AC Separation

Hey all,
I have an AC separation in my right shoulder. I'm told there isn't much to do other than wait for range of motion to come back. Has anybody had this injury? Anything you can tell me about recovery time?
Thanks!
Joe

I've done something very like this to both shoulders, at different times. If you have the ability to go to a Physical Therapist, do it, or get good solid advice on rehab from someone who has been through it. There are tons of exercises that can help to shorten recovery time and increase the quality of the recovery. Recovery time is way variable; two months seemed about standard for me to start climbing again, but that was without any sort of guidance or discipline (read: too dumb to lay off). Try to be patient, I know it sucks; good luck.

Hey Joe, drag about the shoulder. I had a "severe" grade III separation in my left AC a few years back from a wicked mtn bike wreck, so I know the recovery routine well. As Joe H mentioned, get thee to a physical therapist - and make sure it's a sports medicine one. They will get you going on an exercise routine and teach you how to tape that sucker. Therein lies the difference between a sports medicine therapist and some standard hospital physical therapist. The sports oriented one will know that you are champing at the bit ready to go. Rather than having them be the voice that encourages you to do your PT, they're the ones that keep telling you not to overdo your PT. And as I mentioned, they teach you how to tape it.

I was in a sling for 5 days or so before I asked them to start taping (I lost a lot of skin in the wreck, so tape was out of the question for those first days because I had to clean the bandages 3x a day). Anyway, the taping will allow you to do a lot of stuff, like ride a bike (mtn bike w/fork suspension preferably), hard hikes uphill (with poles, but don't weight them, just to keep the arm from hanging there), and start doing your theraband exercises. You'll do those exercises like religion (buy a bunch, they snap). When I knew I would be standing around for a long time, I'd bring the sling with me so the weight of the arm wasn't directly on the shoulder (it's all about what helps it heal fastest, who cares if you look like a dork with the sling).

At 10 weeks I still had issues raising my arm over my head. I could do it, but it really didn't feel right, and there was a lot of range still missing. But I started climbing just the same - I just kept it easy and only used that left arm as a lockoff (So I'd pull down with the right, lockoff with the left on some hold at eye level, allowing me to keep my elbow at my side, and then I'd shuffle my right up again for the next hold to pull down on). It worked and it didn't hurt. What more could you ask for?

It actually took me until 4 months before I could fully reach up without too many issues. But my separation was pretty out there (launched into a tree and then a hillside at ~40mph, and elected not to have surgery because I'm a chickenshit), so I expected it would take a while to get back to climbing. For other activities, I was good to go pretty soon after the wreck - I actually raced another mtb race less than a month after the wreck (granted the shoulder was taped like a mummy, but it worked). It's just that the stresses of climbing, with your arm straight up overhead, can be tricky.

Final thought: you'll know when you can climb again. Those ligaments heal pretty quick once the localized swelling and trauma have calmed down. Then it's just a matter of strengthening and limbering (word?). Do the theraband exercises and set up a pulley system with your old cordalette and biners so you can pull down with your good arm and thus raise your bad arm higher and higher to bring back that range of motion. For once you get to be your own puppetmaster.

Good luck on the recovery!

joe disciullo wrote:Hey all, I have an AC separation in my right shoulder. I'm told there isn't much to do other than wait for range of motion to come back. Has anybody had this injury? Anything you can tell me about recovery time? Thanks! Joe

I am a chiropractic student-doctor and I can tell you what I know about the AC injury your talking about.

1st - tendons and ligaments are avascular, no blood supply, and thus will take longer than other tissues to recover. THe first thing to happen in the healing process is for pain to go away. Most people assume the tissue is healed b/c pain is gone. WRONG. Pain goes first but the cellular remodelling process is slow due to lack of blood supply so give yourself roughly 6 weeks before you demand 100% of your shoulder.

2nd - The AC Joint as in this image is damaged. However, there are three grades I-III for the injury. Important point is that rarely do ALL the fibers of the ligament rupture. Keep in mind that the severity of the sprain has more to do with how many fibers are torn. It is wrong to think every single (millions) of the collagen fibers are torn like in this image. In reality, only some are torn, and the more tearing the more severe.

3rd - There is an underlying cause that created the injury. Why did one shoulder injure itself and not another? Muscles are responsible for joint stabilization. Without muscle function, our skeleton and internal organs would collapse into a pile on the floor. IS your shoulder balanced neuromuscularly? Meaning, someone needs to check the function/fascilitation of the rotator cuff muscles, triceps, biceps, and definitely POSTERIOR DELTOID. The Posterior Delt is often compromised in AC JOINT injury.

4th - Whenever there is an injury, there is cellular debris created. Just like working the circular saw to build a cabinet, there is a lot of debris. Your body needs help cleaning up the mess. Imagine if you cut up a chicken on a cutting board, and don't clean up the little pieces, what would that tissue look like in a week? It would be covered with bacteria! Its the same with your body. Your body is trying to clean up the cellular parts - part of your cells that are no longer "YOU" ie, they are now waste products. THis adds to the inflammation.

At a minimum, if I were you I would get my hands on quality Bromelain and take it 3x day on an empty stomach. I would take roughly 1g day if I injured my AC joint. THis is not medical advice. It is what I would do, understood? ALso useful is a supplementation program providing all the necessary co-factors and minerals needed to rebuild connective tissue. Consider something like this for 6 weeks during the healing phase.

BROMELAIN is derived from the stem of pineapple plants. It is a proteolytic enzyme - it digests proteins. When taken on an empty stomach, it will enter circulation and help the body break down cellular debris.

Ahhh now I've lectured too much for one post. Rest it. Ice 10 minutes per hour for first few days when it is ACUTE. Strengthen and balance your shoulders. Go see a sports chiropractor, preferably one who knows what they are doing with applied kinesiology, and get adjusted! Eat whole grains, organic whenever possible, clean meats and fats, no junk food etc. The more garbage we eat the more inflammed we become and injuries are a result.

I suffered a grade II AC separation a few years ago (I was 42 at the time). It was two months before I could climb at all and probably four months before I felt close to back-to-normal. (I tried to climb a couple of times before it was healed and probably prolonged the process by a month or so due to aggravating the injury.)

I spent a lot of time hiking in my local canyon, taking pictures, and making topos to post on MoutainProject :-)

I also performed religiously the rehab exercises my ortho recommended.

As far as I can tell I have no problems now from the injury (other than the "bump" that you get when your shoulder heals in the new, lower position).

I'm not a fan of surgery but if it's a complete tear or mostly torn, surgery may be the quickest way to get you back on your feet. Surgical repair of the AC joint has come a long way over the last several years and now outcomes are pretty good for durability of the repair.

If the AC isn't that badly damaged, then conservative care via some kind of physical therapy is certainly your best bet at getting back to climbing sooner w/ fewer long term problems.
Either way I'd start w/ a visit to a D.O. and find out how bad the injury is and go from there.
cheers,
BA

Joe, it depends on the severity of the separation. I've had low grade separations. They can heal to climbing functionality within 6 weeks, but not to maximum effort activity at that point. It can be somewhat challenging to determine the exact extent of the injury by yourself; however, if you never injured it before and you look in the mirror and it's asymmetric, it's likely a higher grade separation, probably grade III. These take much longer to heal and often do not heal to symmetry, but they can heal without surgery. Some high grade and some painful after healing separations can do better with surgery. Obviously, then healing is probably 12+ weeks to climbing functionality. Shoulders are complicated joints and significant shoulder injuries are probably best dealt with by someone who specializes in shoulders.

I had a grade II separation on Wednesday evening and i was out climbing again by friday evening. Certain movements hurt while other did not. I did notice more fatigue in the shoulder for sure. I asked the orthopedic specialist and he said i could climb as hard as the pain i could endure but that it would be 6-8 weeks before i would be pain free but i suppose it is different for everyone.

I had a grade III when I was 33. I wore a sling for a few days. I was climbing a couple months after, but careful. Six months later I was 100% with no therapy, except lots of moving the arm around to the point of pain. Got the lump on my shoulder, but it's smaller than it was the first year or two after. Sorry to hear about your injury, hope all goes well.

Thanks so much for all the info guys! I really appreciate you taking the time to write. I'm going to check in with a sports therapist on Monday and get on a program. Thanks again. Joe

my story

21 year old female, very athletic, love running, biking skiing. 4 weeks ago i had acl surgery. 3 weeks after acl surgery i was riding my bike trying to rehab my knee. i cross a crosswalk during a green, turns yellow while im on it, i ride my bike very slow right now because the acl is weak,the crosswalk was slight uphill, almost to other side when light turns red and a car hits me. i fly off my bike and land on my head and shoulder, i was wearing a helmet thank god. seperated my ac its a grade 2/3 doc thinks. its been two weeks. i have never been so depressed in my life. i cant run or ride my bike. my shoulder hurts. it doesnt move around as much but it feels heavy. what can i do to speed up recovery. anyone ever do acupuncture? would a massage help?