I just thought I'd share this link:
www.shoulder-pain-management.com/

Awesome website. I've been browsing many, many sites and this one is quite useful. There are far more advanced sites but some are total Greek to me..

After 9 months of on/off, mainly on, (and also messing the other shoulder now) pain I've decided to stop paddling and rest! Yep, I was pretty stupid not to stop at the time.

Anybody out there with experience with rotor cuff injuries? Any advice or tips would be most welcome for the road to recovery. Schweeeet

Good link AT... nice one.

Whitewaterules wrote:

Good link AT... nice one.

Thanks Boe. Ah, long time. I see you've come out of hiding....?

Bummer about your shoulder, Adrian. I deal with a lot of clients with rotator cuff injuries. I've seen people before and after surgeries. The shoulder can be a challenging joint--a lot like the hip. If you need some exercises, let me know and I can tell you about some great ones that have really helped my clients. I'm glad you are going to take a break---that really is key. It's a difficult, but necessary step. Take care and let me know if you need some exercises.

Yes please. I would be very grateful. Thanks.

Ok--don't know how much time I have right now--I am between clients, so if I don't finish this, I'll give you more exercises later today. It should go without saying (but I'll say it anyway) that these exercises are for when you are done resting and should be done after a warm-up.
Wall push-ups: Stand facing a wall with your arms reaching out trying to touch it. Your finger tips should just brush the wall. Lean into the wall and press your heels down (don't let them raise up). Lower your chest toward the wall (a standing push-up) and then push away from the wall. At the end of the movement, add a slight shoulder protraction (opposite of squeezing your shoulder blades together). Continue for the desired number of reps. Work up to doing push-ups with your hands on unstable surfaces: wobble boards, stability balls, or try doing them with one hand on a basketball (or similar) and the other on the floor. The added wobble will engage the many shoulder stabilizer muscles to help build stronger shoulders than you had before
Rows: In the beginning, I would recommend doing these with some tubing. Loop it around something and hold one end in each hand. Pull the elbows back with the back muscles and squeeze the shoulder blades together. Release. Work up to doing these with weights.
Straight arm pressdowns: Again, use tubing. Loop it over something above your head. Take an end in each hand and with your arms straight, press your hands toward the floor and back. You should look like Frankenstein trying to lower his arms. Again, you can work up to using a lat pulldown bar to do this exercise.
Internal and External rotation: These are the standard rotator cuff exercises. Again, I like using the tubing because you get a better range of motion than with using weights. For external rotation, tie the tubing around a post or doorknob and hold the band in the hand furthest away from the tie-off point, i.e. if you are standing with your right shoulder closest to the tie-off, hold the tubing in your left hand. Place a rolled up towel between your bicep and body to keep flow open to your brachial artery. Open your palm away from your body, pulling the tubing. Keep your wrist straight--it will want to roll open. Open and close your lower arm for the desired number of reps. External rotation from that same position would occur in the right arm--hold the tubing in the right arm and close your arm toward your body. This should be a lot easier than external rotation. Again, watch the wrist--it will want to bend in. Turn around after doing your desired reps and do your internal and external rotation with the other sides.
Whoops! A client is walking in--better go...I'll add more later, but hopefully that will give you a place to start. Let me know if any of those exercises need a better explanation. I was trying to type as fast as possible. Good luck and keep resting!

Great stuff. There are some new things in there I'll have to try. Much appreciated!!!

BTW, how long should I rest for? Sounds like a stupid question... Last I paddled was last Saturday (29 March).

When you say tubing you mean something like this?
www.dme-direct.com/theratube-theraband-t...and-tubing-exercise/

I tried some exercises with a 0.5kg (l lbs) water bottle but the next day it made things worse. I've stopped that now. That was early last week

Ha, I love it. Playaking while working... hehehe. Getting later here now... 20:25

I have some other workouts to do. these are more specified to shoulder dislocation, but are good for the ligaments and tendons in the shoulder as well. I know this is very long reply but I've tried to explain the workouts I use that have stopped my shoulder problems.

First off. I have talked to others about these exercises and even the strength&conditioning coach for the USA olympic swim team.

Secondly. the tendons in my rotator cuff are very elastic, or, the physiology in my shoulder joints have made me have chronic shoulder dislocation. Not complete dislocation but they pop out when ever I please and when even driving a car! These exercises have helped and have not dislocated or popped my shoulders out since I began them.

These are exercises to strengthen the rotator cuff muscles specifically. The rotator cuff is a group of 4 muscles underneath your deltoids and all attach at the joint of your scapula and humerus

What to do:
Get some elastic tubing (can be purchased from almost anywhere) and yes Adrian that's one type of tension tubing you could get, some of this stuff is really cheap so don't pay top dollar or anything. The beauty of the tension tubing is that you can get as many as you want in different thicknesses to increase or decrease the strain, they have resistance through the full range of motion, and they are used in many physical therapy settings.

I'm going to use the right hand to explain all of these to make it easier.

Exercise 1: (jajuama explained this already) Fix your elastic band to a stationary object at just above hip level. Standing at a distance so the band is stretched, hold on to the end of the band with your hand. Your forearm will be at 90 degrees to your upper arm and crossed in front of you so that your hand is at your stomach holding on to the band. Rotate your arm and stretch the band keeping that 90 degree position. Now, the motion here is key and you must follow this rule. As you rotate your arm and stretch the band keep your elbow at your side pinned by your hip. now turn around 180 and with your right hand now pulled to the side of your body, rotate inward to your stomach.

Exercise 2: standing in the same position, this time your arm is straight and at your side. pull the band away from you but only to a 30 degree angle. The muscle you're working only works for the first 30 degrees of arm adduction and for the last 75 degrees or so. So your pulling the band out from your body to about 12"-16" from your side with a straight arm.

Exercise 3: Fix the band to the floor with your feet or at a stationary object that is level to your shoulder. Your going to do the same motion as exercise 1 but this time your upper arm is at 90 degrees to your body. just rotate your shoulder with your forearm at 90 degrees to the humerus.

Here's a good one though that you could possibly start with moderation:
Exercise 4:
One more thing you can do which I feel is very beneficial to me, Get a hold of a work out ball, one that's about a medium-large size. Stand with a wall at your side. Outstretch your arm so that it is at least 90 degrees to your body. your going to lean against the work out ball, pinning it against the wall with your hand in a fist. Now that your leaning with a straight arm against the ball you can feel that your muscle is working to balance and stabilize you. When your ready to step it up, begin to "write" the alphabet with your fist on the ball, the sporadic movement and little circles are going to make you feel like your shoulder's working overtime.

Exercise 5:
Do pushups with a ball under your hands. a large medicine ball or a medium sized work out ball is prefered.

Sorry if some of this doesn't make sense, I tried my best, and please tell me if I said something wrong. lemme know if any of you have any questions.

I don't know if I could help you with your shoulder but i read an article a couple of weeks ago about shoulder injury and paddling. www.endlessriveradventures.com/articles?module=news&showitem=10
I'm sure you know this stuff Adrian but some readers might not. Especially fresh paddlers like me.

I just thought i would fit into this thread.

Good luck with your shoulder! oh by the way: If you hurt your shoulder pretty much next time you might want to use some anti-inflammatory like aspirin or ibuprofen to reduce possible damage due to inflammation. (and against the pain)

Tom

That's definitely the tubing, Adrian--and like Danger said, go for the cheap stuff. it doesn't have to be expensive. The colors usually go (from easiest to hardest) yellow-green-red-blue-purple. It's nice to get one of each so that you have the versatility of the degrees of resistance that each offers. As far as rest goes--the longer the better. Rest in the beginning will always help more than hinder in the long run. It really really really sucks--I do know this--but it's necessary to heal the trauma done. I couldn't tell you how many weeks (yes, weeks--not days). That depends on you and the degree of your injury. Wait at least two and then try a few exercises at a low resistance. If it hurts, then you need to rest some more. I would be unwilling to give you an exact number without knowing more about you and your injury.
Danger saved me some time as far as writing more exercises--he did the work for me. The alphabet exercise is great--really burns. The only other one I would add is another external rotation exercise:
Tie the tubing off at shoulder level and stand facing it. Take the tubing in your right hand with your upper arm parallel to the floor, opened outward. Your lower arm (forearm) is perpendicular to the floor with the palm facing the wall. Keeping the upper arm still, pull the band backwards as if you were throwing a ball backwards. It is a pretty small movement, but you'll feel the muscles working pretty soon.
As hard as it is, though, you really do need to rest. You'll thank yourself later when you aren't facing a whole season off because of injury. Good luck!

Are you a physio or similar jajauma? I don't want to hijack this thread, is it possible I could pm you about a toe injury I sustained about 6months ago paddling. Pinned onto a rock off a 10ft drop in a playboat without proper foot bracing

AT you can do anything which is in a pain free range of motion. You want to limit overhand activity especially when your arm goes up or down with your thumb in the thumbs down position. This jams the humeral head and thefore supraspinatus up against the acromion. But the key here is furst to understand the pathology. What structure have you damaged. Most likley it is the supraspinatus tendon and/ or muscle.

Have you had any prior shoulder injuries? If so what? Do you suffer from shoulder instability... such as shoulder dislocations/subluxations?

Again the key is anything PAINFREE... you want to stay out of the inflamatory cycle. Keep using that shoulder and stretching... in painfree range of motion.

Gee, thanks a lot for the responses! I really appreciate the exercises Dan, and Noel.

Shot Tom, I have saved that page and will check it out soon. (just a bit tired after a 9 hour hike to scout a river today.. Got to do something to keep the stoke alive!)

Allen, you do know that creek boats were invented for a reason, as were bulkhead foot rests...? Good luck with that toe, doesn't sound good.

I've never had a prior shoulder injury Boe. In fact no other injuries except for sprained ankle when I was young (like maybe 7 years old) and a fractured left arm (greenstick) during some stupid wall climbing, inside a dorm...

A question on stretching. Should I do it? I would guess yes. But of course once the shoulders are properly warmed up and have some blood running through them... How important are stretches and which do you recommend?

Thanks in advance.

No problemo! glad I could actually give some decent input on a forum topic! Search rotator cuff stretches on youtube you'll find some stuff. Be careful though, I didn't let my shoulder heal at one point and my whole back, neck, and other shoulder was in very bad condition.

I just thought of something else as well! the human body is very adaptable as we all know, so this is one thing that you can do if your stuck wishing you could exercise your shoulder but it's just too hard and painful. exercise your opposite shoulder. What happens is your body will realize that your gaining muscle or strength or flexibility, and it will adapt and actually begin to build up your opposite limb. Crazy I know but it's true, and it'll give you something to do. Just don't do anything that's going to bulk you up, or you'll be a little asymmetrical.. haha

I know Adrian! I ordered a new kayak late last year, it finally arrived this week (buying kayaking stuff in AU is a slow process!), so I have some decent foot support. I do want a creekboat as well, and it's on the shopping list when I have some spare cash, but it's not really at the top of the list. Most of my paddling is in the surf, the sydney olympic course and other playboat friendly stuff. As much as I'd like to do more creeking and big drops, we just don't have much of it in AU.

_Danger_ wrote:

No problemo! glad I could actually give some decent input on a forum topic! Search rotator cuff stretches on youtube you'll find some stuff. Be careful though, I didn't let my shoulder heal at one point and my whole back, neck, and other shoulder was in very bad condition.

I just thought of something else as well! the human body is very adaptable as we all know, so this is one thing that you can do if your stuck wishing you could exercise your shoulder but it's just too hard and painful. exercise your opposite shoulder. What happens is your body will realize that your gaining muscle or strength or flexibility, and it will adapt and actually begin to build up your opposite limb. Crazy I know but it's true, and it'll give you something to do. Just don't do anything that's going to bulk you up, or you'll be a little asymmetrical.. haha

There is only one problem. Both shoulders are buggered. I'll check out youtube. The internet is a mighty handy thing to have!

But I can feel the difference already after resting for more than a week. Yesterday I used my upper body quite a bit to climb up and down some boulders in a dry river bed and today the shoulders don't feel bad at all. So I will take that as good news..

Well, I think I’ll pull in to see an orthopedic surgeon next week and get a professional opinion on what is going on. Perhaps have an MRI scan too as was suggested by someone via a pm but I guess that will depend on what the doc says. That’s something I should have done long, long ago! Living in daily pain for almost 10 months now is getting a bit much.

Thanks again for all the responses and advice. It will help me for sure. I'll update back here once humpty dumpty is being put back together again.

Well, after many x-rays there is still no conclusion. There are some other ‘things’ that are bothering the surgeon so I’m off for some MRI scans later this week. He said they’ll inject a dye into my shoulder joint, under the guidance of x-ray and a bit of local anesthetic, and that will help to show what’s potting on the scan. Doesn’t sound like a lot of fun and the doc did say it wouldn’t be pleasant. Oh well, at least he didn’t lie. Then I should know whether it’s a case of more rest and then a rehabilitation program or an operation… Bloody shoulders.. At least 10 months of pain will (hopefully) come to an end.

So I did the x-rays as mentioned. Then yesterday (Tuesday) I did the MRI. Before doing the actual scan I had to undergo a process known as an arthrogram. This is a truly horrible thing to do and I’ll quickly explain it. You lie on a cold stainless table in a freezing cold room (maybe they want to preserve bodies in there?) with an x-ray machine over you. They take one x-ray to see what is potting. Then a doctor marks off a position with a marker and injects some local anesthetic. There is a slight prick and almost no pain. After about two seconds he said, “Now I’m going to go a little deeper” and WHAM he knocks that needle in super deep and you can feel it going deep into the muscle as the needle shudders going through everything. This is quite painful and highly unpleasant. Then, still lying on the table (with a blanket over one to avoid hypothermia) they let the local anesthetic become a bit more regional. A massive needle (about 12cm long) is then carefully put into the shoulder. It goes in around 6 to 8cm I think. This has the dye or contrast (the fluid is known as gadolinium) in it that will fill the space inside the shoulder joint. So that needle has to go in very deep. To guide it accurately they take quite a few x-rays while they wear lead vests and you don’t (to increase your chance of cancer and make sure you’re a return customer to the hospital) and this takes a while. Deeper and deeper it goes. And one can feel it in there. It was one of the worst things I’ve ever done. Similar to having ones teeth pulled, and I’ve done 4 beastly molars (I have monster roots) in the chair that left me bleeding for 3 days. Had to use tea bags in my mouth to absorb the blood so hence the reason I haven’t had a cup of tea since 1993.

After about 10 minutes of agony and being freezing cold even though my hands were sweating, I hit the MRI machine. MRI stands for magnetic resonance imaging. If you are claustrophobic, then pray that you never go into one!!! Stop reading now and check out some kayaking videos. I don’t mind going in at all. It’s almost like lying in my bivi bag. But you’ve got to lie still for AGES and the first long scan, of about 20 minutes, I had to do again because they said I was moving and this produced blurred images. It is uncomfortable as they jam your shoulder into a holder type thing and position blocks to force your body into it from the opposite side to keep you there. I wore ear phones and it was very loud. Third scan was shorter but worse; had to have my arm above my head. Zero fun. The entire process I can highly recommend not doing. I rate it low on the fun scale. Did I mention that the MRI room is highly air conditioned with a force 7 storm blowing through there? The flimsy blanket didn’t help much and they wonder why I was breathing so much!

Anyway, so I went today (Wednesday) to see the orthopaedic surgeon. The report that the other doctor was unfortunately made in Afrikaans but I’ll try and say what it says and try and remember what my doc said. Seems that I have a tear on the labrum. Possibly a SLAP tear, I think it says. SLAP stands for Superior Labrum from Anterior to Posterior. My doctor explained it but didn’t use the fancy terminology. It says there isn’t a definite tear at the anterosuperior labrum but the contrast (dye) shows something. Sorry my Afrikaans has gone downhill because I don’t use it much these days. Then something about a previous injury showing something has this in brackets (ALPSA letse). Who knows…

What I understand is that the labrum is torn and damaged. What is the labrum you ask? This is what the internet says:
“A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.
A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum. “

Seems it healed with something hindering my movement a little and something is catching. What the doc says is that he would make a small incision and insert an arthoscope (small lens type thing with a light that can be connected to a video camera) and then he says he’ll hook onto something and pull it gently and see how stable it is. I think he is referring to the labrum? I don’t know. If it’s fine then I guess no further surgery is really required and rest might work, might not though. Otherwise, they can cut me up good and proper and clean away some stuff to smooth it off and then roughen it up so that it creates a new wound where the cartilage can then heal itself in the correct position, which is exactly what didn’t happen in the first place! He will then drill a small hole into the bone where the labrum has torn off and then screw in this little plastic type thing into the bone. Like a self tapping wood screw. It has these awesome little strings coming off of it and these are attached to the labrum, I think. The little screw thing dissolves over a long period of time but those string things don’t. I guess they’re not really a problem.

So I have a decision to makes, which I need to make on Monday. No surgery, rest, do exercises and see what happens. It might work, but who knows for how long. The shoulder will more than likely become more unstable and eventually dislocate after a lot of use and then I’m in trouble.

Or, I can do the whole surgery thing which will also cost around R40 000 (about 5500 US Dollars). Then he says I will have to be out of kayaking for 9 months. I read elsewhere that full recovery can be expected in 3 to 4 months. I’m tending towards the surgery. The grinding at my sternum where my clavicle joins cannot be fixed. It will more than likely get worse. Oh joy. I guess I’ll see how I feel on the weekend. Right now, I’m not a happy man. My entire life almost revolves around kayaking and being active. Kayaking is all I ever think about. It’s really not a good feeling at all. My career cannot even move forward as I need to have a strong upper body for what I want to do. Right now, life is coming to a stand still. And that’s my sad little story…

And that is only my right. Luckily my left is not as bad so I guess time will weave it's magic on that shoulder

Good luck mate, I feel for you!

Yeah. Good luck mate.

Hope it all turn out alright in the end!

Crossing my fingers.

Thanks Dima, appreciate it Thanks Kevin, right now, I don't see the end. It seems to be pretty blurred

Man this sounds shit.. I don't know you much but i am pretty sure you'll make the best out of it! A strong will and positive character makes already half way to recovery.. (if this makes sense? )

Anyway, good luck!

For sure it makes sense. Thanks Tom.

Ugh! That just sucks, Adrian! I was working with a client this morning who has undergone several rotator cuff surgeries (in fact, as I was telling your story, we were doing her rehabilitation exercises)--she didn't have any labral tears like yours--hers were in the actual rotator muscles, but she had to undergo the arthrogram as well. She definitely felt your pain--she said she was crying from the pain during the procedure. I've had several MRIs and know how uncomfortable they are, so combining the two just sounds terrible!
I wonder if it's just a bit of cartilage catching and they can patch you up pretty quickly! That would be fast and nice! Otherwise, I think you are right and that surgery is the best option--better to get fixed now while you are young and have great healing still, rather than wait for the injury to worsen and need more drastic surgery and longer rehabilitation. A sucky situation all around though and you have my sympathy. Injuries suck! Especially when they take you away from the things you love doing. Good luck and thanks for keeping us posted!

Thanks Noel. You are right, they do suck! Big time.. I guess there will be a lesson learnt and there will be something good that will come out of this.

The injection thing wasn't nice. One can feel that needle go through the muscle. AHHHH. I'm not a fan of having anything stuck into me. I can see someone bleed, no problem. But if I see my own blood then I feel sick and want to pass out. So I didn't look at all but it was very bad... Wouldn't do that in a hurry. Maybe after a bottle of brandy or rum!

I guess it's time to hit the mountains around me and get cracking with some serious hiking in the off time.

I'm exactly 24 hours away from surgery now.... Oh well, nothing I can do now.. 150 minutes in theatre and how ironic that one cannot even enjoy the show. Doc says it's a Bankart repair and debridement of the shoulder.

I'm sure I'll come back bigger and stronger!

good luck man. try looking forward to tuesday

Thanks Jeroen. Hopefully I'll sleep Tuesday away under the influence of some powerful pain killers. hehehe. Coming home Wednesday morning.

Back home. hate hospitals. needed 3 screws instead of 1. apart from wrecked cartilage, he found lots of torn muscles. not cool. in severe pain now. be back another time at least I go forward now