how you want to look at it!
Physiotherapy with weights!
Finally I was advised it was time to start low weight flexion & extension exercises with my right arm. For the first week, the extension work was to be limited to 500gram/1kg weights. A small amount of discomfort is allowed, but again not more than 5/10 level pain – and I had to stick to this!
One activity I did find helpful with weights and stretches was cleaning the car. Well it had sat used from nearly 3 months, and was looking rather weathered! Large car sponge, filled with water, approx 500grams. Lots of extension and flexion for the elbow. Lots of rotational movements for the shoulder. So a physio session and a clean car. I was rather sore after, but kept things below 5/10 discomfort throughout.
Running after Elbow Fracture
Best of all, as this was the 7-week mark, I was advised I could begin running. What I was actually told was jogging only and that sprinting, and high powered pumping of the arms was to be avoided at the moment. But still, that’s good news!…. So I did 10km this evening!
I’d talk, what I thought was the sensible approach. By limiting myself to running on the farmers fields, along tractor track, yes you could argue, those are slightly greater risk of the tripping. However if I were to fall over-glad that I didn’t-I would’ve fallen on the mud and soft soil. My theory here was this would protect me if those a fall.
The run itself, was most particularly slow. To this degree, I haven’t even taken a running watch, however I was so pleased to be out. Whilst doing rehabilitation in the previous few weeks, walking around the village. I had made conscious efforts to swing my arms when walking around the country lanes (i probably looked a real numpty, which is why I made sure I was well out of the village before I started) I wonder if this has helped my shoulders. Because my upper arms seem to find with the running. The thing I was aware of Was that my right arm is still very weak, and that I could feel a distinct catch when swaying the arm. Is it went straight in the arm I ran into the tight tendon, or even the metalwork
simply from my perspective, I’m garetful to be ALLOWED to run, and beign able to move that little bit quicker – it felt like such a total contrast to the first time I tried to hurry arounf the road afer my injruy – whihc was not fun!! At least I’m vlearly seeing good progress now!