Friday, 22 September 2017

AC joint recovery, progress and protocol

It’s coming up for 8 weeks since I separated my shoulder. I’m delighted with my progress and although I’ve obviously got a long way to go yet, I’m a lot further along at this point that I expected.

Even two weeks ago, although I was doing some gentle endurance type climbing on my wall and an ever increasing load of rehab exercise, I was still unable to load my shoulder dynamically without some pain. How it would respond to ‘proper’ climbing i.e. 100% effort, with dynamic loading still felt like a big unknown.

Now, I feel rather more confident that I will be able to recover really well from this injury. I can campus without any problem, complete a half one-arm pull-up and have managed to get up some of the ‘medium-hard’ problems on my board. Fewer and fewer moves are causing pain and strength is improving daily. It will still take quite some time to recover 100% of the strength lost. But my day-to-day work is feeling less and less like rehab and more like real training.

I also just had my first day back out at the crag which was a huge boost. Through experience I’m well equipped to cope with the enforced break from my normal routine of outdoor climbing that is so important to me. But ‘coping’ is the key word. It takes active effort to get through the stress of deprivation from being outside in nature and doing that you love. So when you can stand outside in the quiet of the north west, smell the autumn air and dangle about on a cliff preparing a new route until the sun sets, it feels like a huge weight is lifted.

Just this experience is like the sun coming out in my head. Both body and mind are telling me it is time to GO.

 i.e. Go climbing.

A lot of people have messaged me asking to know exactly what I’m doing for my rehab since the results have been good so far. Obviously my program is personally tailored to me, but here is a quick list of the bulk of what you need to know. You’ll see that none of it is rocket science, but also very easy to get wrong in our modern way of life.

There are three central foundations on which the rehab protocol are built. Sleep, nutrition and stress management. The detail of much of this is described in my book Make or Break. But aside from the myriad of sleep hygiene tactics, the main issue for me is just to enforce a hard bedtime to ensure I get at least 8 hours of quality sleep (not just time in bed) with no exceptions. Nutrition wise, I eat what most would describe as a Paleo type diet, although I certainly don’t set out to follow the Paleotm rules. Basically I just eat unprocessed foods - lots of red meat from properly raised animals, lots of leafy green vegetables, lots of eggs and high fat dairy depending on my energy needs. I’m glossing over a ton of detail here but broadly I eat this way for three main reasons. It helps me maintain my weight without having to constantly watch my calorie intake. It is generally anti-inflammatory and this makes a huge difference to recovery from injury or training in general. Finally, it makes it a lot easier to make sure I get all the nutrients in abundance. For geeks, Marty Kendall’s site is a fantastic tool to explore various options for getting your nutrition right. Cronometer is also a great tool for monitoring. I also try to actively limit stress. Getting injured and then trying to recover is already stressful enough and I can see the physiological effects of this quite readily. Lowering the allostatic stress load is important to give your body a chance to heal. In practice this means getting the above factors right, making some space for relaxation and managing my work as well as possible. The biggest challenge in my case is that time spent outside at the crag is possibly the biggest stress reducing behaviour in my life, and being injured tends to remove it! Although I did make an effort to have days outside as soon as I could, I definitely could have done more to get outside earlier in the rehab process.

On top of this foundation comes the exercise protocol. I’m not going to go into the detail here because the principles are in Make or Break. On top of the basic shoulder rehab exercise program, I went for testing with my physio every three weeks to identify weak areas and extra work needing to be done as I progressed. But once I could tolerate movement of my arm I started climbing immediately, but very gently, just moving round a vertical wall covered in jugs. So easy I didn’t really need to pull with the arm at all, and only for a few minutes a day. Each session I could do more, progressing to quicker (or more accurately less-slow) movement and then to a slightly overhanging wall and eventually to moving slowly on a 45 degree wall. I tended to find with almost every new stage of the progression that the first session introducing a new level gave some soreness, but subsequent sessions were fine and I could consolidate that level over the following days.

Off the wall I maintained a daily routine of a standard shoulder rehab protocol - rotator cuff, back and arm exercises with bodyweight, dumbbells, bungee cord and rings. For an AC joint rehab, chest presses, press ups and dips were the very last thing I was able to add - not until 7 weeks and even then very gentle. However, pull-ups were tolerated far earlier. I had a good setup with my rings and feet supported on piled up boulder mats to take weight off. In the first 3 weeks I did assisted one-arm pull ups on the good arm, then two arm static hangs on bent arms, then assisted two-arm pull ups, then unassisted building up from sets of 5 to sets of 20, then one arm locks on the injured arm, and at this stage I can do 50% of a one-arm pull-up. Standard progression. Clearly, someone who was unable to do one-arm pull-ups before the injury would have a progression at a lower level, for instance with a more drawn out progression of assisted pull-ups and then progressing through low numbers of unassisted.

Over all I would say that I have done 2-3.5 hours of work per day, just about every day. Not all of this was hard exercise on the shoulder of course - that is a total of everything, from grip-strength work to hip stretching. There was no hard and fast rule to progress other than monitoring how the shoulder felt during the session and how well it recovered the next day. The only time I felt I’d overdone it was actually in week 7, adding too many dips and press-ups too quickly. I needed to take two full rest days before continuing, and after that left those particular exercises for another week. I was careful to complete all the rotator cuff, scapular and back exercises in my program before doing the climbing related ‘fun’ stuff. It’s all too easy to just climb and ignore the real work.

Now at 8 weeks I am starting to climb and focus on real climbing goals and days out at the crag rather than just rehab goals. So I need to continue to be careful to schedule in the rehab exercises  on days at home, so that they don’t slip off the radar and slow my continued progression.

I must say, 6 weeks ago I could not even imagine the position I am in now. I felt so awful and disabled at that point. If the next 6 weeks brings anything like the same consistency of progress that will be fantastic.


  1. Wish you a fast recovery Dave! As you've proven it's not always dh riding that leads to tossy3 injuries... ;) good to see you rehab so intense and I'm sure you are going strong again soon.

    Cheers Marco

  2. Hey Dave, stumbled upon your site. Just last week I seperated my shoulder and the ortho said its a 2 degree. I found a post from another person stating he was gonna use KY tape to hold the displace ac joint down to heal faster, Do you think this would help? Thanks

  3. I wanted to say that I have loved this blog.Very informative post with lots of information included in
    the posting.You have made some really good points here ! Please find our link ,if you may be interested
    in ,please refer to
    Personal Care Homes Mailing list & Email list