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  1. #1
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    concussion, separated shoulder

    I know there's a long thread on AC separation (which is part of what I have), but I also sustained a concussion today along with the AC issue. Here's the problem: I'm a little foggy on what the doctor said about the AC separation, the severity, and treatment. I apologize for the length of this post. As you can imagine, I'm having a bit of trouble organizing and editing my thoughts, so I can only really go linearly.

    Let's start with the AC separation. In looking through the long thread, it seems like I might have a mild tear or strain of the AC joint. It's twelve hours since I crashed, and I can lift my arm high enough to put a plate away in the cupboard. Not without some pain, mind you, but still. Does that sound like a strain? Is the treatment just ice and rest?

    Now, for the concussion. First, let me explain the circumstances. As I was going over a little kicker, I noticed that someone had moved a rock about the size of two fists into the middle of the kicker. Lifted the front wheel over just fine, but didn't get the back wheel over quickly enough. I remember being airborne and kind of remember landing.

    I was unconscious for about 15 to 20 seconds, don't clearly remember anything from the crash to the paramedics' arrival or (really getting into the ambulance). At the hospital, I had a CAT scan and X-rays which turned up nothing. Based on what little I've seen, it sounds like this would be considered either a grade II or grade IIIa concussion (depending on which grading system you use.)

    Here are my questions:

    1. I was wearing a Giro Atmos, a helmet that I bought when I only did road riding. Obviously, I'm replacing the helmet. Should I get two, though? One that's a bit beefier for mountain-specific riding (like the Giro Xar) and one for road (another Atmos)? Or are they all the same?

    2. What kind of recovery times have people experienced for concussions like this? I realize that it's all fact-specific, but I'd like to know what other people have gone through. My biggest concern in terms of riding is less about my head and more about my knee (banged to hell) and my face (tough to ride when you aren't as good-looking as normal.) Usually, for that last bit, I'd just go faster, but I get the feeling I'm going to be more timid.

    3. And what about the return to riding? How have people navigated the tricky psychological waters of getting back on the back after having a brain rattled? The area that I wrecked on is a normal part of my weekly riding, so I imagine it'll just take a couple of runs there...but what about when I return to racing?

    4. And, last, how quickly have people returned to racing after a concussion?

    I guess the other bit that kind of stinks is, my new bike will be ready next week. My body will not be ready to ride it next week, I don't think. I guess I can stare at it and take pictures of it, but that gets old quickly.

    PS The old bike was undamaged, but they cut off an awesome vintage jersey at the hospital. Bah humbug.

  2. #2
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    Oh yeah, I also had to get six stitches in the gash on my right knee. Does anyone have experience with how long that realistically will take to heal enough that I can at least do my short (2 miles each way) commute to work? Doc says up to 14 days, but that seems like a very long time.

  3. #3
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    You should check the progress of the NHL concussion victims, they've had a slew the last two years.

    A lot have been months before they are ready to do strenuous bike riding,

    Some as long as one year-plus before they are ready for contact,

    As some have been trying to do exercise bike conditioning coming back from concussions the symptoms have been headaches accompanying strenuous exercise. Those guys had to back off and keep the exercise on the lite side.

  4. #4
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    Quote Originally Posted by rideorglide View Post
    You should check the progress of the NHL concussion victims, they've had a slew the last two years.
    I feel like I also heard something about NHL and helmet developments for concussion prevention. Has anyone done testing on various helmets? Obviously, a full-face helmet offers more protection than a regular helmet, but would, say, a Giro Xar offer more than a Giro Atmos? Would a POC Trabec?

  5. #5
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    Keep in mind even when your shoulder feels good enough to ride it takes longer until its strong enough to handle a crash again. They say once you separate your shoulder, you will always have a seperated shoulder. If your reaching up to cupboards at this point 12hrs in I'd say it wasn't too severe. Im just a little over 2 weeks from a grade 2/3 separated shoulder doing ok, constant movement is what i believe helped me dont push it but dont baby it either. As far as your other injuries it's just a matter as time i dont think there is any rehab for concussions, make sure your helmet is properly fitted. Time and ice are your friend, Good luck!

  6. #6
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    I agree with Mission regarding the separated shoulder. I was able to move my shoulder for a few hours after I crashed but once it rested, I could barely move it and mine was a grade I/II per my doc. There was no way I could even lift a plate let alone raise my should to put something away in a cabinet. A lot of rest is important. A sling is an excellent idea to immobilize it so it can heal. For the first week, try not to move it at all- then slight movements when there's no pain.

    Your concussion is much more serious. Anytime you're knocked out, you have to be really careful. I like to comparisons to sports like hockey and football. Once you had a concussion, you have to REALLY careful you don't get another one- your brain can become mush. You can still ride once your shoulder is better (let's say 4-6 weeks), but I wouldn't do any trail riding where thes even a slight chance of hitting my head.

    Here's to quick healing and a full recovery. Take it easy- it might seem like forever now but be careful and take your time- and follow the instructions of your doc.
    ez
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  7. #7
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    Thanks for the reality checks, everyone. My heart wants to be back out there today, but I've got to be realistic about my recovery timeline. Thankfully, my shoulder seems to be doing okay, and the knee that got stitched up has a decent amount of flexibility in it now. I'll do some road riding before I get back on the trails, and even that is probably a few weeks away for me.

  8. #8
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    I had a concussion on my mountain bike in the beginning of 2011.
    I wasn't wearing a helmet (Yeah I know I was stupid, but was thinking I wasn't going to do anything extreme). I rode off a little dirt bank but plunged to the ground, and went over the handle bars and knocked my temple region into hard packed dirt and I'm sure I struck a rock too. My brother and brother in law took me back to the house after they noticed I keep repeating myself over and over haha.

    Anyways I just have some very, very vague memories of the accident, but I came back to it when I was in the hospital bed. And I spent the night there and my CAT scan was clear also like you.

    I had bad anxiety the first nights sleeping and I have to say it took like 4 months for me to feel better. And another 4 to get over the fear of hitting my head again. Also I didn't sleep as well as a I should have. I use to stay on the PC really late into the night and use it a lot which I think slowed the healing process a little.

    I'm now ready to jump back on my bike and go hard again (this time with a helmet , which I also bought a fullface too).

    So I wouldn't worry, you will feel normal soon and it might take a little while but you'll get there. Don't worry as it worry won't get you anywhere. Also take some Omega 3 if you like.

    I was a "mighty worrier" before my accident so when I forgot something after my accident, I thought "Oh no I forgot this is because I hit my head!" but its normal for people to forget the little things sometimes. And I must say after my head injury, reading about the human brain and seeing what psychological effects there are became really interesting to me after haha.

  9. #9
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    I'm an athletic trainer (sports med, not personal trainer). I have a lot of experience with concussions, and have lectured at the graduate level on the topic...

    First thing I tell my athletes when they've sustained a concussion is that it's a form of traumatic brain injury (the CDC classifies it as such). What happens with a concussion in layman's terms is the brain gets bruised and swells. Being encased in the skull, the brain has pretty much no room for swelling. Keeping that in mind...

    When bloodflow increases to your brain, it'll swell even more. It could swell to the point of more or less crushing itself. When you have a concussion, you should be symptom free for at least a week before doing any physical activity beyond activities of daily living. If you start working out too soon - cardio wise or even weight training wise - the swelling will come back. If you've ever sprained your ankle and started running on it before all the swelling is gone, you know where I'm coming from - the swelling comes back.

    Unfortunately, most physicians don't know enough about concussions. They'll usually tell someone to take a week off, and that's about it. What if you still have symptoms after a week? Should you ignore them and start exercising again?

    If you were one of my athletes, you wouldn't be cleared to do anything until a neurologist said so. Reason being first and foremost that you lost consciousness. CT scans are good at looking for bleeding in the brain or structural damages. They can't tell you if you have a concussion or not. The best thing is a clinical evaluation from a neurologist.

    Before you start riding again, you should really see a neurologist. They do a ton of specilized tests that show problems such as balance, reflexes, memory recall, etc. Most are booked up for a while in advance, but if you tell them you sustained a loss of consciousness concussion, most will get you in pretty soon.

    I had a few in my competitive sports days. I didn't do anything about them because I didn't know what the long term effects could be. Since my last one (didn't recover fully from the one before that) I've had chronic headaches, ringing in the ears, and my short term memory is shot. In a way, I'm lucky that that's all I've got.

    I'm not trying to scare you. I've seen far too many of them in my career, and am living it.

  10. #10
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    JR 137, I really appreciate the reality check. Based on what you've said, I reached out to a neurologist and happily got an appointment immediately due to a cancellation. The biggest reason the doctor was happy to see me in for follow-ups were the timing of my first CT scan, within a few hours of the crash. Evidently, that isn't enough time for problems to become evident from a scan, so these follow-up visits and scans are very useful. I haven't had the follow-up scans yet due to scheduling issues, but hopefully that'll happen in the next couple of days. Again, thanks to all for the guidance.

  11. #11
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    Steelpot,

    Glad my advice didn't fall to deaf ears. That happens a bit too often in my line of work. An immediate CT following head trauma is a good thing in that it'll show if you have a life threatening emergency, such as a hematoma (mass of bleeding). It won't however tell much more than that.

    A see too many people go to their primary care doc and get bad or not thorough enough advice. Like I mentioned before, most of them will say take a week off, and that's about it. They won't give you a return to activity plan/criteria. If you just 'got your bell rung' a little bit, then that's usually ok, so long as the symptoms don't last more than a day or two. If they're any longer than that, you could be in serious trouble. I've had a lot of athletes get a concussion off the field and come back with a note from their doc saying 'may return to activity in 1 week.' Those notes are absolutely useless to me, and our neurologist needs to clear those guys when that happens.

    I've handled a lot of concussions without the neurologist. I have a specific return to activity protocol that is based on the type of sport the athlete plays - non-contact, contact, collision. But if there's a recent history of concussion - no matter how minor it was - or if they lose consciousness - no matter how long it was - they see the neurologist every time.

    Again, glad I could help. Nothing's worth messing up your brain. I respect people following their doctor's advice, but I've seen too many of them get this stuff wrong. I think it's a lack of experience with them, not that they're incompetent.

  12. #12
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    JR - thanks as well for the post. Last year, I busted my collarbone and had a G3 concussion (I was out cold for about 7 minutes). Like you said, the ER doc did all the basics and told me to go to my PCP and to see an Ortho. My PCP was in the dark on concussions and gave me a referral to a nuerologist, so I was lucky that my PCP knew enough to send me to someone that has knowledge. The neurlogist said it was lucky (pun intended) that I was busted up as he'd not clear me to ride for at least 4-6 weeks due to the severity of my injury. He said that to be out for that long was concerning.

    Everything ended up ok, the shoulder is healed, but will always hurt when cold or going over jumps/rocks (no surgury, I just let it heal), but like you, my short term memory is freakin horrible and after a full year after the accident, I still have no memory of it.

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