If I were to guess, my right shoulder has been giving me problems for about five or six years. Limited range of motion, loss of strength, inability to throw a ball without pain, all sorts of crackling noises. I thought it was something with my arm and that I needed Tommy John surgery1, but the noises were clearly coming from my shoulder.
The pain has persisted long enough2 where I decided to do something about it, which is to say I plugged my symptoms into WebMD’s crack Symptom Checker. The results included rotator cuff strain, rotator cuff tear, separated shoulder (, and bone cancer3. I figured that I was dealing with the first or second and dreaded the surgery. In a last gasp before calling a doctor, I asked my chiropractor4 what she thought, and she believed it was an impingement of my supraspinatus tendon. The only real treatment is activity; “Keep the shoulder moving,” was her prescription.
The moral of my convoluted medical journey is that not everything is what it seems5. I thought the pain in my bicep meant the injury was there. The supraspinatus is a group of muscles in your back that stretch to the shoulder. The cause? Everything and nothing. I hurt this shoulder in a car accident a dozen or so years ago6 and it appears that I get to live with the pain once again.
“Keep the shoulder moving,” my chiropractor tells me every time I see her. The muscles can only heal through activity and that’s why physical therapy is the most effective treatment for shoulder injuries. It’s what I did after the accident; it’s probably what I should do now.
Rest is preached as an important tool in rehabilitating an illness or injury. Sprain your ankle? Rest, Ice, Compression and Elevation. Hurt your back? Here’s a heating pad. Lay down and get some rest. Get Covid-19? Take your Paxlovid and rest.
But, what if the real answer to everything is activity. What if, instead of isolating ourselves during times of pain and loss, we kept ourselves out there and let the world around us be the healing agent? If interacting with others can help our psyche when we grieve, could it also help the physical manifestations of grief?
An ache…
Often you hear it referred to as an ache. After a person dies, you ache7 for them. The emotional loss is so profound that it figuratively hurts.
There’s the hollow feeling in your stomach, too. The death of a loved one leaves an empty hole in your mid-section that yearns to be filled by something just as meaningful, almost like the phantom pains people feel after amputation.
For me, the very real panic attacks with associated breathing issues, paralysis and racing heart came as a result of ignoring or never really managing my grief in my early 20s. That was a physical result of the mental health impact of grief. Some, though, feel very real physical pain and that’s where I want us to focus.
There are two types of grief pain: that metaphorical ache and hollow feelings, those psycho-physical effects felt while grieving. Then there are physical changes brought on by grieving.
Because grief is taxing. It’s fucking exhausting. It’s like a marathon but without the chafing, blisters and bleeding nipples. It’s an endurance battle in your mind between you, your emotions and reality. Your loss becomes sadness, so you’re crying. It overtakes your life, commanding every thought. Your habits and routines are set to the side to deal with the short-term responsibilities of someone dying, and are just that much harder to restart.
You become angry at the forces that caused the loss to happen; drunk drivers, cancer, opiates, “the voices,” God… Whoever or whatever they were, they get your wrath. Longer term you find that you can’t move on and you get lost in your own thoughts, depressed.
The stress of grief is a burden upon the bereaved. It’s impact is major and there are interventions — meditation, counseling and therapy, and self-care. Like any other type of stress, it can be managed, but grief’s stress brings with it a special set of circumstances. The hopelessness felt by the grieving are like chains shackling you to a wall. Unless you’re willing to fight back and make the incremental moves — as taxing as it may seem at the time — it will always win.
Stress has an amazing effect on the body. It hastens weight gain, brings on headaches, changes your demeanor, and can cause damage to your body.
At the base, we have fatigue. Your brain’s refusal to disengage results in your not sleeping or not achieving restful sleep. Sure, you get eight hours of sleep every night, but are they quality restful hours or are you existing merely with your eyes closed?
Post-death worry and anxiety is a significant stress contributor; the type of thing that keeps your brain churning long after your close your eyes. You continue to work through the cycle of grief, what ifs and whys in your head and they become more prevalent when there is no other stimulus around. No TV on. No phone to stare at. Just you and your thoughts, and guess what always seems to win? Without restful sleep, you end up like a restless six-year-old: irritable, hostile, easily frustrated and triggered, and highly distractible. Sleep loss has a handful of cascading effects that, like the WebMD Symptom Tracker of Doom might indicate, include your death.
If it was just a lack of sleep, you might be able to deal with it. But, wait…it could be worse. Research indicates that spousal bereavement contributes to an increase of pain intensity and frequency. While some of those studied were already living in pain, the loss of a loved one exacerbated it.
People who are grieving get sick more frequently because stress leaves you immunocompromised. Grief stress causes reduced antibody response in many people. I think about last Christmas when my mother-in-law developed Covid-19 and quarantined at home. Here she was, six months after my father-in-law’s death, at the doorstep of a major family holiday. Is it a coincidence that her immunoprotections failed in a manner that allowed Covid onset even though she was vaccinated8?
Let’s go back to broken heart syndrome for a minute. In reality, what you’re talking about is a condition known as stress-induced cardiomyopathy. Grief puts so much stress on your body that it releases mass supplies of adrenaline in order to cope. Unfortunately, your heart isn’t built to handle it; adrenaline causes a narrowing of the arteries that carry blood to the heart, slowing blood flow. The result? Chest pain, shortness of breath, rapid heart rate…all the hallmarks of a heart attack.
Worse than that, the adrenaline can actually fuse itself to the heart muscle which promotes muscle calcification and irregular heartbeat. This is the broken heart syndrome that is common with the most complicated grief.
I think about my long-departed friend Marty Manning, who I wrote about some time ago. Marty was a devoted caregiver for his wife, who had Alzheimer’s disease. Following her death, Marty had a massive heart attack that required open heart surgery to save him. This caregiver syndrome that manifests itself in cardiac events is not uncommon. A study in the journal Circulation showed that a grieving survivor’s risk of heart attack on the day after their loved one died was 21 times higher than normal. A week later it was still six times higher. Add in the associated grief-related stress and the burden that is placed on the body is as great as it is on the mind.
So, what’s the answer?
It’s easy to tell someone to make an appointment with a doctor, but whether it’s talk therapy or a wonky shoulder, the person has to want to participate. Going to a psychologist or social worker9 does little good when the patient isn’t interested. You can’t half-ass therapy, physical or otherwise; your whole ass has to be in the ring.
Fighting off the “it doesn’t matter” thinking also applies to the physical pain of grief. The aches and pains, and other maladies of grief seem easy to ignore when you feel lost and detached following loss. The listlessness of you rocking along the waves as the stress washes over the bow and carries you further out to sea, while the beacon emitted from the lighthouse on shore becomes harder and harder to see.
All we have in this world is the fight. It’s okay to feel bad, to take some time with your feelings and be sad for yourself. But, the fight within us to overcome the grief, overcome the stress, to keep the shoulder moving is how we get better and overcome the pain of grief.
Final thoughts on finality…
“No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing.
”At other times it feels like being mildly drunk, or concussed. There is a sort of invisible blanket between the world and me. I find it hard to take in what anyone says. Or perhaps, hard to want to take it in. It is so uninteresting. Yet I want the others to be about me. I dread the moments when the house is empty. If only they would talk to one another and not to me.”
— C.S. Lewis, A Grief Observed
Dirt Nap is the Substack newsletter about death, grief and dying that is written and edited by Jared Paventi. It’s published every Friday morning. Dirt Nap is free and we simply ask that you subscribe and/or share with others.
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It would have been hilarious if I needed Tommy John surgery since I don’t do anything remotely physical.
I have daily back pain that exists anywhere from 4 to 7 on a scale of 1 to 10, so shoulder pain at a 4 or 5 was nothing.
Apparently this is how you shield from liability; list everything under the sun.
Greatest chiropractor ever. She’s done sports medicine certifications so I trust her.
Coming in at a close second to not trust the diagnosis from the WebMD symptom-o-matic.
T-boned a Lexus that ran a stop sign. My Honda Pilot was totaled. The other driver walked away without a ticket or a scratch. Turns out the cop played basketball in school for the other driver’s husband. That’s nice.
And, what a great word ache is. Mistaken as ancient Greek but very much derived from old English. It doesn’t sound anything like it’s spelled and while it has a meaning, it’s usage is so versatile.
I’m not here to discuss the Covid vaccine today. Fuck off with your anti-vax bullshit.
Or physical therapist, in my case.