Last year when Coen was somewhere around three months old, I went to pick him up and felt a sharp pain in the front of my right arm. I almost dropped him. After I put him down the pain continued, although in a duller way. It hurt like this for a few days and then went dormant for a while. It would come and go but things felt odd in that shoulder most of the time. I always felt pain reaching across my body (like when I reach for my seat belt) and then sometimes when taking my arm out to the side and up.
Historically I’ve been a right side sleeper and most mornings when I wake, my shoulder feels out of place. My husband likes to make fun of the way I pump my fist up in the air until my shoulder pops. Even though I’m left handed, I tend to do more carrying with my left arm. (I feel like most people would carry with the opposite arm, leaving the dominant hand free for doing other things.) So here’s a history that shows my right arm/shoulder are getting smooshed (the technical term) overnight AND being underused during the day.
When I first started my massage therapy practice six years ago, I experienced some similar but milder shoulder pain but as my body adapted to its new demands, it dissipated and went away. When it flared up this time, I tried everything I could think of. I tried stretching my chest but that seemed to make it worse. I worked on my bicep tendon, pecs, teres, subscapularis, and serratus muscles using my hands, therapy balls, and the dowel. The subscapularis work seemed to have been the most help but it didn’t eliminate the problem.
About a month ago, I finally took steps to get help healing my shoulder. I don’t know why it took me so long! I started working with an athletic trainer I know. Even just going there and sharing my history with her helped me make some connections about how my body was kind of primed for this situation. Thankfully, her assessment ruled out a rotator cuff tear and a labral tear. (Insert sigh of relief here!) Instead we decided that I had some bicep tendon inflammation and that my right shoulder was generally unstable and not moving correctly. My collarbone wasn’t moving as it should and my first rib was locked in place as well. She noticed that when I bring my arms out and down from overhead (adduction) my scapula kind of hiccups or gets snagged on the way down, even though it’s pretty smooth sailing on the way up.
She used some enlightening and badass manual therapy techniques to address the tension in my pecs and rotator cuff (remember folks, ‘tight’ doesn’t equal strong). She performed crossfiber friction on my bicep tendon and she even worked my forearm and hand. She gave me several therapeutic exercises to practice and they were HARD. She made it clear that I wasn’t to practice them if I felt pain.
While working through my program at home after that first session, I got pretty discouraged. My arm hurt through all the exercises so I stopped as she recommended. I hadn’t been practicing the crossfiber ice massage she showed me and when I went back for my second visit, the inflammation in my bicep tendon was pretty crazy. I shared with her about the pain I felt during the exercises. We scaled back. She showed me some simpler, more basic things to try. I still felt the pain—I paid close attention and zeroed in on it—it was an uncomfortable sensation in my external rotators. My trainer helped me reframe my perception of the sensation: the muscles were weak and trying really hard. Instead of labeling it as pain, I started to view the sensation as weakness that I was challenging.
From everything that I’ve learned about pain science, I know emotions can play a huge role in the experience of pain. In addition, I find that infusing life events with symbolism or metaphor can help me shift my perspective away from negative self-talk or victimization and into a position that feels more meaningful and powerful. So when I really felt ready to seek help for my shoulder pain, I also started examining any mental/emotional components to the situation.
For me, with pain there is always fear. I think in the case of this shoulder injury, I was feeling afraid that the pain and decreased range of motion would continue indefinitely and that it would just get worse as I got older. I associate the arms and shoulders with the heart and with carrying, giving, and receiving. At the point in my life when this shoulder pain felt most acute, I was in the middle of postpartum depression. I was thinking, oh my god what have I done having this second child? I was tired. I was giving a lot and receiving little. I felt beaten down and I felt a distinct lack of joy.
With the shift into summer this year, I felt like I was coming up for air. Coen was sleeping better and I was starting to get some energy back—and with that energy some hope. I decided to give back to myself and get back to some of my interests from before having kids. I was nourishing myself. I’m finding my joy again. I’m still carrying a lot but I’m getting stronger to support the load. When I do my therapeutic exercises, I think about how my shoulder isn’t just getting physically stronger but how I’m getting stronger and more stable emotionally as well. Because when I feel capable of lifting my arm over my head, I feel more able to care for myself and execute my responsibilities. When my proprioception is on point in my shoulder, I know where I stand and what tools to use to get the job done most effectively/efficiently. I can identify which parts of myself are trying too hard or aren’t showing up or that have been suppressed. I can get reorganized and back on track.
I still sometimes have pain and while it can feel annoying, it isn’t my everything. I have some tools to work with it. I’m not always able to carve out the time to do my specific exercise therapy but I have started using that right arm more, while being mindful of the rotation of my humerus and the placement of my scapula. I’ve started carrying Coen in my right arm until it fatigues (which is really quickly — he weighs 27 pounds!) and last week I vacuumed almost the whole house with my right arm before it wanted to quit.
My right shoulder has definitely adapted to being underused. I’m still blown away by the difference in strength between my left and right shoulders. And while I don’t believe it’s necessary to have a perfectly symmetrical body, I do feel like creating more balanced strength in my shoulder girdle is an opportunity to find a better balance in other areas of my life.
I feel privileged to get to receive this kind of work from such a talented trainer. My next session isn’t for a few more week and then we’re going to do some focus on my rib cage. I’ll keep you posted!