First Aid for Fighters: Stupid Shoulder Injury

by Meredith & Doc Dill

It was time to take the stupid family Christmas picture. I began to trundle down the stairs yelling over my shoulder for my cousins to follow me. I slipped. My left hand instinctively latched on to the railing and didn't let go although the rest of me fell. (This would have been cool had I been falling off a cliff or something cool like that.) After a couple of hours, it became clear that this was not just a minor strain. I couldn't live my arm above my waist without pain in my shoulder. Really I couldn't move it much at all. I iced it and took tons of Advil and when I got home two days later, a P.T. worked on it. It felt much better after that, but it still gets 'tired' when I work out and feels 'delicate' when I do certain things. I.E. after throwing a couple of hard jabs into a focus mitt, I get that 'this minor discomfort is a warning' kind of mild pain. I've been avoiding grappling and throwing hard left hooks.

Doc Dill says:

Well a couple of things could have happened here. Overhead injuries like the kind you describe happen in sports to pole vaulters and gymnasts. In those sports you are trying to lift or hold body weight with one or both arms in extreme flexion. A little too much extreme flexion or a ballistic move like you did (falling with a sudden recovery) and something's gotta give. Three possibilities come to mind: 1) acromioclavicular joint separation (separated shoulder), 2) rotator cuff strain, tear or compressive injury, or 3) torn labrum. Number three is bad and will only get better with surgery if you're lucky. Luckily these are rare. Number two is serious but unless it's a complete tear you can avoid surgery. Number one hurts more than the other two and takes a long time to fully heal but is relatively a minor injury. How do you tell the difference?

Well, 1 will hurt when you touch the end of your collar bone or if you grab the collar bone and try to wiggle it hard. 2 will be painful in the resisted "empty can" position. if a complete tear you will have no pain and be unable to resist at all.* In 3 you will most likely have pain with movement and a feeling of slippage as if you're shoulder wasn't attached right or a painful arc where everytime you move through a motion it hurts only through the same portion of the motion. Whattaya do? Well ICE then strengthen the scapulo-thoracic musculature and retrain scapulo- thoracic rhythm which I'll cover in another article.

* Empty can position fists in front of pockets arm rotated so thumbs point down, flex shoulder so arms are lifted on angles lower than shoulder height, as if emptying pop cans.