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  1. #1
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    separated shoulder

    grade 2/3 shoulder separation. Went off trail into large tree. Only has been a few days in a sling now, question is how long should I wait until I try and start begin moving my arm/shoulder??? I do take it out of sling sometimes and bend it but im hesitant on trying to raise my arm over my head. I dont want to push too hard but I dont want to delay any rehab if it is ok to push a bit. Are there any exercises I can begin now?

  2. #2
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    1st post!

    I had a pretty bad grade 3 last year (had a 130mph off, racing motorcycles). I was able to get back to 75% by 2 weeks. My ortho said to let the pain tell me how far to stretch/move/exercise. I was back racing in 4 weeks with no pain/slight discomfort.

  3. #3
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    Same boat. Off the trail this morning into a tree. Mine is a grade I/II though. Doc said keep it in a sling for at least a week with no movement and then begin moving slightly depending on pain. He told me about 6 weeks but not sure if he's being overly cautious.

    Good luck!
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  4. #4
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    Damn trees, it feels good to take it out of sling i am able to shrug my shoulder and very slightly swing my arm back and forth. Each day the shoulder has improved quite a bit, but still feel like I got a ways to go. I read a lot about this and seems like most docs say to begin some movement as soon as you can as you cant really do further damage to your shoulder as long as your careful. Careful meaning if you feel any pain stop. Good Luck, Z!

  5. #5
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    Quote Originally Posted by mission2 View Post
    Damn trees, it feels good to take it out of sling i am able to shrug my shoulder and very slightly swing my arm back and forth. Each day the shoulder has improved quite a bit, but still feel like I got a ways to go. I read a lot about this and seems like most docs say to begin some movement as soon as you can as you cant really do further damage to your shoulder as long as your careful. Careful meaning if you feel any pain stop. Good Luck, Z!
    Thanks. You too. My wife and I were riding and I looked back to see where she was- stupid move, i know. Oh well.

    If you haven't already, take a look at the 10+ pager thread about ac seps.
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  6. #6
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    Quote Originally Posted by Eric Z View Post
    Thanks. You too. My wife and I were riding and I looked back to see where she was- stupid move, i know. Oh well.

    If you haven't already, take a look at the 10+ pager thread about ac seps.
    Yup read most all of that thx. Shoulders injuries are the worse I've broke both my collar bones before (motocross days) and now this.

  7. #7
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    3 gym exersises to give up once shoulder injury occurs.
    Overhead shoulder press
    Shrugs w weights
    Upright row
    This according to my pt.

    And I never realized how important it is to strengthen the rotator cuff muscles using small 2-5 lb weights.

  8. #8
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    Quote Originally Posted by Eric Z View Post
    Thanks. You too. My wife and I were riding and I looked back to see where she was- stupid move, i know. Oh well.

    If you haven't already, take a look at the 10+ pager thread about ac seps.
    How you doing Eric, have you started pt yet if so what do they have u doing? I've been just twice so far, no real strength exercises yet still just range of motion stuff. Holding stick (broom stick/golf club at home) while laying on back hold with both hands go from belly to overhead as far as you can 3 reps of 15 and laying on stomach edge of bed let arm hang down to floor and pull fist up to armpit also did that with a 5lb weight but I wasn't told to use the weight but it felt fine (com'on 5lb weight that is what im exercising with now wtf) hoping to do some real trails by mid June?.... not sure

  9. #9
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    Quote Originally Posted by mission2 View Post
    How you doing Eric, have you started pt yet if so what do they have u doing? I've been just twice so far, no real strength exercises yet still just range of motion stuff. Holding stick (broom stick/golf club at home) while laying on back hold with both hands go from belly to overhead as far as you can 3 reps of 15 and laying on stomach edge of bed let arm hang down to floor and pull fist up to armpit also did that with a 5lb weight but I wasn't told to use the weight but it felt fine (com'on 5lb weight that is what im exercising with now wtf) hoping to do some real trails by mid June?.... not sure
    Doing well. Thanks for asking. My shoulder improved a ton these past couple days. Still nothing crazy but no pain really with daily activities like starting the car, putting a seat belt on, etc. I can even put some weight on it. No official PT yet but been moving my arm around just to check my rom. So far so good. I have a follow-up ortho appt on 4/30 (3 weeks post accident).

    I'm going to start some basic rom exercises soon- I've been moving my arm and shoulder around a lot lately. I just go as far until a tad of pain is felt.

    I even wrestled a little bit with my 5-year old and that's a good sign

    Is it true about no military press, upright rows (one of my favorites), or shoulder shrugs? I dislocated my left shoulder 15 years ago and it took a long time for that to heal but didn't have any limits on weight training, but did notice my shoulder being weak as hell since the dislocation.
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  10. #10
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    Quote Originally Posted by Eric Z View Post
    Doing well. Thanks for asking. My shoulder improved a ton these past couple days. Still nothing crazy but no pain really with daily activities like starting the car, putting a seat belt on, etc. I can even put some weight on it. No official PT yet but been moving my arm around just to check my rom. So far so good. I have a follow-up ortho appt on 4/30 (3 weeks post accident).

    I'm going to start some basic rom exercises soon- I've been moving my arm and shoulder around a lot lately. I just go as far until a tad of pain is felt.

    I even wrestled a little bit with my 5-year old and that's a good sign

    Is it true about no military press, upright rows (one of my favorites), or shoulder shrugs? I dislocated my left shoulder 15 years ago and it took a long time for that to heal but didn't have any limits on weight training, but did notice my shoulder being weak as hell since the dislocation.
    Hey got some good advice for stabilizing the shoulder for post rehab check out this link

    Shoulder Mobility Exercises for Mountain Biking | Mountain Bike Training Programs

  11. #11
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    Quote Originally Posted by mission2 View Post
    Hey got some good advice for stabilizing the shoulder for post rehab check out this link

    Shoulder Mobility Exercises for Mountain Biking | Mountain Bike Training Programs
    very cool. thanks! i look forward to doing some of these.
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  12. #12
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    shoulder problems

    Quote Originally Posted by Eric Z View Post
    Is it true about no military press, upright rows (one of my favorites), or shoulder shrugs? I dislocated my left shoulder 15 years ago and it took a long time for that to heal but didn't have any limits on weight training, but did notice my shoulder being weak as hell since the dislocation.
    Well, 10 years ago- I wouldn't have cared because I had no symptoms. But now as a 42 yo w 1 messed up shoulder, I understand why my physical therapist doesn't like those 3 gym exercises. It turns out that a lot of folks in PT are there for shoulder issues!!

    Rotator cuff muscles are notoriously underdeveloped in the general population, but are critical to keep strong to avoid injury. My PT says I might not have developed tendonitis in my shoulder had my rotator cuff muscles been stronger.

    I messed up my shoulder swimming! I thought that was the safest thing in the world. I took up swimming after I messed up my ANKLE (another story) and couldn't bike.

    I developed tendonitis in my shoulder due to the overhead motion (kind of like a shoulder press) of swimming the crawl stroke. This was 8 months ago, but I still feel the tendonitis today, unfortunately.

    And it just so happens that biking can aggravate shoulder tendonitis! Whenever your shoulders are rotated forward and your palms are down ie. mtn biking, sitting at a keyboard etc. that position can aggravate shoulders problems. ( A PT can better explain why that's 'not good' anatomically or you'll just have to trust me :-)

    Anyway, I have modified my biking to accommodate the tendonitis in my left shoulder. I leave my left hand on the bar end of most of the time because with my wrist rotated outward that way-- I don't feel the tendonitis 'act up' as much. I might end up switching the left and right brakes too. My alt bars (Origin 8 Space) help too because the hand position allows you to keep your shoulders back more compared to a flat or traditional riser bar.

    p.s. Oh yeah, coincidentally, the end of that video mentions the danger of shoulder presses, specifically.
    Last edited by dcc1234; 04-30-2012 at 08:00 AM.

  13. #13
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    thanks, dcc! i don't like shoulder presses anyway i definitely don't want to cause any issues. i know i'm not getting any younger (38 now) so need to really be careful if i want to do this sport as long as i would like to.

    i'm going to look at more videos about keeping the rotator cuff muscles as strong as possible. i also have to become more flexible and i know that helps a ton to avoid injury.

    thanks for the tips!
    ez
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  14. #14
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    Quote Originally Posted by Eric Z View Post
    thanks, dcc! i don't like shoulder presses anyway :
    ez
    Thats a good plan! glad to be of help. I was pretty shocked to learn the exercises people need to do more of or avoid particularly following an injury. My PT told me a bunch of other exercises to avoid for folks w/ knee injuries- but I guess I'll save that for another topic. :-)

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    I'm an athletic trainer (sports med, not personal trainer). I've heard people argue against shoulder presses, and I've heard people say they're fine. As long as you don't have any instability, I think they're fine. There are better exercises out there, or better put exercises that target the more important muscles. The shoulder press is a bit over rated IMO, just like bench press and traditional squats, but it has it's place like everything else.

    Upright rows are a big no no in my experience. I've seen a lot of shoulder impingement issues that were either caused by them or made far worse by them. Another big no no that I've seen so many times is lat pull-downs with people bringing the bar behind their head. One of the worst things a person with healthy shoulders can do, let alone someone with instability and/or deficiencies.

    I've seen a ton of AC seperations in hockey. They take some time to heal up, but I've found early ROM exercises to be very helpful. I like starting Codman's pendulum exercises and wall walks as early as possible, especially if the person needs a sling.

    Regardless of the injury, I always tell my athletes this - stay in a pain-free range. The catch is there's a difference between soreness, stiffness, tightness, etc. and pain. Fighting through those things is fine IMO. If you're doing something that causes actual pain, you're most likely doing more damage to the area.

    With shoulder rehab, regardless of the injury, I most often use theraband or theratube for resistance. For strengthening, simple internal and external rotation exercises do wonders. So do diagonal movements.

    I haven't thought about it as I'm very new to biking (as an adult anyway), but what DCC says about shoulder issues with mountain biking makes sense. Thoracic outlet syndrome is probably a more common thing that poeople realize with people who do a lot of mountain biking.

    Just some tips for you.

  16. #16
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    Quote Originally Posted by JR 137 View Post
    I'm an athletic trainer (sports med, not personal trainer). I've heard people argue against shoulder presses, and I've heard people say they're fine. As long as you don't have any instability, I think they're fine. There are better exercises out there, or better put exercises that target the more important muscles. The shoulder press is a bit over rated IMO, just like bench press and traditional squats, but it has it's place like everything else.

    Upright rows are a big no no in my experience. I've seen a lot of shoulder impingement issues that were either caused by them or made far worse by them. Another big no no that I've seen so many times is lat pull-downs with people bringing the bar behind their head. One of the worst things a person with healthy shoulders can do, let alone someone with instability and/or deficiencies.

    I've seen a ton of AC seperations in hockey. They take some time to heal up, but I've found early ROM exercises to be very helpful. I like starting Codman's pendulum exercises and wall walks as early as possible, especially if the person needs a sling.

    Regardless of the injury, I always tell my athletes this - stay in a pain-free range. The catch is there's a difference between soreness, stiffness, tightness, etc. and pain. Fighting through those things is fine IMO. If you're doing something that causes actual pain, you're most likely doing more damage to the area.

    With shoulder rehab, regardless of the injury, I most often use theraband or theratube for resistance. For strengthening, simple internal and external rotation exercises do wonders. So do diagonal movements.

    I haven't thought about it as I'm very new to biking (as an adult anyway), but what DCC says about shoulder issues with mountain biking makes sense. Thoracic outlet syndrome is probably a more common thing that poeople realize with people who do a lot of mountain biking.

    Just some tips for you.
    very helpful. thanks. makes sense about the different types of pain; however, i always don't know the type of discomfort i'm experiencing.

    what do you mean by "simple internal and external rotation exercises do wonders. So do diagonal movements?"

    thanks!
    ez
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    Quote Originally Posted by JR 137 View Post
    I'm an athletic trainer (sports med, not personal trainer).

    Just some tips for you.
    Awesome post! TY. My pt also said that folks w some knee probs (like myself) should not do a lot of lunges and leg extensions- that there are a lot compressive forces on the knee w these 2.

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    Quote Originally Posted by Eric Z View Post
    very helpful. thanks. makes sense about the different types of pain; however, i always don't know the type of discomfort i'm experiencing.

    what do you mean by "simple internal and external rotation exercises do wonders. So do diagonal movements?"

    thanks!
    ez
    The different types of pain is a tricky one IMO. Not to sound condescending, but the better you know your body, the easier it is to tell the difference between types of pain/discomfort. The easiest way to explain the difference is generally, the pain I'm refering to is sharp pain and/or a tearing feeling. If you're rotating your shoulder and it feels like you're being stabbed, stop. If you're lifting your arm up and you get a tearing sensation, stop. If it feels tight, stiff, or like it won't go because there's pressure in the shoulder, it's ok to keep going, within reason. It's a lot harder explaining this stuff on a forum than in person!

    Explaining internal and external rotation exercises here will probably confuse you more than help you, to be honest. I haven't explained them in this context before. I'll look for some stuff on YouTube and post a link. In a nutshell, you keep your elbow by your side, bend your elbow 90 degrees, and rotate your shoulder with resistance from a band.

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    Quote Originally Posted by dcc1234 View Post
    Awesome post! TY. My pt also said that folks w some knee probs (like myself) should not do a lot of lunges and leg extensions- that there are a lot compressive forces on the knee w these 2.
    Your PT is absolutely correct IMO. Knee extensions are awful. Lunges are pretty good for people with healthy knees, and if done right can be good for rehab for most knee injuries. The key is doing them at the right point in time IMO.

    For most people with knee problems, especially patella issues, I've found reverse lunges take the pressure off and work well. Doesn't make sense, as it's the same ending point and you're pushing off from the same position (knee almost touching the floor), but it hasn't given people nearly as many problems as forward lunges. Maybe my patients are an anomaly. Most of my experience is NCAA Div I. Predominantly basketball and soccer, but more than enough football to say so.

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    Thx for taking the time to reply and share your expertise! I never knew these things!

    Last thing she said gym related was this:. Whatever your sport is- your likely to get an overuse injury if you do it long enough. That folks might be better off, for example, doing 3 different cardio machines for 15 min each, rather than 1 for 45 min.

    We all want our various body parts to last as long as possible before the inevitable decline that none of us can avoid.
    Last edited by dcc1234; 05-01-2012 at 02:18 PM. Reason: replaced deterioration with 'decline'

  21. #21
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    Can't post a link from my iPhone...

    YouTube search "shoulder internal rotation exercise." The second video that came up (posted by bodylastic or something similar) was a good one. To do external rotation, keep everything the same, except turn your body 180 degrees so you're standing with your opposite shoulder facing the door. Instead of pulling inward, you're pushing outward; everything else stays the same.

    You can also do them with your shoulder at do degrees and your elbow at 90 degrees. Elbow up in the air instead of at your side. For internal rotation, you have your back to the door and rotate downward. For external rotation, you face the door, start near where you ended with internal rotation, and rotate your shoulder until your arm is at 90 degrees (same as the starting position from internal rotation). I guess a simpler way of describing that one would have been face the door and do the opposite of internal rotation lol.

    These are 4 rotator cuff exercises. They're the ones I begin with. There's plenty more that people can do. I also like to drill a hole in a baseball, thread the band thought it and make a knot so it doesn't come out, and have the person go through a baseball throwing motion. That one's done once I feel they're comfortable enough with the basics and strong enough. I don't have them try to throw hard, just work on mechanics. Doesn't matter if they're a baseball player or not, it's a great functional exercise IMO that gets a lot of little muscles.

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    Good stuff....1 more week and I'll be 3 weeks out from the injury (level 3) and back to see the doc. Some of the exercises you mentioned I'll be trying now....

  23. #23
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    thanks, jr. helps a lot! i do know what you mean about the pain thing. thanks again! it's amazing how the shoulder feels now. almost no pain with regular day-to-day activities.
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  24. #24
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    Quote Originally Posted by dcc1234 View Post
    Thx for taking the time to reply and share your expertise! I never knew these things!

    Last thing she said gym related was this:. Whatever your sport is- your likely to get an overuse injury if you do it long enough. That folks might be better off, for example, doing 3 different cardio machines for 15 min each, rather than 1 for 45 min.

    We all want our various body parts to last as long as possible before the inevitable decline that none of us can avoid.
    I think doing 3 different machines for 15 minutes each vs 1 machine for 45 minutes is a bit overkill for avoiding overuse stuff, but that's just me. Maybe for elderly patients or people with a new injury, but not for the general population IMO. I think it would be better to do 45 minutes on a machine, then using a different machine next workout or even next week.

    Every professional has seen different things and hopefully come to their conclusions by analyzing what they've seen. I do this and try to regularly question stuff I've been doing that I take for granted. If your PT has found that this works best for his/her patients, I won't argue it. I haven't found that personally though. I think getting off a machine and starting a new one every 15 minutes doesn't give you enough time on any one of them to get a good workout on that specific exercise.

    I'm really not big on cardio machines anyway. They're great for rehab or for people who've got injuries and can't effectively do certain things, but I think they're very overrated for most people.

    I hate seeking people in the gym on treadmills working out in that "fat burning zone." Definitely not anywhere near as effective at burning fat as people think. It was based on a study done a few decades ago that has been misquoted and misinterpreted and taken as gospel.

    According to the latest exercise physiology research, the most effective way to burn fat is interval training. It's exponentially more effective in my own experience and observation.

    Sorry if I'm preaching and/or side tracking. There's just a ton of bad information out there. I don't claim to be a guru by any means, I've just tried a lot of different things personally and with my athletes, and have seen strength & conditioning coaches do a lot of stuff. I also read a lot.

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