Is anyone here a PT/trainer or have personal access to one?

[Blackhawk]

Like it says, is anyone here a physical therapist/trainer, or have personal access to one (IE - a friend, family member, etc that they can ask an off-the-record question of.)

I'm trying to find the answer to a simple question. I don't need physical therapy, my insurance won't pay for it for something like this (it doesn't cause me pain, doesn't prevent me from functioning in my daily life, and therefor isn't considered medically necessary), and it isn't enough to justify a doctor's appointment. I obviously can't afford a personal trainer. But asking the question *anywhere* just sets off peoples' liability alarms and gets me suggestions to see a therapist/doctor/professinal, which puts me back to square one, aka 'make my best guess.'

Here's the problem: As a result of surgical damage to my spinal accessory nerve during a neck dissection, I have a paralyzed and atrophied left trapezius muscle. It has been that way for seven years. I want to know what muscle/s I should be focusing on in a workout to help compensate for this. That's it.

[Daehawk]

Cant help but must say Wow, 7 years already have gone by? Doesn't seem that long ago I was reading about your surgery.

I did come across this. Eden-Lange procedure ....which I bet you already have....and didn't ask about.

[Hipolito]

I asked a PT in my family, her reaction was similar: she can't really recommend anything except seeing a PT and following their advice. A PT would see/feel the muscle, then recommend proper exercise and use neuromuscular electrical stimulation (NMES) to repair nerve damage and help build muscle.

You may be able to google exercises on your own and try them, but you would need to watch your posture and be careful to avoid muscle substitution.

Also:
- After the surgery, the surgeon should have recommended some PT. Did this not happen?
- Could you see an MD who can write you a prescription for PT? The insurance may cover the PT then.

[Blackhawk]

Also:
- After the surgery, the surgeon should have recommended some PT. Did this not happen?
- Could you see an MD who can write you a prescription for PT? The insurance may cover the PT then.

The surgeon was awesome. He left instructions with the hospital for my release which the staff doctor at the hospital fully ignored, including both the necessary medications (like the one that would have prevented my tongue from swelling to fill my entire mouth) and PT back when PT might have made a difference. And I've already checked into PT. It isn't happening.

Looks like I'm stuck with guesswork, but thanks for asking.

[Blackhawk]

FWIW, I asked the question in five different places, and this is the only place I got an answer at all.

It's frustrating when the options are 'advice' or 'wild-ass guess based on nothing', and all anyone will say is 'see a professional.' The last time I did something like that it took me a year and a half paying out of pocket to get out of debt.

[Carpet_pissr]

I will ask, but not sure about the question. When you say what muscle you should work to “compensate” for your atrophied muscle, are you thinking that another muscle group could do the same work of the trapezius?

[Blackhawk]

Generally when you lose a muscle, others take up the slack. It's not 100%, but it's the best your body can do.

[Blackhawk]

To put it another way, I'm tired of my left arm being so weak. I'm going to be doing exercises to rectify that, likely with resistance bands (cost a fraction of the price of weights, take very little space, and give a comparable workout.) I'm just trying to figure out which exercises to do that will benefit it without causing problems (and figuring out which muscles are taking over for the trap is one way of figuring out which exercises to do.)

[FishPants]

Work the muscle that has a problem, and more importantly listen to your body with the pain. Warm up, warm up, warm UP - dynamic warm ups if you can, then make sure to stretch out afterwards in your cool down.

100% on the resistance bands, I was using them with dumb bells to add "weight" when I couldn't find plates for my barbells - shit works. Reverse trap flies would probably be a good start - sit on the ground, feet straight out, put the band over your feet (so the band is under the sole of your foot). Arms up and out from your shoulders, (like a bike riding posture if the bars were at shoulder height) and pull back and out towards your face. You're better with very low resistance/weight and slow your roll - tempo like a 3 second slow pull, 3 second hold, 3 second slow release back. 3 or 4 sets of 10 and call it a day, come back a few days later and do it again; its about tempo more than weight and resistance to rebuild that muscle at least initially.

[Daehawk]

But he cant feel or use his left trap.

[Blackhawk]

Work the muscle that has a problem, and more importantly listen to your body with the pain. Warm up, warm up, warm UP - dynamic warm ups if you can, then make sure to stretch out afterwards in your cool down.

100% on the resistance bands, I was using them with dumb bells to add "weight" when I couldn't find plates for my barbells - shit works. Reverse trap flies would probably be a good start - sit on the ground, feet straight out, put the band over your feet (so the band is under the sole of your foot). Arms up and out from your shoulders, (like a bike riding posture if the bars were at shoulder height) and pull back and out towards your face. You're better with very low resistance/weight and slow your roll - tempo like a 3 second slow pull, 3 second hold, 3 second slow release back. 3 or 4 sets of 10 and call it a day, come back a few days later and do it again; its about tempo more than weight and resistance to rebuild that muscle at least initially.

Thank you! I'll dig in to it, but yeah - my left trap is gone. The nerve that feeds it instructions no longer functions after the doctor had to do mean things to it to yank my lymph nods. I wonder if doing exercises intended specifically for the paralyzed muscle would be a good way to force the compensating muscles to kick in, though? If not, I simply won't be able to move it, so hopefully no harm done. Like I said, figuring out the right way to do this is a headache.

[Ralph-Wiggum]

I’m no PT, but seems like that would make sense; exercises meant for the muscle you can’t use would necessarily be working the muscles that are compensating for it. That said, if there’s any risk of causing more damage this is definitely something you should consult with someone about first.

[Blackhawk]

I’m no PT, but seems like that would make sense; exercises meant for the muscle you can’t use would necessarily be working the muscles that are compensating for it. That said, if there’s any risk of causing more damage this is definitely something you should consult with someone about first.

I know, and I've tried, but there just isn't anyone that's willing and that my insurance is interested in paying for.

[Ralph-Wiggum]

But seems like maybe you can ask your regular doctor (if you have one) or without necessarily needing to go to a PT. Although I guess they might just try to refer you to someone else.

[Blackhawk]

I have. The question was specific enough that it was outside of her expertise and I was referred to the specialist - that insurance wouldn't cover.

I'd consider joining a gym in the next town over for a month to walk through the problem with a trainer, but it would be expensive, and I'd be afraid they'd just tell me the same thing - that I need to see a physician/PT about it - out of liability concerns.

[hitbyambulance]

is a gofundme to be able to afford a physical therapist out of the question?

[Anonymous Bosch]

I have. The question was specific enough that it was outside of her expertise and I was referred to the specialist - that insurance wouldn't cover.

I'd consider joining a gym in the next town over for a month to walk through the problem with a trainer, but it would be expensive, and I'd be afraid they'd just tell me the same thing - that I need to see a physician/PT about it - out of liability concerns.

Have you considered appealing your health insurer's decision? Because considering you have the support of your PCP who provided the referral, I strongly suspect you wouldn't have much difficulty receiving the coverage you require if you push back and appeal their decision.

EDIT: Here's a helpful Forbes article that walks you through the appeal process and provides links to some useful resources (such as the Patient Advocate Foundation):

Ways To Fight A Health Insurance Denial

[Blackhawk]

Appeal? Maybe. It's been a while, so I'd likely have to start the process from scratch.

is a gofundme to be able to afford a physical therapist out of the question?

It's not worth playing that particular card. This isn't an injury I need help rehabilitating. It won't heal any more than it already has, and doesn't cause me pain. It doesn't even cause me major inconvenience anymore because I've learned to adapt (I just naturally reach for things above shoulder level or off to the side with my right hand, or if I have to use my left my right arm automatically reaches over and lifts the elbow.) I just want to improve my overall fitness a bit and improve the strength I do have in that arm, and I'm not sure how to go about it. It's a personal want, not a medical necessity.

[Pyperkub]

YMCA membership does get you a session with a personal trainer for a day (hour?), and have plenty of classes for things like this. At least at our location, YMMV.

[Carpet_pissr]

I know you weren't necessarily poo-pooing exercise bands (I don't think you were at least), but FWIW I am currently doing PT and they have only used bands with me to date. Broke the shit out of my elbow at end of December, surgery in early January, and still no weights at this point, just bands.

All that to say that bands may actually be better for what you are trying to do, here, but I will ask my PT person (tomorrow morning) and revert. I SUSPECT they are going to give me the same answer you got though, because I'm guessing most serious professionals wouldn't think of trying to give you advice for something like that without being able to see your range of motion, the muscle, and being able to talk to you and ask questions. And it may be also because you COULD do (more) harm if you don't work the muscles properly, based on your current situation. Someone just saying "Yeah, just work muscle X" without knowing or seeing more is probably not malpractice, but I bet it's frowned upon among health pros.

[Blackhawk]

Not poo-pooing! I said,

likely with resistance bands (cost a fraction of the price of weights, take very little space, and give a comparable workout.)

Exercise bands are awesome. Weights are expensive and take up a ton of space. I can get the same workout from a $30 set of bands that I could get from a $500 weight system and I can store the whole shebang in in about six cubic inches. I did my research, and some bodybuilders genuinely prefer them over free weights due to the fact that the resistance increases with the exercise rather than the other way around. I'm really looking forward to starting in with them, probably this week. I just need to decide on a set of exercises.

And I wasn't expecting anyone to ask their own physical therapist. There's no way they'd give actual answers. That's why I was asking about immediate friends/family that could do it off the record. But thank you for the thought. I'll look at the Y. There used to be on in Terre Haute.

[Carpet_pissr]

Not poo-pooing! I said,

likely with resistance bands (cost a fraction of the price of weights, take very little space, and give a comparable workout.)

Exercise bands are awesome. Weights are expensive and take up a ton of space. I can get the same workout from $25 worth of bands that I could get from a $500 weight system and I can store the whole shebang in in about six cubic inches. I'm really looking forward to starting in with them, probably this week. I just need to decide on a set of exercises. And I wasn't expecting anyone to ask their own physical therapist. There's no way they'd give actual answers. That's why I was asking about immediate friends/family that could do it off the record. But thank you for the thought. I'll look at the Y. There used to be on in Terre Haute.

I'm asking, dammit!

I've talked with this girl at length about a lot of stuff. Asked if she would be willing to talk to my niece about a career in PT, etc. I even wrote a pretty impressive (if I do say so myself) email to her boss about how professional she was (especially compared to my previous PT experiences). She would not mind at all if I asked that, and will totally tell me "I don't feel comfortable answering that without more direct info" if that's the case.

I believe she has her masters in PT, and is so enthused about it (the career, profession, her specific job, etc), she is very willing to talk about this stuff on the side (more likely, while I am doing the 30-40 reps of whatever exercise). Very friendly, helpful and chatty. Her enthusiasm about it is one of the main reasons that prompted me to email her boss, so she is a perfect candidate for your question IMO.

[Hipolito]

For people using resistance bands, be careful! I recently went to the ER because I wasn't paying attention to what I was doing, improvising exercises that weren't in the manual. I lost control of the band and it hit me hard in the eyes, leaving my with corneal abrasions. Fortunately, they healed and my vision wasn't affected. If I use that band again, I'll be wearing safety goggles.

[Isgrimnur]

Not the orbs I thought were going to take a hit when I started reading that post.

[Hipolito]

For sale: one resistance cord.

[Carpet_pissr]

OK, so here's what my PT told me (I'm paraphrasing, obviously):

Trapezius huh? Oof, that's complicated, because it does SO much work. Split into three functions.

If the goal is to be able to reach things like you mentioned, she recommends doing rotator cuff exercises. Get in a recliner, get some kind of stick - golf club, yard stick, etc and slowly raise the stick with your arms, up and down - both hands grabbing stick with an overhand grip.

Also recommended isometric exercises - get a dish towel, fold it several times into a more dense square shape, then put it up against a wall. Using your arm with the injured muscle, PUSH directly with a fist into the dish towel (and wall)(, release, and repeat. For that one you should be facing the wall, shoulders parallel.

Then turn your body perpindicular to wall, put rag on OUTSIDE(top) of your injured arm's hand, and push against wall that way, release, repeat (maybe 20-30x).

Finally flip the rag to the other side of your hand (inside), and push that way.


If viewed from ABOVE someone doing these exercises:

________(wall)
RAG
FIST
YOU, pushing in ^ direction with injured arm/shoulder side, your body is facing the wall

second:

_______ (wall)
RAG
FIST
YOU, turned facing > this way (wall to your left), and pushing ^ way with your arm against wall

third:

YOU (shoulders perpendicular to wall), facing > direction, FIST RAG, pushing v direction, toward wall
_______(wall)


Elbows at your side, and for the second and third, you should use a door frame wall so you can get your body directly in front/perpindicular to it.



I * I

[EvilHomer3k]

You do have a few options without insurance. First, a not-for-profit hospital will do the work and do payment plans. Where my wife works if people pay $5 a month that's all they need. Another option is a free clinic. They often have PTs there who could see you. Not all free clinics do but some do. Finally, there are some private companies (she mentioned Rockewll Collins - or whatever they are called now) have PTs and sometimes you can get a session with one there for a small fee.

[Blackhawk]

I'll look into those options (and yes, my hospital will take payments, but I'm not going to go hundreds or thousands into debt that could take years to pay off for one consult), and will likely consult with my doctor again. Maybe she'll let me ask a few questions by phone rather than setting up an appointment in COVIDland.

And Carpet_Pissr - thank you. I know some of those exercises already, as they're the ones I used in my initial rehab. They were helpful for making sure the damage didn't limit my motion more than the mechanical minimums, but I'm not sure they're what would help me now. The shoulder is as rehabilitated as it's ever going to get, and I'm looking to do whatever is next. I really do appreciate you asking, though. I mostly just want to make sure that when I start doing some strength training that uses that shoulder that I don't injure myself. And given that the trapezius stabilizes the shoulder, that might be a real possibility. I'd really hate to yank my shoulder out of its socket just doing a bicep curl.

[Blackhawk]

I finally did get some specifics from another source.

You're in a tough spot.

Without the spinal accessory nerve you're going to have a hard time activating both your trapezius and your sternocleidomastoid.

The sternocleidomastoid is going to contribute to turning/rotating your head and will contribute to the width of your neck. That's not going to actually impact your shoulder much if at all.

Your trapezius is primarily going to be used extend your neck and retract/elevate/rotate your scapula. This can be a bigger deal if it's completely dead as you can get sloping of your shoulder (uneven shoulder height when standing straight) and then can get some alterations around your clavicle and relevant joints if the trapezius is no longer applying passive tension to it. If you try to externally rotate your shoulder against resistance your scapula may "flip" off the middle of your back as your trapezius won't help hold it in place.

If your goal is simply to work the shoulder even though you cannot use the trap, then you actually should be able to do any exercise you can think of that doesn't cause pain or a sensation of instability. Front/lateral raises can be good here and they are nice to do with resistance bands.

Are you able to do pushups and press things overhead without issues? Functionally speaking, how limiting is your injury? If you cannot do anything overhead but can do raises of various sorts then using bands of different resistances you can still get in a good workout through the full range of motion.

I'm asking for more details about one bit, as my scapula 'flipping' off the middle of my back sounds mildly humorous and significantly unpleasant. But learning the type of motion that might be a problem will let me judge appropriate exercises, which is the main thing I need.

[Blackhawk]

Exercise bands are awesome. Weights are expensive and take up a ton of space. I can get the same workout from a $30 set of bands that I could get from a $500 weight system and I can store the whole shebang in in about six cubic inches.

Do not order these. There were so many to choose from that I went with the set that had an insane number of very positive reviews. They are a hazard. Several people in reviews have reported getting injured when the anchors (not the bands themselves) snapped. The door anchor has shoddy stitching that people have reported snapping, while my complaint was that the anchor itself was so small that if you don't have a tightly fitted door, it'll pop right out. The ankle straps are designed in such a way that apply force to them undoes the velcro, which again is going to cause your arm/leg to be yanked and cause the band to snap back. In addition, they've mislabeled their bands. I started with some curls, and they were too easy. So I added more weight. And more. I am not able to easily curl 80 pounds, but with these I was barely straining after 15 reps at 80 (and yes, using them correctly.) I then took the 30 pound cable, hooked the handle onto a 10 pound dumbell, and lifted. Even at it's maximum safe stretch (IE - maximum resistance), the 30 pound cable couldn't lift the 10 pound weight.

How they got 4 1/2 stars from 20,000 reviews is beyond me. Probably people who don't look closely at what they are getting. Mine are being refunded and returned.

I'm not sure what I'll replace them with. I need something, and still don't have the room for actual weights (or money for a gym.)

[gilraen]

Someone probably either paid for reviews or "hijacked" another product's page with good reviews.

Look up non-Amazon reviews for exercise bands - not to get the most expensive option but to figure out what the reputable brand names are.

[Blackhawk]

Someone probably either paid for reviews or "hijacked" another product's page with good reviews.

Look up non-Amazon reviews for exercise bands - not to get the most expensive option but to figure out what the reputable brand names are.

I have been doing exactly that. I'm leaning toward Bodylastics bands sets, which are highly reviewed pretty much everywhere, and they have a cord down the center of the latex that means that they even if they break, they won't snap. They're also more than twice what my refunded set cost, so I'll have to wait for a while.