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Shoulder Subluxation :( Tips for Managing Going Forward
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By OldManRiver
From Cottonwood Heights, UT
Aug 15, 2012
Red Rock, Cannibal crag

Peeled off a roof and my arm was still on a jug around the corner of the roof (going up) acted as a swing and the shoulder popped out before I could release from the hold. The result was a moderate subluxation (partial dislocation) with the humerus ending up out towards the lower front side of the joint (pec side). That section of the joint is normally not strained excessively in climbing, but this particular move was extremely hard on that section.

I've been climbing 2-3x/week indoor and a day or two a week outdoor, and overall condition of the shoulder is pretty strong (aside from the ligaments following the fall). This is a longstanding issue that is typically not bothered by climbing, with the exception of major overhang/roofs and the strain of losing footing/holds.

Planning to follow the routine below, but I'm looking for some input from climbers that have experienced similar problems. Any shoulder instability injuries, treatment plans and recommendations would be appreciated. I've been making a lot of progress lately and have been getting a lot out of the sport so simply stopping for an extended period would suuuck.

www.kapiolani.org/docs/orthopedic/Shoulder%20Subluxation.pdf

Appreciate genuine feedback on this :)


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By Steve M
From MN
Aug 15, 2012

Sorry to hear about your shoulder. I'd been subluxing mine since I was kid, just thought it was normal until talking with my surgeon to repair a labrum tear after a couple of dislocations. Looking back I realize that I had been subluxing as a technique to help out on reachy cruxes...not good! In order to prevent further injury you need to keep hyper aware of what climbing positions are bad and avoid those positions. It's tough to do and makes a lot of climbs harder than they need to be, but it'll keep you in the game. For exercises the key for me is high reps and low to moderate weight.


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By SMR
Aug 15, 2012

Does your PT discuss proper shoulder stabilization when doing those exercises in your link? I am not a PT or doc, but I think pulling the scaps down and in is an important component to building stronger and more resilient shoulders.
In my experience I had scrappy shoulder balance, which unfortunately was made worse by climbing and strength exercises. I experienced on-going pain, injury etc, until I finally figured out how to stabilize my shoulders properly and activate my lower traps. Now I am a fanatic about doing this for all motions but esp pull-ups, lat-PD and every other shoulder exercise I do.


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By OldManRiver
From Cottonwood Heights, UT
Aug 15, 2012
Red Rock, Cannibal crag

It's a lot of isometrics and other low impact exercises that subtly strengthen the inner part of the joint. It's similar to PT I went through after surgery on this same shoulder in 2004.

An encouraging thing is that pullups and climbing in general has the joint stronger than during the last occurrence. My hope is that with this routine and conservative climbing in the short term it can be managed.

PART I
1. Isometrics:
A. Adduction: With a pillow between your chest and your arms, squeeze the pillow with
your arms and hold 5 seconds. Release and repeat 10 times.
B. Flexion: Stand facing a wall with your elbow bent at a right angle and held close to
your body. Press your fist forward against the wall, hold this for 5 seconds, then rest.
Repeat this 10 times.

C. Extension: Standing facing away from the wall with your elbow touching the wall,
press the back of your elbow into the wall and hold for 5 seconds. Rest. Repeat 10 times.

D. Abduction: Standing with your injured side towards the wall and your elbow bend at a
90-degree angle, press the side of your arm into the wall as if attempting to lift it. Hold for
5 seconds. Rest. Repeat 10 times.

E. Internal rotation: Standing in a doorway with your elbow bent at a 90-degree angle and
your palm resting on the door frame, attempt to press your palms into the door frame and
hold for 5 seconds. Rest. Repeat 10 times.

F. External rotation: Standing in a doorway with your elbow bent at a 90-degree angle and
the back of your hand pressing against the door frame, attempt to press your hand outward
into the door frame. Hold 5 seconds. Rest. Repeat 10 times.
2. Careful range or motion:
A. Flexion: Standing with your arms straight, raise your arm forward and up over your
head. Hold this position for 5 seconds. Return to the starting position and repeat 10 times.

B. Extension: Standing with your arms straight, move your arm backward while keeping
your elbow straight. Hold this position for 5 seconds. Return to the starting position.
Repeat 10 times.

C. Abduction: Standing with your arms at your side slowly raise your arms out away from
your body and hold in position for 5 seconds. Return to the starting position. Repeat 10
times. D. Elbow flexion: Standing, bend your elbow, bring your hand towards your shoulder.
Return to starting position. Repeat 10 times. As this becomes easier, add a weight to your
hand to give you some resistance.
PART II
3. Tubing exercises:
A: Internal rotation: using tubing connected to a door knob or other object at waist level,
keep your elbow in at your side and rotate your arm inward across your body make sure
you keep your forearm parallel to the floor. Repeat 10 times. Do 2 sets of 10
B. Adduction: Stand sideways with your injured side towards the door and out
approximately 8 to 10 inches. Slowly bring your arm next to your body holding onto the
tubing for resistance. Repeat 10 times. Do 2 sets of 10.

C. Flexion: Facing away from the door with the tubing connected to the door knob, keep
your elbow straight and pull your arm forward. Repeat 10 times. Do 2 sets of 10.

D. Extension: Using the tubing, pull your arm back. Be sure to keep your elbow straight
and pull your arm forward. Repeat 10 times, Do 2 sets of 10.
4. Lattisimus dorsi strengthening: Sit on a firm chair; Place your hands on the seat on either side
of you. Lift your buttocks off the chair. Hold this position for 5 seconds and then relax. Repeat
10 times. Do 2 sets of 10.


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By Mr. Holmes
From Cascade West
Aug 15, 2012
#2

+1 for the Old man River Advice!

I have re-habed(not real word) a labral tear sans surgery for 7 years using many of the techniques described above. The tubing pulls are referred to as internal and external rotation and can also be done with a pillow or towel inbetween your arm and ribs to insure proper technique.

One to add is sitting with your back flat against a wall and Sloooooowly raising and lowering your arms at 45 deg angles as high and as low as possible without your arms losing contact with the wall serface> 12 reps x 3day.


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By Eric Coffman
Aug 15, 2012
mountainlion

Old Man River the most important thing is to be honest with your therapist. Make sure he/she knows what activities you are doing as it appears you aren't going to "rest" the injury. Then once your joint is stable again it is imperative that you continue your rehab routine to maintain that stability indefinetely or at least until having a stable shoulder joint isn't important to you anymore. Good luck!


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By OldManRiver
From Cottonwood Heights, UT
Aug 16, 2012
Red Rock, Cannibal crag

I read somewhere last night a quote on shoulder instability rehab, basically noting that it never stops. It sounds bad and it is, but the alternative of having non-functioning arms is so much worse that it's worth it. And as soon as you stop strength maintenance the instability will gradually return.

Thanks for the input - I'll incorporating it and probably post the routine on my wall as a reminder to rehab EVERY day :)


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By OldManRiver
From Cottonwood Heights, UT
Aug 24, 2012
Red Rock, Cannibal crag

Doing Isometrics noted above for a week now. This afternoon was the first post-injury gym session. All TR, but flew through almost all the routes I was doing pre-subluxation.

Stopped twice where moves required too much stress on the shoulder, sent the rest of the routes. Bascially not back a level in terms of strength or endurance, just have an asterisk of having to quit before doing certain moves that would undo rehab work.

Stoked to have a good session today though :) Actually flashed the crux on a new route that typically makes me think for a bit, it felt good!

Doing isometrics every day is the plan for now, followed by more muscular stuff. Good so far and the inner shoulder ligaments are responding. Just need to be CAREFUL about reinjury.


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By JerryN
Aug 24, 2012

I had the same problem 25 years ago. Back then there was no concept of PT or rehab. My surgeon just did a surgery to keep my shoulder from being able to sublux. He moved some muscles and a small bone around. That kept the sublux from happening but it didn't keep my shoulder from trying to sublux. I didn't climb back then.

Jump forward to two years ago. I had to get a partial replacement on that shoulder because the head of my humerous wore out from moving around so much. There is no cartalidge in that joint so I had bone rubbing on bone. Now, I have bone rubbing on titanium. My shoulder does feel better than it has for 15 years or so though.

As a result of the whole mess, I have a limited range of motion and can't lift my arm straight up over my head. That makes for some really awkward movement on vertical climbs. Overhanging and low angle stuff isn't too bad but straight vertical can be extra challenging sometimes.

Lesson learned - whatever you do make sure you take care of that joint and don't let that extra movement continue to happen or you could wear it out and cause yourself all kinds of problems.


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By Hamilton Kibbe
From Boston, MA
Aug 24, 2012
About to set up a fire TR anchor

Definitely make sure you don't rush back into high-impact activities. I had the same thing happen a few years back, and was advised to follow essentially the same plan you described. I did for a while but was still climbing, snowboarding, etc. after it dislocated about 10 more times i ended up needing stabilization surgery and it still doesn't feel quite back to baseline yet. Take your time and do those PT exercises!


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By OldManRiver
From Cottonwood Heights, UT
Aug 24, 2012
Red Rock, Cannibal crag

Hamilton Kibbe wrote:
Definitely make sure you don't rush back into high-impact activities. I had the same thing happen a few years back, and was advised to follow essentially the same plan you described. I did for a while but was still climbing, snowboarding, etc. after it dislocated about 10 more times i ended up needing stabilization surgery and it still doesn't feel quite back to baseline yet. Take your time and do those PT exercises!


Which direction does your shoulder sublux? And wrt climbing do you stay away from certain movements that would overwhelm the weak ligaments?

As described before mine is when the elbow goes above the shoulder and behind the chest plane (and the forearm goes up and back). Climbing on vert, slabs and minor overhangs allow me to keep the elbow in front of the shoulder, which has never been an unstable position. I tend to think climbing is safer than skiing/boarding b/c you can control the angles your joints are exposed to.. an exception being a lead fall or being unnecessarily aggressive like I was last week.

Learning more about the nature of your injury would be helpful because I initially subluxed snowboarding in 1998 and eventually had surgery in 2004. This is the first full subluxation since 2004. Overall though I think climbing has really strengthened the joint.. but one moment of carelessness blew it out.


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By kenr
Aug 25, 2012

OldManRiver wrote:
"PART I
"1. Isometrics:
"A. Adduction: With a pillow between ...
... etc ...
"Appreciate genuine feedback on this"
-----------------------------------------

To me that list of exercises looks like a systematic (though not complete) enumeration of possible shoulder motions ... for general strengthening of the shoulder, but without prioritization for relevance to the climbers' subluxation problem.

I'm not any sort of physical therapist or medical doctor, just someone who's spent lots of time working on human + robot mechanical motions, and my instinct is that ...

the list looks too "tidy", too neatly systematic, not what I would expect from deep insight into the messy complexity of the subluxation problem.

I'd love to see some serious attempt at scientific justification for how each of those exercises is specifically relevant to support for the climbers' subluxation problem.

A slightly different perspective: It does not seem credible to me that each of those exercises is equally relevant to subluxation. Especially since several of them are pairings of one motion with its opposite. Perhaps I can believe that both members of one of those pairs are equally relevant, but very hard to believe that both members of every oppositional pair are equally relevant to subluxation.

That's a lot of exercises to do, so I sure would want someone to give me a prioritization (with a plausible scientific justification) -- at least for days when I was short on time.

Sorry but somehow I've lost the links I had to web pages which seemed to have a shorter list of more targeted exercises - (tho I'm not qualified to say if they were correctly targeted). But anyway that's the sort of thing I would look for.

Or if you've got lots of free time and you want extra security, do lots of different exercises (? including others not on the list given above in this thread - perhaps from several different websites ?) with the hope that some of the them are actually relevant to the climbers' subluxation problem.

Ken


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By OldManRiver
From Cottonwood Heights, UT
Aug 29, 2012
Red Rock, Cannibal crag

kenr wrote:
I'd love to see some serious attempt at scientific justification for how each of those exercises is specifically relevant to support for the climbers' subluxation problem.


You make some good points, going with the ones that tend generate the most response from the shoulder (pain, discomfort, etc.) seems to be a good way to ferret out the ones that address the weak area.

Last time I went through PT there were several discussions about "exercise X" is whats going to address the weakness in your ligament. It seemed to be pretty specific for the area where my shoulder is prone to breaking down.

Having been a while since going through PT your points are well taken and I need to put some effort into isolating or at least emphasizing the exercises that will strenthen the weak area without getting things out of balance.


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