AC joint injuries - When the weight of the Earth is thrown on your shoulder!
The footy season is upon us! What that means it’s time for cool and sunny autumn mornings (unless you’ve lived in Sydney for 2022), folk of all ages running in the paddocks like spritely gazelles just for the mountain sized prop to come on by and pop you off your feet and convincingly drive you into the ground. What’s that unpleasant tickle you’re feeling on where your shoulder has hit the ground you may ask? Well it could very likely be your acromioclavicular (AC) joint screaming blue murder!
The AC Joint
The AC joint connects your collar bone to your shoulder blade, it’s near the bony tip of your shoulder. It plays an important role in the function of your shoulder, particularly with shoulder flexion and abduction. It’s also funnily enough one of the more common injuries we see when it comes to contact sports such as rugby and Australian football, but can also happen with any sort of trauma to the shoulder or fall onto an outstretched hand. In fact up to 40% of shoulder injuries have been reported as AC joint injuries in one study.
Types of AC joint injuries
The Rockwood classification system typically outline 6 different types of AC joint injury, which are based on how much damage to the surrounding ligaments there are. We find typically types 1-3 can be managed conservatively, whilst 4-6 generally need a trip down to the orthopaedic surgeon. To determine which type of injury you might have, a scan such as an x-ray, ultrasound, or MRI scan can be used. Our Physiotherapists and Chiropractors can refer you for the imaging, or work closely with your doctor in Milsons Point or North Sydney to arrange these scans for you.
How do we treat it?
Like a lot of injuries it really depends on the individual as well as the severity of the injury. For our team of Physiotherapists and Chiropractors in Milsons Point, we typically find that the following plan of management works well.
- PRICE protocol - where we try protect, rest, ice, compress, and elevate the joint to reduce the swelling and encourage healing.
- Sling up to 48 hours - this helps reduce any strain and excessive movement on the AC joint ligaments to let them heal.
- AC joint compression taping - this is less restrictive than the sling but still provides support of the joint so you can move it around.
Range of Motion and Early Strength Phase
- Start with simple assisted range of motion exercises to active range of motion exercises: this prevents the shoulder from becoming stiff.
- Isometric strength exercises: this involves contracting the muscles without moving the joint much, and can be a great way to help limit and prevent any muscle wasting whilst you recover.
- Bands and weights and more weights: as the joint heals, it is important to start placing the area under pressure with bands and weights to build up its tolerance. Eventually the shoulder will be required to tackle, push, pull, and even take the pressure from a fall again and these exercises can start gradually exposing the shoulder to it.
- Eventually we progress to more challenging and heavier exercises like lat pull downs, farmers carries, deadlifts, and bench-press exercises.
Return to Sport Phase
- Generally an increase on tolerance to impact and sport specific loads to the shoulder
- Knee to hand drops: these expose the AC joint to a sudden impact, creating just enough stress on the ligaments to make them strong
- Medicine ball catches: these help build the fast explosive power into your shoulder muscles again, after you've mastered slow bands and weights.
- Progressive tackle bag work: with soft, medium, then really hard tackles to build your trust and confidence in the shoulder again.
- Use of a thermoplastic AC joint guard: this can help you feel protected whilst tackling when you just get back to sport.
The above plan is a general plan which our clinicians use as a rough guide when planning the recovery of these types of shoulder injuries. There is unfortunately no gold standard when it comes to rehabilitating AC joint injuries, and the best plans are always individualised to what each person's injury is, and what they need to get back to doing.
If you have hurt your shoulder and think your AC joint might be injured, make an appointment to see one of our Physiotherapists and Chiropractors at Milsons Point Health today by calling us on 02 9023 9999 or booking in online today.