Physio for the Frozen Shoulder

Paolo was as direct and merciless with his words as he was with the pressure he brought to bear on my shoulder, neck and back. It was the first time that I had met him, but he was already talking to me like he had known me for a lifetime. He was unapologetic when challenging me, "why are not you making the lifestyle changes that you know you need to make?", "why are not you getting exercise 3 times a week?", and "when are you going to start taking care of yourself?". Good questions. Too bad I did not have any good answers?

At the time I made my first appointment with him my shoulder and elbow were a little sore and stiff, but I could not isolate the cause. Was it the PD?  These days I immediately identify almost any physical, cognitive or imaginary change to my bodily functioning as being attributable to Parkinson's. However, my second response is to pooh-pooh that first response for fear of the label "hypochondriac" being put on my business card. By the time I made it in to see Paolo the physiotherapist today, the range of motion in my shoulder, elbow, and then neck, were becoming more limited everyday. I have been wearing an arm brace just below my elbow, as it seemed to help with daily tasks. But the pain streaked down my arm whenever I put my arm/shoulder in the wrong place or position.

Despite the pain of the probing by Paulo this morning, it was evident afterwards that my range of motion had increased thereby validating his diagnosis and making his prognosis quite likely: if I do not work on the "frozen shoulder" now I will run the risk of rendering my right arm of limited use. I am already becoming a virtual left-handed person due to the tremor, and this would only speed up that switch.   My elbow pain is apparently from acute tendonitis.

I suppose it is only appropriate that today, the 4th anniversary of my "PD Diagnosis Day", I should receive a wake-up call from someone I had never met. After all, that is what happened 4 years ago. Maybe I need the feedback from a distance instead of those close to me. Change must occur. I must do a better job of shining a light into the future and responding now to what I can discern there.

So tomorrow morning I climb back on the "wagon" with my personal trainer and recommit myself to exercise at least 3 times a week for an hour, focusing on aerobics, core and stretching (yuck, how boring).

The Right Arm Swinging - Saga of Stiffness

As with many people dealing with Parkinson's disease, the arm of my affected side does not swing naturally. I must make quite the strange picture. I usually walk quite fast. My left arm soldiers on in fine form with enough momentum to propel me in circles, while the right seems to have forgotten the cadence altogether, standing at attention like one of the Queen's Guards at Buckingham Palace. Recently, it seems to have forgotten how to do a number of things that it would normally. For instance, casually throwing my arm around the shoulders of my wife while out for a stroll on one of these recent cold nights would have been natural and easy only a few months ago. Now it feels as awkward as when I was a 12-year-old in the movies on a first date. Suave and sophisticated I was not. Furthermore, the sudden pain is like someone is wrenching my shoulder out of its socket. It appears that the stiffening is setting in like Jell-O in the refrigerator; imperceptibly slow but nonetheless noticeable from time to time.

Fortunately, the “bradykinesia” (a medical term for slow movement) or “akinesia” (absence of movement) does not affect much else. In some people with Parkinson's this problem can evidence itself in an expressionless face or even "freezing" in place, both constituting awkward and embarrassing social occasions. But for me, this right arm-swinging trouble constitutes nothing more than an inconvenience.

In the great scheme of things, this is hardly a major issue. But, as with the rest of life, learning the little lessons prepares us to take on the big ones. So what can I do about it? This is a question I believe we all need to ask when faced with challenges, in my case related to my mostly silent partner, Parkinson's.

First, when I notice my right arm absentmindedly failing to keep up with the left, I can be more intentional, forcing it to perform its normal duties. Second, I can get back to exercise and stretching (yuck!). Starting tomorrow I will climb back on the exercise wagon that I fall off so easily and regularly. Third, I can see a physiotherapist about doing the right things to offset the onset of stiffness. That I will do in early January. And fourth, despite all of the Olympic fervor and fever in anticipation of the upcoming Winter games here in British Columbia, I can abandon the idea that somehow I need to adopt the pursuit of going "faster, higher, farther".

As I have stated before, most battles begin with how we think about them. We are not defeated when we cannot do what we used to do, only when we cease to do what we can do.

The Rabbit and the Cat

There was a flash of fur as the wide-eyed rabbit raced to avoid the claws of the pursuing cat. 'Socks', still a kitten really, was the neighbourhood's white-pawed hunter, and had just scared up the hapless hare from the nearby field as I was leaving to meet my trainer at the gym. For the feline it was not a particularly important pursuit, but for the bunny it was a potentially deadly game, and for a few seconds I thought it was over. But the freaked out rabbit veered between my front tires and Socks wisely chose to avoid the unhealthy course. His prey lived to see another sunrise.

On the remainder of the pre-dawn drive to my dreaded work out I kept replaying that four-legged chase scene that had taken place before my sleep-deprived eyes. Wasn't that a little like me (the rabbit) exercising my less than cooperative body to stay ahead of the pursuing Parkinson's (the cat)? If I don't take the stalking disease seriously now, while it is still mostly a practical inconvenience, how will I be able to win the race when the 'kitten' becomes larger, faster and more aggressive? It's enough to get me motivated to meet Shelley at least once a week so that she can "encourage" me to run longer, lift more weight and stretch farther. You see, I need the constant reminder and accountability she provides. Despite the way it feels sometimes, she is not killing me, but preparing me to compete in a very serious race; one in which I must stay ahead of the pursuer.

Exercise may not be neuroprotective, but it is the one thing I can do to fight back. Drugs may be necessary, but they are hardly the sole weapon, or even the best, with which to fight the battle. Everything I have read about PD tells me exercise is a must. So despite a busy life and the twinge of guilt for arriving a little later at work a couple days a week, I will persevere. If I fall off the wellness wagon I know Shelley will ensure I get back on.

I know not every PD person can have a personal trainer and a gym membership, but we can all do what we can to try and stay out of the clutches of the worst part of the ever more demanding disease we face. Find an exercise buddy. Walk if that is what you can do. But do something. Let's all fight back and maybe we can stay ahead of the cat for a while at least.