Tendonitis And Stiff Shoulder

[camerata]

Early this year, after a slight pricking sensation in my right shoulder (when raising the arm) had been bothering me for a few months I went to the physical therapy section of Samitivej and was diagnosed with shoulder tendonitis. The doc prescribed ultrasound and stretching, but after only two sessions of mostly having my arm pushing up my back in a "half-Nelson" position it was so stiff I could barely even put it behind my back anymore, let alone raise it. It hadn't been stiff at all before I went there.

Switching to Bumrungrad it was found that I had a trigger point (knotted muscle) in my back and was treated with an anesthetic and "needling" of the muscle. Then some physio at hospital and at home. Two weeks later I had more stiffness and about five trigger points at the front of my shoulder which were treated with "dry needling" - no anesthetic but using acupuncture needles. Fairly painful. The trigger points went away, but 3 weeks later after more physio and anti-inflammatory drugs I had even more stiffness and around 15 trigger points all around the shoulder and back, but especially the deltoid muscle. More dry needling at about the maximum pain level I would want to endure while the doc talked on her cell phone and dealt with a stream of people coming into the office to ask questions.

Right now, my shoulder is sore from all the needling deep in the muscle plus I'm taking a double dose of celebrex so I don't know if there's any improvement. But the range of movement is not good at all and I have to take valium at night so as not to move around in my sleep. The doc has finally told me to pretty much stop physio until the inflammation subsides.

Up to now, what was a mild case of tendonitis has got worse with every treatment in hospital (to be fair, I think I contributed by not realizing the importance of sleeping in a prone position, not carrying things and not putting on or taking off T-shirts), and an MRI scan and surgery have already been mentioned. The only time anything improved was one week when I did no physio.

Has anyone else had an experience like this?

It seems a bit premature to have arthroscopic surgery. As I understand it, if I don't do anything for a long period, there's a danger of developing a frozen shoulder and forming scar tissue that can't be fixed by surgery. But it seems that even gentle exercises cause trigger points. Apparently, without an MRI they don't even know if the pain is coming from tears in the tendon or the muscles of the rotator cuff.

Anyway, a warning. 5-6 years ago the PT department at Samitivej was good, but now they aren't. A friend had gone there a couple of years ago on my recommendation with knee problems and was in agony after they had finished poking her knees and saying "Does this hurt?" The place is half empty most days.

Bumrungrad's PT dept is good but it is way too busy. I have to book 3 weeks ahead for an appointment with my doc or otherwise go on standby and wait up to an hour and a half. For PT, it's always booked in the evenings so I end up with early morning sessions with different therapists - all of whom tell me different things and have their own ideas and a few who don't follow the doc's instructions. They are good, but there seems to be a lack of effective communication between the PTs and the doc.

[FBN]

Please also see the topic "Shoulder Surgery" on this forum started by Griz. Lots of good info there and we should perhaps merge these topics to have a good overview.

When in acute pain with limited movement the best and only option for shoulder physio (actually the best option at any time) is passive physio. In active physio, the therapist does the manipulation and movement while in passive, the patient initiates and does the movement under the supervision and instruction from the therapist.

This prevents the shoulder from being mobilised beyond the pain limit. Forcing movement can cause further damage resulting in a viscious circle of pain, more limited movement, more physio and more pain.

One of the excercises to try at home when in pain is the simple "pendulum" where the patient lets the affected arm hang loosely, under its own weight, leans over sideways and then swings the arm in a slowly widening circle within limits of movement and pain. This relaxes the shoulder muscles and allows for good range of joint mobilisation.

Another is to stand sideways next to a wall and "walk" the hand up the wall in a widening arc as far as it will go and alternate with the pendulum.

This can be repeated several times a day.

In your case, it is essential to get a firm and specific diagnosis. Once there is a lot of pain, it can be difficult to assess by symptoms alone.

Biceps tendonitis presents in front of the shoulder and is perhaps easiest to locate by pressure. Supraspinatus tendonitis presents like a rotator cuff and is more difficult.

Rotator cuff tears are usuall best diagnosed with a MRI with contrast injected in the joint.

[camerata]

When in acute pain with limited movement the best and only option for shoulder physio (actually the best option at any time) is passive physio. In active physio, the therapist does the manipulation and movement while in passive, the patient initiates and does the movement under the supervision and instruction from the therapist.

This prevents the shoulder from being mobilised beyond the pain limit. Forcing movement can cause further damage resulting in a viscious circle of pain, more limited movement, more physio and more pain.

Generally speaking, I've been having passive physio. This is why I suspect other activities and my restless sleeping habits for causing all the trigger points. I don't have any pain at all at rest. But there is sharp pain if I lift my arm overhead or to the side and back. So for everyday activities, no pain. Sharp pain while sleeping until I started taking valium.

One of the excercises to try at home when in pain is the simple "pendulum" where the patient lets the affected arm hang loosely, under its own weight, leans over sideways and then swings the arm in a slowly widening circle within limits of movement and pain. This relaxes the shoulder muscles and allows for good range of joint mobilisation.

Another is to stand sideways next to a wall and "walk" the hand up the wall in a widening arc as far as it will go and alternate with the pendulum.

This can be repeated several times a day.

Right. I'm doing something similar. The two my doc is still saying are safe to do are these:

In your case, it is essential to get a firm and specific diagnosis. Once there is a lot of pain, it can be difficult to assess by symptoms alone.

Biceps tendonitis presents in front of the shoulder and is perhaps easiest to locate by pressure. Supraspinatus tendonitis presents like a rotator cuff and is more difficult.

Rotator cuff tears are usuall best diagnosed with a MRI with contrast injected in the joint.

My doc seems sure it is rotator cuff but says it could be both tendon and muscle-related. So should I go ahead and have an MRI even though I don't intend to have surgery? Is this going to help the doc significantly with my treatment?

[FBN]

No point really if no surgery is planned but I would definitely suggest to do and MRI if surgery becomes an option.

At the moment, the outcome of the MRI will not change management.

[spacefruit]

I have had a similar though possibly not the same problem. here is the sum of my experience:

A surgeon will ALWAYS want to operate.

VERY few profesional athletes have had successful shoulder operations.

Physio in large Thai hospitals is a waste of money and time - always a different therapist, who works off a peice of paper becasue they cant speak to you.

Exercise is crucial - I had to hire a trainer and do it 5/6 days a week (I just cant do it alone - pathetic I know)

Acupunture makes a HUGE difference. But a good Acupuctuirst is expensive (Actualy the one in Samitivej is fantastic).

The big secondary problem is the deterioration of related muscles due to pain motivated modified movement.

Post what happens. There is clearly huge interest in this!

[FITCORPASIA]

Identify the cause, dont treat the symptoms, which is what you have been doing so far.

This is a classic case of muscle imbalance, weakness and instability. Identify the weakness, strengthen the stabilisers which are placing more strain on other connective tissue, muscles and tendons causing pain.

http://www.fitcorpasia.com/general/physiotherapy.php

[billzant]

I am not sure how connected this is to the tendonitis but I had serious problems with my shoulders. It started with my left shoulder 5 years ago when I was working outside Thailand. I had spent three months backpacking and returned to work. Slowly I developed a problem in my left shoulder where raising the arm became more and more difficult until eventually I couldn't raise it more than 15 degrees above the horizontal. And if I jerked the arm I had a searing pain.

The school I worked for had a supposed medical plan, but on visiting their medical centre the doctor looked at it and said if it got worse come back and he would see if he could find someone who could look at it as he couldn't help. The school administrator thought her job done even though I continued to complain and ask for someone to examine me. I was coming to Thailand for term break so I made it clear that I would be seeking treatment in Thailand and would not return if the treatment was extensive. At this they found a doctor who called what I had a frozen shoulder, and that I had had some kind of injury that had caused the shoulder to "freeze". I suggested it could be swimming or the backpack, but he looked puzzled. I had some physiotherapy (3 treatments) before the holiday that made slight progress, and then came to Thailand.

Here is the main reasoin why I am telling this story. During trips to Thailand I always went to Thai massage, and this time I went to Wat Pho. The student assigned as my masseur called in her teacher, and the teacher said she would treat me. The teacher was very good and saw me every other day, and after 6 or 7 treatments (very painful at times) I began to get some good movement back. I began to feel that I would get full shoulder movement. After her treatment I returned to my job, and began using light barbells to strenghen the arm and shoulder. After about 6 months I had nearly full movement back.

Two years later, after I had moved to Thailand, the same thing happened to my right shoulder, although not as extreme. When the restricted movement started I was actually attending a local Thai massge doctor. So he was able to slow down the restriction of movement. I thought it would be quick like it was with the Wat Pho teacher but it took three or four months before I felt that the corner had been turned.

Since then I have started Chi Gung (Chilel - http://www.chilel.com), I do it at least once every two days. Now my shoulder movement is very good!!

I have every confidence in recommending Chilel, as for Thai massage I think I have been very lucky that the two people who have helped me are very good.

Hope you are keeping well,

All the Best,

Bill Z

http://ginsukapaapdee.wordpress.com/

[camerata]

Well, I got more dry needling on Monday and back to gentle exercises yesterday. But new trigger points just keep coming up. The doc said if there is no change in a month I should do an MRI. Frankly, I would like to stop all stretching exercises for a couple of months and see if the stiff muscles can heal themselves, but she says there's a real danger of developing a frozen shoulder.

[Flow]

Well, I got more dry needling on Monday and back to gentle exercises yesterday. But new trigger points just keep coming up. The doc said if there is no change in a month I should do an MRI. Frankly, I would like to stop all stretching exercises for a couple of months and see if the stiff muscles can heal themselves, but she says there's a real danger of developing a frozen shoulder.

Interesting topic. A friend tells me he's been suffering from tension headaches in the back of his head but originating from muscle knots in his shoulder and shoulder blades. He's virtualy tried everything, physio, trigger point injections in the neck, dry needling, swimming, exercising, stretching etc. a major hospitals here in BKK; he's on painkillers 24/7 - any advice for him? Would love to help the guy out as he's truly suffering from this condition. He says doctors work on his shoulders the more pain he gets. Hot showers also lead to an increase in pain or pressure pain to the back of his head.

MRI on head and neck showed up nothing. Nor did a CT scan of spine and blood test. MRI on shoulder possible?

[camerata]

A shoulder MRI is what they are going to give me. I think it can show up pinched nerves or tendons. I'd say it's worth a try. I don't know if anyone in Bangkok knows how to do proper trigger point massage - the PTs at Bumrungrad certainly can't. There is a book called The Trigger Point Therapy Workbook and also one called Trigger Point Therapy for Headaches and Migraines. I got the first one but found it too much hassle to do.

Come to think of it, there was a farang in the queue of the PT dept a few weeks ago saying the needling in his neck was the only thing that helped his pain. Maybe that was him. I guess posture while working or sleeping could be a factor, but I'm sure the docs would have checked that.

[Flow]

A shoulder MRI is what they are going to give me. I think it can show up pinched nerves or tendons. I'd say it's worth a try. I don't know if anyone in Bangkok knows how to do proper trigger point massage - the PTs at Bumrungrad certainly can't. There is a book called The Trigger Point Therapy Workbook and also one called Trigger Point Therapy for Headaches and Migraines. I got the first one but found it too much hassle to do.

Come to think of it, there was a farang in the queue of the PT dept a few weeks ago saying the needling in his neck was the only thing that helped his pain. Maybe that was him. I guess posture while working or sleeping could be a factor, but I'm sure the docs would have checked that.

Thanks a lot for the 2 links camerata!

I printed this thread out for him to read. He says that Thai doctors are pretty useless when it comes to treating patients suffering from myofascial pain - he says they're incapable of diagnosing where exaxtly he needs to be injected.

He's insured and wants to travel overseas for treatment for his very painful condition. Anyone know a good hospital in Europe or Asia that has a GOOD pain / trigger point clinic?

Not in America. His insurance doesn;t cover.

Edited April 16, 2009 by Flow

[Alwaysright]

A shoulder MRI is what they are going to give me. I think it can show up pinched nerves or tendons. I'd say it's worth a try. I don't know if anyone in Bangkok knows how to do proper trigger point massage - the PTs at Bumrungrad certainly can't. There is a book called The Trigger Point Therapy Workbook and also one called Trigger Point Therapy for Headaches and Migraines. I got the first one but found it too much hassle to do.

Come to think of it, there was a farang in the queue of the PT dept a few weeks ago saying the needling in his neck was the only thing that helped his pain. Maybe that was him. I guess posture while working or sleeping could be a factor, but I'm sure the docs would have checked that.

Thanks a lot for the 2 links camerata!

I printed this thread out for him to read. He says that Thai doctors are pretty useless when it comes to treating patients suffering from myofascial pain - he says they're incapable of diagnosing where exaxtly he needs to be injected.

He's insured and wants to travel overseas for treatment for his very painful condition. Anyone know a good hospital in Europe or Asia that has a GOOD pain / trigger point clinic?

Not in America. His insurance doesn;t cover.

I would try Arcoxia for a few days first.

[chiang mai]

I have had bursitus (inflamation of the bursa, also called frozen shoulder) in both shoulders at different times and it is indeed a very common problem, the good news is that in every case the problem resolves itself but often it can take up to two years to do so! In the meantime, the pain can be excruitiating and sleeping very difficult indeed. There are however some things you can do although as far as I am concerned, physio is not one of them - I also would suggest that an operation should not even be contemplated simply because it is not necessary and you cannot un-operate later.

Whether it is bursitus or tendonitus is largely irrelevant, I believe, if it impacts the shoulder joint and reduces range of motion, the ways forward are largely the same. Taking anti-inflammatory drugs does help since they tend to reduce the inflammation but these are only useful in my experience in the early stages, the problem and the solution soon becomes muscle and skeletal focused.

As the inflamation in or near the shoulder joint starts to become more severe and cause pain and lack of motion, the supporting muscles begin to compensate in order to protect the joint and in accordance with reduced range of motion. Some muscles start to enlarge because they are being used more whilst others start to atrophy through lack of use - having physio does nothing to address those issues and that is one of the keys to solving the problem. The second problem is that as the structure of the surrounding muscles begins to change they tend to put stresses on the spine which pulls it slowly out of alignment. Physio goes someway towards addressing the latter problem by relaxing swollen muscles but it does not address realignment of the spine.

I've tried a whole host of physio solutions at several top notch hospitals in Thailand the UK but all without success. What did work for me very well the last time was to visit a Thai chiropractor who a) realigned my spine and manipulated the vertebrae in my neck to block the source of pain in my shoulder. Having blocked the pain I was then free to begin light resistance training in the gym to redevelop the muscles that had atrophied. Using that approach I was free and clear of all pain and 95% of my range of motion returned within eight weeks. I highly recommend the approach I have outlined here and if you need the number of the chiropractor I used, feel free to PM me.

Early this year, after a slight pricking sensation in my right shoulder (when raising the arm) had been bothering me for a few months I went to the physical therapy section of Samitivej and was diagnosed with shoulder tendonitis. The doc prescribed ultrasound and stretching, but after only two sessions of mostly having my arm pushing up my back in a "half-Nelson" position it was so stiff I could barely even put it behind my back anymore, let alone raise it. It hadn't been stiff at all before I went there.

Switching to Bumrungrad it was found that I had a trigger point (knotted muscle) in my back and was treated with an anesthetic and "needling" of the muscle. Then some physio at hospital and at home. Two weeks later I had more stiffness and about five trigger points at the front of my shoulder which were treated with "dry needling" - no anesthetic but using acupuncture needles. Fairly painful. The trigger points went away, but 3 weeks later after more physio and anti-inflammatory drugs I had even more stiffness and around 15 trigger points all around the shoulder and back, but especially the deltoid muscle. More dry needling at about the maximum pain level I would want to endure while the doc talked on her cell phone and dealt with a stream of people coming into the office to ask questions.

Right now, my shoulder is sore from all the needling deep in the muscle plus I'm taking a double dose of celebrex so I don't know if there's any improvement. But the range of movement is not good at all and I have to take valium at night so as not to move around in my sleep. The doc has finally told me to pretty much stop physio until the inflammation subsides.

Up to now, what was a mild case of tendonitis has got worse with every treatment in hospital (to be fair, I think I contributed by not realizing the importance of sleeping in a prone position, not carrying things and not putting on or taking off T-shirts), and an MRI scan and surgery have already been mentioned. The only time anything improved was one week when I did no physio.

Has anyone else had an experience like this?

It seems a bit premature to have arthroscopic surgery. As I understand it, if I don't do anything for a long period, there's a danger of developing a frozen shoulder and forming scar tissue that can't be fixed by surgery. But it seems that even gentle exercises cause trigger points. Apparently, without an MRI they don't even know if the pain is coming from tears in the tendon or the muscles of the rotator cuff.

Anyway, a warning. 5-6 years ago the PT department at Samitivej was good, but now they aren't. A friend had gone there a couple of years ago on my recommendation with knee problems and was in agony after they had finished poking her knees and saying "Does this hurt?" The place is half empty most days.

Bumrungrad's PT dept is good but it is way too busy. I have to book 3 weeks ahead for an appointment with my doc or otherwise go on standby and wait up to an hour and a half. For PT, it's always booked in the evenings so I end up with early morning sessions with different therapists - all of whom tell me different things and have their own ideas and a few who don't follow the doc's instructions. They are good, but there seems to be a lack of effective communication between the PTs and the doc.

[camerata]

I have had bursitus (inflamation of the bursa, also called frozen shoulder) in both shoulders at different times and it is indeed a very common problem, the good news is that in every case the problem resolves itself but often it can take up to two years to do so! In the meantime, the pain can be excruitiating and sleeping very difficult indeed. There are however some things you can do although as far as I am concerned, physio is not one of them - I also would suggest that an operation should not even be contemplated simply because it is not necessary and you cannot un-operate later.

Right. This is not something I'm seriously considering. As I understand it, shoulder conditions can involve tears in the tendons and muscles which may be large enough that to let them heal on their own will result in thick and inflexible scar tissue. Sometimes an operation can repair the tear before that happens. In my case, I initially had tendonitis and then on top of that a stiff shoulder. By not being careful enough the first few weeks I had a stiff shoulder, I think I developed some small tears that the physio is aimed at repairing without excess scar tissue forming. The physio is also aimed at preventing the stiff shoulder from becoming a fully frozen shoulder.

Anyway, all information is welcome!

[chiang mai]

I understand, but I continue to suggest that you consider the skeletal and muscular implications and if your current physio does not work as planned, hopefully it will do so, try pain blocking, muscle building and spinal realignment work as an adjunct to any other approaches you might select.

I have had bursitus (inflamation of the bursa, also called frozen shoulder) in both shoulders at different times and it is indeed a very common problem, the good news is that in every case the problem resolves itself but often it can take up to two years to do so! In the meantime, the pain can be excruitiating and sleeping very difficult indeed. There are however some things you can do although as far as I am concerned, physio is not one of them - I also would suggest that an operation should not even be contemplated simply because it is not necessary and you cannot un-operate later.

Right. This is not something I'm seriously considering. As I understand it, shoulder conditions can involve tears in the tendons and muscles which may be large enough that to let them heal on their own will result in thick and inflexible scar tissue. Sometimes an operation can repair the tear before that happens. In my case, I initially had tendonitis and then on top of that a stiff shoulder. By not being careful enough the first few weeks I had a stiff shoulder, I think I developed some small tears that the physio is aimed at repairing without excess scar tissue forming. The physio is also aimed at preventing the stiff shoulder from becoming a fully frozen shoulder.

Anyway, all information is welcome!

[camerata]

The latest is that after 2 months of treatment my doc doesn't think I am responding the way I should to the dry needling and the physio, so I'm having an MRI tomorrow. She certainly seems to expect an operation will be necessary. When I told her I wasn't keen on an operation (unless the MRI shows some radical problem) she said the other option would be a cortisone injection. But I guess the injection is more useful for bursitis than for a rotator cuff tear, which seems to be what I may have. I didn't see any big difference when I took 400mg of Celebrex, but I don't have pain at rest anyway.

Anyone had any luck with cortisone injections?

[FBN]

Cortisone injections should be reserved for very specific conditions. Rotator cuff tear is not one of them. Usually helpful for AC joint problems or tendonitis.

The best result is when the pain can be located by touch or pinpointed; the steroid is then injected at that point. Where the area is less well located, results are not as good.

Once steroids are injected, an option for surgery is limited. Steroids reduces the inflammatory reaction, swelling and pain but the longterm side effects is actual weakening of the ligament and connective tissue structures, making them less optimal than normal tissue for surgical repair.

Suggest to get the MRI and then reconsider options.

[camerata]

Ha! Had the MRI today and they said no need for injections. About half an hour after I'd left they called me and said the doctor "might have seen something" so I have to go and get another MRI with contrast injection tomorrow. I don't know if this is good news or bad news. Personally, I didn't find the MRI claustrophobic. Soundwise, it's kind of like being in a video game... under water.

[camerata]

The MRI results showed I had no tendon tears but I have synovitis - inflammation of the synovial membranes. So the treatment is to switch from Celebrex to Arcoxia and continue with physio for another month. If there's no improvement, the next step will be a steroid injection in the synovial cavity (not the tendon) to reduce the inflamation enough to get back some range of movement. If that doesn't work, apparently there's keyhole surgery to clean out the fluids caused by inflamation, and it has a much better success rate than surgery to repait tears.

Unfortunately, what they saw that prompted a second MRI was an unrelated bone lesion or benign tumor (or infarction, I think) on my upper arm. So now I have to see a surgeon, Dr Panya, to have that evaluated. It doesn't seem likely to be malignant since there is no pain.

Edited May 12, 2009 by camerata
Added reference to infarction.

[Sheryl]

Oh dear, sorry to hear about that, but you are right that odds are greatly in favor of it being benign.

With synovitis,steroid injections are indicated if NSAIDs and pysio alone don't resolve matters and is usually effective.

Heat applications also a good idea if not already doing it.

[camerata]

Heat applications also a good idea if not already doing it.

The story keeps changing. The latest I heard was use a cold pack on the shoulder to reduce inflammation but use a hot pad on the back to help with the trigger points. But the doc didn't mention it today, the first time I've seen her since the MRI.

[camerata]

Fortunately, the lesion/cyst on the humerus turned out to be nothing worth worrying about, in the surgeon's opinion. But bot he and my physical therapy doc are talking about an operation to clean out the synovial inflammation. And I never get a straight answer about the success rate of the op - just something like, "The success rate is much better than the success rate for repairing a torn tendon." In other words, not 100%.

If one does nothing at all, how long does it take for degenerative changes to take place in the joint? I would think it couldn't be that quick, so 2 or 3 steroid injections and more physio would be better than surgery. I'm not in a hurry. The trouble is the GF keeps telling me to leave it alone and let it heal itself since nothing is torn.

[Sheryl]

Fortunately, the lesion/cyst on the humerus turned out to be nothing worth worrying about, in the surgeon's opinion. But bot he and my physical therapy doc are talking about an operation to clean out the synovial inflammation. And I never get a straight answer about the success rate of the op - just something like, "The success rate is much better than the success rate for repairing a torn tendon." In other words, not 100%.

If one does nothing at all, how long does it take for degenerative changes to take place in the joint? I would think it couldn't be that quick, so 2 or 3 steroid injections and more physio would be better than surgery. I'm not in a hurry. The trouble is the GF keeps telling me to leave it alone and let it heal itself since nothing is torn.

No surgery is 100%.

But you do need a clearer idea of the odds both with and without surgery and implications of delaying it.

I'm going to turn this over to FBN as he has far more knowledge on ortho matters than I.

[camerata]

The latest is I am making progress with the physio since I started taking Arcoxia, so the likelihood of an operation is receding. Depending on the progress over the next 2 weeks, I'll either start reducing the Arcoxia or have a steroid shot (if no progress).

[FBN]

If one does nothing at all, how long does it take for degenerative changes to take place in the joint? I would think it couldn't be that quick, so 2 or 3 steroid injections and more physio would be better than surgery. I'm not in a hurry. The trouble is the GF keeps telling me to leave it alone and let it heal itself since nothing is torn.

Degenerative changes happens more slowly in a shoulder joint than a weight bearing one. The changes physically means that the cartilage covering the bone ends deteriorate and the joint movement is more abrasive causing pain.

The cartilage covering the ends of the bones do not get any blood supply from the bone direct but is dependent on its nutritional requirements from the synovial fluid that forms in the joint from cells in the joint capsule.

For the nutrients to actually be able to enter the cartilage surface, movement is required that creates pressure changes and forces the molecules into the cartilage.

So gentle movement such as pendulum swings are important.

The surgery would be an attempt to clear out any dead bits of cartilage and other debris and flush the joint to "revitalise" the cartilage.

Steroids will only have an anti-inflammatory effect and will not reverse the degenerative changes.

It should be kept as a last resort and special indications such as age, required use of the joint etc all olay a role in the decision to have it done.

[Tolley]

Often for shoulder problems a good chiropractor,osteopath, acupuncturist/ or even masseuse is much more useful than a doctor or phyisotherapist and a lot cheaper.

[camerata]

Can you believe it? I got acute bronchitis and all the coughing resulted in costochondritis (inflammation of rib cartilage) on the left side. So now I can't sleep on my front, right side or left side because of the pain, and I never could sleep on my back...

[camerata]

Update: despite the complication of the rib pain, I'm making progress with the physio. But it seems Arcoxia can raise your blood pressure (mine was 150 two weeks ago and 130 today, compared to 117 normally) so I'll be on a reduced dose and for only another 15 days. So it's looking like I'll be able to recover full range of motion without a steroid injection.

[Sheryl]

Glad to hear it, Camerata and thanks for updating us.

[moe666]

Ingest gelatin for a few days and if you can get it MSM it is sulfur and can help with inflamation, I use this for back pain. Also magnesium will help in relaxing the muscles and could help with sleep. Good luck on what ever you do nothing worse than cronic pain. Also the magnesium will help bring down the blood pressure.