Acromioclavicular joint (AC) separation and World Cup XC races

Video Update from Italy

My shoulder now, more details below.

A lot has happened since the last post, basically I had a horrible cold for 3.5 weeks which overlapped with a significant injury which has resulted in a total of 4 missed (or may have well missed) races and almost 2 months of serious training. It is hard enough when these are local races, but to fly all over the world just to miss races is rough. Especially when the USA Olympic committee is looking at the first four World Cup races to determine which of the eight of us get to go to the Olympics. Not only have I missed the first two, but I am now back to a last row call up if all goes well and I am able to race the third World Cup in Czech on May 12th.

However, if you don't consider racing or training, Todd and I are having a great time traveling.

The last post was about four races in Cyprus, a trip to Italy for the Cannondale Team Camp, back to Cyprus with a cold and unable to race the final race.

March 7th -14th
We packed up and traveled to South Africa where my cold would not clear up and Todd had it as well. I skipped all my workouts trying to get it to go away, then decided to race the National South Africa course the weekend before the World Cup which was probably a really bad idea.  I didn't feel sick anymore, but had a horrible cough and felt weak. I ended up "racing" at tempo pace and somehow avoided getting pulled. I did enjoy the technical sections and only took one B-line.

Huge thanks to Grant and Adrenaline Cycles for the rides and working on our bikes! I love the Kenda shirt, I was trying out the Sealant Compatible Slant 6 as a rear "tyre" for the first time.

 South Africa National race on the World Cup course one week before the WC race. photo by Todd Park

It was hot, I was super slow. I fell in some loose dirt away from any technical section, lost my GPS. On the next lap I stopped and dug around in the dirt till I found it. I was not going to do another lap after the race! This photo was just after I retrieved it. I'm trying to listen to Todd, for some reason expecting him to tell me to quit with one lap (of 5) to go. Instead he says, "Go as hard as you can". In the next photo I laugh.

I had not tried the drop so had to take the long way around in the National race, but felt like I was getting the other lines dialed for the World Cup race. After the National race I found some legal decongestants that allowed me to talk without hacking.

In this video from South Africa I mention the National race and how I was wondering if I would get up the guts to try the drop or not.

A training ride from Adrenaline Cycles to the Karkloof Falls. photo by Todd Park

Wide open spaces of South Africa, easy spin, lots to see. 

March 15th - 25th
Well I did try the drop! I was worried about the 90degree turn above it and scrubbing too much speed allowing the nose to drop as soon as the bike was airborn. Turns out I carried enough speed and the nose did not drop. That's the good news.

Max Plaxton launching the drop. photo by Todd Park

I should have worried about the landing as well. Either I landed too far to the right and tried to lean back to the left (as there was a bit of a left turn upon landing to set up for a gap jump) or I just landed a bit tilted, either way my front tire pulled off the rim and I washed out. Hard. My shoulder seemed to take the majority of the crash, my helmet was broken in three places, the Go Bandit helmet cam mount broke off and I had road rash on my shoulder, back, elbow, knee and hip; the hip bruise is still there. Luckily the bike was fine.

Hmmm.

Should have used a thicker sidewall tire, like the sealant compatible maybe? or more air pressure?

I sat up right away and put my right hand on the left shoulder, I felt a bone sticking way up and my shoulder was dropped.  I assumed I had dislocated the shoulder. Luckily Todd was nearby, he didn't see me wreck but saw the medic running down the hill and knew it had to be for me. The pain was so high that I asked everyone, the medics and spectators, to "Just pop it back in, please!". They called the 4x4 to get me to the ambulance and said no one at the venue could relocate a shoulder, that I had to get an xray first. The Cannondale CFR crew was great, Daniel came to check on me before the ambulance ride and called Todd later to see what the news was and tell us whether a shot and other meds were WADA allowed (there was no data or wifi at the hospital). It is nice to not feel like we are on our own in another country. I am also now up to date on my tetanus shot and that's the way to get one, I never felt the shot or the normal soreness.

Not dislocated (ball and socket is fine), AC separation. More about that below.

South Africa ER

Thanks to spectators (Lowe? probably not even close) for the rigged sling and the woman who brought me my GoBandit. Needless to say, I did not race the first 2012 World Cup three days later, I did watch the best ever race coverage from the couch at our apartment; they showed the entire race on local TV.

The women starting World Cup #1 South Africa

Why you need to be in the front row. photo by Todd Park

One rock section, two "A" lines photo. photo by Todd Park

World Cup course, Manuel Fumic in the Logs.

Look way down at the guy standing below to see how steep this really is.

March 26th 

Back at Adrenaline Cycles where Grant helps Todd pack. 

Pica packs are not my favorite and after this trip Todd also ordered an Evoc bag. We headed back to Tucson, AZ. We are seriously lucky to have such good luggage. The Osprey bags all straps to each other and we (meaning mostly Todd) were able to get everything to and though all the airports.

I saw Dr. Thompson at Southwest Shoulder, Hand and Elbow as soon as we arrived in Tucson. He said it was a Grade Three Separation meaning the three ligaments were severed (and will not fix themselves).

Grade 3  Awesome 2.5 minute video HERE

I chose the non-surgery option and will know down the road if this was the correct decision. Basically the recovery time is much faster without surgery and I had good luck with the no-surgery option when I severed my ACL. So, I couldn't make it any worse unless I fell and put the collar bone through the muscle, his advice was to do what I could letting pain be my guide, allowing everything inside to heal up.

After the first week I kept envisioning a robot with it's left arm torn off , the arm lay on the ground but the hand worked perfectly, as long as the robot would pick up and position the left hand very carefully it was useful, but it obviously couldn't be positioned via the left shoulder. I basically had a remote controlled left hand, which it turns out, is really useful.

For anyone with this injury who may be interested in recovery time:
March 15th
week 1, Days 1-6 Arm in sling 24/7, pain level was pretty high used a ton of ice to get swelling down. Traveled back to USA, full flights = very uncomfortable. Saw Dr on day 6, ditched the sling for the most part and quit the ibuprofen regiment that was started at the hospital.


March 21st - April 6th
week 2, Day 7-14 The swelling started to go down a little, kept up with ice and began taping my shoulder "on", tape covered ~1/3 of my upper body.

Built my 2012 Flash pretty much one handed. I used my teeth more than my left hand, my brake lines now have teeth marks. Cannondale, NoTubes, SRAM and Jagwire were awesome, I had every single part I needed for my custom build, how often does that happen?

Thanks Cannondale for the gimp friendly wardrobe!

I ended up with delayed ibuprofen side effects, bleeding gums, stomach aches and extreme fatigue most of the week. Spin classes at O2 seemed like a good idea so I tried two 30 minute spin classes just to get my legs spinning. In the second class I worked on reaching out to hold the bars. Since I was there I also tried a yoga class with the sling on, not a bright idea, I really liked the challenge, but not the additional pain after.

Major accomplishment! Both building the bike and getting on it. photo by Scott Morris

Scott was there to help finish the bike, he put on the grips and cut the bars for me, no way around using two strong hands for those tasks. Then he test rode it and helped me get up the guts to try and get on. As always he was quick enough to get a photo of it too. I rode 5-10 seconds a few times and was pretty proud of myself. 

I started trying to get on the MTB on the road, just getting on the bike was difficult and painful, balancing and spinning took focus, lots of breaks were required to give the arm a rest. The biggest problem was braking, when you brake the body moves forward and the arm does not. This is a huge issue when your shoulder is only held together with tape. Each time feels like someone shot you in the shoulder; a huge burst of pain, so bad you can't see anything for a few seconds. As far as riding, there is a trick to "stacking" your shoulder which allows you to hold on to the bars, but even the slightest crack in the pavement was to be avoided and turning was not the best idea. Bone-on-bone popping and crunching with extreme bursts of pain were the result of incorrect movements.  I could not twist my head or body at all or the "stack" would fall apart, so a mirror was rigged and Scott had to guide me. I could ride but still couldn't put my hair in a ponytail or wear normal shirts.

week 3, Day 14-21 I started mastering the road, thanks to all my baby-sitters, Scott Morris, Adam Kroger and Dave McElwaine! I worked on trying to get the MTB in singletrack. This included researching braces, I ended up with the EVS Brace. Day 21 I could ride off-road, it was painful and I couldn't pull on bars at all. However I could finally get some zone 2 and a tiny bit of 3 efforts on the road (with lots of rest breaks). 5 minutes in Zone 3 (tempo) was insanely hard, the body was in some other mode for sure, with nothing left for the legs.

I also found a new sponsor, Game Ready, no more leaking bags of ice!

Photo by Scott Morris

My Facebook post with this picture said, "

Exactly 3weeks post injury. Still a ways to go, but getting there. Game plan = stick to travel plans, head to Belgium and see if my arm improves enough to race April 14th. Then Italy for training, followed by Czech and France World Cups. Thanks Scott Morris for the photos, ride plan with bail options, and help packing. Thanks Rick Crawford for the gameplan and Todd Park for worrying about me, but supporting my thinking I can do more than I really can/should, see pic. Of course he didn't know that's what I meant by saying I was going to try singletrack again. I'll blame Scott for that, he said, "you can walk this section" then pulls out the camera..."

Taped, padded and strapped. I can do this, I don't care how much it hurts. Calculating every tiny bike/tire response ahead of time was crucial. 

I was on this intense schedule of recovery because I wanted to race World Cup #2 and also because we had used points to upgrade to flat beds for the first time ever.

So still on mad-recovery schedule I unpacked and repacked. Todd was away the entire time for work so moving a bag meant emptying it one item at a time, without bending at the waist, moving each item, then repacking one item at a time. Most bags stayed where they landed from March 21st till April 7th when Todd came by to pick me up and head to the airport.


week 4, Day 22-28
April 7th-9th

Todd and I caught our flight to Germany and thoroughly enjoyed our private flat bed fort on the plane.

Airline food in the flat bed section.

Game Ready in the sky, icing my shoulder and watching TV!

We stayed a night in my favorite hotel in Augsburg, Germany again with points. Last year's travels are saving us some money this year; then drove to Belgium.

April 10th 
Cold rainy days were normal the entire week. We did a short cold paved/gravel road ride. The pain was pretty low unless I flinched or tried to take my hand off the bars. The biggest issue was I could not react, if the tire slipped even a tiny bit I was jolted with a huge burst of pain and my arm was so weak that "reacting" didn't really accomplish anything in the first place.

April 11th 
Headed to the Houffalize course to give it a go.

I could not ride up the first hill, it was that steep, I couldn't really pull on the bars. Talk about a huge let down, I had worked so hard to make this happen.  I just stood there and looked at the course. Todd figured out pretty quickly that I had just realized this race wasn't going to happen, he walked over and gave me a hug.

Gifts from Todd to make me feel better.

week 5, Days 29-35
April 12th- April 18th

Watching another World Cup. Houffalize, Belgium

We (meaning Todd) finally decided I was on vacation, I rode when I could, did some efforts when I could, watched the Houffalize World Cup which was very spectator friendly. We traveled from Houffalize, Belgium to Augsburg, Germany to Verona and Bibbiena, Italy. I had lots of chocolate, Nutella and Coke Zero...

Pizza and afternoon cappuccinos in Verona

sightseeing

week 6
April 19th-25th

Our awesome vacation spot in the Tuscan mountains

I stopped tapping my arm mainly because the tape I bought for the trip is horrible and when trying to remove it only the top layer peels off leaving all the sticky residue on the skin; which everything including my hair sticks to, for days.  The shoulder seems to be able to hold itself up now and I use the brace for all rides.

I started doing research on the pain I was feeling since it is no longer the entire shoulder but pretty localized and severely limiting what I can do. Everything seemed to fit the descriptions of Impingment or Supraspinatus strain or tear. I contacted Dr. Mike Puchowicz in Arizona via Facebook. He replied that it would be too hard to tell the difference between these and the pain just due to the separation. Dr. Puchowicz provided me with a list of shoulder stabilization workouts, descriptions and You Tube links. That is what I am focusing on now. I hope to be back to training (not just riding) on the road in a few days, and sleeping though the night would be awesome! Here is the article with workouts that Dr. Puchowicz sent me, although he customized a lot of the workouts and suggested ones to replace these.

Will I race in Czech on May 12th?  I have no idea, but I am pretending I am. I sure hope week 6 is the magic week. Everything I found says 12 weeks, but I say 6.

Edit: start of week 7
April 26th - 29th
So it's taken me a week to post this blog and I have actually done two real workouts and some real mountain biking!!! I just came in from the second workout and am pretty happy.  No PR numbers or anything but my power is coming back, tempo now feels only a little harder than it should, not ridiculously impossible like before. The last week's PT workouts or some "off" time really seemed to help.

The super cold rain is gone and it turns out our place is ideally situated for training, as long as you don't want a flat road because everything is up or down. The owner Thomas not only brought over a thumb drive with 27 MTB GPS tracks, most of which leave from the front door, but also explained which ones he thought I could do, which ones would be muddy and which ones led to (and through) must-sees like the La Verna Sanctuary.  We are really enjoying this beautiful place, the time together and even more so now that I can start training.

Prayers said and fingers crossed for Czech May 12th!