A recent fall on the ice gave “shoulder season” new meaning for me. This post is about shoulder dislocations and a reduction technique that you can teach yourself. Based on the four dislocations in my friend group this year, I highly recommend learning this technique. 95% of people that have dislocated a shoulder will do it again. If you spend anytime on the river, or apparently on ice, consider learning this technique.
Telling this story properly also involves nordic skating and breakdancing.
Shoulder season describes the window between the winter and summer seasons. For the past ten years, I’ve filled the fall-winter shoulder with nordic skating. Nordic skating is an absolute blast and can be done safely. Skating opens up new pockets of the landscape, like marshes and swamps that are no fun in the summer. The equipment is relatively inexpensive, especially if you already have ski boots. Check out my other videos and resources to learn more about nordic skating.
Here is a highlight reel from the 2020 ice season:
WFR & Shoulder Dislocations
I finally took a Wilderness First Responder (WFR) training course last March. I had delayed the training for years, even though I knew it was a significant gap in my wilderness knowledge. We have dealt with many injuries on our trips (broken bones, frostbite, snow blindness, infection, hypothermia), but fortunately, my partners had the training I lacked.
I postponed my WFR training because I was committed to taking the course from Deb Ajango, and she only offered it during the peak ski season, when I prioritized time in the mountains. I wanted to take the course from Deb because of her extensive experience in wild Alaska, the same environment I anticipated using the training. I finally buckled down and gave up time on skis for the course this year. I was very impressed with the quality of Deb’s instruction, and I highly recommend her courses, especially for people who recreate in Alaska.
I paid extra attention to the shoulder dislocation part of our training because I knew dislocations were a prevalent paddling injury. I researched why they are so common and have included this explanation in The Packraft Handbook:
How it Works: Shoulder injuries
Improper bracing causes shoulder injuries because our arms aren’t allowed to absorb shock. In a low brace or proper high brace, the low elbows and hands provide shock absorption: force on the paddle blade that pulls the arm away from the body is countered by an elastic force that brings the arm back into position.
High braces with improper technique (hand over head) lead to shoulder injuries because the extended arm can’t absorb shock. Unexpected force on the paddle blade stretches the arm beyond its limit and forces the humeral head out of the shoulder socket. Common sources of the unexpected force are powerful hydraulics, contact with a rock, or the boat pulling your torso underwater or down river.
Over the summer, I interviewed two friends who dislocated their shoulders. I’m not sure these will make it into The Packraft Handbook, so here is one of my write-ups:
Dmitry’s Dislocated Shoulder
I was pushed up sideways against a rock in shallow water. I used a high brace on the rocks upstream to keep my head out of the water. But then the current caught my boat and rolled it beneath me. I knew I messed up, my hands were above my head, and sure enough, my shoulder popped out.
I pulled my skirt and swam. I was full of adrenaline, and swimming wasn’t painful. My friend was able to get my shoulder back in the socket with the baseball technique. He put my arm in a sling and then swung me to the other shore with a throw rope. I hiked out.
Brad’s Dislocated Shoulder
We were skating on Jim Creek, about an hour from Anchorage. Thin ice and open water are typically relatively easy to identify, but one section of the creek had stealth holes. Brad Meiklejohn—friend, mentor, and deep-dive editor of The Packraft Handbook—waited for us to regroup and pointed out the zone of stealth holes. Brad then turned 180-degrees, made two strides, broke through a hole, caught his foot on the lip of the ice, and fell to the ice. He landed with his right arm fully extended.
We unpacked our extra puffy gear and Ben’s sleeping pad to keep Brad warm while he rested on the ice and tried to manage pain. Brad was able to sit upright for a while but then got nauseous and had to lie back down. After partially recovering, I asked if he could sit upright again. I wanted to try the Cunningham reduction technique, which would work best if he was upright. Here is the Cunningham technique as described in The Packraft Handbook:
The Cunningham technique for shoulder reduction
The humeral head wants to be back in the socket; the problem is that the strained deltoids and other arm and shoulder muscles prevent reduction. A safe and non-invasive technique for shoulder reduction is the Cunningham technique. The Cunningham technique involves relaxing tight muscles to allow a natural reduction.
- Help the patient relax as much as possible.
- Have the patient sit upright.
- Sit across from the patient and help them place the hand of the injured shoulder on top of your shoulder. Rest your wrist in the crook of their elbow, where it can apply slight traction.
- Encourage the patient to continue to sit upright with good posture and roll their shoulders back (proud chest).
- Gently massage the muscles of the arm and shoulder, especially the biceps and deltoids.
- Reassure the patient to help them relax. The light massaging should feel good, and if the patient’s muscles relax sufficiently, the humeral head will slip back into the joint.
In Brad’s case, I was just about to start Step 5 when the humeral head slid back into the socket. The reduction instantly took care of Brad’s nausea and mental state. It was incredible to watch this transformation up close.
The Cunningham technique is pleasantly passive. There isn’t any wrenching against the body or anything that feels forced. The intent of this technique is to help the body do what it wants to do. I love that.
The production value of this video makes my work look good, but this is one of the better views of the process that I’ve found:
Ummm, I was promised Breakdancing?
A dislocated shoulder injury can be hard to distinguish from a separated shoulder. “Separated” refers to stretching or tearing the ligaments that attach your collarbone to your shoulder blade at the AC joint. From The Packraft Handbook:
Dislocated vs. separated
A dislocated shoulder can be difficult to distinguish from a separated shoulder (torn AC joint). Perhaps the most helpful clue is to determine the mechanism of injury. A dislocated shoulder is the result of indirect torque, whereas a separated shoulder is typically due to impact, e.g., trying to catch a fall while on skis or bike. Both injuries will show a divot between the humerus and AC joint. A dislocated shoulder will have lost all mobility, whereas a separated shoulder will have some mobility, albeit painful.
Since Brad injured his shoulder while catching a fall, I thought he was more likely to have separated it. He was the one that proposed that it was dislocated, even though he hadn’t dislocated a shoulder before. Regardless, I could tell by looking at his shoulder that it wasn’t separated because I separated my shoulder, twice.
I returned home to Alaska after finishing my graduate studies at MIT in 2008. I spent the winter as a substitute teacher in the Anchorage School District. Substitute teaching allowed me to chose when to work, but more importantly, I was interested in teaching for the school district and appreciated the opportunity to test the waters.
One day I reported to West High and was directed to the dance studio. I was subbing for the dance instructor! She left me a light load; the kids were rehearsing for a performance and didn’t need anything from me.
During their breaks, they broke?
You got it.
Most of the Anchorage high schools have breakdancing clubs. I knew this because, in 1995, I joined one. After high school I co-formed the Carleton (College) Breakdance Squad with King Midas and MC Snak. I was (am?) AK Rock. We were quite bad, and not the kind of bad that means good.
The defining move for breakdancers is the windmill. The windmill involves spinning on your chest and upper back, with your hips and legs never touching the ground. I had tried many times and never figured it out. I thought the West High dancers might be able to give me some tips. Surely it wouldn’t matter that I was out of practice and twice their age.
I did make some improvements. The key was catching and pushing off while on your chest, like catching a large ball and spinning it. I made it around once, maybe twice, and then felt a three-part rip in my shoulder. My ear was pressed to my shoulder; I could hear the tear clearly—a separated AC joint.
We were paid $100/day as substitutes, a nice chunk of change. I stomached the pain, and getting teased about being old, put my arm in a sling and finished the school day.
Thank you. I enjoy embarrassing stories.
Me too. And, I’d like to see this one shared, because…
Please help me get people to sign up for my email list. My marketing consultant and wife (not the same person) say I need to build an email list so that I at least break even with The Packraft Handbook (May 2020). I send infrequent emails with resources, updates, and posts like this.
Excellent as always, Luc.
Great post. Love the break dancing!
This brings back memories, Luc! In 1982, my youngest graduated from high school, and just as his sister and brother, received a trip of his choice. He & I went west to do some white water rafting, and then to Golden CO, and HANG GLIDING SCHOOL! This 49 year old was signed up also, but the last flight of the first day, I flew into the ground and dislocated my right shoulder. The rest of the week I was photographer. Ted didn’t mind, though, he got to do all the driving from then on. I couldn’t work the stick shift on my Vette. It was a memorable trip. Thanks for the reminder, and the medical advice! Bob