shoulder separation, training, regressing

[silly]

So, I was training for a 24 hour adventure race in early August and crashed my mountain bike. No big deal-I crash a lot. But this time, something was different. Anyway, it's a right separated shoulder. ER Doc says to sling it and when I feel good again, continue with normal activities.

In late August I have my race-50ish mile mountain bike ride, 25ish mile trek, 20 mile canoe, rock climb, repel, and rope wall. All of this while wearing about a 20 pound pack with mandatory gear to keep us alive if something goes wrong. Alas, I crash on it again. I come back from the race with my shoulder hurting. Had to leave work it hurt so bad. This time I go to see my GP, and he says it's just extensive soft tissue damage. All should be well. I can train through it, if I can deal with the pain.

So, from this crash, I also dislocated a bone in my left foot from remaining clipped into my pedal. My toes are still numb and it makes balance hard for some lifts- I go see a massage therapist / chiro guy and leave feeling good for a few days. No permanent changes, though. I'm not concerned about this one, as much. They're only toes.

Now, another race down, a couple of mtb races, and a lot of hard riding and my shoulder doesn't feel like it tracks well. It's definitely crunchy and pops a lot. I'm not sure where to go from here. I sleep with a heating pad on my shoulder and neck to try and relax it some, but it's affecting my whole right side. I'm starting to have lower back pain and knee pain. In general, I'm all jacked up. What do I do? I'm training for a big season next spring and I don't want this holding me back.

1. When did the pain begin? August after first recent crash-though it's always been crunchy from other crashes.
2. What were you doing at the time? Or did the pain come on gradually over time? It was all at once. I hit a tree going about 20 miles an hour on a descent and flipped off my bike.
3. Where, anatomically, is the pain? joint / lower back/ beginning knee
4. What does the pain feel like? shoulder joint-dull, lower back-achy, knee-twinge (not a good thing for endurance racer) and under the blade is sharp (doc says typical soft tissue damage-will take a couple of months to dissipate.)
5. Is the pain constant, or intermittent, or only on certain motions? constant in joint and lower back.
6. What motions make your pain worse? Almost anything-rock climbing, riding hard, mountain biking, presses, pushes, stretching too far. It's jacked
7. What, if anything, makes your pain better? trying to forget and a heating pad helps.
8. Does your pain radiate to any other part of your body? lower back
9. What things could you do before, that you cannot do now because of your injury? ride, race with pack, climb, lift
10. What is your main concern regarding the pain and its consequences? Can I train through it? Will it go away? What do I do?
11. Have you ever injured that part of your body before? If so, how? yes...I've crashed on it multiple times, I'm sure.
12. Is your pain getting worse over time? And if so, how much worse over what time period? Its just always there...It's a nuisance, too.

[UConnJulie]

Well, a lot going on with you ... you say you saw your GP, but did you see an orthopedist as well? Honestly, it sounds like you had a lot more than just "soft tissue injury". Soft tissue heals relatively fast, but a chronic AC joint issue does not. For sure you have some instability issues from the repeated trauma.
If I were you ...
1. Go see an orthopedist. Preferably one who deals with shoulders as a specialty. He/she should have a greater appreciation of what you need to get you back to your sport in the shortest amount of time.
2. Focus on rehab/mobility/stabilization exercises for now. Have someone knowledgable look at your scapular stabilization patterns (ie with movement) to see if your lower trap is firing when it should and make sure your upper trap isn't firing when it shouldn't. Also have them look at your static scapular positioning (pain can alter the natural position of the shoulderblade, and if you are holding it in an abnormal starting position, it can alter the entire mechanics of your shoulder movement).
3. Find a good physical therapist who understands the rigors of your sport, and can help you (with exercise, and good manual therapy when indicated) get back to it.

[silly]

Is it possible that the lower back pain and knee twinge is a product of the shoulder thing? Could it be cause and effect? or is there something different altogether (gawd I hope not!)

I'm gonna find an ortho, though when I broke my fingers / wrist in a road cycling accident the ortho my GP sent me to wasn't a nice person. I guess I've been hoping it will "work itself out." you're right....I'll go to the ortho.

Thanks for the reply.

[Jean-Paul]

Sarah, I know the hand doc you speak of just by your comment, and you're right. He's absolutely nuts. He's a good surgeon, so if you have to have your wrist opened up, he's your guy, but other than that avoid him like the plague.

For a good ortho, try Tad Pruitt at Ortho-Arkansas. He's a great surgeon, and he's used to dealing with athletes. He got me back in the game pretty quickly doing the last two surgeries I had on my shoulders. He's a great guy, and he's very in demand (bring a good book to his waiting room... It's called that for a good reason).

He has helped a lot with my little problems that crop up. He gives me a cortizone shot about once every two years.

The best rehab guy in town if you want to go straight to a PT is Rob Tillman. I can't remember his contact info, but if you want to reach him let me know and I will dig up his info for you.

Try to take it easy on your body... You're going to have the range of motion of a tree by the time you're 35 at this rate. Hope your owies heal quickly.

[UConnJulie]

Sarah, no way to know for sure if the lower back and knee are a by-product of the shoulder injury or not without direct examination (at least in my world), and even then it might be difficult. What you do know is that there is a breakdown somewhere that is causing other issues.
I was hoping you'd post here JP since I know you have been through the ringer with your shoulders! Glad that you know Sarah locally and can point her in the right direction of good quality clinicians.

[Jean-Paul]

Sadly, even a good surgeon is not going to know if there is a functional relationship between the lower back injury and the shoulder. One thing you have to keep in mind about orthos is that they are basically glorified plumbers. They can't diagnose something unless they can see it in a static image. If they can cut into it, then you're right up their alley (and you don't want anyone else touching you in that case), but they generally give LOUSY advice to people with regards to rehab.

Just because they can't see something though doesn't remove that fact that something hurts, and if something hurts then there is obviously something wrong. That is one of the practical applications of getting a MotionDNA assessment. All other tests look at a static image, whereas the MDNA assessment looks at MOVEMENT. By analyzing things like kinematic sequence, and by objectively measuring the speed at every joint it can pin point which segment in the kinetic chain is not doing it's share of the workload.

[silly]

An update: Mountain biked 27 miles on Sunday at the Womble. Crashed on my shoulder, again. Went to my GP doc today for x-rays (I went to a walk-in clinic last time) and he said I had about 1.5 acl separation for sure. He thinks I also have a bicep tendon tear, as well and a ligament tear on the back of my shoulder but I forgot the technical jargon. He's concerned that I was still having issues. Anyway, I'm going for an MRI to confirm and them probably to the shoulder specialist. Fortunately, he said I could ride road; given I don't torque the bars too hard or ride techy stuff off road. He asked that I give it a few days to let it settle before I ride, but I have to wear a sling as much as possible. Thank God he rides, so he understands. It's a super bummer.

[Jean-Paul]

Heh... You're like the Energizer Bunny! Or a Timex watch or somthing. "I tore my left arm clean from the body, broke 4 ribs, lost 2 teeth, my right eyeball, and 3 pints of blood, but I can still do road riding."

Let us know what the MRI says. Sounds like an infraspinatus or superspinatus tear. Hope not!

[eastcoastsurfer]

I thought wakeboarding was rough on the body...remind me never to go mountain biking. Good luck!