AC Joint Separation & approach to training log

Training
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Hey all - posting this as I have been finding other people’s posts useful and maybe someone else will find my experience informative.

I am 39 year old guy, healthy, pretty active runner, cyclist, skier, and generally outdoorsy (multi day hike, canoe, etc). I’m a teacher and a dad of 2.

On Dec 26, 2022, I fell skiing. I am a strong skier and lost my edge at about 30 mph - went tumbling forward. Knew immediately that it was a bad crash but couldn’t tell what was wrong. Headed to patrol for ice and Advil and then drove to the ER for X-ray and eval. Initial x-ray revealed a substantial ac joint separation. PA read the x-ray and put me in a sling and advised I follow up with an orthopedist.

Made the Ortho appointment and did a ton of reading on Ortho bullets, Google scholar, watched PT videos, and read individual accounts on forums. My brother is a doctor and I sent him the stuff that felt useful and informative to get his perspective.

Icing a ton (I like icing it, it feels good), taking Advil, sleeping in the sling (with a small pillow under my arm), and generally avoiding use of my arm and hand.

On Wednesday, started trying some light physio movements. Started with pendulums, good arm assisted arm raising and reaching across my torso, and gentle shoulder rolling.

Saw the orthopedist on Friday, Dec 30th. With a few more X-rays he diagonsed it as ac joint separation grade 3/5. Essentially, I have the trauma of grade 3 but separation that is associated with grade 5. AC and CC ligaments are ruptured. However, my clavicle did not puncture it’s sheath or fascia.

He advised no surgery. As long as I don’t mind the bump, he felt that the complications associated with the different surgical approaches are an unnecessary risk. He also said that the grade 5 diagnosis stems from distance of the separation but that it also depends on the camera angle of the x-ray machine. He stated that with additional imaging, we could probably turn this into a grade 3 but that wouldn’t change the treatment. He said that my current approach of self PT is fine and that I could expect a return to running in approximately 2 weeks. I didn’t bother asking about skiing at this appointment.

I have my first PT eval on Wednesday, January 4th, 2023. Likely, I will do PT two days a week with self PT on the other days.

I have a treadmill and I intend to spend a lot of time walking on an incline. I have a trainer and after another week I plan to try it and see if I can make it comfortable.

While I know that KT tape is unlikely to make it heal faster or better, I’m interested it trying it for additional support and comfort, especially when teaching at the whiteboard.

I have a list of running and cycling events in mind for the season which, as of now, I think will be unaffected, the first being a trail running event in early April.

I’ve included some imagery and links that I found useful.

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I had a grade 3 separation in 2008…no surgery and I can do anything with that shoulder now but I lift 2 times per week to keep the muscles around the shoulder joint strong. After the injury, I could ride my MTB bike on the road without pain before I could run without pain. Initially, the swinging of the arms while running caused some pain for me. I hope you recover fast.

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This a 9 day after injury update.

So after working on some self PT for the past five or six days, I had my first formal PT appointment yesterday. The PT heard my story, had me move through some range of motion, and essentially put me on a path of addressing my posture and strengthening the surrounding area of my shoulder. Honestly, he didn’t act super worried or concerned!

I have been trying to understand the relationship between stability and strength. The range of motion makes sense to me, but since I’ve never really had a muscular or orthopedic injury, I am having a hard time separating the ideas of stability and strength. The PT described it as thinking about distal vs proximal strength; as the load gets further away from the fulcrum (my shoulder joint), the lever of my arm is less well supported. I commented, “so, basically, I have a wobbly fulcrum” and the PT said, “well not that wobbly, there is a lot of muscle there.” He emphasized that strengthening the rotor cuff was going to be really important for my recovery.

I did electrostimulation, massage, and moved through a range of exercises, most with a stretching band. This youtube video isn’t exactly what I did, but it includes a lot of the same exercises.

My PT homework for the week is postural: shoulder rolls (2x10 reps) and holding my arms out, at full wingspan, against a wall, keeping my shoulder blades against the wall (4x15 seconds). This morning, in addition, I did the stretch band work and it went fine.

Tonight’s goal (and the goal for the next few days) is going to be the bike and treadmill. Its my aim to do easy riding, Taku (and similar) and continue the uphill walking on the treadmill.

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Hey, thanks for the info - I have spent a lot of time on forums, searching up AC joint, and reading about other people’s successful recoveries is really helpful.

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I separated my AC joint to the same degree in January, 2022. Similar situation - caught an edge at high speed on the snowboard. My ortho is a cyclist, and we aimed to get me back to riding ASAP. No surgery, several courses of steroids, PT protocol, and strict orders that I wouldn’t be sprinting out of the saddle for a while. PT helped immensely to get my mobility back. I was back to riding the trainer within a week, albeit without a ton of pressure on that arm. A month later I was on a cycling trip to SoCal to do a lot of climbing (with some discomfort).

HOWEVER - despite having full mobility now and it not sounding like a box of rice crispies every time I move, I still have nonstop pain and can’t yet sleep on that side. It’s still inflamed, and Ortho has advised me that it will just take a while to resolve as there’s not a ton of blood flow to that area. I’m taking a daily regimen of Turmeric to help with inflammation. I’m still doing PT exercises, but really don’t have the strength and stability as before. I can finally sprint out of the saddle again, but rock climbing is pushing it.

I’ve been injured many times from being a lifelong athlete - this one is taking FOREVER to heal and pain to resolve. My best advice: Be prepared for the long haul.

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Hey, sorry yours is still painful - I’m a little lucky in that I tend to prefer sleeping on my back, so sleeping hasn’t been too bad. I tend to sleep with a pillow under that arm to reduce pressure on the joint and that helps, plus adds a physical thing that is a little in the way in regards to rolling over.

My pain isn’t bad, at least right now. This morning, I was able to do 10 overhead presses with 10 lb dumbbells without pain. I couldn’t do more - my shoulder starts feeling tired and sore.

That’s really what I’m finding with my injury - use throughout the day, leads to tired and sore muscles. I assume that all those muscle groups are adapting to their increased use. I want to thank you, however, for your advice about healing time - I tend to push too fast and things tend to take a long time to fully heal. Slow and steady is my plan and the reminders are helpful!

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Sounds like you’ve got an incredible plan and things are going well! That’s epic!

This shoulder is healing slower than my compound fractured (and surgically repaired) humerus :crazy_face: :crazy_face: Recovery is weird :man_shrugging:

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Thought I would write another short update.

I’ve been to PT three times and I saw my orthopedist this morning. I’ve been doing the PT exercises on my own as well.

Right now, I can do all the stretch band exercises comfortably. I can do kettlebell swings with an 8kg bell (I also own a 16 and a 24, I haven’t tried those yet). I can do overhead press with 10 lbs, I haven’t tried more yet. I find there is nothing in my normal life I can’t do.

The orthopedist says that my range of motion is 100% or very close to. No follow ups required. He stated that at this point, surgery would just be cosmetic and not return any strength/ability. He also stated that the failure rate for these AC separation surgeries is around 20%, much higher than ACL repairs. He described that the follow up after a failure is worse and that if I don’t mind the bump, I shouldn’t pursue surgery. My orthopedist wrote the Rx for PT for 12 weeks, but stated that I could basically stop whenever I want. I’m sure the PT would have something to say about that!! I’m intending to continue going for a while, I’d like to feel stronger and more comfortable before I consider stopping.

As far as I understand, I’m recovering really well and I feel lucky that the injury wasn’t worse and that things are going well.

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@NickZambeck