ASAD - Arthroscopic Sub Acromial Decompression Rehab log

  1. ASAD - Arthroscopic Sub Acromial Decompression Rehab log

    I had this op just over 2 weeks ago and managed to keep a short diary of my rehab back to training over this period. Obviously the rehab is still ongoing but thought this might be useful to others either with the same/similar condition (basically impingement of the tendons in the shoulder) and considering whether they should go the surgical route and what they might expect.

    By way of background i injured the shoulder falling over with about 6okg bag in one arm and used my other arm to break my fall. Something went at this point but it felt reasonably ok at the time. A few weeks later i noticed discomfort when training the shoulder and over about 6 months had various diagnosis and treatment and eventually discovered i had some damage to the rotator cuff and the way it was healing had reduced the space for the tendons to move freely in the shoulder, confirmed by MRI.

    Being **** scared of surgery and having a long period out of training, i went for the non surgical rehab route over the next 9 months, including 3 cortisone shots, endless stretching, rotator cuff strengthening and physio, but the end game was that there just wasn't enough space in the shoulder for the tendons not to keep catching. So reluctantly decided to get it sorted.

    Log will follow

  2. There is probably too much detail, but decided to post the whole lot as sometimes it isn't just the training aspect that people worry about when having surgery. Questions welcome.

  3. ASAD Log
    Arthroscopic Subacromial Decompression of right shoulder
    Date of Surgery: 05/05/2017
    Location: Nuffield Hospital, Kingswood Road, Tunbridge Wells
    Anesthesia: Nerve block followed by general anesthetic
    Time of surgery 9am
    Awakened from surgery 10am

    Day of surgery (Friday 5th May 2017)
    No sickness from anesthesia.
    Right arm completely dead from shoulder down to hand, with only small movement possible in fingers. In a sling.
    Used bathroom about 11am, a little unsteady on feet
    Had lunch midday, no issues, although still a little groggy.
    Went home 3pm, ate normally the rest of the day, didn’t sleep again until normal time at night
    Sleep reasonably easy as arm remained largely pain free due to nerve block, but also took Codeine as a precaution.
    Hand was slightly swollen due to water retention moving down arm from shoulder. Hand flexation several times every 30 minutes helped a little.
    During night started to feel arm more and water retention in hand dissipated. Took off arm brace for the remainder of the night. Slept on back.

    Post-surgery +1 day (Saturday 6th May 2017)
    Sleep previous night ok, by morning nerve block feels it has largely worn off.
    Slept later in the day for an hour or so, to make up for disruptions in the might due to getting up to take painkillers and general discomfort trying to sleep in the same position.
    Felt well enough to attend gym in morning. Did only leg exercises using machines (leg press, leg extension, leg curl, adductor, abductor). Kept weights well within normal ability (circa 60% - 70%), but sufficient to get the lower body muscles working.
    Performing mobilization exercises for arm as prescribed by hospital. Generally are quite easy although ones involving lifting the injured arm in front of and away from body and also to the side and away from body are quite hard, with stiffness and some discomfort in the shoulder area /AC joint.

    Post-surgery +2 day (Sunday 7th May 2017)
    Sleep previous night was very disruptive, but this is wat specifically due to the shoulder. Although there was the usual discomfort from sleeping in the same position (on back) and getting up in night for painkillers. Not using the sleeve at all.
    Sleep during the day for a couple of hours.
    Returned to gym and was pleasantly surprised that I noticed that moving the arms up and down with elbows in at the sides presented little discomfort or stiffness.
    I therefore did some light triceps push downs at the cable machine using a rope and some hammer curls using dumbells. In both cases I kept the weights very light 25%-30% of normal weight, but aimed for higher repetitions, 15-30 reps.
    Also, trained calves without any restriction using leg press machine and performing seated calf raise in rack.
    Developed rash on arm in afternoon. Research suggested this is some form of auto immune response to the surgery/anesthesia where the body is still under adverse stress. I believe the timing of this is also linked to personal situation on this day and not specifically to the surgery itself.

    Post-surgery +3 day (Monday 8th May 2017)
    Sleep better the prior night. Decided to not get up in the night for additional painkillers as it didn’t seem necessary. Generally, however there is still a loss of 1-2 hours due to not getting comfortable when awakened and having limited positions to use to get back to sleep.
    Mobility gradually returning with the ability to move the arm into positions away from body assisted by the other (good) arm.
    No adverse issues from prior day workout.
    Decided to try one arm rows. Movement placed minimal stress on shoulder as elbow kept close to body the whole time and pulling up motion towards body when leaning down over a bench doesn’t seem to bother the deltoid area. Kept weights at 60% of normal level but higher repetitions, 20 – 25 per set.
    Also, performed some very light 10% of normal weight machine chest press. This was uncomfortable for the front deltoid and AC joint area but was useful to put the arm through this range of motion for a few sets.
    Worked also on core by performing one arm plank and then realizing that it wasn’t uncomfortable to also utilize the injured arm also.
    Post-surgery +4 day (Tuesday 9th May 2017)
    Sleep continues to improve with no painkillers used and getting more used to sleeping on back. Still getting up to an hour of extra sleep later in the day to compensate for general quality of sleep being lower.
    Training partner returns from short trip away. Train legs and aim to get closer to a normal leg workout.
    Perform back squat in rack, split squat, barbell glute bridge and leg extension.
    Squat was performed using only left arm to support barbell in correct position allowing the right arm to hang to the side or in front of me, but to the need to avoid the more extreme stretch and compression of the shoulder when supporting the barbell.
    Weight was slightly less than normal for back squat circa 75%, but aimed for higher repetition in range 10-20, depending upon weight. Using just the one arm to support the barbell does create a slight imbalance and the tendency to twist slightly, so it something that needs consideration to ensure you use the core muscles to counter this tendency.
    Split squat and glute bridge was largely unaffected in weight.
    Leg extension could be performed normally without any restriction.

    Post-surgery +5 day (Wednesday 10th May 2017)
    Sleep into a general pattern. Generally lower quality sleep, with the loss of 1-2 hours of sleep per night. No real pain when sleeping on back. Sleeping on good shoulder is also becoming possible for shorter durations, although having the bad arm across my body is not so comfortable. Sleeping on bad should not really attempted.
    For mobility, movement to the side and away from body is becoming much easier and comfortable in the first arc of circa 45 degrees. Beyond 45 degree to 90 degrees is still quite uncomfortable in the AC joint area where coplaning of this joint took place and presume there to be some inflammation in this area still that needs to settle.
    Movement of arm in front and away from body is also relatively comfortable up to 45 degrees and beyond this point is more uncomfortable.
    Trained calves, forearms, triceps and core. Triceps using the triceps pulldown using the rope, this time up to 80% of normal maximum. No issues with this. Forearms were ok, although getting the dumbells into position for wrist curls engages the front deltoid and therefore caution is required when preparing for the movement. Once in position the act of curling the wrist provided no issues for the shoulder.

    Post-surgery +6 day (Thursday 11th May 2017)
    Sleep as previous.
    Gym decided to push into new territory, by training back with lat pulldown, heavy one arm row and a wide grip chin up.
    Lat pulldown was fine. Caution is required not to swing or engage deltoids when getting into position. Ensure that pulldown is to front of chest rather than behind neck. Used up to 90% of normal weight, slightly higher repetition 10-12.
    One arm row already I knew was fine but increased weight to 85% of normal level. No issues, again making sure strict movement, using the muscle, avoiding bouncing.
    Wide grip chin up was also fine. Performing 7 repetitions after already doing pulldown and row. So, this is probably close to normal level of performance for a muscle that has been pre-exhausted.
    For shoulders, I did 3 sets of shrugs using up to 75% of normal weight. Small discomfort in AC joint area, but otherwise no issues as arms and elbows remain static and should joint is not moving in any arc motion.
    Also, did 3 sets of seated face down 30 degree rear deltoid dumbbell raise using 70% of normal weight, focused on range of motion and strict form with higher reps 12-15. Range a little tight on the injured shoulder in the highest position, otherwise fine.
    Did a couple of set of lying rotator cuff dumbbell lateral raises using 60% of normal weight. No issues. Will focus on building further rotator cuff work into future workouts.

    Post-surgery +7 day (Friday 12th May 2017)
    Sleep largely consistent with prior days.
    Trained biceps and chest. Biceps was ok doing hammer curls, but sore on the AC joint area when doing supinated standing curls. Seated concentration curls likewise. Kept the weight below normal level 20kg instead of 26/28kgs dumbells. This was probably a little too much given how sore the AC joint felt, backed up by Physio advice the following day.
    For chest I tried decline dumbell press. This has been the hardest exercise since surgery, as this placed the highest stress on the shoulder and AC joint. The AC joint seems to be the area of discomfort, whilst the deltoid itself seems fairly pain free in this movement. I worked up to 36kg dumbells, (normally do 50kg the max my gym has), but it didn’t feel especially good on the AC joint, and as with the biceps curls, probably should have lowered the weight on this.
    Arm/forearm rash that appeared on +2 days after surgery has largely gone and is not giving me any issues.

    Post-surgery +8 day (Saturday 13th May 2017)
    Sleep improving, with sleeping on back and side (non-operated arm) more comfortable for longer durations.
    Saw Physio today. Was impressed by progress made just over one week post-surgery. Wound marks just reveal two small slits and are otherwise unnoticeable. First day where I have not felt the need to sleep during the day time to make up for loss of sleep during prior night. Suggestion of more frequent icing and use of ibuprofen to help keep the AC joint inflammation under control and to be more sensible on chest and bicep curls, until the AC joint feels a bit more settled.
    Trained legs. Pretty much a normal intensity workout, doing goblet squat (heavy dumbell/high reps), split squat, back squat and leg extension. Was also able to hold barbell in normal position with both hands for all squatting activity.
    I also performed some rotator cuff strengthening work for the last 5 minutes of the workout.

    Post-surgery +9 days (Sunday 14th May 2017)
    Calves in morning, seated calf raise and on leg press machine and some stationery bike riding.
    Afternoon trained back and shoulders, doing wide grip chin ups (bodyweight), barbell row and then shoulder shrugs, upright barbell row (but keeping elbows slightly below parallel) and side lateral raises. Side lateral raises was a little uncomfortable on the AC joint, but generally this workout didn’t create any pain or significant discomfort for the shoulder.
    Overall the deltoid feels in good order, range of motion in front and upwards is possible all the way to the arm being vertical and fingers pointing to the ceiling, but this is still a little sore and tight in the AC joint area.
    Iced the AC joint twice during the day and took ibuprofen twice during the day to assist in reducing inflammation.

    Post-surgery +10 days (Monday 15th May 2017)
    Sleep feeling more normal on back and on side (good arm).
    AC joint still feels a bit sore from the activities of the prior several days, but icing and ibuprofen seems to help settle it down.
    Trained core, biceps, forearms, rotator cuff, so hopefully give the shoulder a bit of rest time before training chest tomorrow.

    Post-surgery +11 days (Tuesday 16th May 2017)
    Chest remains quite sore when doing dumbell press, but keen to keep pushing into the discomfort, whilst not into pain. Worked up to 36kg dumbells. A bit disappointed that I didn’t feel able to go any higher and therefore not progressed beyond what I did in my last chest workout. This is likely to be because I probably overdid it previously and the shoulder needed more time to recover from this.

    Post-surgery +12 days (Wednesday 17th May 2017)
    Saw physio today. Continues to be happy with progress and stated that the reason why I was able to return to training so quickly was due to having good condition going into the surgery and the fact that I didn’t leave the surgical option until the impingement became more acute and limiting.
    He quoted some cases where people have left it until they cannot raise their arm or use it for any meaningful exercise, so they go into surgery already with significant loss of mobility and muscular condition, which then needs longer to fully rehab.

    Trained legs, which continues to be my favorite area as it is completely unaffected by the shoulder surgery. Did barbell glute bridge, back squat, split squat and leg extension.

    Post-surgery +13 days (Thursday 18th May 2017)
    Trained back and shoulders. Back training is completely back (excuse the pun) to normal. Chin ups (weighted and unweighted) followed by machine rows. For shoulders, I did upright row and decided to try dumbell shoulder press for the first time. Positioning was difficult, but managed to find a position where it felt reasonably comfortable. Worked up to 20kg dumbells, which also about half of what I’m capable of, marked a milestone, as this is one of the hardest exercises to get back to after shoulder surgery.
    Continuing to ice twice per day and take ibuprofen for the anti-inflammatory benefit.

    Post-surgery +14 days (Friday 19th May 2017)
    Trained chest (dumbell press up to 42kg for 5 reps). Still have to train slow and there remains some discomfort, but able to handle more weight than previously. Also did dips for the first time for several months as this previously caused me discomfort prior to surgery followed by cable cross overs, which felt most comfortable of all.
    Then trained triceps doing triceps pushdowns using the lap pulldown bar. No issues other than slight discomfort getting the bar into position.
    Starting to use massage ball in shoulder to help break down some of the scar tissue, which seems to be helping.
    Continuing to ice twice per day.
    Trained core and rotator cuff in evening.
    Saw consultant for follow up. Happy with progress. No issues or concerns. He noted that whilst externally the wound has virtually disappeared, there will still be trauma inside the shoulder from drilling away at the bone and under the AC joint.

    Post-surgery +15 days (Saturday 19th May 2017)
    Trained calves, seated and leg press machine, then trained biceps standing supinated bicep curl. The supination still generates some discomfort but less than when previously training biceps and managed to work up to 22kg dumbells, which is not too far off from what I was using pre-injury (26kg), using strict form (no swinging like some guys do to try and use the 30s or 35s ��). Also, trained forearms, as I’m still trying to help rehab long term elbow tendinitis (golfers elbow).
    Overall feeling very happy with progress and don’t feel that I have lost any condition of underlying strength due to the ability to return to training so quickly and modify my routine around the surgery trauma.
  4. One hour after surgery

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