I’ve been dealing with a rotator cuff impingement for the last couple of months. Of all the (many) injuries I’ve had, this one has been the strangest. It didn’t present or progress like anything else I’ve experienced – and because of this, I made a lot of mistakes. So I thought I’d share what I learned from this injury in the hope that it might help somebody else.
Please know that I am by no means a medical professional. This is just a recount of my experience and the things I learned about my body. For all I know, I could be an alien and none of this could apply to you (hopefully not though).
Friday, June 25th: How it happened
I was working out the moves on Rappin’ Boyz – a route at Mt Charleston. At the last bolt, the micro-edge that I was standing on broke. I fell unexpectedly and shock-loaded my shoulder. It hurt… but not that much. I came down to be on the safe side and didn’t climb any more that day. But I wasn’t too concerned. It just felt like an awkward fall – those often hurt, whether from a bruise, a scrape, or a shoulder pull – and I didn’t think much of it.
The next day, I was supposed to climb with some friends. I didn’t go, but I still thought it was a minor tweak. Here’s the message I sent:
“Yo! I tried Rappin Boyz yesterday (super cool route – thanks for the recommendation!) but a foot broke and I tweaked my shoulder a little bit. So no climbing for me today. But I’m sure it’ll be fine tomorrow or the next day – not a big deal, more of an annoyance 😫 I’m psyched to get back on that thing!! Hopefully tomorrow 🤞”
As you can see, I’m not worried about it at all.
What I did next
I took three days off climbing entirely – this is kind of my standard approach if I hurt something. If it’s a small tweak, like I thought this shoulder thing was, it will often disappear completely within a few days. Many a time, I’ve tweaked a knee and spent four days limping around only to be fully recovered on day five.
My shoulder didn’t improve very much in these three days, but progress isn’t linear and I didn’t feel like it was “bad” pain – you know, the kind of pain you get when you know that you’ve hurt yourself for real. I climbed the next three days, taking it very easy. It got worse. That brings us to Friday, July 1st: a week from when it happened.
I took another four days off climbing and tried to self-diagnose what was happening. I came to the conclusion that it was a minor tear in my front deltoid and did some light shoulder exercises to target the front delt, using resistance bands and a Nalgene, nothing more. My deltoid was tender to the touch, and my symptoms seemed to match up with a tear. But over the next four days, it hardly improved – maybe 1-2% improvement per day. I did not pay enough attention to this fact: mistake number one. Yes, it was improving, but probably not enough for a correctly diagnosed “minor tweak”.
I couldn’t hang on jugs with straight arms – but I could if I bent them. Getting dressed hurt. Driving hurt. Showering hurt. Sleeping hurt.
On the fifth day, I had to go on a plane. Come day six, it was worse – no surprise. In hindsight, flying disguised what was really going on. Yes, I would expect spending time in a low-pressure environment (i.e. an airplane) to make any injury worse. But I think put too much of the blame on flying, given that I was now 12 days post-injury and it wasn’t a blunt force trauma injury like a sprained ankle. This was mistake number two.
I decided to give it two more days, bringing it to two full weeks post-injury. If it still wasn’t any better, I would go to PT. If not for the plane, I would have seen a PT sooner – but as I said, I over-weighted the effect of flying.
Friday, July 8th: Time to see a PT
On Friday, I reached out to a PT and set up an appointment. His earliest availability was Tuesday… four days away. This was mistake number three: it would have been better to get an appointment in the books earlier and cancel it if need be. By the time of my appointment, I had already been injured for 18 days. I had done a little climbing in the first week on easy things only. Things weren’t looking so good.
In the four days between making the appointment and attending it, my deltoid stopped hurting – but my shoulder pain remained. Until then, I was still under the impression it was a minor deltoid tear – I even wrote it on my patient intake form. But this change meant my diagnosis was wrong. So I stopped my shoulder exercises and just waited. It was a shitty weekend.
At my appointment, I was diagnosed with a rotator cuff impingement. Some of the exercises I had been doing were helpful for that but some were harmful. Diagnosing/treating yourself from the internet can make things worse! Luckily, in my case, the outcome was probably neutral.
Treatment
I was given a bunch of rotator cuff exercises and advised that it would be best to take another week or so off if I could. At this point, I wasn’t about to push it by climbing too soon and was happy to work on these exercises and hold off on climbing to give my shoulder the best possible chance to recover as soon as possible. My PT said that once I could hang with straight arms on jugs, it was safe to start climbing again (easy things, with slow progression).
He also emphasized that it was important to not aggravate the inflamed tendon in my shoulder. Impingement is basically just this tendon getting red and angry, so priority number one was to avoid making that any worse. Hence the week off – to let the inflammation go down and build up some rotator cuff strength in a careful, controlled manner. In all the rehab I’ve done, there is this part where you need to walk the line of doing enough to stimulate recovery but not so much that you make it worse – and this seemed to be an even bigger factor in this injury.
After the appointment, I took ibuprofen around the clock for four days to help get rid of the inflammation. I also took collagen every day before I did my PT work. The day-to-day improvement was huge. (This was confirmation that I was not seeing enough improvement from my earlier self-prescribed treatment too.) The following Monday, I could straight-arm hang on jugs and thus climb. It only took six days from my appointment to be climbing again – albeit carefully.
What happened next is confounded by my getting sick (so annoying) and a week-long trip to Costa Rica (awesome). It ended up taking about a month after my PT appointment to get back to 90%.
Friday, August 26th: Shoulder status now
I would say that my shoulder is at about 95%. Some moves still hurt, and I’m still doing my PT work every day, but it hardly restricts my climbing. I’m still getting back into climbing shape, regaining strength and work capacity, but I’m very happy to be back climbing things that are hard for me.
What I learned
I would rather see a PT over nothing and waste a $150 consult fee than wait 18 days to see one and potentially save some cash. In the future, I would see a PT sooner – like within 7-10 days of injury. The setbacks in my climbing would have been fewer had I done this.
The pain I felt in this injury was different. I did not give this enough credit. It didn’t feel like a muscle tweak, a pulled ligament, or anything I had experienced before. The simple fact that the sensation was different and I didn’t have any life experience to draw on should have been my cue to see a PT much sooner.
If I diagnose myself in the future, I will pay more attention to my improvement – or lack thereof. If something doesn’t sort itself out in 4-5 days, I will see a PT. I now know that I could make the injury worse by misdiagnosing myself. Injuries can be complex, and I was thrown off by the deltoid pain. I’m not a professional, and I should have seen one sooner.
Shit happens
If you climb, you will get injured. Sometimes it’s something you can control and sometimes it isn’t. I couldn’t control the foot I was standing on breaking, but I could have done a better job at controlling what happened next. I paid a lot of attention to what was going on (hence this rather detailed account), but I still made a number of mistakes. All in all, I think I did an okay job with the information I had – I could have climbed through it and made it much worse! – but I could have done better. Hopefully, this will help you to do just that.
Feel free to message me if you have any questions about any of this. Mistakes are to be learned from, and I’m more than happy to share mine for the greater good.
Image credit: Ryman Wiemann