Recovering from a dislocated shoulder

Bikers: If you get nothing else from this post, watch this video Showing Kocher’s method for putting your shoulder back in (I paid a very nice ER doc $800 for a live demonstration). Of course, you should see a doctor as soon as you can, but maybe it will spare you a scary hike.

One Sunday (July 25, 2015) when I was bored with riding on the road, I took off for a trail ride. It was an amazing 45 minutes before I got into trouble. I started on the beginner trails at Duthie Hill. Even though it was a damp morning, the trail was so nice I kicked myself for not going up there once a week all summer.

I started slowly and cautiously. I’ve had bad luck falling off my mountain bike – a couple times since I got it last year. After the beginner trail, I went to another nearby Grand Ridge trail which is more difficult (see photo above). I rode a ways out before turning around. Unfortunately on the way back I hit a loose patch of gravel on the outside of a narrow turn. My front wheel washed out to the right and I flew like superman into the ground – landing mostly on my chest. I landed with just the right forced to dislocate my left shoulder.

A nice young lady came along two minutes later. I asked her “This doesn’t look normal does it?” showing her my shoulder. “No,” she said. She graciously pushed both of our bikes out while I hiked. I carried the weight of my left arm in my right-hand. Surprisingly, it was not that painful. I didn’t relax until we hiked / jogged for about 20 minutes out to the road.

I’m writing this post to share some of the supplements I found trying to accelerate my recovery. Unfortunately, it’s been very slow. Over a hundred days now. I was able to get back on my bike after about 2 1/2 months, but I completely missed the last month of the race season. Luckily, it was only about two weeks that my arm was in a sling and I couldn’t type. It seems like my shoulder will be back to normal around the end of the year (5 months total).

Here are some of the supplements I that I tried.

  • Glucosamine
  • MSM
  • Gelatin (collagen) – (helps re-grow tissue)
  • Fish oil
  • Daily vitamin
  • Cissus quadrangularis (helps joint healing)
  • Magnesium (relaxes muscles)
  • Ginger tea (reduces inflammation)
  • Vinegar Apple cider  – forget why I started, but I drink this now to when my stomach is out-of-whack.

It’s really only Advil that I can definitively point to as helping my recovery. I should’ve taken more sooner in order to sleep better and heal faster, but I didn’t like the idea of numbing the pain. I think the nice snugness of my newly reformed shoulder capsule is due to many of the supplements that I took (primarily the Gelatin).

I also used a heating pad, stability ball, foam roller, and tennis ball in a sock to release tight back muscles.

I did a number of exercises recommended by a physical therapist. Other than slowly strengthening and stretching my shoulder, it’s hard to say which helped the most. So I won’t list them here.

The big lesson from this is that I need to keep working on my skills. The Total cost of the accident: a $2,000 trip to the ER, and a $1,000 chipped tooth.

Update: day 87 (12.5 weeks)

Motion continues to increase slightly every day. I’ve started doing Tony Horton’s Shoulder rehab workout.

Update: day 102 (14.5 weeks, 5 November 2015).

I was still having trouble sleeping last week. I can’t get used to sleeping on my back. A cold I got earlier in the summer came back. I’m pretty sure it’s because I wasn’t getting enough sleep (5 hrs a night). On a doctor’s recommendation, I’m back doing three Advil an hour before bed. It’s made a big improvement in my sleep.

Related

Commuter Bike Recommendations

After years of bike commuting, the drive train on my 15 year old mountain bike (circa 1990s GT Backwoods) is starting to skip. I asked my biker friends on Facebook to recommend the ultimate urban commuter bike.

My criteria: Lightweight, geared for hills, low maintenance. My budget is only around $1,000. I don’t want something custom, just something practical. Ideally, also stylish with fenders and and a rack.

From Johnson Donglecorn: I recommend any internally geared hub, I like Rohloff. I also recommend a steel frame. I’d find an older (2000ish) Lemond. They use really nice Reynolds tubing (853 for example). Buy an IGH built up wheelset, and build the rest from your spare parts bin. Also,  I really wanted a Civia Bryant when i test rode one for fun.

Scott Nonnenberg: I’ll try to be the zen perspective here. First, decide your minimum requirements. Then, spend as little time as possible finding one that achieves those things and be done. You’ll be overwhelmed and/or led astray by the market’s focus on differentiators and not the core things that matter to you. I didn’t fully do this, but I did just go to REI and bought one that rode well and was reasonably cheap ($600 – Scott SUB 30).

The principle is taken from this article in the Journal of Consumer Psychology. Take a look at my note summarizing it.

With regard to the bike,  musts haves are: disc brakes, rack, fenders. Nice to have: wider tires to make the bike more versatile, internal hubs or other drive train changes to reduce maintenance costs. Solely my opinion: Mountain bike style handlebars will help with maneuverability, and you want enough gears to reduce sweating while riding.

Matt Terich: There are a lot of stock commuter bikes that are decent and stylish with internal hubs. Public and Linus come to mind. Very affordable. For commuting, albatross bars would be better than flat.

Eric Artzt: I have been riding a Rawland with an SRAM 3-speed internal / rear derailleur combo. Although the above is awesome, in retrospect given cost and weight considerations, if I had do-agains, I would go with a real derailleur and no front derailleur. I would definitely go for disc brakes and a rack/fender compatible frame. Additionally, get the bolt-on wheel skewers — basically, you want to be able to u-lock the thing with one of the compact locks, without worrying about parts being removed. There are some incredible deals right now on off-the-shelf disc based commuter bikes. It’s a bit hard to justify going fully custom.

I can’t wait to read Scott’s journal article above. I think about this kind of “maximization vs. satisfaction” stuff a lot.

 Scott Neilson: If I was replacing my 50lb Dutch wonder, I, Like Johnson above, would take a hard look at a Civia Bryant. My friend Matt is very happy with his Salsa Vaya too.  Unfortunately, those are both well over the $1k budget. You could join the hordes of Surly folks and get a Disc Trucker or, like Matt says, go the Linus route. My friend Clarke (a serious cyclist and aesthete) is very happy with his Linus Roadster, I just wish it had discs.

 Matt Leber Go test ride the Civia Cycles Bryant at Counter Balance Bicycles near U Village. It’s a little above your budget but is a nice bike. While a Rohloff hub would be nice, the hub alone is your entire budget. The Alfine on that Bryant should do the trick. The belt drive should be virtually maintenance free. I’d comment more but I’m off to go clean my chains on 2 bikes.
 Jason Morris I think internal gear hubs feel like your pedaling in sand. There’s a higher transmission friction loss than a chain drive. Unless you’re just cruising on the boardwalk, you’ll feel it.
Scott Neilson I hadn’t heard that about planetary hubs before. I’ve been very happy with the Nexus 8-speed that’s on my Jorg & Olif Dutch bike but, of course, a little friction would be hard to discern while riding around town on 50lbs of the early machine age. Here’s a good review of the Civia bryant which is my top vote for Adam’s dream commuter.

Summary

The Scott SUB 30 was kind of what I had in mind. However, I’m going to try and find a Bryant for a test ride. Drive train maintenance is always what ends up stopping me from riding. I think I would prefer flat bars for commuting, but we’ll see. Oh, with regards to Scott & Eric’s comments on consumer psychology, I’m definitely a “satisfier” (not a maximizer)!

4 Hour Bike Racer

This is post is a working draft. My primary New Year’s resolution for 2011 is to win a category 4 criterium. Specifically, I’m shooting for my local Seward Park or Volunteer Park crits. I have raced before, mostly 15 years ago (made it to cat-3, but never won a cat-4 race).I’ve been inspired by the pragmatic approach of The 4 Hour Body, but it is missing a chapter on cycling. So this blog post will be my attempt to write that chapter. Also, I’m working on a mobile application for behavior change – inspired in part by the work of BJ Fogg. I’ve had positive results using behavior hacks the last few months, so I thought I’d take on this ambitious goal.

Please leave a comment (question, answer, or cheer me on) using your email address and I’ll send you an update when I’ve got the training plan fleshed out.

On-bike workout schedule

I have 3-6 months to pull this off. The question is: what is the most time-effective way to get in shape? I’d like to avoid 4 hour long rides via the scenic Renton airport or on the body-rocking (tree root infested) Burke Gilman trail if possible. I think the alternative is interval training.

I’m hoping that – like the sprinters in 4HB – I can train at less than full interval lengths and get the full benefits. If I concentrate on sprints and strength, I’m hoping that early season races will help with overall aerobic fitness.

Another idea is to take a track racing course that I’ve heard is offered locally. I’ve never done it, and could gain some fixie cred (not that I want it). Oh, and I live smack on top of one of Seattle’s 7 hills – and don’t have a car. So I’ve got that going for me.

My Quora question: What is the best 12 week training plan to prepare for a cycling criterium?

Strength (weight) training

I’m guessing that I can start with the 4HB chapter on “Becoming super human.” I’ve already got the tights for it. My interpretation is that the main requirement is lots of dead-lifting. The glute exercises are easy, but I may need to join a gym to find enough weight to dead-lift (and large enough kettle bells).

Another fallback is the P90X “Legs & Back” workout video. You can find it on bittorrent sites, if you can make it past the Russian bride ads. When doing the workout, I substitute push ups and sit ups for the back part. I’ve found it to be challenging, effective, and comprehensive (meaning I walk funny the next day if I haven’t done it in a while). It can be done in an hour from home.

Training with power (and other forms of measurement)

Serious bike racers attach power meters to their rides to measure their power output. Non-serious bike riders use power motors to get up hills. You can also measure your heart rate to determine how hard your body is working. Measuring both enables you to determine how efficient your body is becoming as you train it.

The only problem is, I haven’t yet found a power meter for less than $500.

So far these seem to be the most affordable (not sure about quality):

I’ll find a few others and set up some craigslist alerts. If you know of any for less than $500, please comment below.

A quick Google search turned up this book: Training and Racing with a Power Meter, which looks like a good training guide. Again, I’d love to find some way to optimize the process to the minimum effective dose. I’m also wondering if simply timing myself up a hill will suffice (the hill eliminates the wind factor).

Lastly, inspired by 4HB, I will estimate body fat and take my measurements. This should help with motivation. Haven’t decided yet if I’m going to post it here.

Skills & Tactics

My earlier racing experience (insert photo of wrecked bike and bloody leg) has given me a little knowledge of how to not get taken out by an idiot, not get dropped, and occaisionally get to the front. I’ve ridden the two courses a number of times. I’ve also been riding a little bit on rollers, which I can tell has improved my bike handling. I have a feeling there are going to be a lot more rollers in my future due to the extremely sunny Seattle spring time (I only like to ride in the rain).

I would like to read up on sprinting form though. I’m sure improving my form (I’ve never really worked on it) would go a long way.

If all else fails, I’ll recruit some friends with dogs and bull-horns to throw a little mayhem into the last lap of a race to give me an advantage.

Bike

2006 Pinarello Dogma. My mistress. I may upgrade my Ultegra pedals to Speedplay pedals if I have the hankering to upgrade something. The cleats on my cheap Pearl Izumi shoes keep coming lose.

I do need a bike-fitting and tune up. I’ve never done a bike fitting. A friend recommended Rusty at TN Multisports. Maybe they can evaluate my riding form too.

Diet & Supplements

I’m starting with the slow-carb diet as a default. Need to tweak it for strength building and recovery.

Recovery drinks [link forthcoming] – I swear by these since using them to complete P90X. A big glass after a work out prevents me from being sore the next day, and I’ve noticed makes me come back stronger faster. Really wish these were around (or I wasn’t so cheap) when I raced before.

Protein Powder [link forthcoming]. Both seem to help with building muscle and more importantly give me something sweet to drink when I’m craving a milkshake. I often add bananas, almond milk, and Hagen Daz vanilla frozen yogurt.

Magnesium & Caffeinated Gu for the short races. I haven’t propperly measured the effect of either. I will report on their effectiveness as the season progresses.

4-Hour Body Cheat Sheet

February update: The slow carb diet has produced noticeable fat loss. I’m a thin guy with a fast metabolism, but the diet has helped with love handles and revealed my abs! I’m not tracking my body fat percentage, but I am taking pictures.

I follow the diet for breakfast and lunch, but I’m not hard core about dinner and desert. I’m exercising a fair amount (bike rides) in addition to the exercises I list below. The extra protein seems to be making me stronger faster, which is exciting.

People reading this post seem to be primarily interested in:

  • Cat vomit ab exercise: Get on all fours, exhale your breath, and hold your stomach in for 12s. It is hard to recognize the direct results of this, but it seems to be playing a role in giving me visible abs.
  • Torture twist exercise: A side crunch exercise where you hold yourself in the reclined position without any back support. Great core exercise, and it is getting easier.
  • Two legged glute activation raises: Lay on your back with your knees up, raise your  hips. I think this is contributing to better strength on the bike.
  • diet rules: for me, it is all about beans and eggs for breakfast. A high protein start to replace my previous high-sugar routine. I drink lots of protein shakes (I love almond milk) when I feel the urge to snack.

More updates below.


I’ve been thoroughly enjoying reading The 4-Hour body. Tim Ferriss’ passion and hacker mentality appeal to me. The book is an encyclopedia of fitness hacks – the minimum effective doses to achieve the results you want. I completed 3 months of exercising at least 5 hours a week at the end of 2010. In 2011, I’m hoping to re-ignite my career as a bike racer. The 4-Hour Body has been a fun way to get started.

Below is my cheat sheet for the diet and exercise I’ve been attempting since January. I made a lot of bookmarks in the book. I wanted the exercises I was targeting all on one page with a photo-collage for easy reference. Even if not not useful for you, I think it is worth sharing to give you a flavor for the book.

4-Hour Body Photo Cheat Sheet

click for larger version

My favorite discovery in the book so far is the “pelvis reposition stretch” (circled in red in the collage). After 3 minutes kneeling on the floor, I found myself standing straighter immediately. The effect was surprising enough that I feel that one stretch was worth the $15 I spent for the book.

“Get on all fours, knees under the hips, and remove all weight from one knee for 90 seconds to two minutes. Next, shift your weight about 4” to the outside of your support knee (frame 2) and rotate the foot in slightly as shown. In frame 2, no weight is on the left leg. Hold again for 90 seconds to two minutes. Repeat on the opposite side.”

Enjoying these tips so far? Please click one of the sharing buttons to see my diet and exercise details (text will appear instantly).




My Diet and Exercise Picks

  1. Slow Carb Diet (p72)
    1. The rules
      1. Avoid “white” carbohydrates
      2. Eat the same few meals over and over again
        (Adam: this is working great for breakfast and lunch)
      3. Don’t drink calories. No milk, soy milk, soft drinks, or fruit juice. Coffee & wine are OK.
      4. Don’t eat fruit. Tomatoes and avocados are OK.
      5. Take one day off per week. Eat whatever you want.
    2. Allowed foods
      1. Proteins:
        1. Egg whites with 1-2 whole eggs for flavor (or 2-5 whole organic eggs, including yolks)
          (Adam: I microwave my eggs for breakfast, add beans, sauerkraut, and salsa)
        2. Chicken breast or thigh
        3. Beef (preferably grass-fed)
        4. Fish
          (Adam: Should be eating more – I like fish. I do fish-oil supplements)
        5. Pork
      2. Legumes:
        1. Lentils (daal)
        2. Black beans
          (Adam: At first I didn’t like them, now I gobble them down)
        3. Pinto beans
        4. Red beans
        5. Soybeans
      3. Vegetables
        1. Spinach
        2. Mixed vegetables (including broccoli, cauliflower)
          (Adam: Incredibly, I’m eating lots of broccoli – but not much of the other vegetables listed here)
        3. Sauerkraut, kimchee
        4. Asparagus
        5. Peas
        6. Broccoli
        7. Green beans
  2. 6 Minute Abs (p175)
    1. Myotatic (swiss ball) crunch. 1 set x 10 reps @ 4s (with 2s pause each end). Add weights when can do more than 10.
    2. Cat vomit. 1 set x 10 reps hold for 12s.
      (Adam: I think this is working, but I’m not sure. It is easy enough to do, so I keep at it.)
    3. Front plank. Work up to 90s hold.
    4. Side plank. Work up to 90s hold.
      (Adam: I found these difficult, so I do the torture twists below instead)
    5. Hip flexor stretch. 30s each side.
  3. Maximal Strength (p414)
    1. Dynamic stretch. Over-and-unders. 1 x 7 reps.
    2. Push-ups: 12 reps (foot in the air < 50 degree angle)
      (Adam: due to my work the end of 2010, I’m currently doing 20 reps x 5 sets of push-ups every other day. I try to get my foot up now and then)
    3. Deadlift. 1 set x 3 reps @ 95% IRM, 1 set x 5 reps @ 85% IRM. Plyometrics immediately after: box jumps, jump rope, or 15m sprint.
      (Adam: I still haven’t figured out how to get enough weight for these (I need to join a gym). I use 50lbs, but need to get that up to 300lbs!)
    4. Torture Twist: 5 sets of 5 reps (30s rest between)
      (Adam: these are getting a lot easier after a month)
  4. Ultra-endurance Stretches (p376)
    1. Hip flexor (Iliopsoas) and quad
    2. Pigeon pose for pelvic symmetry and glutes (see cheat sheet photo).
    3. Foot on top of table (see cheat sheet photo).
    4. Pelvis reposition
    5. Glute activation
  5. Perfect Posterior (165)
    1. Two legged glute activation raises. 1 x 20 reps
    2. Flying dog. 15 each side.
    3. Kettlebell swing (working from 20-50 reps and adding weight)
      (Adam: also need to figure out how to work in more weight here, only using 25lbs x 75 reps currently)

This looks like a lot, but it is actually less than half an hour, and can be done every other day.