Shoulder Injuries

[Gary Fluitt]

After reading Wes' post about his shoulder I thought I should share something about the shoulder injuries I've endured. Maybe if you're nursing a sore shoulder you'll get something out of this.

<b>I'm not a doctor but I play one on TV</b>
I've no medical training other than EMT, so take the following info with a grain of salt.
The Rotator Cuff is made up of a bunch of tendons that lie under the Acromium bone (that prominent shoulder bone that attaches your Scapula to your Clavicle). The rotator cuff tendons (Supraspanatus, Infraspanatus, Biceps Tendon, etc.) connect to your upper arm bone and run underneath the Acromium bone.

In slalom (and rock climbing and surfing, my other two favorite sports), you raise your arm repetitively, and the rotator cuff tendons, especially the Supraspanatus, ram into the Acromium. This will eventually cause inflammation of that tendon, and tendonitis if there is not enough room in your shoulder around those tendons. This is likely what Wes has and some rest and anti-inflammatory regimen will do the trick to reduce the inflammation.

If you fall on that arm and REALLY ram your Humerous up into your shoulder "socket" you may get something called "Traumatic Impingement". That's when the tendons get pushed up against the prominence of the Acromium. You may get little micro tears in the tendon as well but nothing serious. This will not show up so well on an MRI. Typically your Doc will put you on VIOXX or something like it, it may take months to go away (or not). Last effort before surgery is a Cortesone shot to the joint itself. Yeah I tired that too.

If that doesn't work you're looking at arthroscopic surgery to repair the tendon, and possibly Acromioplasty to shave down that bone and give your tendons more room to move around.

The worst thing that can happen is a full rotator cuff tear. This is what happened to me last fall, when at ABQ, skating Indian School with Gary Holl, I slammed the opposing wall of the ditch, rammed my Humerous up into the shoulder socket, fractured the Humerous bone and shredded the tendons. This was a couple of weeks before Morro Bay, so I had to race the Worlds with a broken shoulder and a shredded rotator cuff (poor me). Same thing happened to Steven King first race of the 2002 season.

If you tear a tendon in your rotator cuff, it will not repair itself. It's surgical. Your orthopedic surgeon will likely have to do a full on filet of your shoulder. My guy tried to do it arthroscopically but when he got in there is was a total wreck. The tendons were all shredded. Looked like cauliflower. He pulled the cameras and sliced me open. In this procedure they have to unfold your deltoid like the pages of a book (or a small magazine in my case), pump water into your shoulder to give room to work, and deburr any tendons that are still attached (not torn). The torn tendon they will actually cut, pull it up from your Humerous, and screw it back into your shoulder bone with a couple of little cork screws. While they're in there they will likely do some acromioplasty, amputating some of the Acromium to give your shoulder tendons some room.

The worst part of Rotator Cuff injuries is the rehab. It takes a good six months to really get your range of motion back, and in my experience, another six to get your shoulder strength back.

One thing I will warn you of, and Wes's post brought this thing to mind. The MRI is not an exact science. I've had MRI's done of both shoulders, and both were WRONG. On my first shoulder injury (snowboarding), the MRI indicated Full thickness rotator cuff tear. It wasn't torn, just minor micro abraiding. That repair could have been done arthroscopically saving me months of rehab.

The second MRI I endured said the rotator cuff was intact, but when they got in there, it was fully torn. So I'm 0-2 on MRI's and I don't trust them. If you do get an MRI, make sure you get the "Contrast Injection" first and get a couple of opinions on the film.

I had a pretty gnarly rotator cuff surgery in late January. I started skating again in April at Paso Robles, probably 2 months sooner than I should have. I did serious PT 3/days a week for 3 months. I don't have any strength in that arm for pulling the gates, but I can run cones.

Last thing. Make sure you stretch your shoulders before you run cones. I have a series of about 7 stretches I can send you if your interested. If your shoulders are sore after skating, ICE THEM. I know it totally sucks to ice a shoulder cause it's really hard to keep the ice on there, but hey, it's better than drugs and surgery.

Oh yea, be careful about your wrist braces too. You want the palm of your had to slide a little when you go down, so that you don't ram your arm up into the shoulder socket. This is what happened to me in ABQ. King's wrist brace broke when he went down at SF, jabbing the plastic into the pavement and acting like a tent stake. If his palm would have slid a couple of feet, he probably wouldn't have trashed his shoulder. If you're concerned, you might consider slider gloves.

I gotta shut up now.

[Eric Wallgren]

I had back to back consecutive slams on my left shoulder in the Cyberlslalom at G3, and hadn't considered the load I'd subjected the shoulder to from my hands on the pavement. It wasn't really painful for a couple days, but worsened steadily. 3 weeks later it's really improving. The pain was localized to a fairly narrow portion of my range of movement, and only existed when I applying tension, not pressure. The bottom line is that slide gloves are going to be made tonight before I begin practicing tomorrow. Very Informative post. Thanks.

[Wesley Tucker]

What surprises me is that when we were kids (those of us who aren't anymore, that is,) I don't ever remember anyone complaining about their shoulders. We slammed knees, elbows, hips and heads, but I can't remember a single shoulder injury.

Now it looks like a plague has descended on those who slalom: Gary, Gilmour, me, Geezer and who knows who else? What's so infuriating in my case is I fell RIGHT. I did a great impact absorbing roll. Still slammed the shoulder.

I wonder if toting a beer belly somehow alters our center of gravity so the shoulder slams first instead of the elbow? Someone should make a study of it. I know: we'll get Gilmour to do it. He seems to have a lot of free time!

[John Gilmour]

I think it is pretty easy to identify those racers at risk for shoulder injury and those that likely will have a better chance at avoiding a shoulder injury.

I think most people can drastically reduce the likelyhood of a shoulder injury if they take preventive action.

1. Learn how to fall to reduce impact (I do teach this)

2. Fall absorbing the impact with the most padded part of your body.... no not your butt, your knees. Never put your hands behind your back in a fall.

3. Hit the pavement with arms extended and do not put more than 20-30 % of you body weight on your hands.

4. Keep your knees together...don't let a dime drop.

5. Wear sliding palm gear if at all possible.

6. Do strentgthening exercises to your shoulder concentrating more on the minor groups initally.

By doing this you are supporting the shoulder in all directions. If you work on the Major groups first the minor muscles will not have the room to develop. Do lots of PNF exercises.

After stengthening the minor groups (A total gym is great for this) you should work on the Major groups around the shoulder taking care to change the peak stress ont eh muscle group from time to time so that you can get even development around your shoulder. The objective is a very defined shoulder with high mucscle definition but no single group of muscles dominating the shoulder. (A chain always breaks at its weakest link.

How can you tell if you are risk?

My test is pretty easy. Lift a 5 pound weight up with your arm extended from your side. Now how much muscle tissue is on top of your shoulder before you hit bone over the largest group. Less than 1/2 an inch? Time to hit the gym. Feel around your shoulder when you tense it . Feel an area that is bony in the front? How bout the rear? Do exercises to fill in the gaps.

I am no Doctor- but I have subluxed/dislocated out my right shoulder over 100 times and my left one about 15 times. I know what keeps them in their sockets.

7. Before doing exercise do Pendulum exercises to warm up teh cuff so you don't get inflamation of the joint.

8. If you are rehabing an injury take a full size towel soak it with hot water as hot as you can stand. Wrap your shoulder to losen it a bit. Do your stretching exercises like Pendulums and walking your fingers up the side of a doorway and front of a doorway.

Do your exercises and later ice it down.

9. Don't do lat pull downs or shrugs if you have shoulder impingement. You'll likely just stretch the cuff or inflame things. Yoga is a good exercise alternative.

10. Seek out a qualified doctor and physical therapists advice instead of listening to me.
Doctors who treat themselves a fool for a patient.

[Hans Koraeus]

Maybe we should start protecting our shoulders and hips as well. Seeing Simon Levene slamming his shoulder in Paris and laying on the ground for 10 minutes was not a pretty sight. Falling with control/body facing down the hill is ok. We have our kneepads and wristguards. But if you get the slightest twist in your fall your shoulder and hip will take it all. 95% of slalomers will have no protection at all for this.

Luckily this is not happening very often beacuse normally if you loose control you just stear out of the course. But when in a competition you are likely to push your margins and increase the likleyhood of taking risks and falling.

Actually I saw one of the racers in Paris having this shoulder pad protection with hard plastic like on our kneepads. Whould be nice to know some more of these kind of protections.

[Chris Eggers]

Michael Dong has been using plastic protection in Morro Bay last year. You can see his picture at:

http://www.sk8mag.de/contests/morro_bay02/index-en.html

I think it was also because he had a shoulder injury prior to the race. Maybe he sees this post and can say a few things about his padding and how much it influenced his maneuverability.

[Mike Ohm]

I re-injured my shoulder(supersponatus and deltoid) at the G3 racing alongside Keith Hollien. He popped a cone and it went smack under my front wheels. I got ejected and the first thing that hit were my hands. I wear wrist guards and of course went to my knees too.

Rehab included ice 3 times per day and stretching my arm across my chest. I also visited and sports medicine chiropractor guy. He combined electric muscle stimulation and deep tissue massage and my recovery time was quick. The key to many muscle injuries is ICE ICE ICE. Hopefully your injuries do not involve tears that mean surgery. Gary Fluitt is a warrior!

[Steve Prue]

now if you are a true idiot and twist in mid-air during a high-side fall to protect a)bad left wrist and then realize that you have to b) protect your full tattoo sleeve arm, twisting the opposite direction....

you end up falling on your shoulder badly and breaking your collarbone in the middle of a parking lot in new jersey and having Noah drive you to the hospital where you explain what a 35 year old man was doing breaking his collarbone on a skateboard.

"racing, sir."

[Gary Fluitt]

Thanks for the compliment Ohm, but I'm no warrior. I'm a MORON.

Try explaining to your orthopedic surgeon, who just discharged you from PT, when you come back narry a week later with a purple pectoral muscle, and a totally detached clavicle. THAT's idiocy.

After my little medical novella above, what do I do but hit a hay bail, at my own race, in QUALIFYING on the first day, and snap a clavicle.

The good news is that somehow I managed to keep the rotator cuff intact (we think). I'm trying not to think about that.

I saw the film of the fall later that day. I clipped the hay bail with my heel side Avila, and immediately went into orbit. Came down on my shoulder so hard that my head smacked the pavement and bounced. Thank GOD I was wearing a Giro full face helmet. I would have lost teeth for sure judging from the ground plastic face piece.

Oh yeah, no more hay bails. They're fine for lining a sketchy corner for those goofy downhillers, but they don't make very safe cones.

Now wearing a figure 8 brace. How do women wear those Bras? I DO NOT feel sexy.

As for shoulder protection, I will now be wearing my little motocross jersey with capped shoulders. Sure I'll look like RoboSlalom Boy, but if I slam again, maybe I'll get up and keep racing.

<img src="http://www.asphaltplayground.com/images/fluitt_paso.jpg">