Shoulder AC Separation Recovery

I separated my left shoulder AC joint this year and thought some notes about the recovery process might be helpful for others who have this (somewhat common) injury.  There are much better sources of information out there, so if you want quality just go to these links:

Dave MacLeod AC Joint Recovery: https://youtu.be/kfV34SsQd38

E3 Rehab Recovery Protocols: https://youtu.be/QZAuiCGwJME

Also, it's worth noting that I have several partners who have successfully recovered (non-surgically) from this injury and are fully functional as athletes (both climbing WI5, one of them is climbing 5.13!).

Initial injury: I blew up my shoulder on May 17th (2023) in a fairly violent skiing accident where I fell and cartwheeled several times.  I also did some damage to both knees, needed some stitches, and had a variety of bumps and bruises.  I'll focus on the AC injury, as it's the most significant and of greatest interest to most climbers.  My injury was a full AC separation with both ligaments fully torn and significant separation in the joint:

Week 1: Not very functional, in sling 100% of the time, needed help to take my shirt off.  Shoulder was quite achy but didn't require opiates to manage.

Week 2: Ortho surgeon confirmed that non-surgical route should work.  Start basic PT and mobility exercises.  At this point I couldn't even lift my arm over chest height.

Week 3: Progressing through PT, able to start doing some very basic tasks.  Started going for short walks.

Week 4: Got clearance from Ortho and PT to remove the sling for tasks like cooking, eating, and working on a computer.  Probably 75% of mobility returned without load, still very weak though.

Week 5: Similar to week 4 but with improving mobility and strength.  Out of the sling for several hours a day at this point.

Week 6: Discontinue sling use.  PT changed from ROM exercises to load-bearing.  Daily tasks are totally fine, zero chance of doing a single pushup or pullup.  Initially, lifting 5lb felt fairly difficult, but strength was improving with every session.  Wearing a backpack definitely was still causing discomfort.

Week 7: First time returning to bouldering gym, no issue carefully climbing easier problems.  Actually flashed some technical V4s but steep V1-2 is still not great.  Did a couple pushups.

Week 8: Re-introducing some trail running, able to lift moderate weight (10lb) during PT exercises.  Climbing easy routes outside.  Doing pushups in sets of 5, managing a few pullups.  No discomfort with a typical daypack.

Week 9: Climbing 2-3 days a week, hangboarding without any issues.  Technical/slabby problems feeling pretty good about 1-2 V grades below my normal ability, steep climbing still feels yucky.  Did 2x5 pullups.  Wore a light pack for a 10 hour hike and it didn't bother the shoulder.

Week 10: This is about where I'm at today.  I'm probably stronger and more functional than a "regular person" and able to mostly go about life normally.  I am still noticing weakness in the shoulder (and my fingers, which took a long vacation) but I can easily go the gym and climb a normal length session.  Still need to be careful on steeper or more powerful problems, shouldery moves are iffy and I don't love lockoffs.  I can do nearly all normal weight bearing movement, but the left side is still maybe 80% strength of the right.

Based on the way this is going and how my friends have recovered, I expect to be fully functional and not notice this injury once I am recovered.  I expect it'll be a couple more months to get there, but already, only about 2 months out, I am back outside doing my normal activities several days a week and I don't have any significant pain.

If you're dealing with the early stages of this injury, note that mine felt ABSOLUTELY HOPELESS in the first few weeks, but it progressed quickly once the initial healing was complete and I was able to start using it and doing PT.  I have a very good sports medicine PT who has been amazing and I have been highly motivated to follow her instructions.  Since getting mobility back, I have been doing 3X 2 hour sessions of PT every week, which is a grind but I think it's really paying off.

Despite being a pretty serious injury, this doesn't seem like one that will cause chronic problems or reduced recreation ability.  So, if this happens to you and it is stressing you out, be optimistic!  Lots of success stories with this.

Hopefully this helps someone else!

Update: As of October, approximately 5 months post-injury, I am nearing 100% functionality.  I'm not quite climbing at my max yet, but less due to the shoulder and more due to the time off and then spending a lot of the summer climbing like a trad dad (<5.10 and alpine).  I have been regularly climbing in the 10+ range lately, which is typical for me.  So, to reiterate what I said above, if you have this injury, be optimistic!  There is light at the end of the tunnel.

Hi Kyle - thanks so much for this post. Hope your recovery is still going well! I just separated mine a couple weeks ago and am starving to hear another climber's first-hand account of recovery. I sent you a DM. Please let me know you if you're willing to chat about your recovery process. My phone number and email are in the DM. Thank you!

I had a grade 5 tear. All ligaments gone, major displacement and went sans surgery.
It took well over a year before I could do a push ups, but kneee push ups after about 6 months were okay. Pull ups and climbing were doable much faster than I thought at about 3months(wider grip pullups took longer). It's amazing how much the collar bone and those ligmanents being intact stabilze for pressing movements and general should stabilization. I had relearn how to stabilze the whole shoulder area without the help of the skeleton like it used too..... that was a "fun" body game.

It took about 3 years in total until I felt like I was truely 100% again. I dont think about that injury at all anymore at 5/6 years out. Little crunchier than before for sure, or sometime my nubbin' hits something and your reminded it exists. In the end, total recovery was much longer than I expected, but I was out engoying my climbing life again after 9ish months although still very green and certain things would be no go, I could still get out there.
The mental peice was harder for me, I was at my peak climbing wise, and that was tough to fall so far from that high point. That beng said, I apreciate climbing more and have more fun more now even though I'm not pushing nearly the same grades. With that joy increased, I consider it a serendipitous event all said and done.

One big thing that helped me was serratus push ups if you dont have those in your regimen. That and incline bench press (dumbells easier to start than bar, but the bar is better IMO), starting very light. These 2 seemed to help my body learn to stabilze the shoulder best out of the menagerie of PT I was doing.

Glad to hear you recovered in seemingly great time frame. You are right in giving hope to others who have this kind of injury. You can come back to a full climbing life more than likely. It's amazing how well your body can heal without surgery given enough time, therapy, and acceptance to be uncomfortable through the process.