After falling head first from the top of his camper van ‘Hercules’* managed to catch hold of the roof rack that he had been busy tying his 25 year old boat to. (It really should have been in a museum, but try telling Hercules that).
Swinging in the sun from one arm, feet dangling 4 foot from the ground,Hercules wondered to himself whether he might have damaged anything.
In true male form, Hercules waited until he could not raise his arm above his chest, had lost power and grip to the point where he could no longer open a jam jar and was living with 8/10 arm and hand pain before seeking my help. I referred him for a scan which found a tendon in his shoulder to be hanging on like a silk thread…
One successful operation later, Hercules disappeared back into his camper van for his travels to the Greek islands…without allowing me to assess him post-operatively.
”It’s all better now…see you at Christmas”…..was the email I received. I shrugged my shoulders and thought “He’ll be back”.
Piece of advice people… when an osteopath says to you “it’s not better yet…your treatment plan is not complete”… believe them!
Sure enough Hercules returned to my clinic 10 months later. Given the all clear from the surgeon and signed off from physio with a fully functioning, full range of motion, power and strength, shoulder. Good as new…
…Except Hercules now had the same arm and hand pain, plus headaches and neck pain on top. He had also lost 50% of the mobility in his neck and was now experiencing regular headaches. He had been advised nothing further could be done and he now had to live with the pain in his arm and hand, as the shoulder was now fixed and fully functioning. Had Hercules not been an avid wind surfer and rock climber he may have accepted his fate, but since he was home for Christmas he popped in to see me to ask if any of his pain could be treated.
What to do?
On assessment I too found he showed full power, grip and range of motion in his shoulder and hand – his nerves were fine – so why was he still in pain?
Further prodding and poking revealed that the muscles in Hercules’ neck, arm and hand had tightened up like concrete. They were so tight that they were literally pinching the nerves in the upper arm and forearm and referring pain into his arm & hand. The tension in his neck muscles had literally stopped him being able to move his head and neck.
The body is extraordinary. When you have a situation like a tendon in the shoulder rip off the bone, the surrounding muscles in the arm, neck and shoulder all kick into action to compensate and allow you to perform the same actions with your arm. You can actually function fairly normally for some time in this way, which is why it took so ling for Hercules to seek help. Sometimes however, they forget to relax, leaving you with more pain than you started with.
Explanation of Hercules post-operative pain
After a tendon is corrected and re-attached to the bone, the patient experiences a lot of pain at the incision and operation sight, from inflammation and tissue healing. To avoid placing pressure through the operation site, the patient will tighten the neck, shoulder and arm muscles around the operation site, so that the muscles do all the work, rather than the tendon. This is normal procedure for healing.
Unfortuanely, sometimes, once the tendon is completely healed, the patient has now developed different compensatory patterns of movement, and continues to move in a way that avoids using the tendon. As a result the neck, and arm muscles become over-used, and also used in ways that they were not really designed for. If muscles are over used, or used in ways they were not designed, they tighten and shorten, and eventually fatigue, causing pain, headaches, and restriction in movement.
After giving Hercules immediate basic osteopathic treatment to reduce the tension in the muscles of his arm and neck, I gave him an exercise program to re-balance the mucles in the neck so that they transitioned from being tight, painfull muscles, to being strong and balanced. The program also developed core stability in his neck and released and mobilized his upper back – taking the strain off the shoulder. Had his upper back and neck been left as restricted as they were, this would place a lot of strain through the shoulder, and would possibly result in a re-occurrence of the original tendon injury.
Hercules is now pain free, headache free, and has full neck and head mobility. He does however, practice his muscle balancing exercise program regularly, and attend osteopathic ‘MOT’s‘ twice a year.
Never give up
Post-operative care is aimed at restoring full function back to the operated area. If you are left with any pain, anywhere after you are discharged from your doctor, don’t accept it as somthing you have to live with. Get a second, third and fourth opinion! Contact a local osteopath to ask their advice on whether it is necessary for you to live with the pain, or if something can be done to resolve it. If you don’t like the answer, contact another osteopath. Just keep questioning until you find a solution to your pain.