It would be nice to be fully healed and have bike rides to talk about, instead of blathering on about shoulder injury and what not. But it is what it is, and though not fully healed after nearly nine months of therapy and two surgeries, I have reached a few milestones. After riding a few times in February and March, followed by a five week hiatus, I am once again able to ride. Even though my first time out was to end abruptly with a broken spoke.
But first, the milestones.
There’s a machine at the therapy clinic called the Torture Machine SHARQ.
A picture of the SHARQ, stolen from the manufacturer’s website at www.sharqcts.com.
The SHARQ is a bench with a side structure attached. You sit on the bench and stick your arm through a pivot, and then clamp your arm and shoulder. Using a wheel attached to a pulley system, you can, with your other arm, cause the clamped arm to move up and down. You can torture yourself to your heart’s content.
Another stolen picture showing in detail how the arm is clamped in.
There are two types of rotation possible on this machine. With the top of your arm (shoulder to elbow) sticking out straight, external rotation occurs when you rotate your arm clockwise, your hand moving upwards. Internal rotation occurs the other way, downwards.
Since your non-clamped arm is the one providing the force to cause rotation, via the pulley system, the rotations on the clamped arm are said to be passive. If you were to use the clamped-in arm by itself, the rotations would be active.
Really crude illustration of external rotation, (moving your arm upwards, with arm straight out to the side, and elbow bent at 90 degrees.)
SHARQs Like Arms
With a sore shoulder, the SHARQ is no picnic. At least for you. For the SHARQ, well, it likes to eat arms and spit out the remains. I grimace whenever I have to get on the SHARQ. I laugh, with empathy, when I see others do likewise.
Last week I got to vertical on the SHARQ – in both directions. A major accomplishment.
When I first tried using the SHARQ last November, I couldn’t even put my arm in the blasted thing without a lot of grimacing – let alone rotate my arm. As the weeks passed, I tested myself on the SHARQ every now and then, and by the end of March, just before my second surgery, I was getting 40 degrees external rotation (arm up) – if I struggled hard and grimaced a lot – and 60 degrees internal (arm down).
After recovering from Surgery #2, one day, on a fine Wednesday afternoon, I finally achieved vertical in both directions.
I had actually gotten to vertical downwards (internal rotation) the week before, but getting vertical with external rotation proved a bigger challenge. It took an extra week.
After reaching vertical, somewhat in disbelief, I used my other hand to quickly point out this achievement to my therapist, who was watching nearby.
Yeah, uh-huh. That’s me. I’m the man!
I only lasted a few seconds before having to back off and lower my arm. But to be there at all, after many months of trying, was amazing.
Another exercise I do is lay on a bench, face up, and hold a stick with both arms extended straight. The idea is to move my arms up and over, as far back as possible. This movement is called flexion, and in this case, it’s another example of passive motion, as the non-injured arm does most of the work. The injured side is just along for the ride.
Passive flexion stretching on a bench with a stick
When I first tried doing this kind of passive flexion, last October, I couldn’t do it at all. Even seemingly easy 90 degrees (straight up) was out of the question. By March, I was in 120-135 degree territory.
The ceiling at the therapy clinic is tiled, and I often use those tiles as landmarks – goals to reach when viewing upwards with my line of sight towards the stick. First I could only get to the tile overhead, and then as the weeks passed, to the next tile, then the fluorescent light fixture, then the air conditioning vent. But I was not able to “reach” the corner of the ceiling and wall, (as viewed with my line of sight.)
And I really wanted to reach that corner.
During the same fine Wednesday afternoon that had me achieving a milestone on the SHARQ, I finally “reached” the corner, at 150 degrees flexion.
Since that time, I’ve gone further down the wall, to the windows, all the way to 160-165 degrees. It’s not perfect, but it’s pretty darn good.
Active vs Passive Motion
The problem is – and it’s a big problem – I’m only able to achieve these milestones when using passive motion. As hinted at earlier, passive motion is when you have someone else (such as a therapist) move your arm, or to have your other arm aid in the motion. With passive motion, you only prove that the movement, the range, is possible. It’s quite another thing to get the same range with active motion, when your arm does the moving all by itself.
Active motion has been a big challenge for me – and a big puzzle. The therapists have been puzzled too, as well as my surgeon. Why passive motion, but not active, even with lots of strength training? So on to the second surgery, where a lot of scar tissue could get cleared away.
New Therapist to the Rescue
After three weeks of recovery from the second surgery, I was getting bummed. Even though my shoulder was looser (before, it felt like it was being squeezed in a vise), and passive motion had improved a lot, my active motion was poor. It hadn’t improved at all.
Was the surgery a failure?
During this time period, I was put under the care of a new therapist, a recent college graduate. She’s turned out to be a blessing! She quickly diagnosed what had been puzzling all of us. She conjectured that my problem was I had simply forgotten how to move my shoulder properly. After nine months of being screwed up, I did not have a sense of where my shoulder was. It was hiked up most of the time, jamming the joint, making it hard to get any range with my arm. I needed exercises specifically tailored to correct this.
I related this to my surgeon during a checkup, and after he saw that I did indeed have decent passive motion, but poor active motion, he fully agreed with my therapist’s new training plan.
Now I’m off to the races. I can clearly see the path to success. I think I’ve turned the corner.
One of my new training regimens is to do exercises in front of a mirror, where I can see how my injured shoulder is positioned compared to the other. Seeing how the good one moves is a big help. And it seems to be working.
The only problem is, I have to look in the mirror and see myself as I truly am, all twenty-five extra pounds of belly fat, double chin, and everything.
I’m a mere donut of my former self.
It’s motivated me to start exercising again, to start riding my bike. So out I went last Saturday, on my first ride in five weeks.
Broken Spoke Ranch
I hooked up with the Los Freeloaders group, riding east through Gainey Ranch and beyond. I figured I’d do 20-30 miles. It’s still a bit difficult on the bike, but not like before the second surgery. There was no need to slowly ramp up the miles, using multiple baby-step rides. Nope, I just plunged in and rode.
But 15 miles in, at a stoplight, the light turned green, and I proceeded to stand and pedal, only to hear and feel something snap — a spoke on the front wheel.
So much for my day!
Good thing I was stopped when the spoke broke. Good thing we were right next to AJ’s, the place where we often loop back for snacks. Being so close to AJ’s, I walked my bike over and waited for the others to return, and in the meantime called my wife for a ride home.
I said on the phone, “Could you come get me? I broke a spoke on my bike.”
Now, all she heard was, “Blah blah blah …? I broke … blah blah blah.”
I almost gave her a heart attack, she said later. Guess maybe I should have said, “My bicycle is broke …” instead of “I broke my ….”
On the drive home, I thought about that broken spoke, how it broke off at the nipple. Why now? Why this way? Why on the front wheel? That’s not the where spokes usually break. Usually, it’s the back wheel that has the problem – the wheel that takes more weight, more abuse.
Then it dawned on me. The break was most likely due to the crash, way back last August, when I had slammed into a knee-high pile of gravel, head on. Mostly likely, the spoke nipple was stressed during that crash, or perhaps afterwards when I had the wheel re-trued. And after the measly 200 miles or so I’ve ridden since then, the nipple finally gave up the ghost.
Makes me wonder if there aren’t other stressed spokes or nipples on that wheel. Makes me wonder if instead of just replacing that one spoke, I should get all new ones and have the wheel completely rebuilt.
You see, I really don’t want more spokes to break, which might cause the front brakes to rub and the front wheel to lock up. Having that happen while zooming down a hill at high speed could send me over the handlebars again.
And I don’t really want to do that.
In the meantime, I’ll ride on a spare wheel, and keep working on my shoulder, looking forward to the day when everything’s fine, and I can return to writing about all the fabulous rides I’ve been on.