Posts Tagged ‘right shoulder’
12/28/11 – Am I Treating the Symptoms or the Problem? TMJ Related?
Posted by admin in Reflections on December 28th, 2011
I felt it. I knew it would happen, and it did. I am now all about the workouts! I don’t know what it is about me, but I have a very difficult time doing something until I feel like it is right. Well, folks, the time is right.
I have been to the gym more times in December than October and November combined, and I hope to continue this trend through the whole of next year.
Once again, I am rehab-ing my knee – myself this time. It was not getting better with just the strengthening of the multifidi or hip muscles. So, I have brought out the tiger tail, specific area massage with my own hands, icing and the foam roller. It is responding well, but I have to stay on top of it.
Due to the relapse in the right knee as well as the right shoulder, my thoughts this week have been largely wondering around the question of “Am I treating symptoms or the problems?” The shoulder is less of an injury than the knee, but still, why do they keep walking the line of injury? Does this mean that there is another underlying problem that I really need to look into? Am I just treating symptoms?
I am also wondering about my TMJ. Is TMJ the actual problem to almost everything else?
I have been working on relaxing my jaw at all times in combination with making sure my shoulders are pulled down and back (which has gotten easier with the strength building!). The only time I cannot for sure control the jaw clenching is during my sleep. For sleep, I was wearing a night guard, but I lost it about two months ago. I decided to try it without the guard by relaxing before sleep and reminding myself not to clench or grind when I sleep. I think some of it has been getting through as I am feeling more relaxed in my neck and shoulders, but I have a LONG way to go as more relaxed is all relative. My neck and shoulder muscles still feel like rocks, just more like sandstone rather than granite.
Over the last month, I have also been incorporating a line from a short play I saw years ago, the name of which is lost in time. The line is, “Just stop it!” In the play a psychologist tells her patient to “Just stop it!” whenever the patient brings up the crazy actions in her life. I couldn’t help but think that was so brilliant at the time, and then just last week I was talking to my massage therapist who was telling me about a man who got a massage as a gift. When he showed up, he didn’t have any knots. How is this possible? No knots, not even in his shoulders? What’s his secret? Then, the line from the play popped in my head, “Just stop having knots!” Really brain? Wait. Is it possible to just stop having knots by sheer force of will?
As a side note, my husband also has zero knots. None. Zip. Nadda. No knots. Not ever. He also has a stressful job, and works out a lot. No knots. I’ve asked him about it. Of course he has no idea. I do know that he does not ever clench his jaw. Never. How is this possible? Why do I clench and he does not?
Then, I started thinking about my TMJ. I clench and grind, and I have tight shoulder and neck muscles with tons of knots. Could this be the problem that causes my symptoms?
According to emedicine health (http://www.emedicinehealth.com/temporomandibular_joint_tmj_syndrome/page2_em.htm), TMJ can be caused by clenching of the jaw and grinding of the teeth, or bruxism (check and check). People who clench might also chew pencils, gum or other objects when not eating. The chewing reinforces the clenching at all times, and can cause TMJ because the jaw muscles are not getting a chance to relax between meals like they are supposed to. Bruxism on the other hand is grinding of teeth, which largely happens at night when someone’s bite is off; when he/she is missing a tooth; or if someone has a lot of stress or anxiety.
Now, I find this reinforcing to me as I used to be a chronic gum chewer. I would not be found dead without gum on my person and in my mouth, unless food was in my mouth. I quit chewing gum over a year ago because of the other effects chewing gum has on your esophagus and digestive tract in general (Chewing gum signals the start of the digestive process by causing the mouth to produce saliva. Then, the stomach responds by producing acid that would be necessary if food were to hit it. However, with gum, there is no food that ever hits the stomach, and then the extra acid is just sitting around causing trouble.). To find that not chewing gum also helps reduce the clenching is phenomenal! Two benefits in one!
Ok. The treatment for bruxism? Medicine Net (http://www.medicinenet.com/teeth_grinding_bruxism/article.htm) says that for teeth grinding do one or more of the following:
– Mouth guard
– Stress reduction (either by counseling or medication)
– Reduce or avoid caffeine and alcohol
– Train yourself to not clench or grind (“JUST STOP IT!”)
Well, there it is! Just stop grinding your teeth, silly. Why didn’t I think of this before?
What it turns out to be with feet (sans orthotics for nearly two whole years!) and jaws is that you have to do all the work. Sure a mouth guard will help, but what about when you lose it or forget it on a long trip? The real solution is to do the leg work yourself. Figure out how to train yourself to stop. Then, “JUST STOP IT!”
Now for my continuing experiment to meet my goal of not needing any external structures to live my life to its fullest, I will continue to work toward relaxing my jaw at all waking hours. During workouts, I press my tongue against the top of my mouth, which does two things: 1. stops me from clenching my jaws 2. activates the multifidous muscles next to the c1-4 vertebrae, which need to work some anyway. So far so good 🙂
9/13/11 – PT, My Jaw Story, and a Workout!
I am moving toward a goal of posting more, again, on the blog 😉
So, today was a visit to Travis about my right shoulder. I originally started visiting him concerning an inflamed biceps tendon, but since then, it has changed to more a slightly sore infra-spinatus. The cause seems to stem from my lifelong habit of clenching my jaws together,which I am also seeing a different specialist for.
Anyway, over the weekend I had to get a massage to relieve my shoulder pain due to excessive clenching, which causes a chain reaction of my levator scapula getting tight and causing a downward rotation on my shoulder blade, which then causes the rest of the rotator muscles- that are already a little too weak – to work super hard to get the upward rotation on the shoulder blade. The end result is an inflamed small muscle or tendon in my shoulder and a very tight neck and top of shoulder area. Argh.
The massage enabled me to run the 5K Iron Girl on Sunday, but by today, I was already super tight again and feeling some discomfort in my shoulder. Travis, being the incredibly knowledgeable PT that he is, did a very specific massage, which loosened up the muscles enough so that we could actually do some exercises. He, then, took it fairly easy on me due to the inflammation of the new area.
I also told him what I had learned about my jaw from the specialist at UW. It goes something like this:
I broke my only crown, which I had had for 10 years, in January of this year and had it replaced in February. After the replacement is has hurt and continually extruded (or pushed up). My dentist filed it down three times before determining that it was probably something more serious and sent me to an endodontist due to my long tooth roots.
Cut to endodontist: She determined that I had a cracked tooth, which had been held together with the old crown, and opened up with the new crown, which equals a ROOT CANAL! Yay! The root canal was supposed to solve the problem and stop the tooth extrusion.(She also measured my tooth roots b/c I was wondering how long they were and why they were considered so long. It turns out my tooth roots are 25mm long, and a normal tooth has roots approx. 22mm long. And now you know….)
Note: this whole time I am wearing my night guard religiously each night. My night guard is basically a mold of my teeth with some kind of plaster built up on the front part to keep my teeth from touching in the back. The only teeth that touch are the front ones, and boy can I feel it in the morning on the front teeth when I’ve had an exceptionally clench-filled night.
Well, the root canal on August 16th did not stop the tooth from continuing to extrude. My endodontist even did a file down to help ease the discomfort about one week later.
In the mean time, I set up an appointment with the TMJ specialist at UW. I explained the whole process to him, and he immediately was impressed that I knew how long my tooth roots were. 🙂 I’m such a nerd sometimes. Anyway, the result of the dissertation I made and the observations he made were that my night guard was causing the tooth to extrude. WHAT?! The freakin’ night guard that I dislike anyway is causing this entire catastrophie?! ARGH!
Here’s what was happening. He said that it is well known and thought of that a tooth on the top of the mouth without a tooth to oppose it on the bottom will overtime extrude because it does not have any force to oppose it and keep it in place. It is still known, but not really thought of (as in it is not the immediate conclusion) for bottom teeth, which is what my tooth is. So, my bottom tooth was inflamed, which means that the bone is building up around the root to help protect it, and the tendon surrounding the roots are working overtime to try and get the inflamed object to go away (i.e. extrude). Normally, after the root canal the tooth has a chance to calm down and stay in place b/c at some point in the day, it will hit the opposing upper jaw tooth and stay in place. However, due to my unfortunate nightguard, my back teeth NEVER touched, and my poor inflamed tooth was able to continue to push out each and every night.
He told me to throw out my nightguard because he was going to give me a new one (the temporary is a simple sports self-mold model – this thing is huge, but all of my teeth can touch the bendy plastic substance it is made out of). His theory was that with the touching of the teeth on something, the back tooth would begin to intrude, which it has, happily, done! Woohoo!
The second part of my treatment is all behavioral, i.e. I have to change my clenching habits during the day. I also learned that your teeth do not actually touch when your jaw is in a resting position. Many of you already knew that – lucky for you. I had no idea! I’ve been clenching my whole life thinking I was relaxed! No wonder my shoulders are like rocks.
So, my homework is to continually remind myself to relax my jaw – keep the tongue resting behind the front teeth while the teeth remain slightly apart to give the jaw joint space. I have been completely amazed by how often and how severely I clench during the day, even. It’s crazy! I especially clench during upper body (specifically shoulder) exercises. I also clench when I run, get really stressed at work or just sit and read facebook. My day now consists of me checking the status of my jaw and relaxing constantly.
I told Travis all this today, and he also added that the levator scapula is very tight possibly due to weakened multifidi on the C1-4 vertebrae. So, I now am working in pushing my tongue against the roof of mouth to fire those extremely tiny muscles along my spine. Woohoo! I’m just afire with crazy crap to keep up with.
Travis also finished analyzing my running video that we made several weeks ago. Due to the file size, I will not have it in my possession until I am able to get a thumb drive to him to download them. I will save his findings for the video.
I also ended my day with a workout from Melissa. Woohoo! I’ve gotten it all in this week. I’m going to try and run tomorrow as it will be day three after the race, which should be enough time for recovery, maybe.
Things are very exciting right now. I really believe if I can tame my jaw clenching, then I will see a huge reduction in my various discomforts and ailments. Never underestimate how connected the entire body is.
p.s. Travis measured the flexibility of the achilles tendon by measuring how far away from the wall I can stand and touch my knee cap to the wall. I’ll explain why in the video post, but for now the numbers – so I don’t forget them.
The right foot (big tow) was 5.5cm from the wall, and the left foot (big toe) was 7cm from the wall. These numbers are new measurements that I look to improve to the goal of 10cm for each foot over time.
9/23/10 – Last Appointment with Physical Therapy
I had my last appointment with Travis at Seattle Physical Therapy on Thursday, September 23, 2010. It was for my right shoulder that I had spent the last four appointments in that office, and last week, Travis told me that I was good to go. My shoulder has not completely healed, but since I do my “homework” or exercises, he told me that there was really no need for me to keep coming to the office.
So, I’m finished with one part of my Village.
What a mixture of happiness and sadness as Travis is a wonderful motivator and coach. He is also a huge geek about biomechanical processes. I will miss having him explain the functions of the tendons and muscles in the foot and shoulder.
However, I am so glad that I have come so far!
Good bye Seattle Physical Therapy and Travis Orth. You have been invaluable to me in the last year, and I appreciate all of your help in getting me back in working condition! 🙂
Quick and Dirty Update on Last 3 Weeks, Then Back to Regularly Scheduled Blog!
So, these past three weeks have been a whirlwind of excitement and exhaustion. The school year began with full force; at the same time I was house/dogs/cat/fish/newts sitting for friends who go to go to Burning Man; and I was trying to maintain a workout schedule. Whew!
Well, the house/dogs/cat/fish/newts survived; my students are awesome this year (so far); my workout limped along.
I also had several appointments with Travis, my physical therapist, who is currently treating my right shoulder, which I am calling the last of my old injuries. It is well on the road to recovery, and next week I should be released from physical therapy for good 🙂 That is barring any new weird things that might happen. So, Yay!!!
Melissa, my personal trainer, has been awesome! She has been supplementing my physical therapy on my shoulder with more specific and difficult serratus anterior exercises. I really do have a great team!
On the chiropractic front, Dr. Larry has been keeping everything in line – hahaha! While Lynda, my massage therapist, aka the muscle whisperer, has been working with my right shoulder mainly to keep it functioning without all that tightness.
All together, these past three weeks have been challenging and rewarding. I’m looking forward to a more normal routine where I can workout regularly and begin running training again.
8/25/10 – Personal Training – Boy is Melissa able to think on her feet!
So, this time Melissa did not get any notice that I would need to adjust my workout for an inflamed shoulder. However, she did not miss a beat!!! She just reworked my exercises to include some small muscles moves for my serratus anterior as well as some of the other small muscles.
It is so frustrating to go back to such simple moves, and it is even more frustrating to have them be difficult!!! I am doing a plank on a hard medicine ball with my back rounded to work the serratus anterior. My abs are really strong, but my serratus anterior is not. So, if I am doing this correctly, it is really challenging.
I am doing Vee Raises with 3 lb weights. So ridiculous! THREE POUNDS! GAAAHHHHH! They are so difficult. Oh well, after this I will be able to lift real weight correctly.
Anyway, it was a fantastic workout, and I look forward to moving past this phase of treatment on my right shoulder.
Physical Therapist 8/24/10 – Discharge Day – Nah, new treatment for right shoulder….
So, the day after my very successful run, I had my appointment with Travis for a discharge from PT of sorts on my left foot. However, I wrote him an email the night before to let him know of my right shoulder woes. My right shoulder and I have a history, you see.
It all started when a public transit bus made a left turn in front on me in the rain with me coming off the downward incline on a hill. Well, my little car did not have ABS. So, I pressed my breaks, my wheels locked, and I slid right into the bus. Luckily, I had every kind of airbag known to man as well as some fancy shock absorbing technology in the front end of my car, which enabled me to walk away without a broken bone. However, I did have some whip lash, and my right shoulder has not been the same since that day. Oh, and in case you were wondering, the bus won in that completely unfair battle with my wonderful little car being declared totaled, but, for the record, it was the bus driver’s fault.
Ok, back to my story. I did not do anything for my shoulder for six months. When I did seek medical attention, I saw a medical doctor (read: cortizone shot) who referred me to physical therapy (in hindsight, I realize I should have gone to a chiropractor like everyone told me to). Unlike this current round of PT, my first shoulder therapist was not what I had hoped. I could tell that my shoulder was in the wrong place because when I did my exercises, it hurt. It felt like the ball in the shoulder bone was always rubbing against the top of the shoulder socket. When I told my physical therapist, she just told me to keep doing the exercises and it would get better. Instead, it only got worse.
This, consequently, is the only time I have been disappointed in physical therapy.
A couple months later, I moved to Seattle. It was during the awesome, yet, long road trip out to Seattle, WA from Atlanta, GA that I really got “stove upâ€. By the time I set foot in WA state, my right hip was killing me (hurt to walk) and my right shoulder continued to feel very inflamed toward the top of the socket.
At the strong urging of my road trip buddy, AiHanh, I decided to see a chiropractor. That’s when the insurance website and serendipity (his location being awesome, etc.) introduced me to Dr. Larry who proceeded to put everything back in proper alignment, and I had not felt relief like those first few adjustments in a very long time – I’m thinking since before the car accident.
Anyway, after a year of adjustments from Dr. Larry, my shoulder started to hold it’s position (apparently it was still very weak in the small muscles). The only time I had to have it adjusted during this happy period was after I had travelled. It turns out that carrying heavy bags is hard on a shoulder that is weak.
However, about a month ago or two months ago (I see Dr. Larry every two weeks), my shoulder (as reported in earlier Chiropractic posts) needed to be adjusted regularly. These adjustments were really making me wonder what was going on with my shoulder. It was also beginning to be a little sore after workouts, but that’s it….until Sunday.
Saturday and Sunday this past weekend, I took sailing lessons, which involve a lot of pulling ropes, errr, I mean lines (shoulder work). Well, by the end of the weekend, I was icing my shoulder daily. Not fun, and definitely not normal and healthy.
Now, back to my physical therapy appointment.
The shoulder, it turns out, is Travis’s favorite injury to treat. I postulate that it is because the shoulder is so complex, which would make it very fun and intellectually challenging to figure out what is and is not working and put it all back into working order.
So, with Travis gleefully listening, I related my shoulder story. He then looked at the shoulder and had me do some tests. Here’s what he found:
My right shoulder blade sticks out more when resting than the left one. This indicates a weak lower trapezius muscle, I think.
My right arm has less range of motion than my left when brought around to the back.
My right arm has pain when lifted straight up and has less range of motion when trying to extend it back when in the straight up position (I am sure there are much more succinct ways of putting these, but this is what I’ve got at the moment).
(Is Dr. Larry reading this b/c if so, then he will know for my next appointment) My upper middle back is very tight and the T8 vertibrae is sore.
The diagnosis:
The Serratus Anterior must be strengthened (this is the muscles under the scapula-shoulder blade-that holds down the scapula). The upper traps are doing most of the shoulder work. The Suprasinatus or the little muscle that becomes the ligament that attaches to the top of the shoulder bone, needs to be strengthened after the inflammation has gone down. The shoulder bone sits too far forward in the socket. Therefore, I must learn and practice keeping it back and in the correct position.
The plan:
Week 1 (I only have to go once per weeks since I DO my exercises :-))
Lay on side with large towel roll under top arm. Holding a one pound weight with arm bent at 90 degree angle, move through entire range of motion 10 times X 3 sets.
Take Red Theraband and pull down on ends with small range of motion, arms extended and palms down. This works the Serratus Anterior (the muscle that controls the bottom of the scapula or shoulder blade) as well as the lower traps, which are incredibly weak.
Roll upper middle back over foam roller stopping at T8.
Woohoo!!!
And, yes, this is part of the process of running barefoot! With an inflamed shoulder, it is difficult to run without pain in the shoulder. So, meh.
8/23/10 – Run 9A – 1.5 miles :-)
Posted by admin in Training (running, cycling, etc.) on August 29th, 2010
On Monday (8/23), I ventured forth to run my longest run for the summer:
walk 1/4, run 3/4, walk 1/4, run 3/4.
After not having much luck in this area for the past few runs, I was not overly confident that I could make it. However, I did! But I did break the “if you have symptoms, stop†rule on the run. For the last 1/4 mile of running, my right knee was “complainingâ€. I really wanted to make this distance, though. So, I powered through to the end.
I iced as soon as possible on my right knee, my left posterior tibial tendon (for good measure) and my right shoulder (more on that later). You should try icing all those at one time; it’s a very entertaining balancing act.
Anyway, the next day, I did not have any trouble with my right knee, nor did I have issues with my left posterior tibial tendon. I did, however, have a problem with my left shoulder, which had been building over the last month.
Well, at least I made my distance!!!
8/4/10 – Chiropractor and Massage, Finally
What a banner day! I wake up with my nerve in my right arm raging, my quads screaming at me with every movement, and my ankle feeling fine.
So, I arrive at Dr. Larry’s office EARLY, which I never do. As a matter of fact, I think I’m 20 minutes early! Do ya think I’m really looking forward to this visit?
Anyway, when I get to the room, I launch into the shoulder explanation:
Me: “You need to adjust my shoulder b/c my nerve is shooting pain down to my elbow.”
Dr. Larry: “Let me test it first.”
Me: “You really need to adjust my shoulder….”
Dr. Larry: “Just let me test it. Hmmm. Ok. I’ll adjust your shoulder.”
My Shoulder: “CRACK!”
Me: “Ahhh.”
Dr. Larry: “That’s amazing! Have you thought about becoming a chiropractor?”
Ok, so maybe we said slightly different things, but it was something to that extent. I really think that my chiropractor is awesome. His shoulder adjustments are actually a special move that he kind of invented, which as he has said is a combination of two moves to make one super move – “The Macarena”. This is my favorite shoulder adjustment. It always does the trick.
He also did the standard pulling my leg, adjusting my ankle and of course the L5 for the sciatica.
Next, the massage 🙂
Lynda was back from her awesome bike ride across Ohio (correct me if I’m wrong, I think it is Ohio). So cool! She stayed with people she knew all across the state and ate homemade cookies that a family was simply GIVING away to the bike riders. She slogged through thunderstorms and finished with a family wedding. She is awesome!
Then, on her first day back in the office, she has to deal with me – muwahahahaha!
So, she gets to the right shoulder first. Turns out that b/c I have not been wearing my night guard, I have been clenching my jaw, which is not causing issues with my jaw. Instead, the clenching is completely screwing up my right shoulder! It’s all connected, baby.
So, she works some magic on my shoulder muscles (she’s like the muscle whisperer – they release when she tells them to). Then, down to my oh-so-sore quads. I was so not looking forward to this as I knew it was going to hurt.
And it did, but she was able to get the muscles and tendons to relax, which did quicken the recovery time.
My left foot was really crunchy, too. It did decide to relax a bit. She also released my hip flexors.
Overall, a really wonderful and very needed afternoon.