AC Joint Injury - Need Advice

[Gandalfnet]

Not sure if injury advice is for this forum, but I cant see another.

2 Weeks ago, I think while doing dips, I injured my right shoulder.
I thought it was just a stained muscle. A week later it still hurt at one specific point at the top of my shoulder. I thought I had a rotator cuff injury so Iwent to the Dr and he says I have strained my AC joint. He gave me some new topical anti-inflamatory.

Tried to go back to after about 4 days but the pain was way too much. it has been another 5 days now and still hurts.

He now says if I want it I can get a cortisone shot in my shoulder.

I hate being out of the gym and I think I am starting to loose a bit of mass as I am down 5 lbs. I have searched and there is little information here about an AC injury. So I have a few questions.

Has anyone had this injury?
How long did it take to recover?
What did you do to help it?
Did you work out during recover and what did you do?
And have you had a Cortisone shot for it?
Should I give it more time before getting one?

 

[pumpchaser]

Here's my advice - like me you have shoulders that are susceptible to trauma from heavier exercises involving this area. Having been there and having waited months not weeks to see improvement that never came, i'd say wait a few weeks with zero direct activity for the effected area if you want to be sure it's not going to heal, then get the shot. FYI cartilage and ligaments take months to repair given the low blood flow. The shot works like magic, only problem is not to lose the effect in future by getting one each time there's a problem.

The way to avoid long-term problems is to find and stay with exercises that will not agrevate your shoulders, this problem will likely return if the same shoulder-stressful exercises, like dips, are done. The cortisone will get rid of the problem but the problem will return unless you learn to adjust to less stressful exercises. You could do dips using different positioning, but i consider it playing with fire, just too stressful; better to just find less traumatic l alternatives like decline benches instead.

On the shot itself-the person giving it makes a huge difference. You want a doctor who LISTENS and is paying attention to where the problem is. If you don't feel this is the case, walk out and try another. I've had a lousy doc give me the shot and he missed the spot while heavily bruising the area with a deep injection-wasted opportunity. The better doc asked where it hurt, made a series of dots with a pen on those areas of the shoulder, then proceeded to make shallow injections into all those areas. Immediate solution and NO trauma to the muscle because he was LISTENING...

 

[hornedfrogs07]

Give it more time, DON'T get the shot.

I'll get back on this tomorrow when I've got more time and give more info.

 

[pumpchaser]

I've tried both - first tried to wait out the pain, literally waited months after a training-imposed injury. Didn't do anything due to the slow blood flows and repair into cartilage/ligaments. That's just me; wait as long as possible to first see if there's progress. At the point that it becomes obvious that there's no improvement, the shot must be administered as a last, and very effective resort. The proviso must be that the problem exercises causing the trauma must be removed, otherwise the pain will reoccur, and you don't want to make the shots a routine-they lose effectiveness with each that is received.

Also, good warmups of each joint must be a staple of any routine.

 

[Gandalfnet]

Thanks for the great advice.
I cannot wait 3-4 months for this to go away. I'm giving it 1-2 weeks to see if it improves.

Is there different thoughts as to one deep needle or multiple shallow ones?

Also Dips are a core tri/chest exercise. Do you know of any other low shoulder impact ones. Most tricep exercises require arms above shoulder level.

I do a 3 mile run before working out, thats my warm up. Is specific stretching of the shoulders a must?? Perhaps that is my downfall.

Thanks for the great info, I will wait to hear from SL.

 

[pumpchaser]

The subtlety of technique by the doctor is the difference between an excellent doctor and the many who simply go through the motions. 2 weeks before getting this excellent treatment that i'll always remember, i got the same shot from the team physician for a professional Canadian football team. By all reasoning, he should've been excellent. He was talking to someone else while administering the shot, missed the right area and instead only contributed a deep bruise from a deep injection; wan't paying attention nor was he doing a good job in any way. This tells me that status and alledged experience doesn't count for much in being a good doctor or specialist.

Dips can be replaced by various exercises that don't create quite the same trauma yet still hit the medial and lateral heads, actually there are similar exercises that hit those areas better. The best alternative i've found is dips between two benches, hands on one, feet on the other at equal or higher elevation. This shifts the center of gravity away from the shoulders backwards to the triceps, so you've got a better exercise and better pump and no shoulder trauma. Secondly, there are now many gym machines in which you sit and push down on handles on each side, similar effect. Just my opinion, after recovery from an injury i'd suggest a couple of weeks or a month of exercises that totally avoid dips altogether until it's obvious that normal function has returned to the area - lat machine pushdowns would be the least traumatic, or close 10" grip bench presses using medium reps and a good warmup set or two.

After the shoulder is better, ease back into the training and always do a couple of minutes of slow windmills to warmup the shoulder areas, alternating in one direction then the other, back and forth till the area's warm... Any exercises that have even the slightest chance of re-creating shoulder trauma should be the second exercise done for the bodypart-for triceps, do another exercise first before going to dips, etc., after already warming up the area. Also, reps for triceps should always be medium, above 10/set in general, both because the triceps respond better to medium reps, and to avoid excessive joint stress/injury to the shoulders and elbows.

 

[Gandalfnet]

WOW, this is why I come here, and it says you are a rookie, not.
Thanks very much some excellent intelligent advice that I will use.

I will ask my Dr about shallow injections and will incorporate the new Tri exercises. Dips were usually my last (after pull downs, skull crushers and presses) My reps were usually 10x4 sets so I am doing that already.

Many Thanks again.

 

[Golden_Muscle]

I didnt read your thread, but here is what I have to say......

1. Dont do anything that hurts it.
2. Take glucosimine
3. Take anti-inflamitories (natural)
4. Ice it 3-4 times a day
5. Go to physio therapy and get interferential, and ultrasound therapy.
6. It will take about 3 months to get better IF your lucky, and you will lose strength and size etc..... just accept it!
7. Dont get a cortizone shot because it is supposed to be BAD for your joints in the long run.


It will get 100% better so dont worry. I had it once in each shoulder and once in my elbow, and they all healed 10000%.

Welcome to injury land! You will feel small and shitty for months, but thats part of what we do. Be more careful training.

 

[Golden_Muscle]

Oh, and stretching does not prevent tendonitis, and your warm up is too much IMO, but you might have different goals than me.

 

[pumpchaser]

Disagree-i had the same problem and rested, did everything right. All that happened was that i burned 6-8 months waiting for recouperation. Completely wrong on the cortisone issue-excellent remedy IF, IF it's only used once every few years (not over used); only a long-run problem if overused too often. Like anything, it will lose effectiveness and hurt your joints if used too much AND if you don't learn to find alternate exercises that don't recreate the problem-MUST find other, gentler exercises for the future..

On the question of warmup, i've had the same shoulder problems, and this is only one way, and an effective one for many years now, to adequately warm up. I think this guy's disagreeing simply to appear knowledgeable-funny though. BTW, the holistic healing rhetoric typically only works with mild problems if at all, not something like this. I consider holistic approaches to be akin to chiro - does it really make a difference or is it just an imagined difference? Hard to say.

 

[Golden_Muscle]

Disagree-i had the same problem and rested, did everything right. All that happened was that i burned 6-8 months waiting for recouperation. Completely wrong on the cortisone issue-excellent remedy IF, IF it's only used once every few years (not over used); only a long-run problem if overused too often. Like anything, it will lose effectiveness and hurt your joints if used too much AND if you don't learn to find alternate exercises that don't recreate the problem-MUST find other, gentler exercises for the future..

On the question of warmup, i've had the same shoulder problems, and this is only one way, and an effective one, to adequately warm up. I think this bozo's disagreeing simply to appear knowledgeable-funny though. BTW, the holistic healing crap only works with mild problems, not something like this..

Are you refering to me in this post? I got my info from a professional BTW, and he is VERY knowledgeable. Hows that for funny?

 

[hornedfrogs07]

Thanks for the great advice.
I cannot wait 3-4 months for this to go away. I'm giving it 1-2 weeks to see if it improves.

Is there different thoughts as to one deep needle or multiple shallow ones?

Also Dips are a core tri/chest exercise. Do you know of any other low shoulder impact ones. Most tricep exercises require arms above shoulder level.

I do a 3 mile run before working out, thats my warm up. Is specific stretching of the shoulders a must?? Perhaps that is my downfall.

Thanks for the great info, I will wait to hear from SL.

I'd begin by rest and icing the area, with some NSAIDS like ibuprofen in there to help control the pain and inflammation. From the very beginning, you need to be working on rehabbing the injury and working to restore ROM and strength. This can be done on your own, with a physical therapist, etc. You need to be doing rotator cuff work, internal/external rotation work on the GH joint as well as the AC joint, etc.

Since you're past the acute stage (where RICE method is really needed) by now, you absolutely need to start on rehabbing the injured joint to help you maintain (somewhat) the strength there, and regain your flexibility with the joint articulations. When working on this, begin by heating the shoulder area (massage w/something like Icy-Hot, etc., heat packs, or a hot shower even) to loosen up the tissue and prepare it for work. Do your rehab, then ice it down to prevent it from swelling back up and defeating the purpose. It would be best to get a PT, AT, or orthopod to design a rehab specifically for you, rather than me generalizing one online. If you don't want to go that route, you need to be working the joint in all planes of motion with VERY light weights (talking less than 4-5 lbs here), and/or well as using therabands for resistance. Generally, 3 sets of 15-50 repetitions in each movement -- Yes, a good rehab will take quite a chunk of time, but it's more than worth it.

As for cortizone shots, they really do nothing but mask the pain. The body hurts because it's trying to tell you that something is wrong with it - that's why I think using too many painkillers (corticosteroids, nsaids, tylenol even) is really detrimental, because you never allow the injury to heal; you just mask the pain and can wind up making the injury even worse. Excessive use of corticosteroids will very, very likely lead to degeneration of the connective tissues (tendons, ligaments) over time. Now, one shot to keep you moving won't hurt, but like I said, it just masks the underlying problem, leaving it to resurface again in a couple weeks or months when the shot's effect wears off.

There's a big difference between shooting a quarterback with cortisone in the shoulder before a championship game just so he can play, and a noncompetitve athlete such as yourself just trying to stay in the gym - You'd be MUCH better served by taking time off (as God-awful as it sounds) and getting rid of the injury and preventing it in the future by strengthening the area.

Originally posted by GoldenMuscle
1. Dont do anything that hurts it.
2. Take glucosimine
3. Take anti-inflamitories (natural)
4. Ice it 3-4 times a day
5. Go to physio therapy and get interferential, and ultrasound therapy.
6. It will take about 3 months to get better IF your lucky, and you will lose strength and size etc..... just accept it!
7. Dont get a cortizone shot because it is supposed to be BAD for your joints in the long run.

1) Good advice
2) Possibly good advice
3) " " "
4) " " " (generally only in the acute postinjury stage though)
5) Physical therapy is a very good idea. Interferential probably isn't the best stim waveform to help that heal, and continuous ultrasound would do nothing for that injury except heat it before rehab. There probably aren't any calcium deposits to be broken up in an injury like that.
6) Not necessarily that long.
7) Possible.

 

[pumpchaser]

Bottom line, and cutting through the blather, no amount of "professional" info compensates for real experience and common sense - unfortunately, highly certified doctors and specialists are often WRONG. I've had shoulder trauma of this type, and have dealt with it effectively with a few cortisone shots spaced a few years apart. Does not simply mask the pain at all; it's a lasting solution if adjustments are made to remove the cause of the problems - adjustments are essential otherwise the problems will come back. This has nothing to do with abuse of cortisone or other drugs as seen in professional sports, which is a flawed analogy and scare tactic using an extreme example. There's a big difference.

Used in moderation, it did exactly what was hoped, was extremely effective and almost magical. Key is to adjust one's routine to ensure that the problem exercises are never repeated. Then in the first week back, warm up very carefully and use only light resistance and high reps on the effected area until the second week-don't push it too hard until normalcy returns, or reinjury's possible and worse complications.

Occasional shots, years apart, might sometimes be necessary for those like you or i who have weak shoulders. Occasionally, despite all efforts, the shoulder will flare up from the smallest thing-happened once just from opening a heavy and hard to move window. It's just part of the territory for us unfortunately, but something that can be worked around.

On icing down and rehabing, that's fine for the first week or short term, but after that you're left with either taking months off with no guarantee of a solution, not unlike my experience, or being proactive. Those suggesting months of rehab probably work in the biz and make money off this.

 

[SCG2]

definitely do NOT get the shot. all the special exercises and care in gym will certainly help, but this problem is a lot more easily solved than most people believe. go get some ART.

read my responses (stonecoldgold) in this thread:

http://www.****************/forum/showthread.php?t=101525&highlight=shoulder+pain+mehta

 

[hornedfrogs07]

.....if adjustments are made to remove the cause of the problems - adjustments are essential otherwise the problems will come back....

1) This has nothing to do with abuse of cortisone or other drugs as seen in professional sports, which is a flawed analogy and scare tactic using an extreme example. There's a big difference.

.....Key is to adjust one's routine to ensure that the problem exercises are never repeated......

Those suggesting months of rehab probably work in the biz and make money off this. [/B]

Saying that I said using one shot of cortisone is abusing it is BS. That's like saying that using AS is abusing AS, or using some damn tylenol is abusing it. Everything has its place, and I don't believe that corticosteroids are necessary for his shoulder to heal, pump.

I'm not suggesting "months of rehab" - I'm saying that he needs to rehab the injury to make it better, however long that may take in his individual case.

Corticosteroids will mask the pain so you can "work around it" and "accomodate your problem" but they don't fix the underlying problem that something is wrong there. To fix that, you have to first get rid of the injury, and then strengthen the area to help prevent recurrences.


Oh, and I guess you could say I "work in the biz," but I'm actually a student, PAYING to go to school and learn this stuff, and I'm sort of at a loss as to how I'm going to make money by giving Ganda this advice.

 

[SCG2]

regarding pump and spikey's debate:

i don't doubt that a couple cortisone shots spaced years apart can help. but this does overlook the initial causes of the shoulder inflammation in the first place. inflammation is a result of trauma. cortisone will kill the inflammation, but it will not heal the trauma. it will, in fact, make the trauma worse, even if only by such a small degree that it is outweighed by the reduction of pain that comes with the reduced inflammation. could most people get away with this? probably. but if you don't want to have to restrict yourself in the gym or spend unneccesary amounts of time and money on conventional rehab, the best solution is to heal the trauma. by far the two most effective methods i have experienced are Active Release and Prolotherapy. Between these two protocols, there is not a soft tissue or joint problem I haven't been able to solve.

And for the record, I have no financial stake in recommending these treatments. I am a poor, unemployed, aspiring professional athlete, and I have spent thousands of dollars out of my own pocket (sometimes in lieu of eating!) on ART and Prolotherapy. I recommend them so vehemently because I believe they can save people from a lot of suffering.

www.activerelease.com
www.prolonews.com

 

[pumpchaser]

Blah, blah, blah. Unlike these guys, i've BEEN there, done it. The shot's work, and I've made it clear that you've still got to remove the source of the trauma, which are the exercises done. If you ensure that you don't go back to the same problem-creating exercises, warmup well and are careful in future, the shot's are EXCELLENT. I have a feeling these guys think Tenet was doing an excellent job with the CIA and should've been kept on. That's it for me, can't keep beating a dead horse..

 

[SCG2]

actually i have been there. i've had cortisone shots in several locations because i needed a fast fix to get me right back on the football field during the season. the problem always came back, without exception.

 

[hornedfrogs07]

I've never personally been there and/or done that. (I've always just had to fight through whatever pain there is, because I'm too damn hard on myself and refuse to see an AT, PT, or OT. That's probably why I'm going into the field I am, so I don't have to trust anybody else.)

I HAVE, however, seen about 7 of these AC injuries in the past year. 2 required surgery, and therefore took about 4 months for a complete rehab (you can't be too careful in the offseason), but the rest required a couple weeks rehab exercises and modalities, and the person was fine. Not a single one had a shot to keep going.

 

[Gandalfnet]

Well Guys I really didnt mean to touch off such a debate but I think all info is great for board and me.

So far the Topical anti-inflamatory hasnt made a dent. Still hurts after 3 weeks now. Went back to the Dr and after discussing all the options (and he is a PT advocate) he told me when it bothers me enough to come back and get the shot. Going down for 3 months is just not an option.

It basically boils down to how much time I can afford to take off and how much time I have for PT. The answer is none to both.

As long as we are discussing cortisone injections does anyone have any more info on multiple shallow VS single deep injection??

I'm probably going this friday. Thanks for all the great info.