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Ideas for after surgery? Plus looking for a trainer

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  • Ideas for after surgery? Plus looking for a trainer

    I've currently am recovering from a surgery (6 weeks) that leaves me with limited mobility of my right arm. I've got my physical therapy exercises but my insurance doesn't want to foot the bill on real physical therapy. I'm thinking vaulting may be a great way to get strength, flexibility, and balance back into my right arm/side. Currently, I can only lift my arm to shoulder height, can't reach behind me (like touching your back). My arm is also extremely weak. Because of the dressings I had after surgery, my shoulder is pitched forward, it's very difficult to pull my right shoulder in line with my left. It's also constantly higher than my left shoulder.

    My right arm is my dominant arm so it's been interesting learning to do things with the left. I would like to get as close to "normal" as I can, but even my surgeon warned I may never have full range again.

    Does vaulting sound like a good option? I figure I can get some horse time as well as some good exercising.

    Any other ideas?

    I'm looking for a woman named Odette Riegman. She's ARIA Certified in Vaulting and Dressage and is also NARHA certified. Google searches return addresses and phone numbers in the Central Coast and in the Bay Area, so I don't even know where she's located. Anyone heard of her? But it sounds like she may be a person of interest for me.

  • #2
    It sounds like you're in dire need of formal physical therapy. Has your doctor appealed the PT denial with the insurance company? Often times, a letter of medical necessity will do the trick and get you the help you need.

    Vaulting requires a lot of strength and flexibilty; with the range of motion and strength you describe you currently have, I would be leery of you getting on a horse (even on a lunge line!) What happens if you fall off? Especially if you fall off and re-injure your arm?

    What type of surgery did you have?

    (I was an orthopaedic medical assistant for a few years and may be able to help you with some key phrases to help get your insurance to cover PT.)



    • #3
      You REALLY NEED PT. Please do whatever it takes to get it.

      I have a collarbone that is two inches shorter than the other due to the bad call of the ER doc. It has ruined my body. I work every day to be as straight as i can... Your asymmetry sounds very much like mine...
      "Kindness is free" ~ Eurofoal
      The CoTH CYA - please consult w/your veterinarian under any and all circumstances.


      • Original Poster

        The surgery I had was to remove an abscess from my armpit. I have an auto-immune disease called Hidradenitis Suppurativa. I had a few sweat glands removed also that were affected. My incision was fully closed, rather than left open to heal. So in my armpit, I have far less skin than a "normal" person to be able to stretch, reach, etc. So no adverse affects to the bones/ligaments/tendons. The arm is weak because it was immobilized for 4 weeks. I think all the shoulder stuff comes fully from the dressings I had the first week after the surgery. They used a lot of that foam tape and essentially taped my shoulder into a forward position.

        The problem is that I have Kaiser, and they never want to pay for anything extra. (I'm going to an doctor out of Kaiser to start laser treatments for my problem because Kaiser won't okay them.) The doctor doesn't think I need PT, says my shoulder will go back to normal "eventually" and states that I just have to accept that ROM may never fully come back, because of the nature of removing so much skin. But it takes constant thinking to keep my shoulder in line and down. When I'm just relaxing it pitches forward and up.

        The incisions are quite sealed, Doctor doesn't think there is much worry about ripping open seams any more. I do have at least one more post-op in late Aug.


        • #5
          I would start by going to an orthopaedic surgeon to specifically address the weakness and loss of ROM in your shoulder.

          After having your arm immobilized for four weeks, you most definately need PT. You are actually at risk for developing adhesive capsulitis ("frozen shoulder"). If you don't regain your ROM now, you could potentially LOSE more ROM and end up with a frozen shoulder. That requires a manipulation under anesthesia to break adhesions and very, very aggressive PT afterwards. We used to send people for their first PT session directly from the surgery center - then PT daily for 2 weeks, then cut down on the frequency of visits.

          Please do not attempt anything (like vaulting!) until you get the strength issue addressed.

          Feel free to PM me if you have any questions.


          ETA: I am actually going for surgery next week for the opposite issue - my shoulder joint capsule is stretched out from repeated microtrauma. My shoulder is currently very weak as well - when I went to PT to try and gain strength before surgery, any exercises they had me do made my shoulder partially dislocate (subluxation).

          The shoulder is a very unique joint in that it is the most mobile joint in the body - and there is a very fine line between not enough motion/full motion/more than full motion.

          Get thee to an ortho doc ASAP!


          • #6
            Go talk with the vaulting trainer.
            We started students on a barrel, not a horse, to preserve the horses.
            Beginners don't need to be bouncing on a horse's back until they learn the very basics.
            On the barrel you can figure if vaulting will help you and what you can do.


            • #7
              PT FIRST!!!

              Very unfortunate the physician is not referring for PT. Four weeks of total immobilization can create several problems in and of itself (besides the weakness).

              You can get by on a skeliton schedule of PT, which may be an advantage in getting it approved. I would also second the second opinion and IMO to explore the possiblity you have early stage adhesive capsulitis based on your comment....
              "When I'm just relaxing it pitches forward and up."

              Lastly, you are looking at several months of rehab and strengthening. I'd hold off looking for a vaulting trainer until you know what your shoulder will allow you to do.

              medical Mike
              equestrian medical researcher


              • Original Poster

                Wow, I shall fight for PT now, because of the auto-immune issues, I have enough problems with my joints. (Ever hear of a 3 year old complaining of their elbows hurting? That was me.)

                I'm one to fight for my health, I fought (and lost) for the laser treatments but willing to pay out of pocket. Kaiser doesn't own laser equipment and don't want to pay an outside facility.

                She did give me exercises to do at home. I do them in front of a mirror to try to keep proper form, and quite frankly they hurt to do them (don't know if that's good or bad). They hurt because of the feeling of stretching skin, not the joint itself.

                How much does PT usually cost? Right now, on top of Kaiser expenses, we'll be shelling out $100/appt out of pocket for my laser treatments soon.

                Since my surgeon won't okay PT, should I try through my primary doctor?


                • Original Poster

                  Oh, and I don't know if this matters or not. But during my recovery, I had extreme muscle pain from the bottom of my shoulder blade to the shoulder to my hand on my right side. I was given muscle relaxants which helped mildly (From a 9 on the pain scale to about a 5-6).

                  Muscle pain went away around week 3.


                  • #10
                    I am beginning my 5th month of PT following a 4-part humeral head fracture (broke the top of my arm, right at the shoulder joint). It HURTS. PT HURTS. Shoulder PT HURTS. Did I mention that it kind of hurts a little??

                    You have a very different issue than I do, but as others have said, you have also immobilized a joint that doesn't like to be immobile, and needs to be moved to regain ROM.

                    My PT sessions, according to my bills, run me $166 per 45 minute appointment. This is with the PT associated with my ortho group--quite chi-chi and sought after in our area. (I just like the super experienced sports ortho docs!)

                    You can call around and get price quotes. Please continue to do the exercises given you. I would also add a hot, moist towel before you do your exercises--my PT gives me moist heat for 9 minutes before. Ice afterward for 10-15 minutes is good too. Take pain meds, get a second opinion, and take your time. But do get more PT to address the ROM--surgery down the road to free a frozen shoulder is the pits!!
                    Proud member of the "Don't rush to kill wildlife" clique!


                    • #11
                      You can go through your primary doc for a PT referral....but I personally would be seeking an opinion from an orthopaedic doc.


                      • #12
                        Being from Canada things are different but if the surgeon will not send you for PT get your primary to send you.

                        I am currently on month 7 of PT after 2 shoulder surgeries in 5 or 6 months. I have been in physio since July 2008 for this issue and let me tell you you do not want to go through what I am going through and have been through so do whatever it takes to go to PT. I pay $ 55 per visit (totally out of pocket) and have been going essentially weekly for one and half years, and twice weekly since surgery round 1. My visits tend to be between 1 1/2 to 2 hours and I am currently doing exercises and icing 6 times per day.

                        Good luck.