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  1. #526
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    hi guys. this could be a very long post but i will try to keep it short.

    16 weeks today since went OTB and over the drop...... started having flashbacks but that is another story...

    i have been following a conservative approach (no surgery) as advised by 3 different doctors/surgeons.

    went back to see my surgeon 2 days ago. I lost confidence in him... won't bore you with the details.

    Had a thorough going over and the conclusion was that I have a full range of movement and good power transfer, but I have lost some strength due to under use (because I neglected the physio and was doing my own thing)

    Just back from the physio with a whole set of very specific exercises to get going with.

    Still have the pain at the end of the bone feeling and the surgeon asked me if i can live with it.... I said yes.

    So for the moment I'm sticking without the surgery and working on my muscles

  2. #527
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    Had surgery yesterday. Not too bad yet good drugs help. Dr said everything went good.

  3. #528
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    more physio

  4. #529
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    It's been about a week since surgery and I'm off all pain meds and have no pain. First 3-4 days were the worst not much pain but the drugs suck. I can't believe people want to take that stuff. Going to the doctor tomorrow the get stiches out and find out when I can start PT. As far as the shoulder goes it feels like it is hanging normal again but it's hard to tell with the sling. It's swollen but bump isn't noticeable. I just hope it heals up good and strong and I can get back to riding soon.
    Last edited by Andy17; 12-01-2012 at 07:51 AM.

  5. #530
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    Quote Originally Posted by TranceX View Post
    For those of you considering surgery for a Grade 3 separation for cosmetic reasons here's what it looks like without the surgery.

    Here I am less than an hour after the "incident".



    This is 6 and a half months later. Notice the difference? Not much.



    Cracks me up when friends come up and say, "hey it's looking better!" I'm like "really? You do realize that's the end of my collar bone sticking up there right? It doesn't get better....lol."
    Not everyone looks like that with a grade 3. When I was just standing with my shoulders in a neutral position my clavicle sat in it's natural position and swimming kept my shoulders strong enough to support the weight of my arm. I had very little deformity or difference in height between my shoulders.
    Disclaimer: I no longer fix bikes for a living.
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  6. #531
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    I posted awhile back in this thread, but I can't remember what I said and I don't feel like looking through 22 pages to find out.

    So, here's my short back story. I did a grade 3 separation of my left shoulder 5 years ago, September of 2007. I ended up not having surgery and did pretty well. In 2010 I went to an orthopedic surgeon who specializes in shoulders and knees of athletes. I was having some issues. He kept me from doing surgery, we made some changes to my physical therapy and resolved the issue.

    In June of this year I went down on my shoulder. It was a really minor fall. But in the weeks after I started having issues. The most bothersome was subluxation of the joint. Basically at random times, my clavicle would slip up and over my scapula and then pop back into place. If you've dislocated a joint, you know it's not comfortable. This was happening 2-3 times a day. There was no clear pattern so I couldn't just stop doing the movement that caused. it. It was most problematic when it would happen while riding. I'd lose all the strength in my arm and almost crashed a couple times because of it.

    I went back to my surgeon, who by now knows me really well, he took care of a bone spur and torn ligament in my ankle in 20120. Also, in addition to being his patient, I take care of his bikes. After an extensive assessment he determined that I tore much of the muscle fascia in my stabilizing muscles. My surgeon suggested surgery.

    I've been researching AC reconstruction since my original injury. 5 years ago the prevailing thought was that those who under went surgery and those who used only physical therapy would end up at about the same level after a year. In the last couple years there have been some subsequent studies looking at long term results. New data suggests that even if you opt for the conservative route after a grade 3 separation, you will eventually end up going under the knife because you will develop arthritis in the joint much more quickly then those with an intact joint. This, combined with my now grade 5 separation made the decision to have surgery easy.

    So, I went under the knife just over 5 weeks ago. I was released from my immobilizer sling on Wednesday and started therapy on Thursday. Right now it's just stretching to restore range of motion lost from being immobilized for 5 weeks. I'm still in a decent amount of pain. Still popping percocet two or three nights a week. I'm limited to no lifting over 5 pounds for another 5 weeks, but I can already tell that all the popping and clicking is gone. Each day I feel much better. I'm optimistic that I'll be better off than prior to surgery. I think that having attempted the conservative approach with good results until I made things worse by crashing again puts me in a unique position to be able to assess the outcome of the surgical route vs physical therapy. I'll let you all know how things progress.
    Disclaimer: I no longer fix bikes for a living.
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  7. #532
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    that is an interesting post.

    in my last update following the 3 month visit to the surgeon, I said that I had lost confidence..

    following his insistence that conservative approach is right for me, and it seems to be going well, he rounded it off by saying that I "shouldn't have any trouble at all" doing my job (I more or less work from a desk)

    Right from the beginning I told him that what was important to me was to be able to do the active things that I like doing....

    Due to a change in job i am also changing health insurance cover next friday. The new cover is supposed to cover existing conditions, but I will be moving country which means a new doctor.

    I'm tempted to find the best doctor I can in the new town and get a completely fresh opinion.

  8. #533
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    I did just fine without surgery for 5 years and would have gone many more had I not made things works.

    Really, my only limitations were holding a heavy weight in my arm for a sustained time. I'm not a lifter, but I could lift anything I wanted to, I just couldn't hold things for an extended time (think, carry a kid around a store).

    I could swim (I had a mental lapse a few years ago and got into triathlon). I actually think swimming was very good for strengthening the stabilizer muscles. But, I had to limit how much I swam or my shoulder would get irritated. I found that I had to keep it below 6000 yards a week and was better closer to 4000 yards a week.

    Riding was fine.

    I didn't do any paddle sports post separation, but I imagine I'd have had the same limitations as swimming.

    That being said, after reading the more recent studies, it seems that if you are an active person with a grade 3 separation, you will eventually end up having surgery even if not doing it initially. You might not get reconstruction but you will have to deal with arthritis in the joint. I'll try and find a link to the studies.

    Look for a a surgeon who specializes in athletes. My surgeon specializes in the shoulders of athletes. He also knows that being able to ride, ski and play with my kids are much higher up my list of priorities than work. I couldn't have found a more qualified doctor.
    Disclaimer: I no longer fix bikes for a living.
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  9. #534
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    One Year Later, I'm 95%

    Those of you that just had it - there is hope! It's not over! Mine turned out pretty good.

    I posted on here a year ago - Grade 3 right shoulder after hitting a jump wrong at Whistler. Bruised or sprained the left too (apparently while I was doing a rag doll unconscious down the road). Broke a rib, finger, etc.

    I'm 39. Didn't get surgery. So glad I didn't. I was back on the bike in three weeks, probably six months before I felt really normal, but now I'd say I'm 95%. Like I said, I'm 39, half the joints on my body are at 95% so I figure that's pretty good!

    I can lift, ride, sleep on that side (for a few hours at least). Just got back in the thai kickboxing gym a month ago, straight right and right hook to the body are as hard as ever. Life is good.

  10. #535
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    Quote Originally Posted by dwnhlldav View Post

    That being said, after reading the more recent studies, it seems that if you are an active person with a grade 3 separation, you will eventually end up having surgery even if not doing it initially. You might not get reconstruction but you will have to deal with arthritis in the joint. I'll try and find a link to the studies.

    Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.

    Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.


    Interesting that the opinions on how to treat a AC tear are so polarized.
    Slowly slipping to retrogrouchyness

  11. #536
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    Quote Originally Posted by G-reg View Post
    Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.

    Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.


    Interesting that the opinions on how to treat a AC tear are so polarized.
    I've been searching, I'll continue... The study didn't say that surgery would prevent arthritis. It said that those who did not get surgery in the beginning would develop arthritis that could/would be bad enough to require surgery in the future. It also said that those who had surgery immediately after the injury would also develop arthritis (supporting your doctors opinion). The short version of the conclusion was that surgery or not following the initial injury, people with grade 3 separations are very likely to require a surgery years down the line. Keep in mind that the study looked at the Weaver-Dunn procedure as the initial repair. The study I remember most clearly was published in the last year or two.

    As far as the difference of opinions, it seems to me that it's the difference between general orthopedic surgeons and shoulder/athletic specialists. Keep in mind, my sample size is limited and I am in no way criticizing your surgeon or putting down his abilities or knowledge.

    I've been to 3 different orthopedic surgeons for this injury. Initially I self diagnosed this injury because the ER doctor missed it. My clavicle was not displaced when my shoulders were in a neutral position so it was an easy mistake to make. Due to outside circumstances, I didn't get in to see an orthopod until 12 weeks post injury. In that time I did a lot of research. The first two doctors I went to shared your doctors opinions about this injury. They also had no idea what I was talking about when I brought up the newer procedures. The third doctor is an orthopedic surgeon who specializes in shoulders of athletes. Though he was aware of the most recent techniques, and helped develop one as a surgeon for the Navy, he kept me from doing surgery. At the time I first went to him it was a year post injury, or 4 years ago. I was back to all my normal activities. He suggested that since I wasn't having more than occasional discomfort I should continue therapy. He also said the if I did surgery then or years down the road, the surgery would be the same. So I didn't get surgery. I went back to him a couple years ago because I was having some issues. Again, we did not do surgery. I made some changes to my therapy and resolved my issue. It wasn't until I fell in June and upgraded from a grade 3 to a grade 5 separation that he thought surgery was the best route.

    Some of this you may know, but hopefully it helps others understand what's going on with this injury.

    AC joint separation involves two major ligaments. One goes out from the end of the clavicle, horizontally and attaches to the acromion. This ligament is rarely rebuilt. The second major ligament is vertically oriented and goes from the clavicle down to the coracoid process. When both of these ligaments are torn, you have a grade 3 separation. There are a couple different approaches, but from my discussions with my doctor and the studies I've read, the latest technique is to remove 1cm from the end of the clavicle, and then use a hamstring tendon to rebuilt the ligament from the clavicle to the coracoid process. The tendon can either be from a cadaver, or your own. It's the same tendon used in ACL reconstruction. This seems to be the most current technique and has produced better results that the Weaver-Dunn procedure. It's also what I had done. The method your doctor described will alleviate interference between the clavicle and acromion, but does not help to stabilize the joint and will certainly lead to arthritis down the road. The weaver-dunn is widely known and is still the defacto repair for surgeons not specializing in shoulder repair. The Weaver-Dunn was a decent fix for problematic grade 3 separations and for more severe separations, but it did not produce a joint as strong as the original and that is why it's not indicated for grade 3 separations that respond well to therapy.

    Here's an abstract to a study of the most recent technique. You have to have a subscription to see the full article. My doctor's PA printed it out for me. Clinical Outcomes of Coracoclavicular Ligament Reconstructions Using Tendon Grafts

    Studies have shown that there is little benefit in rebuilding the ligament from the clavicle to the acromion. They also show that using either a cadaver hamstring tendon or an autogenous (from you) hamstring tendon to rebuilt the Coracoclavicular Ligament resulted in a joint that was at least 95% as strong as the original joint. Sometimes stronger. Using your own tendon is less likely to have complications. Using a cadaver tendon puts you at risk for rejecting it.

    The testing is quite interesting. The way they tested these repairs was to rebuilt the joint on one side of a cadaver and then fail test both shoulders and compare the results of the rebuilt side to the uninjured other side. (I'm totally donating my body to science when I die)

    I can say that all of the clicking an popping I had prior to surgery, and for the last 5 years, is gone. I'm almost 6 weeks post surgery. My biggest issue is loss of range of motion do mostly to being in the immobilizer sling for 5 weeks. It's coming back quickly. I'll be very happy with the results if things continue to progress as that have.

    Disclaimer: I'm not a medical professional. This is a synopsis of my own personal research into AC joint reconstruction. I'd like to link all of my sources, but I replaced my computer since doing the research and lost many of the links. Should have switched to google chrome earlier...
    Disclaimer: I no longer fix bikes for a living.
    National Ski Patroller to feed my winter habit.

  12. #537
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    Quote Originally Posted by dwnhlldav View Post
    ... the latest technique is to remove 1cm from the end of the clavicle, and then use a hamstring tendon to rebuilt the ligament from the clavicle to the coracoid process. The tendon can either be from a cadaver, or your own. It's the same tendon used in ACL reconstruction....
    This is the technique I had done April 2011.
    I have fallen with my bike, as well as gone straight up over the bars, since then.
    I can say honestly that as I travel up and over, my thoughts do center around my shoulder and trying not to land on it.

    So far, I've been doing pretty good with that!

    I continue to stretch my upper body and shoulders frequently just to keep up my ROM, as well as other exercising when I make myself do it.

    I have been doing pullups for quite a while now with no issues concerning my shoulder.

    Basically, I am glad I had the surgery done (approx. 8 weeks after the injury).
    There is nothing so unusual about my shoulder that reminds me of my injury... either feeling anything different, or seeing anything different.

    I had cadaver ligament two times.
    As mentioned many pages ago here, the first time around the ligament stretched and my clavicle returned to the post-injury state.

    Two weeks later the surgeon went back in and put a new ligament in and this is the one I've been living with ever since.

    Thanks for all the up-to-date info... I enjoy reading this thread as more people add on!

  13. #538
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    Good info!
    Slowly slipping to retrogrouchyness

  14. #539
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    Quote Originally Posted by G-reg View Post
    Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.

    Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.


    Interesting that the opinions on how to treat a AC tear are so polarized.
    this was my surgeon's main argument against surgery.- that the risk of athritis was greater following the surgery than left alone

  15. #540
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    i'm still no further forward in forming a definitive opinion..

    lifted up my son yesterday straight in fornt of me (about 30kg) That hurt a bit.

  16. #541
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    I am 4 weeks out from a grade 2 AC. Day 1-3 were hell. Progress from there was fast and encouraging. I wore a sling for 3 days then ditched it. didnt take pain pills, just advil. Have been to the gym every week since week 2 at least twice. First time i was useless. Great improvement since then at about 25% of usual weight. I even did shrugs this weekend which was impossible previously.

    Just had follow up with dr. yesterday and he said gym is fine with high rep count. 25+.

    I rode at 3 weeks....gingerly with pain. Rode this weekend with almost no pain at about 80%.

    I am 37 btw.

    Good luck and speedy recovery to everybody.

  17. #542
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    Oh and btw: My dr said that the ligament will indeed "fuse" back together on a grade 2. He didnt like the term regrow.

    On a grade 3 or above they generally do not he said. I mention this because i read conflicting info on here about ligaments healing/regrowing.

    I asked about reinjury from another fall and he said at 2 months it should be as strong as pre injury (ligament wise).

  18. #543
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    I joined the club about 2.5 weeks ago. Grade 3 AC Separation. Honestly the pain wasn't ridiculous at first but the discomfort since that has been bothersome. I initially opted for the non-surgical route but after reading more about it here and other places I think I'm going to get the surgery.

    I can't stand the thought of not being active on a bike for at least 3-4 months, but I think that in a years' time I'll be happy I went this route. I've never had surgery before and I really hope I'm doing the right thing here.

    Here's a pic from the ER.
    Attached Thumbnails Attached Thumbnails Ac Separation (shoulder Separation)-xray0002.jpg  


  19. #544
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    Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level.
    Anyone want to chime in on rehab and time frame that have had surgery?

  20. #545
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    Quote Originally Posted by Andy17 View Post
    Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level.
    Anyone want to chime in on rehab and time frame that have had surgery?
    For me, rehab time was pretty lengthy, but my injury was complex, and I had the surgery at age 55. In a sense, I'm more or less stuck with a a process of ongoing re-hab for life.

    All of which points out that there are so many variables that come into the equation of how long one can expect to rehab. Degree of separation, other damage done, age and health of the patient are some of the biggies. Some of them. There's lots more.
    Re-Cycled Person who rides a mountain bicycle.

  21. #546
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    Quote Originally Posted by jhhall View Post
    I can't stand the thought of not being active on a bike for at least 3-4 months, but I think that in a years' time I'll be happy I went this route. I've never had surgery before and I really hope I'm doing the right thing here.
    It's a long read but this whole thread is full of info on rehab and such.
    I started my story on page 12.
    I did very little rehab with a PT, instead I worked on it at home, while driving in my car...
    The important thing for me was to be a COMPLIANT patient... which is damn near impossible for me.
    Take yesterday and today, for example. I am 4 weeks out from hernia surgery and not supposed to be lifting more than 10 lbs, but I rode up into the hills yesterday to clear some trail. A bit of sawing with a handsaw, mostly cutting branches, briars...
    Today I removed the bumper from my GF's p/u to hammer out a couple of dents she put in them. I took it all slow and easy, but still... I'm sure my surgeon would have given me the evil eye!

    Back to the topic at hand...
    I wore a soft sling with pillow block after my first surgery and the repair failed.
    After my second shoulder surgery in 2 weeks, I was put into a more rigid brace than the sling with foam block.
    I made sure I followed doctor's orders MUCH better that time and it paid off.

    Quote Originally Posted by Andy17 View Post
    Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level.
    Anyone want to chime in on rehab and time frame that have had surgery?
    After 6 weeks waiting for surgery, then 2 weeks with a failed attempt at surgery, I spent another 6 weeks recovering from the second. The brace, a change in my attitude, and time spent moving my arm (as allowed per doctor's orders from initial rehab and after brace removal) through as much normal range-of-motion planes as possible, helped me get back pretty much everything in movement.

    I have recovered my strength as well. I can climb at the indoor rock gym with no issues, do pull-ups, lift weights, and most importantly... MOUNTAINBIKE!... as good as I could before.

    I did the wall crawls, stretches on every plane I could think of and could take, and created a pulley device to help.

    The device I made was similar to something I saw at the PT office.
    I used a bit of webbing and a slider, figure-8 descender, some rope, and two hand-width sized pieces of 3/4" pvc.

    I fashioned the webbing to have the slider on one side of a door, with the webbing passing through the jamb to the side I was on.
    With the door closed, it became my anchor.
    The other side of the webbing(loop) went through the figure-8.
    I ran rope through the other end of the figure-8 such that it was a length that would hang down to my sides.

    I slipped each piece of pvc onto the rope, then tied the rope back to itself to fashion handles.

    Holding onto the pvc handles, I could use my good arm to pull my recovering arm up from various positions.
    I could stand with my back to the door and pull my arm straight up in front of me.
    I could stand with my recovering side to the door and pull my arm up sideways.
    I could stand away from the door and pull my arm up behind me.
    I even took this on the road with me.

    You can get imaginative and do plenty of PT on your own as long as you understand the mechanics of what's happened to your shoulder, what's happened since the surgery, and what you are trying to accomplish with your PT.
    It really is simple mechanics, if that helps you think it through that way... it did for me.

    When driving, I would slowly raise my arm up to the steering wheel repeatedly as exercise until it was fairly easy, then I started walking my arm up over my head on the headliner of the car. After that, it was lifting my arm over to the passenger side, eventually getting my arm far enough back to get behind the headrest.
    The opposite of that was reaching across my chest to grab my seatbelt(not as great an extension as the other direction, but it was better than nothing).

    I just spoke to a friend of mine who had a ligament repair to his shoulder along with other work to the joint.
    He was given a unit that was basically a portable cold pack device.
    He had to pay for it (or hopefully his insurance will), but using that often after surgery has really helped him out, he said.
    I offered to buy it from him, figuring I'll probably have a need for it down the line if I keep up with my style of mountain biking! LOL

  22. #547
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    Quote Originally Posted by Andy17 View Post
    Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up.
    Thanks Andy! Let us know how the appointment goes/went.

  23. #548
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    Quote Originally Posted by wsmac View Post
    It's a long read but this whole thread is full of info on rehab and such.
    I started my story on page 12.

    Back to the topic at hand...
    I wore a soft sling with pillow block after my first surgery and the repair failed.
    After my second shoulder surgery in 2 weeks, I was put into a more rigid brace than the sling with foam block.
    I made sure I followed doctor's orders MUCH better that time and it paid off.
    Thanks WSMAC - I went back and followed your story - good read. I'm glad to hear that it's all paying off for you.

  24. #549
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    Everything going great, it's in perfect position. 3 more weeks in the sling.
    I cant wait to get back on the bike.
    Last edited by Andy17; 12-11-2012 at 05:31 PM.

  25. #550
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    I got the go-ahead to start riding on the trainer. My doctor doesn't want me to risk falling for another few weeks so nothing outside.

    Now, I just need to find my trainer. I think I may have loaned it to someone...
    Disclaimer: I no longer fix bikes for a living.
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