SnowSphere Surgery: Dislocated Shoulders, Coccyx Crunchers & Alcohol at Altitude
New for SnowSphere, resident Doc Natasha Gilchrist answers your questions on ski and snowboarding injuries. This month, The Doc looks at dislocated shoulders, a painful case of a crushed coccyx and the age old myths that surround drinking alcohol at altitude.
Recurrent Shoulder Dislocation and Rehab
I dislocated my right shoulder three seasons back, then again three times last year (once playing tennis) and once again on the slope this year. I had surgery to repair the Bankart lesion last October but that didn't seem to do much given this year's incident.
My question is: what are the best exercises to strengthen up my shoulder muscle - especially the ones holding the arm joint in place - as my shoulder cup is not much cop any more?
Sorry to hear about your shoulder dislocating like this. Once a shoulder dislocates several times, it is termed "shoulder instability".
The very best way to prevent this is early treatment of the original dislocation and thorough rehab to stop it from happening again. When the shoulder dislocates, it tears through all the ligaments that hold the shoulder in place. Inside the shoulder joint is also a bit of cartilage that makes the arms fit better into the shoulder joint. This can also be damaged, meaning the fit is not as good and finally, there can also be a bit of bone broken off the shoulder joint.
This is what you had repaired, the Bankart lesion. Having this repaired early reduces recurrence to 10%, but only if you have really good rehab afterwards and if you avoid activities that put you at risk! As you have dislocated it again since surgery, things are not looking too good. You may need to have further surgery to mend the ligaments/tendons and cartilage too. It would certainly be worth having another MRI.
The bad news is that even if you have further surgery, if you continue to snowboard, you will almost certainly do it again. On the positive side of things, there are exercises you can do to strengthen things up and if you get going on them now, things may be improved by Christmas.
You had better get good at landing those jumps, there's no room for crashing out now!
Try these exercises, but rehab of the shoulder is complex and you should see a physio for extra guidance:
1. Push ups against a wall (standing)
2. Push ups on floor, but using your knees to lean on and not your feet.
3. One armed push up on a gym ball.
4. Use rubber tubing to pull against while pulling your arm up into the "stop sign" position.
5. One armed throw and catch of a ball against a minitrampoline or to a friend.
I returned from a snowboarding holiday feeling pretty good, a few aches and bruises but nothing in particular, but now, a few months later my a*se hurts when I sit for long periods of time..
How do I know if I have damaged my coccyx?
Ok, firstly a painful coccyx has the great name of Coccydynia and has a number of causes; inflammation/bruising, instability (movements of the small joints and ligaments), dislocation and fracture. Your pain seems to have occurred several months after your snowboarding efforts and so we can't assume that the boarding was the cause.
However, injury to the coccyx area is so common in snowboarders that it is highly probable that you did damage it back then and you may have recently done an activity that flared up the problem. Even sitting for prolonged periods can aggravate it.
The pain is usually in the middle of the buttock cheeks and just above the anus. It is usually worse with sitting and as you move to stand up. The pain can come and go throughout the day.
The most important thing is to get a proper diagnosis and this will require a trip to your GP. Ask for a "sit/stand" xray as these give better pictures. If the xray is ok, then you can try simple things first, such as pain relief in the form of paracetemol or ibuprofen. A cushion can also add some much needed relief. Varying you sitting position and sitting with a more upright posture can also help you to sit more on the pelvic bones, rather than the coccyx.
It may also be worth a trip to an osteopath. As I think you suggested, they do sometimes offer manipulation to the coccyx that is done "per rectum"! I believe this is not always done under general anaesthesia - so ask before you agree to it!
Obviously, avoiding aggravating activities is the best way to avoid it getting worse or recurring, so either don't fall on you bum or buy an azzpad.
Finally, if all else has failed, then ask to be referred to an orthopaedic surgeon who can inject local anaesthetic or even surgically remove the coccyx altogether. This is not always successful in treating coccydynia however.
Drinking at Altitude
Does drinking at altitude (i.e. in a ski resort) get you more drunk and lead to worse hangovers?
It is a well held belief that drinking at altitude has more effect on you than drinking at sea-level. However, there have been a number of studies done in this area and none of them have been able to prove this fact.
All the studies agreed that alcohol has a detrimental effect on your decision making process and your ability to perform tasks both at altitude and sea-level. They also agreed that without alcohol, your ability to make decisions is also reduced by being at altitude. However, when the same subjects were tested again at altitude with the addition of alcohol, there was no further reduction in their test scores. They also measured blood alcohol levels and found these were also unchanged by the effect of altitude. So, no excuses for being a light-weight now!!
You may suffer more from the effects of drinking due to dehydration. It is common among skiers and snowboarders to exercise all day without re-hydrating properly at all. Many people are guilty of drinking alcohol or caffeine drinks in the day which also add to your state of dehydration. If you start a big night out, already dehydrated, you are in for a big hangover!
Alcohol also causes your blood vessels to dilate (become larger) in your skin and this allows you to lose heat more quickly. If you were to fall asleep in the snow due to alcohol, your risk of hypothermia and death is much greater. Alcohol should, for this reason, never be used to treat a person who has become too cold and it is advisable to always drag your mates home even if they are refusing to get up off the snow!
In the case of serious altitude, i.e over 3000m (10000ft), the risk of acute mountain sickness (AMS) is much greater. It occurs in up to 4% of visitors to altitude and it is very difficult to predict who will be affected, although if you have had it before you are at increased risk of getting it again. The effects can be serious and can often make the person appear to be drunk. If nothing is done, the person can develop fluid in their brain and in their lungs and die. It is obviously vital, therefore that you do not drink alcohol at these altitudes. You and your friends should look out for changes in each others behaviour and breathing and act quickly to bring them down to a safer altitude.
Just remember: re-hydrate, eat, party, re-hydrate more and bring your mates home!
Her next wish is to Heli-ski in Alaska. She now works as a General Practitioner in East Sussex, having specialised in Sports & Exercise medicine. Her particular interests are skiing and running injuries. She is a member of the British Association of Sports & Exercise Medicine.
A big thanks to the GoneBoarding Community for their questions.