Dear Beth,

About two weeks ago, I dislocated my right shoulder in a mountain bike accident. Are there any excersises or any thing I can do to help speed up the recovery? Not being able to surf is driving me crazy!

I never ended up going to a doctor (which I should have done in retrospect). But my shoulder is getting better day by day and I have started surfing again (although with a good amount of pain when paddling). I do have full motion, with pain, if I extend my arm over my head, but nothing terrible.

Thanks,
Travis

ANSWER:

Hey Travis,

Well, sounds like things are healing up nicely. However, before you get too nuts with surfing (seeing that fall is coming up quickly but not quick enough!), I would keep an eye on the pain you get with arms up over head.

Watch to make sure that surfing does not increase that pain and make sure that you notice it getting progressively better, like the rest of the injury. Try to maintain stretching to make sure there is no “lock up” of that joint. Ice and anti-inflammatory could be a call post-surfing if you find there is increased pain and swelling.

As for exercises, I would definitely figure out a rotator cuff/shoulder routine to protect this from happening again. Avoid going into the range of motion which is causing pain until the pain has subsided. I would really be careful surfing too much, too soon since you still have some pain in an area that mimics the paddle stroke.

So, in a nut shell keep up some good stretches, be patient and let the pain subside, and get on a strengthening program. If you need help with the strengthening program, a one-time visit to a great physical therapist would be a smart move (not to mention they could give you an idea on where your injury stands!). If you live in San Francisco, Potrero Physical Therapy is the one for you.

Good luck and let me know if you need more info.

Hasta,
Beth

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QUESTION: How can I avoid surgery on a torn rotator cuff?

Beth,

I have been having a terrible time with my shoulder lately.  Three years ago I partially tore my rotator cuff and impinged it surfing with webbed paddling gloves. I did phsical therapy and it got better, but it still troubled me sometimes.  Lately, it sort of locks up on me and causes tremendous pain when I am doing some random movement, like lifting my arm up or putting on a shirt. It will then hurt considerably for a while, and limit my range of motion and my activities (can’t surf!). I’ve been practicing yoga for a little while now, and there are times when my shoulder will lock up in various postures (not  weight-bearing postures). This is really getting me down—I want to avoid surgery, but it just gets worse and worse. I’ve also developed a sore neck on that side and wonder if it could be related. I was hoping you could point me in the right direction.

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Beth,

I have a couple small tears in the rotator cuff in my left shoulder, which were diagnosed by MRI. I’m going to PT 3 times a week, is there any reason not to surf? I haven’t been since I did it 2 months ago!

Thanks,

Jonathan S.

ANSWER:

Part 1:

Hey Jonathon,

Below is a response from a wonderful PT who lives and surfs here in SF. My main recommendation would be to not surf until the tears are healed as you would hate yourself if you surfed once and set yourself back another month or so. I would also recommend doing as much trunk/core fitness plus leg strengthening and cardio work to maintain a high level of fitness once you are able to surf again. Ask your PT what you can and can’t do. Check out what the pro below has to say.

Hasta,

Beth

Part 2:

Jonathon,

Sometimes Beth consults me with questions from SurfPulse. I am a physical therapist who has spent a lot of time surfing. Two months out of the water can be frustrating. Don’t worry, you will get back to surfing. I am assuming that you and your medical team are trying to avoid surgery, so at some point you will need to start tailoring your rehab for returning to surfing. I would first consult your current PT and orthopedic MD for their opinion, they know a lot more about your situation.

Before returning to surfing you will want to make sure you have full range of motion and strength without symptoms. For example, when you mimic the movements for surfing, there is no pain. If you have symptoms with the movements or afterwards, the cuff is being irritated. Small tears can progress to larger tears and this is what you want to avoid. Your physical therapy program should be addressing the mechanics of your shoulder to allow you to paddle and go from prone to standing without straining the tissues of the shoulder.

Beth is a very smart Exercise Physiologist who has done a lot of work with surfers. She can help you with designing a few great return-to-surfing simulation exercises. I hope this helps! Take advantage of the down time to cross train and get in shape with exercise and nutrition. Good luck!

Lance Harriman, MSPT Potrero Physical Therapy

(Posted 1/9/05)

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Hello,

Hey Beth,

I have something going on with my shoulder. I’ve been surfing for a couple of years, the last year pretty consistently at OB and Pacifica (2-3 times per week). For the last few weeks I’ve been going out longer than usual, sometimes up to 3 hours, and Monday morning I woke up with a sharp pain in the middle of my right shoulder. I took some ibuprofen, rested, and the pain went away. But now when I make a circling motion with my arm (like a swimming backstroke), I feel the muscles crunch and hear a clicking sound. What’s going on, and what should I do about it?

Thanks,

Jason T.

ANSWER:

Jason,

Welcome to my world, or should I say, my old world. When I was a competitive swimmer a thousand years ago and swimming 12 workouts a week, I had the same gig going on. But every night it felt like someone was inserting a knife into my arm.

Without getting a professional diagnosis, my educated over-the-Internet guess is that you have a bit of impingement going on in your shoulder- or a bit of tendonitis. I am guessing these two scenarios because you did not complain of a major blow to the shoulder area and because you have increased your surfing time. So basically, I am guessing you have an overuse injury and some swelling going on in the shoulder joint. The shoulder girdle is super complex with lots of tendons, ligaments, muscles, bursas, tissue, etc all flowing in different areas and all wanting to lie perfectly in their spot. As we surf and surf and surf and don’t ever stretch or rest, that area gets out of whack and pissed off! The clicking and crunching is often a result of this. Things aren’t flowing smooth so they make noise! If I have been surfing a ton and then finally get my butt into my yoga class, my shoulders sound like grunge music. At the end of the yoga class, they are finally quiet and well lubed.

I wish that I had known this during my swimming career because it would have saved me a lot of pain and could have improved my career! Yoga has saved my life and my shoulder, hip, back, neck, ankle… you get the idea—pains. It opens up your upper body so we don’t stand slumped forward, thins out the ultra bulky neck muscles so our head can actually turn comfortably, and allows the spine to sit properly. All of which help out the shoulders. Ice and Advil definitely help, but are more of a band-aid for the problem. You have to take a different route to prevent it from continuing.

Again, this is just a guess as to what is going on. A doctor definitely knows better than me—so go see one to make sure! I hope this helps. I apologize for the ramble session, this is just a pain I know all too well!

Hasta,

Beth

(Posted 9/14/04)

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Hi Beth,

I was checking out your stuff on the SurfPulse site—very cool. Anyway, around October 1, I surfed three lovely days in a row at OB and ended up with a sore right shoulder. It felt like rotator cuff tendonitis with the addition of a kink in the back of my neck—like when you sleep on it wrong or held a telephone between your shoulder and your ear for too long. Here it is December and I still have those symptoms. The shoulder is a bummer for paddling, but the pain in the neck is especially a bummer since it is always there.

Anyway, I did see a sports medicine MD around Oct. 10th, who also thought it was rotator cuff tendonitis, and he prescribed a set of exercises that he thought would clear it up in six weeks. He said at the time he thought after a week or so of rest I should be able to go out for “easy” surfs. Well, I live at OB so I don’t know if that is possible. I have continued to surf about 1 to 3 times a week. It’s sore but I live with it. I would love toget back to 4 times a week. And so, here is the question—if I want to avoid shoulder arthritis, should I totally stay out of the water until it totally gets better, like for 6 weeks or something? I hate to do that, but I am getting towards 40, and I really do not want face arthritis or somethingthat is permanently debilitating. Any thoughts? Thanks a ton! Robbie

ANSWER:

Hey Robbie,

Sounds like a familiar ailment. I have dealt with the dreaded shoulder tendonitis for years and believe me, it isn’t comfortable. Unfortunately tendonitis is a swelling of a tendon which can get repeatedly inflamed when aggravated. Ice helps a great deal as does Advil and rest, but you also need to be informed as to WHAT is causing the tendonitis and HOW do you fix the problem. You can continue to treat the injury acutely but you need to find out what you can do to get rid of it permanently.

For example… is it due to poor posture? Are you compensating elsewhere due to pain so you are super tight in certain areas? Is it surfing that aggravates it or are you not stretching enough? Rest will probably make your shoulder a lot happier but if taking the time off is going to kill you, I would try a few other measures. (Again this is my opinion based on your complaints. Basically, be smart and listen to your body)!

Start taking a yoga/stretching class if you don’t already. In rehab, range of motion comes first and then you start strengthening the injured area. You may be super tight. I would also try to get a few sports massages from someone who knows injury. I know of a great yoga place here in the City.

Ideally, rest is probably the number one helper but it still isn’t going to assure you that the next time you surf, you won’t re-injure yourself. Figure out what caused it in the first place and tackle that problem. Good luck and let me know if this helps!

Hasta, Beth

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Dear Beth,

One surprisingly heavy day this summer at Rockaway I had a macker crash right on my head as I was duck-diving. My left shoulder was shook like a twig and it was pushed/pulled down violently. I felt a sharp pain around what I think is my rotator cuff, in the front. I surfed a few days after that but was irritated, then took a week off with LOTS of ibuprofen. Since I have noticed tightness but not any great discomfort (sometimes hurts to sleep on it, rolls under when I’m sleeping on my side, especially after surfing a lot). Yesterday I was scrambling to get a wave and threw a stroke with all my might, feeling a similar pain. I awoke with a mildly swollen delt. I iced a bunch last night and am back on the Advil. What can I do to keep this from happening again, improve mobility and get rid of pain? (I’m already on glucosamine for the knee.) I’ll take it easy for the current monster swell but want to get back on ASAP.

Thanks, Andrew

ANSWER:

Hey Andrew,

Probably a good idea to stay out of the water as the surf is huge! I went down to Pleasure Point and caught a few fun, big ones yesterday but today is a different story.

As for your shoulder, rest is key as is Advil until the pain and swelling subside. I definitely suggest a good stretching regime, which focuses on stretching your chest, bicep, and other anterior muscle groups to help prevent the dreaded “surfer stance” with the shoulders rolling forward. Yoga is not a bad idea as you are forced to hold your stretches for a long time and you tend to get an overall body stretching experience. However, if you tore something during the initial accident, you may feel a lot of pain when stretching. If you have insurance, I would highly suggest a checkup with a Physical Therapist or an Orthopedic surgeon to rule out any tears within the rotator cuff.

I imagine you have some scar tissue surrounding your injured wing which will continue to aggravate you until you get rid of it. Again, this can be done through a series of stretches or yoga, but you may benefit greatly from a few visits to the massage therapist. Try to find someone who has a background in sport-related injuries and see if they can give you any answers. Shoulders can be tricky and if one area is tight, then you may feel pain in random parts of the joint.

Once the pain has subsided and you have regained full range of motion, I would then suggest a rotator cuff strengthening program to strengthen the opposite “surfing” muscle groups in order to create a balance in your shoulder girdle. Please consult someone to rule out any potential tears!!

Good luck and let me know if you have other questions. Happy turkey day!

Hasta, Beth

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Hi Beth,

I just ran across the site with your tips column and found some great info. I was wondering if you have any knowledge on the condition of a separated AC joint. I did it sometime ago (2 yrs maybe) and didn’t even know it. I kept up the pull-ups, some weight lifting , etc. and now it seems there’s some arthrosis there. I had major pain while paddling, so I went to the doctor. You know it’s serious if it hurts while surfing.

I believe it’s arthrosis of the AC joint. From what I’ve read, this usually follows the separation sometime later down the line. In my case I never went to the doctor to diagnose the separation until 2 years later, this past June, because I felt no pain until then.The bump was there but since I felt no pain for 2 years I continued the pull-ups, etc. at a pretty heavy rate of use on the shoulder, then last June it got to where I was in intense pain in the areas I described.

I went to rehab for the joint separation and I did exercises to strengthen the surrounding area. The pain is pretty much still there although down a notch or so. I was looking at a site on the Internet and saw the symptomsfor arthrosis of the separated AC joint and the conditions are matching. Pain in the front of the shoulder, pain going down towards the chest and going down the upper back. Also this clicking noise. Any tips rehab or treatments? Let me know. I’ll also hook you up with some Latin music CDs if you enclose your address, as I’m a marketing manager for Universal Music Latino.

Regards,

Bruce

ANSWER:

Hey Bruce,

I actually went and checked out on the Internet the difference between arthritis and arthrosis and there isn’t much of one. They are just different stages of a similar injury. Do you have pain-free range of motion when you’re not surfing? Trouble sleeping or pain in the morning? Are there any cysts formed on the bones?

What I would do is get back on a serious rehabilitative program for the rotator cuff. Sounds like you have been doing some pretty aggressive exercises for a not-so-happy shoulder joint. I would start to do the band work I assume you did post-initial injury in order to strengthen the small muscles that hold the shoulder girdle together.

The first thing you want to make sure is that you do have full range of motion and that your muscles surrounding the area are nice and flexible. If one area is severely tight, then you may have an imbalance which is causing a major pull in the shoulder area. So flexibility is key.

For right now, let pain be your guide. If surfing kills it, you may need to back off and let things rest for a bit. You may want to go back to your physical therapist and get a guideline for what needs to happen. Getting you back in the water is the goal and you don’t want to make things worse or prolong the pain by “guessing” your symptoms and the cure.

Good luck and give me some feedback.If you need some recommendations for a good physical therapist or a killer yoga class—let me know. It definitely sounds like you may need some guidance.

Hasta,

Beth

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