Julie first wrote about her shoulder repair surgery last July, sharing some of her experience of the first several weeks of adapting and healing. Now, more than a year and a half out from the surgery to repair two large, complete rotator cuff tears, she shares her thoughts about the ongoing work she calls “radical self-care,” and all that’s involved in keeping that shoulder healthy. Julie has chronicled her progress through journaling because, as she says, “At each point, it’s good to look back and reflect.” In this interview, she shares some reflections on the process with us.
Q. It’s been a year and a half or so since your rotator cuff repair surgery. Before we get into how that year has been and all that you’ve learned, how’s your shoulder feeling now?
A. It’s very functional these days, but not like when it was a 20-year-old shoulder. I’m really pleased with what I can do; still, it’s been an ongoing process of knowing when to be careful. Sometimes I’ll be doing something and it just sort of feels like it’s too much. It might be a task like helping stow the kayaks in the barn, with my arm overhead, and it won’t feel quite right. When the shoulder gets achy or sore, usually a day or two later, I think, “Okay, what have I done?” And I have to totally respect that it’s not something I can just bull through. So, I’m generally back, but there are definitely things I’ll never do again, like lift bales of hay or kayaks overhead. Still, there’s been a significant change in my function since before surgery and I’m really pleased with that.
Q. How did you approach healing from your surgery?
A. I was out of work for a total of four months. Because of the size of the surgery, it was a slower process. For eight weeks, I was not allowed to do any active motion; I just had to let it heal. I knew that at 12 weeks, that tendon would be only 60 percent healed, and that complete healing wouldn’t happen until six or eight months after surgery. By the time I went back to work part-time at four months, it was still not 100 percent there. The two factors affecting success rate with my surgery were age and degree of repair, and I knew I had about a 60 percent chance of success. I was motivated to support tissue healing in any way that I could. That healing process was very much a part-time job during the four months when I was out of work. Everyday tasks like cooking a meal took a lot longer and required figuring out new ways to do things. I focused on strategies like getting enough sleep, eating nutritionally for tendon health by focusing on things like protein, bone broth and minimal sugar. And, of course, doing my physical therapy exercises. By the time I went back to work, I had pretty good function and motion, but I knew the work would continue. I had a lot of fear around whether the shoulder would heal properly, and I did everything I could to turn that fear around into positive energy and motivation.
Q. What was it like to get back to work?
A. The whole return to work part was very interesting. My job is so physical. I knew I needed to be very careful about how I used my shoulder at work by modifying manual therapy techniques and specific challenges like lifting. I had to retrain my body, focusing on details like engaging my shoulder blades to support the work of the shoulder itself. I had to practice a lot of mindfulness with every movement, retraining my body and creating new ways to use my arms. I transitioned into full-time work after two weeks of part-time. I knew I’d be tired, and I was, but I was surprised by how long it took to feel like I was on my game clinically again, until I felt fully confident. It was almost like I needed to retrain that part of my thinking, like a muscle that hadn’t been exercised. All in all, it was a couple of months before I was in the swing of it. I told myself that I didn’t have anything to prove to anyone and I didn’t have to be a superwoman. It was good to keep that in mind, and know that whatever I did would be fine. I knew that I was still healing and wouldn’t hit the max point of tendon healing until seven or eight months out.
Q. When was the first time you really felt like your shoulder was working well?
A. The surgery was in June of 2016, and it was at some time the following spring that I realized I wasn’t thinking about it every minute of every day. It felt really good. I’d been increasingly active during the winter, but I didn’t do any snow shoveling. I did ski and snowshoe and get out into the woods. I felt like it was healing well.
Q. Is there any activity you continue to avoid now? How do you know?
A. I definitely avoid doing too much overhead. I continue to avoid doing any quick or jerky movements, especially those that are out to the side, including pushing and pulling; I keep all use in front of me. I avoid a lot of twisting (things like opening a tight lid to a jar) and I absolutely don’t do any overhead heavy lifting. So, I can pick up a bale of hay if I keep it at waist level, but no higher. I am able to put my kayak on my car, but only if I’m deliberate and mindful. Paddling is fine, but I learned that it’s best if I’m in my own boat. I got back to spinning class, too. It’s always about the mindfulness. I can know it’s too much in the moment, but sometimes it takes a couple of days for my shoulder to bother me, so there’s a constant modification process of what works and what doesn’t work.
The cool thing was when my surgeon said, at almost four months post-surgery, “If I didn’t know better, I’d think you’d really healed this thing.”
Q. Looking back over the last year and a half, what strategies evolved as your favorites for self-care?
A. I realize now I’m not at an endpoint and never will be, and that these tendons can get too stretched out or tear again. The surgery was on my dominant arm, and the shoulder is so important for function, so it’s really up to me. I can do all the things that are important to me, like taking care of the sheep and working in the garden, but I still have to practice active self-care. That involves a lot of mindfulness and listening to what my body is telling me. I keep a daily self-care journal, and take a few minutes to reflect on how my shoulder feels at the end of the day. I’m still following a home strengthening program at least three days a week and being careful not to use the shoulder in ways that make it vulnerable to injury. Nutrition continues to be a big part of active self-care for me. I make a killer bone broth for collagen on regular basis and stick to really good nutrition with lots of protein, diverse vegetables and very little sugar. The cool thing was when my surgeon said, at almost four months post-surgery, “If I didn’t know better, I’d think you’d really healed this thing.” I totally attribute that to a multi-faceted self-care program. I know that you can’t speed up the physiology of healing, that you just have to respect it. It’s easy to push too much, in an effort to get back to normal quickly, so I tried to respect the process.
Q. What do you think was most helpful?
A. I don’t negate the surgeon’s role at all. She really did her job, and did it very well. Still, it’s so much more than that. I do love that term “radical self-care.” It’s not about any one thing, so much as embracing that concept and following through. It felt so important to respect the time and energy that healing requires that healing is a part-time job. For rotator cuff repair, it’s almost a yearlong process and it’s a multi-faceted process. I believed I could have a profound effect on that process, in spite of a not-so-great prognosis for the surgery. The hard part is dealing with what your fears and expectations are. I thought a lot about my worries, concerns and fears and how to shift all of that into a positive focus. I knew my specific surgery had a high failure rate, and I still wanted to do my part.
What I feel like now is that this shoulder experience has been a microcosm of aging. I’ve had to be mindful, be willing to modify how I do things with ongoing adaptation and exercise positive control. It also requires grace.
~ Julie Dewdney, PT