Tuesday, 10 December 2013

Part III: Rehab....this time with thumbs....

It is December 2013, just over 15 weeks post-MIMS. Last week, I was able to take my first pain-free freestyle stroke. I only did a very tentative 100m, but still.... progress at last.

Things began to change about 6 weeks ago, when I went to see a sports physio who is physically located within the University of Leeds and who tends to the sports scholars within the university as well as to stray university-based lame ducks like me. On our first meeting, Sophie gasped in horror at the extent to which my shoulders are pulled forwards, although she also noted that my shoulder and back muscles are strong and in good shape, with "nothing sticking out". I felt oddly, unjustifiably proud, trying not to dwell on the possibility of having things "sticking out". Sophie's approach to physiotherapy is very direct and thumb-oriented. In short, the goal was to "re-set" the joint by releasing the muscles across my chest and into the front of the shoulder, and then strengthening the muscles at the back of the shoulder to hold the joint properly in place. This, I was told, should release the impingement, allow the irritation to go down and get me back in the water in no time. Rather ominously, she also warned that if there wasn't any improvement within a few weeks, it was probably a sign that something more fundamental was awry and I would need referral for an MRI and specialist. And with this warning still hanging in the air, with me lying prone on the massage table, she dived in, thumbs first.

As anyone who has subjected themselves to sports massage / physio will know, the pain associated with this particular "therapy" is exquisitely intense. In my mind, the pain is a kind of mustard green - not sharp or hot....just nauseatingly unpleasant. Unlike other treatments where pain might be a sign for a  practitioner to stop, pain is a green light to a sports physio - the successful location of a particularly painful spot is simply a prompt to dig deeper, to chase the pain along the particular muscle or tendon. In the days that followed each session, I developed green-brown bruises, my skin sore to the touch, healing just in time for the next round. To complement the thumbs, I was given daily exercises - simple, gentle stretches at first, then more pronounced stretches to build on my increasing shoulder mobility, and now strengthening exercise to build the muscles at the back of the shoulder to better support the joint. I do them every day, twice a day. It is training like any other, but a sorry substitute for the pleasures of swimming.

But there is no doubt - after each visit, my shoulder inches another step towards recovery. It is slow at first, and then suddenly, last week, I realise that I am throwing on a jacket without so much as a twinge, or reaching sideways to pick up a file without the slightest aggravation. I'd been doing kick-only sets in the pool for a few weeks, finally able to hold a kick board out in front of me, but with this realisation of unnoticed recovery, I head to the pool and do a session of gentle drills. I lie on my side, fins on, lead arm out in front in a streamlined position, switching sides at the end of the lane. After 10 painfree minutes of this, I try taking 6 kicks, then taking a single stroke, rotating into the streamlined position on the opposite side; 6 more kicks, and another stroke. I focus all my attention on getting my arm in the right position and am careful to avoid actively pulling or putting strain on the shoulder. But still, after lengths and lengths of this drill, there is still no pain. I switch to every three kicks, and still no pain. At the end of the session, I take off the fins and swim 100m full stroke, hypercautiously. It feels unbelievably weird - as if I had been taken apart and then not put back together properly; nothing seems to work in co-ordination with anything else. But if you take a 15 week break, I suppose that's inevitable. But it feels so amazingly good to be able to do even this small amount.


I had my final session with Sophie last Friday, and my shoulder was so transformed that she struggled to find anywhere really painful to dig into. Progress indeed. And with that, and a list of exercises to do, I was discharged and ordered to go forth and start swimming....but only very gently, building up slowly. I am determined to be disciplined about it, even though we're off to Lanzarote next week, where the temptations of the glorious clear-blue sea await. And in January, I have an appointment with Swimsmooth coach, Emma (Active Blu) to start fixing the stroke problems that almost certainly underlie all of this.

So in my wildest hopes, this is the conclusion to my rehab narrative - a shoulder restored through the painful but effective ministrations of Sophie and her thumbs. There are absolutely no guarantees, of course, and my shoulder still feels precarious and fallible, but for now at least, it's off to the pool I go.

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