Thursday, November 17, 2011

What I've been doing - Part 2

(continued from the last post...) 

I was so glad that I had taken the time to work my shoulder, upper arm, upper back, and pec muscles before going to the Emergency Room (ER). At the ER, they decided to do a CT scan. The technician had me lie down on the bed (trolley?) and asked me if I could bring my arm over my head and rest it on a pillow above me on the bed. I hardly thought that was possible, but he assured me that he would help me and convinced me to try. The ER doctor had confirmed that my shoulder did not appear to be injured. The technician said he would brace my arm as we inched it up and over to where it needed to go.  He carefully placed a hand over each side of my elbow joint. His hands overlapped my lower and upper arms, and kept the angle locked. Each movement was not of separate parts of the arm, but the arm moved as if it were one piece. We moved an inch or so at a time and soon, my arm was lying above me on the bed, and I had experienced no pain.  In fact, for the first little bit, it felt good because my arm was getting a change of position. I couldn't believe that it worked!

I thought about it, and if I had not worked my pecs and my shoulder and upper back muscles, it might not have gone so smoothly. I probably would have succeeded in getting my arm in position for the CT scan, but I suspect it would have been somewhat painful, judging by how much those areas needed to be worked.

Fast forward.

They gave me my diagnosis, informed me that I would have to have surgery, and sent me home with some meds and an estimated surgery date. While I waited, I tried to keep myself relatively pain free.

One night, I was trying to get to sleep, and suddenly my left thumb started to hurt.  It was throbbing.  I was exhausted and not thinking very clearly, but my first thought was that the brachialis (p. 113) refers to the thumb.  I reached over and started to work the brachialis trigger points, which are located in the lower part of the front upper arm (by the biceps). They were sore. Within a few seconds, the pain was subsiding in my thumb, but I continued to work the brachialis until it was substantially softer. The next day, when I went to look things up in my trigger point manual, I saw that brachialis was the most likely muscle to cause pain in the thumb  It made sense. The brachialis had been held in the same position for several days. It was stressed because the bent elbow limited its movement in either direction.

On the first day of the correctly prescribed meds, I felt so much better, but then I got a weak, but very unpleasant headache. I thought, "Oh no!  I'm already taking all of this pain medication.  If that isn't taking care of it, I don't know what I'm going to do!" Then my inner trigger point detective kicked in.

My neck had been through quite a bit lately. Where do most headaches come from? The neck. I had been wearing a sling, and my neck was bearing the weight that my shoulder and arm usually bore. Not only that, it was dead weight, and it had been necessary for me to assume awkward positions to keep from bumping and hurting my arm.

Also, because it hurt my arm so much to sleep lying down, I had been sleeping sitting up in an arm chair with my feet up on a footstool. My neck had been in all kinds of positions. I was often sleeping in a "C" position, with my neck tucked into my chest. This made it harder to breathe, too. The muscles in the back of my neck were being held in an extended position too long, and the muscles in the front of my neck were being held in a shortened position too long. Both conditions create trigger points.

First, I worked my sternocleidomastoids (SCMs) since several of my symptoms appeared to be caused by the SCMs. Then I worked my scalenes and any of the muscles in the back of the neck that I could reach. I was not using very good ergonomics because I was limited to one hand. I tried to make up for this a little bit by taking frequent breaks. I focused on relaxing my working arm and hand each time I took a break. I also worked my right arm's flexor and extensor muscles after each session of neck massage. The headache pretty much disappeared halfway through massaging the SCMs, but I continued until I had got every trigger point that I could reach.

Later, I ended up with a similar headache and I was able to get it under control very quickly, but I realized that I need to do more in the way of prevention. I located a few pillows, including a neck pillow to help support my neck. I arranged things so that I was not sitting with my head thrust forward, or some other awkward angle. This helped a lot.

My sling was causing its own set of problems because of the extra strain it put on my neck. Also, the way that the sling fit my arm actually caused me pain. The straps of the sling attached at the elbow and wrist and I could feel a significant pull in both areas. Ordinarily, that might not be a problem, but my elbow was injured and the extra pull on my elbow made it hurt worse.  I decided to make my own sling and design it with these issues in mind.

I sewed up a 4-5 inch wide, padded strap, with one end folded back on itself about 11 inches and sewn to form a loose loop. I placed the loop over my splint and found that somewhere near the middle was the ideal place for the sling to pull up. I pulled the strap straight up and over my left shoulder, pulled it around my right waist to the front of my body. I was trying to decide what kind of fastener to use, when I noticed that the weight of my injured arm would hold the end of the sling in place, so I left it at that (I probably really shouldn't have been making a sling in my condition, anyway...). Sometimes, I use my arm as the weight and sometimes I tie the end of the sling to the loop part, depending on what I am going to do. The point is that I got a sling that was not hurting my neck or elbow. I was trying to prevent more problems than I already had.

The new sling is much more comfortable and my neck is not being pulled forward.  

The sling goes straight up to my neck, around my back, and to the front.
(Note:  For some unknown reason, my camera takes pictures in mirror mode, so even though it looks like the right arm is in a splint, it is actually my left arm.)

Sunday, November 13, 2011

What I've been doing - Part I

Note:  Refer to the "What Happened..." post for background information.  

One of the first things that I did once we got my arm stabilized in a sling and once we had given me some ibuprofen, was to work any trigger points that I thought would have been affected by my fall.

I visualized what might have happened in the fall. I pictured my elbow hitting the ground. I could imagine that muscles and bones in my upper arms and my forearms would be jarred quite hard. I could see that all of my shoulder muscles were probably affected. They would have to work hard to keep my shoulder in place.

I steered clear of working trigger points in my arm in the beginning because I did not want to inadvertently put pressure on the broken bone, wherever it might be.

I started out working my infraspinatus, supraspinatus, and my pecs.

The infraspinatus and supraspinatus are the muscles that lie on top of the shoulder blade, or scapula. There is a raised part of the shoulder blade that goes across the upper half of the shoulder blade. It is sometimes referred to as the scapular spine. The infraspinatus is the muscle that lies below the scapular spine. (Infraspinatus means "below or under the spine.") The supraspinatus is a muscle that lies above the scapular spine.

I worked the infra- and supra- spinatus with a lacrosse ball against the wall. I was very careful to keep my injured arm from moving.  It felt good, not only because it felt good to work the trigger points, which did need work, but also because working the trigger points released endorphins; my pain was partially relieved.

Since I was already up, I decide to work my gluts, lower back, and quads, too. A fall like I had probably involved most of my body, now that I thought about it.

I also worked my pecs. I could feel that they were very tight.

During our first visit to the doctor, the practitioner suggested that I unwrap my arm from time-to-time and work on trying to extend my range of motion.  Later, when I was getting zero pain relief from the meds, I wondered if I had a pinched nerve somewhere.  It felt very much like pinched nerves I've had in the past.  I knew that working my trigger points would help to release something if it were pinched, so I began to work on the upper arm and lower arm muscles.  I had also been working on my scalenes and sternocleidomastoids.

The only measurable pain relief that I got during this time period (between the first doctor's visit and the ER visit), was when I worked my trigger points in my arms.  I worked from the top of the upper arm down toward my elbow, and from the wrist area up toward the elbow.  I used supported thumb or supported fingers, and sometimes used a pinching technique, which I know is not very ergonomic, but I was trying to be careful to avoid the bones as much as possible.  I could feel each muscle relax and the pain subside as I released its trigger points.  It became more difficult, however, as I got closer to the elbow. I was so exhausted but so happy that my pain had subsided enough for me to get to sleep. I would get to sleep, but I'd wake up an hour or two later with screaming pain again. The muscles that had just been loose and relaxed were now tight as a spring.

I knew there must be something else going on. At this point, I wondered if anyone would be able to help me with my pain at all. Here I was taking Lortab (I did not realize that I had been prescribed a half dose), and it was not helping at all. The only thing that had helped me up to that point was trigger point therapy, and that was only temporary. Plus, I was exhausted from no sleep, and from tensing up against the pain. I could feel the tightness going further up my arm, into my shoulder and neck muscles. I could also feel that my abdomen was as hard as a rock, and my hips and upper legs were tensing up, too. I felt like a giant corkscrew.

In the middle of the night on Wednesday/Thursday, my husband and I decided to try the ER. I really didn't know if they would be able to help. I anticipated them trying to take an x-ray of my elbow again. I hadn't been able to extend my elbow enough at the on-call doctor and the technician there was not very sympathetic. She said, "I warned you that it would not be fun."

Before we left for the ER, I worked my upper arm, shoulder, and pec muscles. I wanted to have as much flexibility coming into that experience as possible.

(To be continued...)

What Happened By the Light of the Silvery Moon

I injured myself last week, and I have been using trigger point therapy a lot.  To explain what happened, I am including an excerpt of an email I sent our son, who lives in another part of the country. It will save me having to do so much one-handed typing, which is slow. Plus, it makes me dizzy following my finger all over the board.  The pain meds are helping my pain (thank you!), but they make me a little dizzy.  :) 

This post will establish what happened. I will then write in a following post about how I am using trigger point therapy to help me through this.  

Last Tuesday, I was walking to Young Women in Excellence at the church. Emily and Dad had gone earlier, and I was by myself. I was looking at the beautiful full moon and a bright star. I guess I was not watching where I was going very well because I stepped on the left edge of the sidewalk and half of my foot fell to the grass below, taking the rest of me with it. I was suddenly sitting on the sidewalk, and at first, I was just embarrassed and I looked around, hoping that nobody saw me. The pain soon made itself known, however, and I didn't care if anybody saw me. I waited a minute, trying to get my pain under control, and then tried to get up. I couldn't pick myself up. My left elbow hurt and felt kind of loose, like the joint wouldn't hold if it were to have any weight on it at all. At this point, I hoped that someone would see me because I needed help to get up.

Daniel Lyon was the first to spot me, and he came out to investigate. (I was about 25 feet from the east entrance, and Daniel was in the lobby with some other boys.) When he came out, I said something like, "It's me. I can't get up. Can you go get my husband?" Daniel walked a little closer and appeared to be squinting. He couldn't tell who it was. So, I said something like, "It's Sister Miles. I've fallen and I can't get up. Can you go get my husband for me? He's at Young Women in Excellence." Daniel was about to go in and get help when Brother Erik Dunne walked up, and he said that he would take care of it. He was going to give me a hand up, but when I told him that I couldn't use my left arm, he lifted me up by my armpits from behind. He had me sit on the couch in the lobby and he went to get Dad.

We went to the on-call doctor that evening and they took x-rays and said that nothing was broken. They did say that there was a shadow there though; so to be cautious, they put a splint on me and told me to go to my regular doctor in a week to have them x-ray it again, just in case. I could not extend my left forearm all the way--too much pain--so they had not been able to get a complete picture. 

They also gave me a prescription for Lortab to take if I needed it for pain. I tried to just take ibuprofen at first, but after that first night, I asked Dad  to fill the Lortab prescription. After 3 doses and absolutely no pain relief from the Lortab, I was getting pretty discouraged. The pain was excruciating. I was at a 9 on a 1-10 scale. Finally, at about 2:30 in the morning Wednesday night (Thursday morning), I asked Dad to take me to the emergency room. When I was explaining everything to the dr there, he asked me what effect the Lortab had on me. I told him that it did absolutely nothing. He said something like, "Whoa! What do you mean it did absolutely nothing? Didn't it make you loopy or anything?" I told him that I had felt mildly tired and a little dizzy for about 20 minutes after the second one, but then it went away. He said, "Wait a minute! Do you mean second dose, or second pill?"  I told him that my prescription said to take one pill up to four times daily as needed for pain. He then informed me that 2 pills per dose is the proper prescription for an adult. So, no wonder the Lortab wasn't doing anything. He said, "We've got to get that pain under control!"  (I was certainly okay with that.)

Then he told me that he thought that my arm was almost certainly broken. He said that the "pinched nerve" pain that I described would make sense if the bone was broken at the elbow in the funny bone area. 

He had the nurse bring me 2 percocet (pain meds) and an 800 mg Motrin (equal to four regular ibuprofen). She also gave me some anti-nausea medicine because percocet can make people nauseous. Then they came and got me and did a ct scan on my elbow.

A while later, I started to feel some pain relief. And, believe me, it was relief. I had been tensing my muscles everywhere, bracing against the pain. 

The doctor came in and said, "Yep. Broken. Broken and angulated." 

So, I have to have surgery to fix it. I will go in on Monday (I'll probably be in surgery when you read this). I could use your prayers. 

My pain is much better under control now, more between 1 and 3 mostly--sometimes up to a 5, but that is much better than a 9. 

Here is a picture the ct scan of my elbow. The half-moon piece needs to be reconnected to the end of my humerus (the bone on the right).  They are going screw it back on and hope for the best. They told me that I probably won't have my full range of motion back. 

Mari's elbow.  Just a note to clarify.  The lower bone is not broken.  This is a CT scan and it takes pictures in slices(?).  What we see is parts of two different bones, but they are not injured. The humerus (upper arm bone) is the bone that is injured.  It has the half-moon shaped piece broken off. Click to enlarge.

Tuesday, November 8, 2011

Working with the Theracane, Part 2

In this post, I will share more ways to use the theracane.

The theracane is great to use on your upper back, neck and shoulder muscles. Experiment with the larger knob and with the smaller knob (described in the last post) and see what you like best.

Whenever you can, let the theracane do the work for you. If you can, use the hand that is opposite the area to be worked to exert the pressure. It is easier to work trigger points if the muscle containing the trigger point is relaxed.

Theracane is working muscles on opposite side of back.
Front position of theracane to work other side of back.

To work your shoulder muscles, hold the cane with the curved part up and extending to the back. Place one hand on the curved part of the theracane and the other on the lower end of the cane. Place the large knob at the end of the curve on your shoulder. Push down with the top hand, and out with the bottom hand. Experiment with the leverage until you get the desired pressure.  
Using the opposite hand to exert the pressure.
Using the large knob is quite effective for the muscles in back of the neck and is especially useful when trying to get to some of the deeper muscles in your upper back and neck area. When working the muscles in the back of your neck, it is a good idea to lean back into the cane, relaxing the muscles that you are working.

Working the side of the neck.  
Your upper back and shoulders have several muscles that are layered on top of each other. Sometimes, it is necessary to push quite hard to get to a trigger point in the deeper muscles. Remember to let the leverage of the theracane do the work for you.   

There is a deep trigger point here.
Whenever you can, brace the theracane on something else in order to give you more leverage with less effort. If you are sitting, you can brace the bottom of the cane on your lap. You may also be able to brace the cane against your chair or couch. I have found a lot of places to brace my theracane when sitting in the front passenger seat of a car.  

Theracane is braced on lap, so that only one hand is working.

Using arm or wrist to give a break to the hand.
The large knob of the theracane is also good to use on the trigger points at and just below the rib cage in the back and side. Use caution here. These trigger points are very, very tender, and it does not take much to work them. I work mine perhaps two or three strokes and then come back to them later.  Also, stay on the muscles.  Don't start digging deep into the area below the ribs.  You have kidneys in there.  

To work this area, place the theracane curve around your waist, with the knob in back and the stick in front. Place your hands outside of each of the handles. Push forward with the hand that is closest to the straight end.
Working the back and sides near the bottom of the rib cage.
You can also use the large knob to work your chest muscles. Again, use caution because some of the chest muscles are also very tender. Go easy at first, and you will get an idea of how much pressure is just right.  (See my post on working pecs for more information on working your chest muscles.)  

 The theracane is a pretty handy tool.

Here is another theracane tip:  Take it in the car with you when you are driving. When you are stopped at a light, instead of getting upset at how long it is taking, work a couple of trigger points. (But don't relax so much that you are not ready to go the second the light turns green...) 

Tuesday, November 1, 2011

Working with the Theracane

The theracane is an incredible tool. It allows you to deep-massage places that you would not be able to do by yourself.

In this post, I will demonstrate some ways to use the theracane on four areas: the scalenes, the muscles in the back of the neck and head, the muscles under the arm, and the spinal muscles.

Before we get started, a word of caution... It is easy to get really carried away with the theracane. You might start really digging in, and later end up very sore. You might even end up with bruises. (Ask me how I know.) So, it is a good idea to go easy in the beginning. You will learn how much pressure to use on each area as you continue to practice.

Also, it is a good idea to have a layer of clothing of some kind between you and the theracane, especially when you are working more sensitive areas.


In a previous post, I demonstrated how to work your scalenes (muscles deep in the side of the neck) with supported fingers as the tool. It is also possible to work many of the scalenes with the theracane. It is a good idea to have worked them with your fingers first, so that you have an idea of where they are located, how the trigger points feel, and how much pressure to apply.

Start out with the theracane upside down. Place one hand on the ball at the end of the curved area. This will be your "anchor hand." Place the other hand up on the straight area, somewhere between the two handles. This will be your "guiding hand."

One hand on end of cane.
Alternatively, you can place the guiding hand on the lower handle. You may find that this gives you even better leverage.  
Guiding hand on lower handle.

Experiment with positioning your guiding hand until you can easily push the small knob into your scalenes. The idea is to use as little effort as possible and to let the leverage of the theracane do the work.  

Working scalene with theracane.

Change position for the fourth scalene.

In position to work fourth scalene.
Bring one hand up and place the other on the ball at the end of the theracane (not shown in picture). Press up on the bottom of the theracane to put pressure on the working knob. You may want to put your upper hand on top of the closest handle for more leverage.

Working fourth scalene.

Muscles in back of neck and head

As usual, do not press directly onto the bones of the spine. You are fine to gently press on your skull, however.

There are several layers of muscles in the back of the neck and head, some of them very small. Using one of the small knobs of the theracane can be an effective way to work these trigger points.

To work these muscles, bring the theracane to the back of the neck with the curve of the theracane extending forward. Bring the higher small knob to the back of the neck, holding the theracane in the middle of the curve on one side and just in front of the ball at the end of the stick on the other.

You can work the points by pressing the theracane forward, or you can hold the theracane stationary and lean your head back into the theracane.

Working the back of the neck.
You can use even less effort by bracing the theracane handles into the back of a chair, and leaning into the knob. I sometimes do this lying down in bed also, but you must be extremely slow and gentle when you lean back. I have had times when I had a headache, that I put the straight part of the cane (between the knobs, or right in the curve) right where the back of the head starts to curve (in the suboccipital area) and leaned back into it. It made it possible for me to get to sleep when nothing else worked.  

Brace the theracane "handles" against the back of the chair.

Muscles under the arm 

The muscles under the arm can be hard to get to and they are very important. Many of them are also quite tender, so go very, very easy.  

First, place the theracane in front of you with the curve extending back. Place the knob at the end of the curve, under your arm.  

In position for working under the arm.
Holding the end of the theracane with one hand, grab the top handle with the other hand.  

Ready to work the trigger points under the arm.
Use the leverage of the theracane to work the trigger points under your arm.  

Working trigger points under the arm with the theracane.
Side view.

Spinal muscles 

The theracane is particularly useful for getting the muscles right next to your spine.  

Get in position by bringing the theracane behind you with the curve extending forward.  

Getting in position to work the spinal muscles.
Place your arm behind the theracane on the straight end, in a place that is comfortable for your size body. In my case, it is between the lower handle and the end knob.  

Place your hand behind the theracane.
Place the top small knob of the theracane onto either side of the spine. (Never use the theracane directly on the spine.)  Slide the theracane up and down searching for trigger points. Then work them as you find them. Most of these will be quite small, so your stroke will be shorter and more focused.   

These are just some of the ways that you can use the theracane.