UKC

I hoping to tap into the collective wisdom of UKC to help steer me towards a decision, and align my thoughts regarding rehab of a shoulder issue I have.

Should I/do I need to jump for the expense of an MRI which I'd really like to avoid the cost of.

Before anyone jumps up to start shouting..... I have seen professionals, albeit maybe not climbing specific physios. My local climbing physio isn't available until 1st Sept... 

Ive been climbing about 10 years, and 'pushing it' for me, for around 5 of those maintaining a sport grade around 8a.

For almost as far back as I remember Ive had a weakness with my right shoulder. Not major, but something Ive been aware of. Over the years Ive done enough rotator cuff strengthening exercises to keep any real problems at bay.

November 2022, climbing trip to Greece, and ticking routes up to 8a+ my shoulder became aggravated. I pushed on and on return to the UK I stopped climbing for x3 months. (figured it was raining anyway)

Picked up climbing steadily again this year, weakness is still there.

x3 weeks ago, nothing specific happened but whilst climbing my shoulder 'went'. General loss of range of motion, typical rotator cuff injury type symptoms. A definite 'game over' type injury.

Physio booked, start rehab.... rest, regain mobility, then strengthening. Had x2 check in appointments over the x3 weeks.

After x2 weeks I was feeling good, so went for some light indoor climbing with no issues.

Another week passes with rehab and stretches etc etc.

This weekend past, I tentatively went outdoor climbing getting back on an old project. Monoculture, Portland. A route I know well, so figured I'd be okay as I can limit how hard I tried. Anyway, ticked it first Redpoint. Shoulder still felt fine, no issues at all.

Moved to the 6c next door (not wanting to push it) and end up buggering my shoulder again. Stretched out move.

Loss of range of motion etc etc, the rehab starts again.

- I know I started climbing again too soon. Thats on me. Idiot. Lesson learnt.

The question I'm asking is......

I wish to push forwards and continue my progression through the grades.

Even If I spend x6-x12 weeks strictly rehabing my shoulder, will it always be a limiting factor for me if I don't know what's going on, or how sever the injury actually is? Does it make sense to cough up the money for an MRI now incase surgery is the best option?

More than anything, I'm annoyed at myself as I was feeling optimistic and happy with my progress before this weekend. I'd really struggle if I ended up injuring it again after nursing it for a full 6-12 week period.

Any thoughts appreciated, I'm going around in circles.

I'd go and get an MRI personally just to know exactly what's going on, and to know if you can make it worse or not. if it's a rotator cuff injury and you lose range of motion each time, there's a chance you can get a frozen shoulder on top of the rotator cuff problem which has happened to a friend. That's really not fun. He got surgery and he's on the road to being 100% after 6 months.

I suggest having a consultation with a shoulder specialist / surgeon. They will be able to advise on the cause of the problem and whether you need an MRI, x-ray etc. and then the way forward. All they deal with is shoulder problems, nothing else and, as such, are experts in that area.

Try and find a consultant that understands sport injuries. If the NHS can't refer you quickly enough, then going private may be the only option. Yes, it will not be cheap, but worth it in the long run.

Well done on Monoculture, desperate little monos at the top.

CB.

Thank you. That's what I needed to hear. 

Do you know at what stage he had an MRI to figure out his injury?

Thanks, I don't suppose you happen to have any recommendations? 

I had a torn tendon in the shoulder last year that put me out of climbing for many months. I was in absolute agony with lack of sleep, etc.

Eventually had a consultation with a shoulder specialist and he thought that the tear had healed but I had now frozen shoulder! I had an MRI and x-ray which confirmed that it was.

Treatment followed and I am back climbing as before the injury.

The good news is that, apparently, having frozen shoulder in one shoulder means you are more likely to get it in the other shoulder. Can't wait!!

I have sent you an email with details.

CB.

at least a few months after rehab when his range of motion wasn't coming back. Defo see a shoulder specialist and get their opinion like climber bill said above.

I'll give you my personal experience. I picked up shoulder and elbow injuries from climbing a lot in my 20s and 30s. I had a workplace medical scheme and wouldl refer to this. The pattern would always be the same; go see an orthopaedic surgeon, get referred for some imaging ultrasound or MRI, then get referred to 10 sessions of physio (using their partnered physio service), which never satisfactorily resolvled things, then go back and have a discususion with the orthopeadic surgeon about the merits of surgery, in which cases I generally decided they were niggling injuries I could live with and would try to manage the condition. Sometimes they would administer a corticosteroid injection into the joint tissue, and various physios tried various things from rehab to accupuncture to chiropracty. 

In all this time, I couldn't train properly and I varied my standard to the condition of whatever injuries I had at the time. 

Things improved a bit when I insisted in seeing a physio of my choice and chose one with some experience of treating climbers.  Then things improved a lot in lockdown for a couple of reasons. 

One was reading and applying the philosphy of Make or Break, in terms of understanding the physiology and treatment options for your injuries  for yourself and taking ownership of the management of your condition, rather than giving this over to the system.  The learning for me was the default medical pathways you get pushed through are not always optimal for a climber. The rehab was insufficient to condition your body for the intensity of climbing, and that to resolve injuries and to remain injury free further specific conditioning is necessary. I also better undersood the biomechanics of the shoulder and could do mobility and conditioning exercises in a way that was much more beneficial to climbing movement. An example is understanding rotation of the shouler girdle and why this is critical for both reducing impingement and engaging the power chain of muscles to pull through the shoulder. You could argue that this was the physio's job, but they failed to both impart this understanding or prescribe the correct rehab. E.g. it was all inward/outwards rotator cuff strengthening, which doesn't resolve for an immobile shoulder girdle and incorrect shoulder function. 

Two. I had already learned that pilates helped with mobilty and conditioning. In lockdown I began more intensive floorwork and whole body HIIT which upped the general body conditioning and that includes a lot of targeted mobilty work for the back and shoulders. I've continued that in a gym with weights and cable work. Getting whole-body stronger helps an awful lot with injuries and injury prevention. You also have to overcome the idea that your injuries prevent you doing this training. Good physio is progressive stress to strengthen or balance tissues. It shouldn't be painful, which is symptomatic of being damaging. And it should progress beyond a point where your symptoms are resolved to a regular routine of prevantive conditioning and antagonistic training. 

So, long post, the main advice of which is to bone up on what could really be causing your shoudler problems and how you might treat it, experiment with these and see what works, and use the medicial options as part of your toolkit, but don't assume that they hold all the answers.  And yes, I would get the MRI as a start point to rule out damage that may need surgery. 

Thanks for your input Max factor. It's useful to hear.

I certainly understand and buy into the concept of 'owning your injury and rehab process'.

MRI is actually booked for tomorrow morning and a follow up with a consultant orthopaedic surgeon on the 15th. Hoping the outcome is that surgery isn't required and a good rehab routine will see me back to being match fit in a few months time.

Worst case scenario is that the injury warrants surgical treatment..... but at least the ball is rolling.

Thanks again, J

Get the MRI, get it interpreted by a qualified person, give that all to the climbing physio.

Get well soon