The Shoulder Journey
I will start by saying this is one approach to managing injuries fast and successfully. Obviously, I made the decisions that were best for me in my situation. So, always consult with a health professional to make sure the strategies are right for your personal situation.
Saturday, the 8th May 2021, I severely injured my shoulder.
In summary it was a complete dislocation of my left glenohumeral joint with labral tear (cartilage injury) and two fractures, one completely through the glenoid fossa and the other through the humeral head.
On Monday, the 10th May, I was back in practice, adjusting and navigating the injury while maintaining a very physically demanding role both as a chiropractor and fitness professional. As it turned out I never missed a day of practice.
Yes, I did have a colleague (thanks Dr Ashleigh O’Brien) come in and help on that first Monday as I determined my capacity to continue practice, but I continued teaching fitness classes and managed the injury exceptionally well to speed my recovery.
Luck had nothing to do with my recovery.
Having a focused passion for health and fitness across the last 20 years meant I had the conditioning and know how to stack the chips in my favour. I will share here the approach I took to speed up and optimise healing.
How it happened
The week leading up to the 8th May was exciting for surfers all along the east coast of Australia. The swell was large and I for one was very interested in a couple of locations that were potentially more suited for bodyboarding on the larger swells.
I had been keeping tabs on a reef break called Dickies Reef at Moffat Beach. I drove down early enough and saw two stand-up surfers paddling out to the reef. The reef looked too full (too much water – high tide). I grabbed a coffee and watched the reef for 45-minutes as the two surfers struggled to catch anything at the reef.
I decided to tie the surfboards to the roof racks of the Ranger as they were in the tray, and I popped my bodyboard and fins (flippers) on the grass. I was in a rush to find somewhere to surf and took off towards Point Cartright. I got a fair distance up Nicklin Way when I realised I had left my bodyboard and fins on the grass at Moffat Beach.
So, I did the big U-turn and went to collect my forgotten equipment. I was pleased to find the gear where I had left it and chucked it in the back of the tray.
I often consider that the universe turns us around for a reason and I decided it was a message to check out a couple other surf spots closer to Moffat Beach. I checked Dicky Beach to not much avail and then I headed to the Currimundi river mouth and wow!
It was top to bottom barrels up to double head height and not very many surfers or bodyboarders there to compete with. I couldn’t get in the water fast enough!
I ran to the car, chucked the wetsuit on, grabbed the fins and the bodyboard and ran very quickly back to the river mouth and paddled into the surfing line-up in moments.
I asked the few lads out there how it was all going, and the consensus was it was “big and fast” which was music to my ears. To me that meant they were uncomfortable with the conditions, and I was ready to charge into some massive barrels.
I caught two waves first, a left-hand and then a right-hand barrel and was super happy with how the waves were lining up.
A larger set of waves came through and I paddled deep into position and took off on what I still consider to be the best wave I have caught on the east-coast. The bottom turn was explosive, and I lined up beautifully along the wave, the lip of the wave barrelling over the top of me, easily over head-height, and I thought to myself “this is living!”
Then as it does sometimes happen a second little lip formed on the wave, and I used it as a little ramp to pop off and spray the water in a cut-back manoeuvre. With the force of the water and the positioning of my left arm in flexion and internal rotation, as I extended my left limb away from me for the cut-back manoeuvre, it turned out to be the perfect position to dislocate my shoulder.
I felt the left shoulder clunk in an unusual way and immediately knew that was not a trivial clunk. First though was ‘I should have authorised the income protection’ second thought was ‘what am I going to do on Monday’ and then I thought ‘better check the shoulder is dislocated before I catastrophise’.
All this went through my mind before the amazing wave engulfed me and put me through the washing machine. I was holding my arm before I surfaced and took the moment to look at where my upper arm was situated. Sure enough the shoulder deformation was there to suggest that my humeral head was sitting underneath my glenoid fossa (the socket the humeral head should sit in).
I had assisted relocations in previous first aid encounters. But for the life of me could not create enough downward traction to affect a relocation on myself. I was still at the mercy of the ocean at this point and recognised it was time to paddle myself in to get some help.
I ran up the beach with my fins still on to the confusion of a couple who were strolling along the beach, and I will always remind the look on their faces once they recognised that my left shoulder was not where it should be.
I got to the lifeguard tower where the lifeguards had watched me run up the beach also confused with why I was running in fins. It was apparent when they came down from the tower. They were both impressed with my composure especially given this was my first ever shoulder dislocation. Of course, I was quite aware of what was happening and the steps to follow with my Chiropractic and fitness background.
Unfortunately, the lifeguards were unable to physically help me with the relocation respecting their jurisdiction and could only call me an ambulance. I sat down and attempted the traction down and external rotation manoeuvre to no success.
Another option is to lay face down and let the arm hang vertically down, so the muscle relaxation and weight of the arm allow for a relocation of the humeral head back into the glenoid fossa (the socket). At Currimundi there are three permanent stools there to enjoy a beverage while looking across the ocean. I lay uncomfortably across all three to reproduce the lying face down manoeuvre. After almost 20-minute I was too uncomfortable from lying that I chose to sit up and it was during this transition that my shoulder relocated.
It was a great mental relief that the relocation had happened. The lifeguards offered me an icepack to control the inflammation and potentially act as light analgesic which I accepted while waiting for the ambulance to arrive. I was also pleased I had no changes in sensation to my arm or hand indicating potential nerve or vascular injury.
The ambulance arrived maybe 15 minutes after the relocation. He wasn’t sure due to my composure and vitals that there had even been a dislocation to which the lifeguards could attest. I took a quick opportunity to thank the lifeguards and get changed out of my wetsuit and into some dry clothes before heading to the emergency room at Sunshine Coast University Hospital. I noted I could still put my t-shirt on over my head at this point too, which was a great sign.
Upon arriving at the emergency, I was offered and took the neurofen to aid with any oncoming discomfort. I remember trying to call my wife a few times to let her know what had happened but as it turned out she had her phone on silent and would be oblivious to any of the event until I came home later that day. I was in the hospital for the best part of 3-hours. I was hoping to get an MRI to get a clear picture of the internal injury, but the emergency department doesn’t have access to those facilities. The x-ray did show a bony fracture at the lower part of the glenoid fossa and other indicators of labral injury (cartilage injury).
I was given a sling to support the shoulder in the short term with recommendation to follow up during the week for further medical opinion. Once discharged I had to call my friend Andy to take me back to Currimundi to pick up my Ranger and drive it home. It is fortunate that I have an automatic car for the drive, but truth be told my arm and shoulder at this point were still very comfortable and functional.
I arrived home and Savannah, my wife, was entertained by the whole ordeal but pleased I was still very comfortable and functional. To the point that I took the surfboards off the roof rack of the Ranger and washed up my wetsuit.
The Recovery Strategy
The recovery process was an opportunity to demonstrate what the body is capable of when managed well, stimulated the correct way, and nourished in a way that allows it to flourish and thrive.
There were still a couple of unknowns in the case management for me after being discharged from the emergency. What soft-tissue damage was there and if there was what intervention was best for myself and the business?
These would be clearer across the week as I accessed advanced imaging and consulted the right professionals.
The take home here is that there are strategies we can implement immediately to improve the outcomes from an injury.
The strategies I engaged included strict ketogenic diet free from sugar, dairy and wheat. Alcohol free and caffeine free regime (truth be told I have not had a caffeinated coffee this year – well once but that was an accidental and it buzzed me hard!). I pursued chiropractic care twice weekly, Chinese medicine and acupuncture weekly, magnesium floats every two-weeks, a strong herbal and nutritional supplement regime, clean water and nearly daily exercise.
The Ketogenic Regime
Engaging a ketogenic regime free from dairy, sugar, wheat, alcohol and caffeine decreases the bodies inflammatory load consequently leaving more energy to be spent on resting and repairing. I started my ketogenic regime immediately.
I also utilise intermittent fasting to allow the body to spend extending periods of time in the reparative state. I typically go with an 8-hour eating window and a 16-hours fasting window. During my ketogenic regime food is fuel. Typically, a protein source like eggs, chicken or fish combined with vegetable driven salads. Very little if any fruit to keep the carbohydrate load down too. What carbohydrates I did consume came from vegetables most notably sweet potato.
How did I know I was in ketosis? I use a skin-prick test for blood sugars and beta-hydroxybutyrate (BHB). BHB reflects whether the body is in ketosis or not. The aim with the ketone strips is to be in ketosis not a severe ketosis, meaning the bigger the BHB recording does not mean better ketosis, in fact it probably suggests ketosis has gone too far.
As for the dairy, (refined) sugar, wheat, alcohol, and caffeine, all are inflammatory and take energy that could otherwise be used for healing the injury at hand (or shoulder in my case). Sure, some people can tolerate some of these food groups better than others but at the end of the day if optimising health none of the above foods are essential nutrients in our diet.
Clean water is essential too. We use a Zazen water filtration system. I can’t express how important to drink clean water as opposed to tap water.
To me this is obvious. For many who have made it this far through the blog it may be something to consider each time we experience trauma, physical, chemical or emotional.
It is our nervous system that co-ordinates all functions of the body and integrates all systems. The nervous system is the only system that co-ordinates directly with all other systems, so it is absolutely integral to nurture and optimise. This is the role of chiropractic care. Always has been, always will be.
The chiropractic adjustment restores function to the spinal column primarily, where the vast majority of our peripheral nervous system innervates. By stimulating the spinal column chiropractic care can optimise function of other systems like the musculoskeletal system or the digestive system.
Dr Carmen Atkinson, my chiropractor, is fantastic with adjusting the extremities too (the arms and legs). With an extensive endurance athletic career, she also understands the benefits of chiropractic care for not just optimising recovery from injury but optimising performance while competing in endurance events.
I pursued chiropractic care twice weekly for 12 weeks while navigating the shoulder injury and without a doubt it truly accelerated my recovery. I believe increasing the frequency of care is totally indicated following new trauma (physical, chemical and emotional).
I have been consulting Chinese Medicine and Acupuncture for a couple years now as part of my wellness regime. In the same vein as chiropractic care, I increased the frequency of Chinese acupuncture following my shoulder injury.
Interestingly enough my primary Doctor at Bloom Chinese Medicine and Acupuncture, Dr Grace Jones was not available, but Dr Renee Knott was and we embarked on care around mobility of the shoulder and to support my body to heal.
I have had training around Chinese acupuncture strategies to target a region from another area called reciprocal regions. I frequently presented with a current functional limitation in my shoulder range of motion and Dr Renee would use acupuncture in other regions like my right shin, foot, and thumb to improve function in my left shoulder while I was performing an activity. It was truly remarkable the changes we both observed and while I was aware of the technique it was next level to really experience the changes. They were for the best part immediate for me.
Dr Knott used acupuncture around my left shoulder and cupping on multiple occasions to support ongoing care.
Magnesium floats have been part of my wellness regime for the last 6 years. I initially started them in Western Australia and my first impression was disappointing. My low back was very uncomfortable for the first session, and I considered forgoing the next two appointments I had pre-booked. I was however still aware of the benefits and pushed on with the following two session that became increasingly more comfortable, relaxing, and rejuvenating.
Magnesium has multiple benefits but in short facilitates many systems. Magnesium is involved in over 500 different chemical reactions in the body and we turn magnesium over rather quickly. Magnesium gives our body the capacity to switch off, the antagonist of calcium that turns systems on. For example, calcium causes muscle contraction and magnesium facilitates relaxation, so when we are low in magnesium, we are prone to muscle cramping. The same can be identified in our nervous system too.
The float pods are fantastic for sensory deprivation, allowing us to rest deeply and consequently lowering hormones like cortisol which are beneficial for keeping inflammation low and keeping the immune system reigned in but at chronic high level slow healing and inhibit deep restorative sleep.
During my recovery I was floating once every 2-weeks and I continue to float every 3-weeks for my wellness too.
Supplementation is powerful when utilised well. My goal with nutrition and supplementation is to have all the building blocks available for repair and regeneration and then push the accelerator with other herbs.
My base of supplementation has been what ATP Science call the 4-pillars of health. Daily I supplement with ATP Science Vital Foods, their high quality multi-vitamin, ATP Science Gutright, their high polyphenol modbiotic product that supports amazing gut health, ATP Science Immune RX, their immune system adaptogenic support that improves the functioning of the immune system, ATP Science Golden Oil, their turmeric oil that captures omega 3, 5, 6, 7 and 9 and ATP Science Z-Mag, their zinc, magnesium, selenium and taurine supplement. This covers the building blocks daily.
I used Metagenics Bio Absorb PEA (palmitoylethanolamide) which is great for support in nerve pain and inflammation. I also used Metagenics Inflavanoid Sustain care for pain and inflammation too.
Further to that I made sure I was using ATP Noway protein, a bovine derived collagen protein using the Bodybalance registered collagen peptides that improve absorption and utilisation in the body.
Then to push the accelerator I use ATP Science Alpha Jupiter which is marketed as their male hormonal supplement. The component in this product that I love so much and does help with hormonal profile in both men and women but more specifically increases the cells affinity for nutrition is shilajit. Shilajit increases microchondrial biogenesis and increases CoEnzyme Q10 in the mitochondria by more than 1500% compared to supplementing with CoEnzyme Q10. In simplicity, this makes metabolically active tissue, like a new injury, super hungry for building blocks so repair can be accelerated.
I don’t use the metagenics products now I have recovered but for the most part am still on all the ATP Science products. I cycle off Alpha Jupiter every three months.
I will keep this section simple.
Les Mills Bodypump saved my shoulder. Yes, I am affiliated with Les Mills as a trainer for Bodypump, RPM and Sprint but without hesitation, the consistency with which I have trained over the last decade with Bodypump is a major contributing factor for my shoulders successful recovery.
Return to early activity is critical. Cardiovascular training at minimum. I returned to teaching Les Mills RPM on the Monday after my shoulder dislocation, participating in RPM again on the Tuesday, Les Mills Sprint on the Wednesday and Thursday, replaced my Thursday mid-morning Bodypump class with RPM and participated at home with a modified Bodypump.
I continued with this regime for 3 weeks including two Bodypump classes at home per week. After 3 weeks I returned to leading Bodypump fitness classes twice a week and still do now.
How did I modify Bodypump?
Essentially made sure all movements remained under shoulder height and were not causing pain. Those who have worked with me in the practice around shoulder rehabilitation know that I’m a strong advocate for under shoulder height being high-yield and low-risk versus over shoulder height being high-risk and low-yield.
Barbell squats became plate squats, clean and press became barbell rows, shoulder presses were upright rows.
Eventually upright rows became high-pull movements and then plate clean and presses before eventually re-engaging barbell clean and presses.
I could still perform chest press and push ups with the knowledge that execution targets the chest and less into the shoulders.
Tricep manoeuvres utilised barbell extensions, tricep pushups (on the knees to start), kneeling kickback rows and modified or seated dips.
Biceps performed well and abdominal training removed all shoulder rotational moves.
It was about 6-weeks before I could get a light barbell up and over onto my shoulders and probably 8-weeks before full heavy training had resumed.
The only other activities included spike-ball therapy on the shoulder girdle and the broomstick into the arm pit (I can send a video demonstration on this if you are interested!).
The exercise was calculated and progressive. I was patient with my body and at multiple times I was tempted to jump back into the higher levels of activity but knew that experiencing a setback may prevent me from 100% recovery.
The MRI taken on the Tuesday after the injury clearly showed the cartilage injury and the two fractures. All three professionals including the radiographer, the Sports Medical Doctor and Orthopedic Surgeon were impressed with the health of the rotator cuff which I attribute to Les Mills Bodypump. The Sports Medicine Doctor and the Orthopedic surgeon had recommended surgical intervention on injuries with far less damage as displayed on imaging, but both agreed that because I could exercise pain-free within days of the injury that surgery would not have me in a better functional position ever.
Within 10 weeks I felt confident of my healing and function but held off returning to surfing until 12 weeks (it was 13 weeks technically as week 12 wasn’t a good surfing week).
The strategies and suggestions made here are for example only and you should discuss options with your health professional to make sure these strategies are best for your situation. This regime got me back to full function fast with no time away from work. I’m stoked.