Llamas, Anyone?
by Robert Langley

When Shoulder Safety Doesn’t Work

By Robert Langley

Any good paddler knows to keep your elbows in front of your body; don’t reach back rotate!

Notice the good arm/shoulder/ back in these two paddling strokes

It takes very little force to dislocate your shoulder once it is in a vulnerable position. But what happened when that Class IV was a little more than you bargained for or that innocent-looking, one-foot-deep rapids turns in to a medieval rack? Now you’ve got a dislocated shoulder, a limp arm and it hurts like h*ll. Just about all paddling classes include some discussion of shoulder safety but they never tell you what to do when you screw-up. Here are some guidelines for getting back on the water after a shoulder injury.

1) Get your shoulder reduced (That’s medical gobbledygook for relocating it.) as soon as possible. The longer you shoulder is out of socket the more damage can be done. This is especially true for large, muscular individuals. All those big muscles tense up and reduction becomes much more difficult. Note that there are a lot of bad things that can happen when a shoulder is not properly reduced. If your shoulder is reduced in the field be aware of any numbness that may be caused by pinched nerves or blood vessels.

2) Seek medical attention. An x-ray can tell if all of the hard parts are intact and back in the correct place. It will take an MRI to tell how much damage was done to the soft tissue.

Note the arrow points to a torn rotator cuff, which can only be detected with an MRI

3) On your first doctors appointment ask when, rather than if you will start physical therapy. I don’t know what the right answer is but six weeks after your injury is too long. In today’s world of HMOs, PPOs, and ECPs (whatever) you will have to be your own advocate. It is imperative that you keep your shoulder moving. If you put it in a sling for six weeks hoping it will get better you will soon find yourself with a case of adhesive encapsulation. (More medical gobbledygook for frozen shoulder.) Waiting too long to get physical therapy and having loss of range of motion in the affected shoulder is a common problem.

4) Once you have started physical therapy, make your own toys. For less than the price of a typical copay you can buy or make the tools you need to do 90% of what you do in therapy at home. Augmenting your physical therapy sessions with a good home program will speed your recovery, but follow your therapist instructions about how hard to push.

5) Don’t over do it. You get three strikes with a shoulder before you will need surgery. Don’t spend them all in you recovery. Don’t immobilize your shoulder but don’t re-injure it either. Dislocations often result in rotator cuff tears. The muscles take time to heal. Pushing them to hard can be counter productive and lengthen your recovery time.

6) Settle in for the long hall. Shoulders are the most complicated joint in the body and take time to heal. Six months to a year is not an atypical recovery period with good physical therapy. Two years or longer is possible without physical therapy.

7) Once you’re back on the water make good shoulder health part of you routine. The reoccurrence rate for dislocations is very high. Make rotator cuff exercises part of you workout to help prevent re-injury.

Here we have Robert Langley "Back in the Paddle Again: