AC Joint Separation

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  • #54298

    Any (hopefully positive!) stories or advice for a Grade II/III AC joint separation? Took a heavy fall on my left shoulder at the weekend and x-rays confirmed the damage.

    Keen to get back ice, mixed and rock climbing and mountain running but realise it’s going to a long road. Any positive early steps I can be taking for rehab?



Posted In: Injury & Rehab

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    Thomas Summer, MD on #54368

    Hi James!

    Any other damage? Was/is surgery discussed?
    Are you wearing a sling at the moment? Look for a good physio and prepare for at least 3 months with conservative treatment.

    have a quick recovery!

    JWTM on #54371

    Thanks Thomas – no other damage to the shoulder bones thankfully. Maybe a bit psychologically with the abrupt change of expectations for this year 😉

    The consultant said they’d prefer to go with conservative treatment over surgery at this stage but that it could be reviewed if physio wasn’t working.

    I’ve been using a sling the first few days and at night (I’m 5 days since the injury now) but have been trying to wean myself off it when at home. I’m guessing I should try and challenge (pain-free) range of motion as soon as possible? Think I’ve come to terms with the reality that it’ll be a long road back but very willing to channel all my frustration into making as good a recovery as I can.

    Thomas Summer, MD on #54378

    Hi James!

    Good that there is no other damage (the psychologic damage is up to you;-))
    I would recommend using the sling for some more days. Give everything some rest. Better do it now, then go back to it later. Do you have already a good physiotherapist? If not, then step one is to find one, who can guide you through the rehab.
    Grade III is the border to surgery. But if there is no other damage, then it’s a good idea to go with the conservative treatment. This way you can also be back sooner. …if you are patient;-)

    take it easy!

    KT on #54402

    Hey James,

    For a patient-perspective, I separated my shoulder about 15 years ago and had bi-weekly to monthly separations afterwards. In discussing with my surgeon, I went without surgery. There are distinct ranges of motion I avoid (climbing overhangs where I am required to reach above and behind my head) and with that I have been able to go 5 years without separation and no real impact on my activity level; I am still able to climb as hard as I want and don’t think there would be an issue swinging tools in vertical ice (though I don’t ice climb).

    Obviously your results may vary depending on the details of your injury and you should listen to your doctor but thought I would share in case it is helpful.

    Good luck on your recovery!

    JWTM on #54408

    Wow – sounds like you had a tough time of it. Glad to hear you’ve made a decent recovery overall. Good to know and to help focus on the long term if I encounter set backs along the way. Thanks for that KT!

    Thomas Summer, MD on #54424


    Please be careful with comparing injuries! I have to tell that to my patients all the time;-) Everyone is different! Better to learn from each other about the mental part. Focus on the process and be happy about what life has to offer.

    JWTM on #54439

    Thanks Thomas – yes just taking it a day at a time now, focusing on keeping positive (mostly!)

    Resmo on #54955

    Hello everybody
    I also had a grade 3 ac joint injury. It’s now been 6 weeks for me. I have been climbing and bouldering for 10 years (boulder up to V11 / climbing 5.13c.
    after 3 weeks I climbed again for the first time (Slab Climbing 5.10c was almost painless.
    Week 4: vertical to 5.11b.
    Week 5:overhang up to 5.11c.
    week 6: 5.12a / V5.
    unfortunately far from my previous limit, but it is slowly coming. Above all Gaston and crossmoves and dynamic moves are not yet possible without pain. I also think that it will take 3 months to fully recover.
    How does it look for you now after 4 weeks have you already been climbing?
    Thanks for a feedback

    JWTM on #54957

    Hi Resmo

    Welcome to the club!

    I’m on a pretty conservative protocol here on my physio’s advice but getting good range of motion and just beginning some basic strength stuff now – no climbing or running yet, so am just clocking up mileage on a turbo trainer along with a lot of rehab exercises. The way I’m trying to look at is that I can’t necessarily speed healing up, but can probably slow it down if I just try and push through it.

    I did find some interesting articles out there from pro climbers Dave McLeod and Jonathan Siegrist (links below) but more out of interest to see their recovery than trying to follow their protocols or level of rehab as I wasn’t climbing anywhere near their level before the injury:

    AC Joint Sprain Grade III: Full Interview with Jonathan Siegrist

    I found JS’s comments on blood flow restriction training interesting as a way to maybe do some light work and get blood moving through the affected areas. Also that DMc sometimes forgets which shoulder he injured is encouraging, though as Thomas said above, everyone is different.

    I’ve also been reading ‘Rebound’ by Kuzma and Cheadle on the mental side of recovery which has been useful – particularly the concept that recovery is now your sport rather than just comparing your now with your pre-injury self and to put effort into that rather than trying to rush back. Not sure if any of that is helpful or not! I’m trying to be patient for once as I’ve ignored rehab (a lot) in the past and am reminded of the consequences by my body regularly 🙂


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