Grade III AC Separation - your experience?

I went down hard over two years ago - Ive told the story before but I ended up obliterating my hamstring, separating a bunch of ribs as well as my shoulder.

At the time my shoulder was diagnosed as a Grade 2, maybe 3 AC and while it was injured, non-surgical options are the normal path. Fast forward over two years and the damn shoulder is still a big problem. Ive crashed a number of times since and the result is that my shoulder is now a very clear Grade III (1.0cm more than the other shoulder). I was xrayed last week and while the separation is worsened, the shoulder seems to be mostly stable in that it isnt terribly worse under load (although it does separate another 5mm).

Im riding with it as is - its a bitch! The pounding it takes on steep gnarly stuff is real. Lately its been hurting a lot during and after each ride, especially if I have a decent push up (like I usually do!) and Im have to lift the bike, which is why I went in for a reassesment.

It seems to be right on the line between surgery or not. Ive been reading journals (background in this) and I think that I stay the course and not have surgery. Concerns are that surgery will mean about 4 mos recovery and that fixing the AC will increase risk of clavicle breakage when I crash again. In addition, it seems that delayed surgery isnt as successful as right away.

For those of you who have found your way through Grade III ACs, what did you do and how did it turn out? My current plan is to stay the course but I would not expect that someone who rides a lot, on the Shore and in the Park (especially as poor as I do!) etc... can make it through years of riding with a Grade III. My guess is that its inevitable - and in that case doing it when it must be done is the plan.

Lets talk about AC Joints!!!!

what type of rehab are you doing?

I did sooo much physio after the crash - roughly 9hrs a week in the clinic for 5 mos and at least that much outside of the clinic in parallel. Then I stopped 6mos or so in. Half or even more of that was for the hamstring (it wouldn’t fire at all without electrical stimulation for 4mos, I lost all ability to contract it) but I’ve recently restarted the normal elastic band rotator cuff work. It won’t help the AC but it will help stabilize the shoulder in general. Not much else to do. ACs don’t heal.

Yep I know they don't heal past a certain point of being stretched, I was more interested in what specifically you are doing to increase the stability of your shoulder girdle while it is under movement and being stressed. A good physio would develop a rehab program to help with the stabilization of your shoulder girdle and that extends way beyond band work for the rotator cuff. I'd suggest either getting on your physio's case about your rehab program or finding a new physio to get you the help that you do need. Also don't just go into the gym and start throwing weights around thinking you might be helping, with a hyper mobile AC joint you first need to learn how to keep the shoulder girdle and AC joint stable through basic movements first before you're ready to start tackling exercises that put more demand on the AC joint. Then danger is that with activities such as MTB you could be causing micro trauma which over time will lead to greater instability of the AC and maybe a compulsory surgery to repair the damage.

Agree. I’ve been contemplating a new physio. 

Any suggestions? 

I’ve been thinking Tri Peaks Physio. Seems to be knowledgeable on MTB injuries.

Unfortunately I don't really have any recommendations for a specific physio, but there are a few things to look for when considering any sports rehab specialist.

1. they should do a work up and give you a diagnosis with some detail as to what's the issue is
2. they should devise a rehab plan and give you some idea of timeline and progression, although it may not be able to be very accurate depending on the nature of the injury
3. they should be doing regular follow up to see how the rehab is progressing and if it isn't either review the diagnosis or revise the rehab plan

I'd say to anyone that if you aren't seeing some level of measurable progress after a few weeks and somewhat regular progress after that and your physio is not re-evaluating you to see why you're not progressing then it may be time to consider another opinion. If it seems like your physio is not doing much more than giving you some heat/cold therapy, TENS or ultrasound and simply putting you through the motions then leave and find someone else. The caveat to that is that you as the patient MUST do your homework, otherwise even the best physio will have limited results.

Think of it this way, if the alignment on your car was way out and all your mechanic did was sell you new tires every few months would you keep going back or would you look for a new mechanic?

/\I wish somebody had told me this before I went through years of physio with an ineffective therapist. Spot on.

Just like medical doctors, they vary in quality (What do they call the person in medical school who graduates at the bottom of their class? Doctor!). Don't hesitate to swap out therapists, you don't have time to not be making progress.

Im over two years post injury so whatever has deteriorated between injury + 6mos and now is my fault alone, but I was not left with anything to do other than band exercises - which are semi-helpful at best.  I think that the slide in the recent many weeks is from going over again (and again) and tearing it further.

Im resuming physio type exercises and wouldnt mind having a new physio look at it to develop a plan to maintain status quo the best I can. Syncro, Im sure that you are right that its being damaged - even forgetting about when Im flying over the bars; the pounding cant be good for it.

Anyone had surgery for a Grade III? Its not my plan but would be interested to hear how it unfolded. I sort of view it the same as when the dentist tells you that your filling is looking a little old and should be replaced. Nothing will ever be as good as your natural tooth and once you start grinding that out more to make room for a new filling, the clock starts on when you need a crown! Same for this - I think that surgery for AC starts the clock for when a clavicle breaks. But maybe Im wrong?

Posted by: Ddean

Agree. I’ve been contemplating a new physio. 

Any suggestions? 

I’ve been thinking Tri Peaks Physio. Seems to be knowledgeable on MTB injuries.

Dude ya that's a bad injury . As someone who has spent alot of time and money at a sports physio switching up can be a good idea.

Jen Turner or Sarah Jung at Moveo have been effective, they are who I use. Luckily haven't been in in a while.

Christ, I had a grade 1 & it was painful enough. Good luck on the recovery.

I hurt both shoulders a few years ago, but at different times.  The first time I did physio and it wasn't good; that shoulder isn't right.  With the other shoulder, I went to sports medicine physio and that shoulder is fine.

Both were grade 2.

Only thing I can suggest is an Xray to check the degree of separation, and then a doctor or good physio to see if there is a non surgical option for recovery.

Shoulder injuries are quite common in contact sports (and even somewhat common with bikers), with those athletes able to achieve recovery.  There should be a proper treatment to get you back to, or close to, normal.

Thanks switch - yes it was xrayed and diagnosed when I was injured and they did a full set of xrays and an additional diagnosis recently again - confirmed grade III AC right now with 1cm of separation and 5mm of additional separation under load. I wish that I could say that it’s the only injury that continues to plague me, but it’s one of a few things so it gets lost in the noise and seems normalized. 

I think what I’m going to do is get a referral to a sports Med to discuss if my plan of no surgery (which includes lots of riding and occasionally flying over the bars) is realistic with a Grade III but also look into a good Physio. Thanks Brock - I’ll look into your recommendation.

Check out Jay Inouye at Performancelab Rehab.  He was recommended to me by several co-workers, one of which dealt with extensive shoulder problems for about 15 years before seeing him.  He couldn't say enough good things about him.

My issue was piriformis syndrome, and with one session he was able to set me straight, and provide mobility and strength work to maintain the situation better on my own.

He was on the medical team for the Toronto Blue Jays at one time (in the Delgado days), and is very familiar with shoulder injuries as a result.

Man, I bet we're all a bunch of trainwrecks on this forum. Been nodding along to the injury descriptions.

Careful about that old hamstring injury too Ddean, piriformis pain is no joke. (Be very interested to hear about your fix for that idle). Keep those hips loose. Btw, my grade 2 shoulder was 3 years before full function, and still requires daily attention. Maybe wait it out a bit longer before considering the scalpel?