AC taping/brace

[Mr Punch]

Type 3 AC separation in 5th week. My good shoulder's 4mm, the separated one got to 12mm apart, now the doc's stopped taping after a month (which seemed to be his arbitrary decided time to do so as opposed to anything based on observed recovery) and has "settled" at 10mm. Still seems awful big to me. Rehab exercises seem to be going well though: pain decreasing, mobility increasing every day.

Question: is it worth buying an adjustable shoulder brace to further pressurise the clavicle into the acromion bearing in mind it'll take another week to get here at least, or is most of the tissue damage mostly going to be stabilised by now?

Cheers!

[taai gihk yahn]

I wouldn't fixate so much on the distance of the spearation, I would focus on functionality - in other words, how is the inherent stability and dynamic usage? if bracing improves this, then it's probably a good idea to utilize it until u r back up to speed (meaning that the brace should b used in conjunction with time out of the brace to improve function w out it); since this wil probably take more than a week to achieve, seems reasonable to get the brace...

another thing: ur rehab needs must include treatment of not only the local AC joint and associated muscuature, but also things like scapular mobility / stability, scapulohumeral rhythm, rib cage mobility (during breathing and active arm / spinal movement), also latissimus, serratus anterrior, and lower traps should all b cleared; a good therapist will also clear spine and pelvis, as they will be involved in any compensatory strategies

[R]

Managed to pop the left twice and the right for the third time a couple of years ago.

The degree is related to the relative amount of tearing (if the Dx is based on something other than the docs opinion:' ). A third degree suggests tearing of the AC capsular ligaments, the conoid and the trapezoid ligaments. Now if that is the case you will likely have a permanent deformity (I had 2nd degree tears and still have drops at both AC joints). The pain goes away and the mobility returns. I don't think there is anything that will fix the drop other than surgery and that has not been shown to do much over the long term.

Brace it if you like but I would guess that when you start getting knocked about the drop will settle at a distance and stay that way with use. Might scar/tighten up a bit over time but if the structural elements are torn to that level I don't think there is really much you can do about it if you are going to be particularly athletic.

Hope this helps.

Personally I keep playing rugby and the AC does not affect my tackling (or my judo/wrestling/KF). :' )

R

[taai gihk yahn]

Managed to pop the left twice and the right for the third time a couple of years ago.

The degree is related to the relative amount of tearing (if the Dx is based on something other than the docs opinion:' ). A third degree suggests tearing of the AC capsular ligaments, the conoid and the trapezoid ligaments. Now if that is the case you will likely have a permanent deformity (I had 2nd degree tears and still have drops at both AC joints). The pain goes away and the mobility returns. I don't think there is anything that will fix the drop other than surgery and that has not been shown to do much over the long term.

Brace it if you like but I would guess that when you start getting knocked about the drop will settle at a distance and stay that way with use. Might scar/tighten up a bit over time but if the structural elements are torn to that level I don't think there is really much you can do about it if you are going to be particularly athletic.

Hope this helps.

Personally I keep playing rugby and the AC does not affect my tackling (or my judo/wrestling/KF). :' )

R

if u keep "popping" them, it is a strong suggestion that you have limited mobility somewhere in the system - for example, not just at the AC due to scarring, but at the sternoclavicular joint, which limits the ability of the clavicle to move w the acromion; or perhaps there are other areas in the costal cage, or scapular mobility is compromised, etc.,

my suggestion would b to get screened / treated by someone knowledgeable in looking at the body not just in the area of injury, but globally as an interconnected unit (could b a PT, altho most suk; a skilled osteopath, or chiro who does more than just spinal HVLA; a Rolfer, or tuina guy could b fine as well); the rationale is, altho ur AC my be beyond hope, if u get optimal mobility at all the relative areas near and far, u might see a marked difference in terms of the ceidivism u r demonstrating - personally, I would look into it, bec in a few decades u might be looking at some major surgery like a total shoulder if the pathomechanics start causing chronic breakdown of the glenohumeral joint (which relies on good clavicular mobility in order to move through it's own range);

just sayin'...

[R]

if u keep "popping" them, it is a strong suggestion that you have limited mobility somewhere in the system - for example, not just at the AC due to scarring, but at the sternoclavicular joint, which limits the ability of the clavicle to move w the acromion; or perhaps there are other areas in the costal cage, or scapular mobility is compromised, etc.,

my suggestion would b to get screened / treated by someone knowledgeable in looking at the body not just in the area of injury, but globally as an interconnected unit (could b a PT, altho most suk; a skilled osteopath, or chiro who does more than just spinal HVLA; a Rolfer, or tuina guy could b fine as well); the rationale is, altho ur AC my be beyond hope, if u get optimal mobility at all the relative areas near and far, u might see a marked difference in terms of the ceidivism u r demonstrating - personally, I would look into it, bec in a few decades u might be looking at some major surgery like a total shoulder if the pathomechanics start causing chronic breakdown of the glenohumeral joint (which relies on good clavicular mobility in order to move through it's own range);

just sayin'...

Appreciate the advice :' )

In this case the cause has been invariably trauma.. been jumped on and landed on by guys 15 stone (225 pounds) +with my arm in a compromised position. Also had a major rotator cuff tear after getting caught with a wicked drop seo nage in a match. But not to worry. Full ROM and muscle strength in the shoulder and girdle. Good spinal mechanics and no functional loss. Being 53 weighing about 150 pounds and playing rugby every weekend seems to be the major factor in my being re-injured relatively regularly. Fingers crossed nothing got hurt at all last season!!

Oh and by the way. I am a manipulative physio/physical therapist who has post graduate training in a variety of areas. Worked as the physio for a rugby club for 5 years and I am very familiar with these sorts of injuries so post-injury rehab was not forgotten.

;' )

You are correct though that too often people don't look at the big picture.

IMHO there are two major causes of problems. Trauma (which you have limited capacity to control) and the long term failure of the body to cope with all accumulated stiffness/poor movement patterns/weakness we acquire through our lives. Personally I feel that the structural approach is good but limited. That's why I get so many patients who have failed when they have only received the passive treatments offerred by less progressive approaches. Of course I am not talking about illnesses etc as these are obviously a different ball game.

Just sayin :' )

[Mr Punch]

I wouldn't fixate so much on the distance of the spearation, I would focus on functionality - in other words, how is the inherent stability and dynamic usage? if bracing improves this, then it's probably a good idea to utilize it until u r back up to speed (meaning that the brace should b used in conjunction with time out of the brace to improve function w out it); since this wil probably take more than a week to achieve, seems reasonable to get the brace...

Cheers Chris, was hoping you'd be around. I have a semi full range if movement. I can move it in any direction standing in a stable posture, but still have trouble from different positions. E.g. I can put my hand over my head, but I can't bend into a yoga side bend on the opposite side to the affected shoulder. I don't know if the brace would help with that position: I'm well enough practiced with relaxing parts of my body to be able to relax the shoulder enough to get it in that position and when I'm being manipulated I suspect I wouldn't be able to go much further in that direction even with the Physio acting as the brace if you see what I mean.

I suspect the brace would offer me the support to be able to move quicker, but as a mug's guide the way I understood the rehab protocol it's ROM, strength, strength over full ROM, endurance, speed...

another thing: ur rehab needs must include treatment of not only the local AC joint and associated muscuature, but also things like scapular mobility / stability, scapulohumeral rhythm, rib cage mobility (during breathing and active arm / spinal movement), also latissimus, serratus anterrior, and lower traps should all b cleared; a good therapist will also clear spine and pelvis, as they will be involved in any compensatory strategies

As for my rehab needs, I think you've just insulted 2000 years of samurai "ganbare" spirit and should therefore offer to fall on your own blade before cutting your own wad off. Taping, depending on which of the six physios I got on the day, consisted of a pad of cotton laid lightly or tightly jammed in anywhere from the top of the trapezius to the acronomion itself and secured with two short Elastoplast bandages.

Again, depending on the day, rehab has accidentally activated my shoulder blades occasionally, but otherwise you may well be talking Swahili.

They haven't really told me any exercises to do, but I've been trying to keep as much of the affected area and my back activated in some way since Day Three (they basically told me not to move at all for a month, but being a pigheaded **** I've been trying to get my ROM back since then).

[Mr Punch]

R, thanks to you too.

My degree was based on the distance on the X-ray. At the four-week assessment the doc looked at the X-ray, surprised himself that it hadn't changed so much, measured it again to be sure, asked me how I felt (not to show him any movement or anything) and said he was going to stop taping it anyway as they were going to start the rehab manipulation (as though you can't tape it and just take the tape off to do the rehab as I had been doing since week three...).

As you can probably gather, I'm only asking such an important question on here because I don't have access to anyone I have trust in.

I could go on with a list of the things I'm dubious about with this guy (doing sit-ups for a herniated lumbar disc etc)...

I am heartened by your confidence I'll be back up and at em in good enough time!

[taai gihk yahn]

[QUOTE=R;1129267]Oh and by the way. I am a manipulative physio/physical therapist who has post graduate training in a variety of areas.
what kind of stuff? (Maitland, Cyriax, Kaltenborn, Mulligan? etc., etc.)

Worked as the physio for a rugby club for 5 years and I am very familiar with these sorts of injuries so post-injury rehab was not forgotten.

cool;

You are correct though that too often people don't look at the big picture.

understatement of the century...of course, what possible influence could the pelvis have on the shoulder

That's why I get so many patients who have failed when they have only received the passive treatments offerred by less progressive approaches.

heck, even if the passive treatment they had bef they saw u was good, u'd c the body "run with it"; sometimes, I'd get these people with long standing ridiculous problems who would get markedly better the first 10 minutes, not bec I am a genious, but bec most PT's out there have no clue about what it available to them, and so they sweat it out, cranking away at people's glenohumeral joints for months and months, when all they needed to do was release a simple rib restriction...

[taai gihk yahn]

Cheers Chris, was hoping you'd be around. I have a semi full range if movement. I can move it in any direction standing in a stable posture, but still have trouble from different positions. E.g. I can put my hand over my head, but I can't bend into a yoga side bend on the opposite side to the affected shoulder. I don't know if the brace would help with that position: I'm well enough practiced with relaxing parts of my body to be able to relax the shoulder enough to get it in that position and when I'm being manipulated I suspect I wouldn't be able to go much further in that direction even with the Physio acting as the brace if you see what I mean.

I suspect the brace would offer me the support to be able to move quicker, but as a mug's guide the way I understood the rehab protocol it's ROM, strength, strength over full ROM, endurance, speed...



As for my rehab needs, I think you've just insulted 2000 years of samurai "ganbare" spirit and should therefore offer to fall on your own blade before cutting your own wad off. Taping, depending on which of the six physios I got on the day, consisted of a pad of cotton laid lightly or tightly jammed in anywhere from the top of the trapezius to the acronomion itself and secured with two short Elastoplast bandages.

Again, depending on the day, rehab has accidentally activated my shoulder blades occasionally, but otherwise you may well be talking Swahili.

They haven't really told me any exercises to do, but I've been trying to keep as much of the affected area and my back activated in some way since Day Three (they basically told me not to move at all for a month, but being a pigheaded **** I've been trying to get my ROM back since then).

well, the bottom line is whether or not u have confidence in ur rehab "team"; if u r getting widely contrasting approaches, or lack of continuity of care, I'd b a bit concerned, as it suggests they r not talking to each other about u (which is often the case); u may want to shop around a bit more? PT's / physios r not all alike...

[bawang]

wow mister punch, what happened to your shoulder???

you sound like you fought an elephant

[taai gihk yahn]

ur PM box is full, sir; clean house!

oh, and my response to ur last PM:

"lol @ DO's having a "few" problems - the whole profession is rife w issues, internally and externally - UK / Fr. DO's at least hav a comprehensive approach, but in the US they r all but done in terms of OMT, <2% do it - and then they gripe about PT's not being qualified (xcept Michigan State CE, they r realistic about it);of course they all hate Upledger, but hav to admit he's the reason most people r aware of cranial/OMT;
who is Singh? is he UK DC?
wife is MD (Latvia, then re-cert here) and DO (Fr);
not familiar w Mezierre, more hip to Janda / Levitt et. al. but will look into it; hav u looked at Myers / Anatomy Trains? good stuff
very much looking fwd to hearing ur views on the various injuries people post on the forum (and enjoy the many armchair-types on here as well who will offer highly specific "advice" based on no clinical information, lololol!)"

[Mr Punch]

well, the bottom line is whether or not u have confidence in ur rehab "team"; if u r getting widely contrasting approaches, or lack of continuity of care, I'd b a bit concerned, as it suggests they r not talking to each other about u (which is often the case); u may want to shop around a bit more? PT's / physios r not all alike...

The physiotherapist that I go to is a 2 min walk from my house. The system in Japan is that you don't have any reservation system generally so it's potluck as to how long you wait . This means that the physio I go to usually takes about two hours to get treated at least. Which is 10 mins of electrical current applied somewhere in the area (!), 10 mins of massage and manipulation (there are sic guys who do this - they all differ of course in what they do, and they don't even write notes as to what they've done each time - again, in Japan SOP) and 10 mins manipulation for my broken wrist too, with the rest as waiting time. I do know a good physio about two hours from my house, and I know another four hours from my house. But there's no way I can go to those as a working man.

So it's mostly down to self-diagnosis and my own net-researched stretches and exercises.

This country is completely backward in physio care (well, the medical industry itself in general is a joke). Basically, imagine I said I'm in rural Kenya and just happen to have one passable physio near me!

[Mr Punch]

wow mister punch, what happened to your shoulder???

you sound like you fought an elephant

No, I fought a road. They're hard. Bicycle crash with another one coming the wrong side of a busy country road with no pavement through a red light on a blind corner.

[Mr Punch]

Mind you, if they were totally useless I would have to try and find somewhere else. Every day in rehab the Physio guys do make my shoulder and wrist feel better and move better so that's the main thing I guess. And coincidentally, this morning's guy was giving my lower back and my neck a good probing before the manipulation exercises.

[R]

ur PM box is full, sir; clean house!

oh, and my response to ur last PM:

"lol @ DO's having a "few" problems - the whole profession is rife w issues, internally and externally - UK / Fr. DO's at least hav a comprehensive approach, but in the US they r all but done in terms of OMT, <2% do it - and then they gripe about PT's not being qualified (xcept Michigan State CE, they r realistic about it);of course they all hate Upledger, but hav to admit he's the reason most people r aware of cranial/OMT;
who is Singh? is he UK DC?
wife is MD (Latvia, then re-cert here) and DO (Fr);
not familiar w Mezierre, more hip to Janda / Levitt et. al. but will look into it; hav u looked at Myers / Anatomy Trains? good stuff
very much looking fwd to hearing ur views on the various injuries people post on the forum (and enjoy the many armchair-types on here as well who will offer highly specific "advice" based on no clinical information, lololol!)"

House cleaned :' S

Will answer you here in case anyone has read your comments .....

DO's vary considerably from country to country...both in their skills and their interest in co-operating with the rest of the medical community..

Simon Singh was sued by the British Chiropractic Association for saying that some of their ideas amounted to questionable practices... they were really unable to defend their position so backed off.. but not before they had every free speech science person investigating their claims, their history and their credibility... I think the advertising standards council here went after a huge number of them for mis-leading advertising on their web pages...

Mezierre pre-dated Myers et al by decades and has a solid base in Japan, Brazil, France, french Canada etc.. you might look up Postural Reconstruction or similar titles.. they have an extensive education program at the graduate level. She believed that you needed to release excess tension/tightness.. she came up with three muscular chains that are in some ways similar to the musculo-tendinous meridians in TCM. Her treatments are more like yoga than anything else.

Enough of the blather :' 0

PM me if you want to discuss any of this further :' )

R