I realize that when I wrote the first article in this series
I said I’d write every 1-2 weeks and it’s now been about 11 weeks, but in my defense, there wasn’t much to say for at least five of those weeks.
The MRI showed an extensively torn labrum and a tear in the rotator cuff (supraspinatus), but the extent of the latter wasn’t clear. I went in for surgery on September 4th, and once inside the shoulder, the surgeon confirmed the extent of the labral tear and that the RC tear was a lot worse than the MRI suggested—complete thickness tear. He described the operation as two surgeries at once, and the surgery report concluded with the phrase “an extraordinary effort was required…”. (If you’ll recall, the original ortho I met with told me I didn’t need an MRI… good doctor.)
The labrum was torn 270 degrees around—I’m told that with a shoulder dislocation, 90 degrees is typical, so I tore triple the normal amount. That explains the sound of green tree branches tearing that I heard at the time of the injury. Basically I tore my arm off. He used 4 anchors to reattach the labrum and 2 for the rotator cuff.
The pain in the first 36 hours post-op was considerably worse than the pain of the original injury. It wasn’t helped by the PA accidentally prescribing me half the correct dose of hydrocodone, but it abated pretty quickly and I was off the pain meds by the third day.
I was in a sling for 4 weeks after the surgery, which was easily the most miserable part of the entire experience to date. It was like having a duffle bag slung over my shoulder while being rear naked choked by a really weak guy for a month. Sleeping was also a near impossibility—it was like being in a fight with my wife for a month straight and having to sleep on the couch, but only in a single uncomfortable position.
The biggest concern the surgeon had was joint capsule tightness due to the extensiveness of the injury and subsequent repair, and the extended period of immobilization. The capsular tightness turned out to be very real—once I finally got out of the sling, it felt like my joint capsule was full of concrete. When you’re stretching tight muscles, there’s still a sense of elasticity at the end range—with my shoulder, the end range feels running into a brick wall. He’s predicted a 10-12 month recovery.
The day I got out of the sling, I had essentially zero active range of motion—I basically couldn’t move my arm at all except for a few degrees of internal-external rotation with my elbow tucked against my side. Passively, I could get about 45 degrees of shoulder flexion, about 20 degrees of abduction (although not even directly lateral), with my elbow bent to 90 degrees, I couldn’t even get my forearm straight forward, and with my arm hanging at my side, I couldn’t get my hand behind my hip. Suffice to say it was pretty depressing.
I also had some lingering partial numbness in my fingertips even after I was out of the sling. That took a couple weeks to disappear. Presumably it was the result of inflammation around the nerves.
I started physical therapy the next day, which was primarily testing range of motion, some simple passive stretches, some light isometrics, and then a bout of ice. I was given a short list of stretches and exercises to do 2-3 times daily:
- Assisted active shoulder flexion (using my good arm to help raise my bad arm and trying as much as I can to lift the bad arm itself, which was virtually not at all)
- Passive external rotation (elbow at side and bent to 90, pushing my hand out with a PVC pipe)
- Wall crawl (inching fingers up along the wall to try to get passive shoulder flexion)
- Internal and external rotation isometrics against a band
- Prone scapular retraction/depression with 10 second holds
Every couple PT sessions, I would get a few new exercises or new versions as ROM and strength progressed.
The week of October 12th, my passive flexion reached 140 degrees—by passive, I mean after 30 min of being worked on and having my PT just about standing on my arm to push it into position—and could get about 90 degrees active flexion. External rotation was a little better but I could still barely get past 90 degrees (90 degrees being my forearm pointed straight forward with my elbow bent to 90 degrees).
The PT added some more stretches and exercises that week:
- Presses with a PVC pipe (“press” is a generous description for this movement – more like a partial standing incline bench with an oddly internally rotated left arm being dragged along by my right arm)
- Internal and external rotation isometrics against a doorjamb
- Push and pull isometrics against a door jamb
- Passive abduction (using a PVC pipe to push my hand up)
- Snatch and clean grip flexion while lying on a foam roller
- Pulley flexion (using a cord and pulley to lift the arm into shoulder flexion)
- Band scapular retraction and depression
The week of the 26th, the PT was able to get me into 155 degrees of passive flexion, and after getting warmed up and stretched, I was able to get about 110 degrees of painful active flexion. Passive abduction was about 100 degrees, and active close to 90. External rotation was about 100 degrees active (if the forearm straight forward is 90). With the elbow at my side, the PT was able to get about 110 degrees of passive external rotation; with my arm abducted a bit, a little more. I could also get my hand slightly behind my back.
The PT warned me early on that the ROM would initially improve relatively quickly, and then the final range would take considerably longer. I’m beginning to see that slowdown now.
The therapy generally is very painful—passive stretches and PNF contract-relax stretches, and occasionally some movement against her light resistance. At the end ranges of motion, it feels like the capsule is about to rip in half. It is entirely unenjoyable.
I did essentially no training at all during the period of time when I was in the sling save for some unweighted squats, lunges, split squats, crunches, back extensions and the like, along with all the shoulder work. A week after I got out of the sling, I tried safety squat bar squats again—definitely a little painful but tolerable with light weight.
By last week, I was able to load the squats more with less pain, but my strength is not particularly impressive right now after doing little to nothing for two months and losing 8kg. Once I can squat consistently again, I suspect it will come back relatively quickly. I’m also hoping I’m a month or so away from being able to hold a barbell on my back for squatting, but that may be overly optimistic—I couldn’t even hold a 6” cambered bar today. I think I may be able to front squat sooner using a strap on the left side to hold the bar rather than getting my hand under it.
I’ve also been sneaking in some very light dumbbell curls (10-12 lbs) 2-3 days/week, and have tried some bent rows with the same weight, but with a bit too much pain to be able to convince myself that the PT was wrong to tell me not to start this stuff yet. I’ve also done some dumbbell shrugs with 30-35 lbs very slowly and cautiously to try to bring my traps back from the verge of extinction.
This injury has become a bit of a delineation in my lifting career (if you can call it that—I’ll be generous today). Had it happened years ago, I don’t think it would have had the same effect. The reality, however, is that by the time I can lift again, I’ll be 36 years old and still have all the same non-lifting responsibilities I have now, such as coaching a large team, running a business, and trying to keep my wife and daughter and dog from hating me. I was hanging in there fairly well for my age and obligations, but this setback may prove to be more than I can truly rebound from due to the circumstances. There’s no question I’ll return to lifting in the gym at the very least, but whether or not I return to competition, at least at the national level, is questionable at this point. But who knows. I said that before a few years ago after quitting competition for 5 years to focus on coaching and building Catalyst Athletics, and that didn’t last. Ten-twelve months is a long time, and I’m only at the leading edge of it. I suppose a lot can change.