This is a continuation from the last post, “Kyudo Injuries: Shoulder Part I.”
As I mentioned in that last post,
I am not medically trained and have a relatively short history with the bow. My answers are by no means absolutely correct or set in stone, but rather just my small personal experience.
Well, well … I’ve made my trip to the orthopedic clinic (seikeigeka) and found out lots of enlightening information.
As a small recap, I hurt my shoulder in March last year by pulling too strong of a bow too quickly after a period of not shooting. Until now I’ve spent the year on and off of practice with a constant “something” in my shoulder. Not too much to make shooting impossible, but enough to give me trouble. Last October I went to a general hospital and got an x-ray and an MRI to reveal inflammation in what seemed to be my biceps and rotator cuff. I was told to take 3 weeks off, which I did (though I probably could’ve been more “restful” during that time), and came back with it feeling a little better, but there was still “something.” Now I’ve had enough of the mystery and want more information so I went to an specialist orthopedic clinic as they focus on the musculoskeletal system.
Yesterday I got an x-ray which revealed I had a fracture in my right clavicle. This didn’t seem like a big deal and irrelevant since it must have happened when I was a senior in high school playing football. I remember having some shoulder pain, but never was aware that it turned out to be a fractured clavicle. I then talked with the doctor a little bit and scheduled an MRI for the next day, which is today.
After the MRI I met again with the doctor to reveal lots of interesting information. The MRI revealed I do in fact have a minimal amount of edema (fancy word for swelling and inflammation) which is caused by friction. Both the rotator cuff and the biceps muscle move by rubbing on the bone, and too much stress on these parts can result in this kind of edema. The good news there is no rupture, which means there is no immediate problem, and that this can be fixed with care in a month or two. The doctor said there is surface level arthritis.
WHAT?! YOU MEAN THAT TERRIFYING DISEASE OLD PEOPLE GET WHEN THEY CAN’T MOVE ANYMORE?!
No. Apparently arthritis is much more common than that simple image I had and according to arthritis.org, “Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease.”
Specifically with the biceps muscle this condition can also be called biceps tendonitis which according to http://orthoinfo.aaos.org/topic.cfm?topic=a00026:
“Biceps tendinitis is an inflammation or irritation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bones in the shoulder.
Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. They can often be relieved with rest and medication. In severe cases, surgery may be needed to repair the tendon.”
So, the doctor said I need to rest for at least a month, and to help the healing do some rehabilitation about twice a week and take an anti-inflammatory. He also gave me a shot of something (probably should’ve remembered that name, I’ll ask next time) to help lubricate(?) the friction of the rotator cuff and biceps. I’ll go back in in two weeks after some rehabilitation to get a check up and one more shot.
I was very concerned about what all this meant for practicing kyudo. “Can I practice kyudo like normal while this heals?” “Can I practice a little kyudo until this heals?” “Do I need to rest completely?”
Can you guess what he said?
“Rest completely. Do rehab. Think about training again after a month if things are better.”
Not the answer I was looking for, but then I went looking for the answer to making me as healthy as I can be, not to how I can shoot the bow regardless of my health.
I found out one more interesting little bug of information concerning pain while sleeping. Right now the most painful thing I can do is sleep on the shoulder, which happens to be my favorite sleeping position. I of course don’t now, but will still sometimes feel it getting sore when I sleep in other positions, which the doctor said was caused by sleeping in certain ways that cut off the circulation to the shoulder. I guess I’ll have to be careful how I sleep as well if I want this to heal quickly.
So, I ran out of questions and was whisked off to rehabilitation.
Coincidentally, the guy who helped me with rehabilitation was a father to one of the students I teach English, too. Small world in a small town in a small country. He was easy to talk to and I probed him for as much information as possible.
First, he just had me lay down with a heat blanket on the shoulder for a while. Then we did some stretches, and then he massaged the area around my shoulder.
I explained the movements of kyudo and how I think I injured my shoulder (pulling too strong of a bow too far with my elbow out back instead of to the side). He then explained how a lot of it is related back to my broken clavicle from 12 years ago. He said because of this, flexibility in my shoulder has been lost, meaning that the action between my clavicle (sakotsu) and scapula (shoulder blade) (kenkoukotsu) is limited, which means that extra help is needed from the shoulder muscles including the biceps and rotator cuff.
Related to the bow, this means that at this current state more pressure is put on my shoulder muscles and tendons because of the fracture in my collar bone. I suppose this means I need to do some extra exercises to strengthen and build flexibility in my right shoulder as soon as the inflammation goes away, and be extra careful about not pulling too strong of a bow and not pulling too far.
The biggest thing the guy said who helped me with rehabilitation was that I need to strengthen my shoulder blades, and use them more when I shoot.
HAHA! Does this guy teach kyudo?
In my experience, all skillful kyudo-ka have said that we need to pull with our backs (which largely means our shoulder blades) and not with our shoulders. This guy asked me to take the form of shooting and I did and he looked at my back, pulled my shoulder blades together and said if I moved like this then the pressure would be taken off of my shoulder during shooting.
I’ve heard that in the past a lot of people were told to squeeze their shoulder blades together in the full draw. Now, I often hear that instead we need to work on expanding our shoulder blades out. These seem like two completely different movements, and so I get the feeling like I’m not getting something really important about how we’re exactly supposed to pull the bow “with our backs.” Or maybe there’s a huge divide in the kyudo community about how we should pull the bow. (I guess that’s not exactly new news). Well, I’ve got lots of questions now for teachers.
Anyway, I tried to pry this guy for an excuse to continue training and asked, “So, is it OK if I practice while this is healing? Or do I need to rest completely.”
He made a scrunched up face and said, “You need to rest your shoulder until the inflammation is gone.” I remember the doctor saying earlier that, “This can heal in a month or two if you rest. If you continue to shoot the bow like this it may take up to a year to heal.” I asked the doctor if maybe this could get worse and rupture if I kept going and he said no, but he said the day before that if this inflammation doesn’t heal it can evolve into different problems. Perhaps it evolves as a different kind of arthritis. Or maybe just doesn’t go away and I feel like I have a bum shoulder for the rest of my life.
So, I kept thinking and told my wife about all of this,
“Maybe I should just practice a little with a light bow until this is healed.”
“You mean that if you rest for a month it might heal completely? Can’t you be patient for a month? Isn’t that what you’re practicing all the time in kyudo? Learning to be patient?”
Again I am humbled. I guess I just need enough people around me to tell me to take the month of so I can let this thing heal before tests and tournaments that start in the spring.
Every Wednesday morning there is a group of about 5 or 6 of us who are practicing for upcoming tests so we practice a lot of the zassha (sitting form) and mochi-mato (sitting form performed for renshi test). I will go tomorrow in my civilian clothes, tell everyone what’s going on, serve coffee and tea to everybody, and just hope there are more people who will encourage me to rest instead of shoot.
I guess I need to take it one day at a time and keep my hands off the bow, and keep them from floating in air over my head. You’d think I was addicted or something.
Kyudo is one hell of a drug!
So let’s say I have to take one month away from pulling the bow, or possibly two. This totally sucks, but I would still have enough time to return, smarter and stronger than before, ready for a renshi test in June. In this time I can still practice sitting in kiza (kyudo torture sitting), study for the test, and read through the kyo-hon (kyudo manual) again.
Oh yeah, and I can spend time on all the other important and magnificent things in life that don’t have to do with shooting a bow!
So, that’s all for now. I’ll be sure to be talking a lot more about all of this and the progress, for myself to clear my thoughts, and to provide a case for anyone else who may be dealing with injuries out there in the kyudo world.
Apparently learning to not pull the bow is another important lesson in kyudo. Who’d have thunk it. I sure didn’t, or did and didn’t care.
Down into the cave of stillness.