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We started our taper the week before our LCM meet. I wasn’t in that good of shape yet after coming back from a two week vacation at the end of July, so I wasn’t really in tapering condition….but what swimmer would pass up some taper workouts given the opportunity? So of course we did a lot of sprints and race-pace sets, and lo and behold, my shoulder decides to pop out in practice two days before the meet.

All I did was push off the wall. I always hang onto the wall with my right/good arm. When I push off the wall, my left arm drops down and ‘leads’ my left side off the wall, and I bring my right arm over my head as I push off into a streamline position. Well, apparently I was pushed off the wall “too hard”. I felt my shoulder crunch and pop as I thrust my left arm down and out underneath the water as my right arm was coming over my head. I cursed the gods and continued to swim the rest of the workout. This time there wasn’t any anger, sadness, or even frustration. It all just felt completely REDICULOUS at that point.

The next day I was greeted with the familiar feelings of weakness, dead arm, and pins and needles. And I didn’t care. I had only signed up for 4 sprints at the meet anyway, two events each day. I went out and bought some of those “instant” ice packs and packed them in my swim bag. I loaded up on ibuprofen, sucked it up, and swam my events. Whatever! I just made sure to use caution around the walls, which made for some crappy finishes (was happy with my :32.5 in the 50m fly however).

The next week, I scaled back to doing half swim/half kick workouts again. Well, it was more like ¼ swim, ¼ kick, get out, go home, and ice. I avoided strokes for a week or two and just swam easy. Swimming with this injury has never been unbearably painful; it just feels sore as hell. In the few weeks after I re-injured it, I found that if I pushed the pace too hard my arm would just go numb. I didn’t feel any clicking this time around, so that’s good I guess (I hope there is still some cartilage left!). But I felt like frickin’ Nemo….swimming along with a gimpy, useless fin and everything.

Throughout all this, my coach kept suggesting that I see a physiatrist to possibly help me sort things out. So, I finally went to my general practitioner and basically demanded a referral to the physiatrist. I took the first appointment available, which was during the second week of September 2012. I don’t think I got even five sentences in when he interrupted me and said “You should have had the surgery a long time ago.” Oh, fantastic! He proceeded to tell me that he recommends surgery for people of my demographic after the 2nd or 3rd instability events. “After you re-dislocate once, the chances that you will continue to do so are about 99%.” He was frank in telling me that there were no exercises that I could do to help my situation, and that even if I lived in a bubble, I could still injure myself from sneezing (which I had already done in the past).

I mean, I guess I knew all this. I knew my injury never did nor would ever fully heal. Maybe I just needed someone to flat-out say these things aloud to me for it all to really sink in.

By the time I got my MRI results in March of 2012, I was slowly working my way back up to full workouts in the pool. I was doing half swim/half kick workouts, and during this time I paid close attention to how my shoulder was feeling. I eventually found a good ‘test’ for my shoulder: front sculling. By doing this I could sort of tilt my ear to my shoulder, and listen and feel for any crunchy sounds which became magnified underwater, lol. As my shoulder healed, the crunchy feelings and sounds would dissipate. It was also a bit hard at first because my right shoulder would compensate for the weakness in my left. For a while there both of my shoulders were pretty sore!

Since I wasn’t too keen on having surgery (the thought of not being able to swim for several months was too crushing to me at that point), I decided that I instead would be hardcore about my PT routine. After my last subluxation, I went back to PT for a month before I decided to just continue on my own. I also started to research other possible treatments that might help me. I learned about Active Release Therapy (ART) after poking around the USMS forums, and decided to give it a shot. In late March of 2012, I started seeing a chiropractor who specialized in ART. I remember during my first assessment, the chiropractor was testing my range of motion and she said to me, “Wow, you shoulders are fun to play with!” That made me laugh.

ART treatments are like short, super focused, intense massages. The chiropractor uses a small stainless steel tool to dig deep into your muscles with the purpose of breaking up scar tissue to promote healing. She was always apologizing for ‘torturing’ me, but honestly I didn’t find it all that painful….actually most of the time I thought it felt great! (Perhaps I have a high pain tolerance?) I also was given additional exercises and stretches to do along with my regular PT routine.

After about a month, I was mostly functional and feeling OK in the pool again. We had our Association Championship meet in the middle of April, and I had decided to sign up for a few short events (50 fly/breast/free) and told the coach that I’d be down for some relays too. My goal this time around was to make my seed times AND keep my shoulder in its socket, lol. Luckily, I was able to accomplish both, so that was a success! It was a lot of fun too even though I wasn’t in the best shape.

During the spring and summer of 2012, I kept to a strict PT routine (3x per week) and continued to get ART treatments every other week. By the middle of June I was back in great shape....gotta give some credit to an entire month of kick sets! I was back up to swimming 4 and sometimes 5 days per week. My shoulder felt solid, and as a bonus “the click” that I felt during backstroke had gone away! I think that a flap of cartilage shifted after my last subluxation or something. But whatever, I was happy to be backstroking again, as it is my second best stroke after fly.

However, all good things must come to an end. In mid July, I went on vacation for two weeks. Blast those pesky vacations getting in the way of training! I didn’t swim at all while on vacation (was visiting NYC), so when I got back I was waaay out of shape. Oh well, just gotta build things up again. I made plans to get back into somewhat decent shape for our long course meters meet at the end of August. It would be my first LCM meet in 16 years and I was totally stoked.

I must have still been in a denial phase, because two days after the meet I went back to the pool. My shoulder and arm were dead sore, but for some reason I had to test it out. I made it through warm-up before I got out. My entire arm had gone numb with pins and needles, and I was feeling “the click” during freestyle which was something I had only felt with backstroke before. No bueno.

I felt like there was a whole lot more at stake this time around. Over the past six months I completely re-discovered my love for the sport, and I knew that I was a better person because of it. At this point I knew that I should go back to the doctor and get some professional medical advice on my whole situation. The game had changed for me. Now that swimming was back and in the near-center of my life again, I had to take my injury more seriously.

A few days later, I got referrals to go back to physical therapy and to see an orthopedic surgeon. The ortho doc ordered an MRI and told me that I should do kick-only workouts for a few weeks. My plans for training and attending the next upcoming meets were pretty much shot right there, which was disappointing in the least. So, for the month of February 2012, I did kick sets in the gutter lane and went to physical therapy 1-2 times per week. My MRI was scheduled for early March, right after I got back from vacation.

A week after my MRI, I had a follow-up with the orthopedic surgeon. My results were as follows:

IMPRESSION:
1.Avulsion of the anterior posterior labrum with intact periosteum compatible with Perthes lesion.
2.Linear labral tear involving the superior and posterior labrum.
3.Hill-sachs deformity.
4.Undersurface fraying of the suprastpinatus tendon.

Basically, I have fairly standard traumatic dislocation injuries. Perthes lesion is a variant of a Bankart tear. Hill-sachs refers to a compression fracture in the humeral head, caused by bone-on-bone action when the shoulder dislocates from the joint. My labrum is all torn up and detached from the glenoid in certain areas. All this damage adds up to having a shoulder that doesn’t stay in place all that well. My rotator cuff and biceps tendon are A-OK though, so I guess that’s good lol.

So, based the results, I was recommended for surgery. I asked the surgeon, on a spectrum of minor to severe instability, where was I? I mean, I had read that some people have shoulders so unstable that they dislocate in their sleep! “Well, it’s not good, but it’s not horrible,” she said. I found that to be really helpful – NOT lol. She told me to think about my lifestyle, and if I would be willing to continue to live with my current situation of occasional interruptions followed by an annoying level of pain/soreness/dead feeling/pins and needles. She said that swimming itself would not make the injury worse – only actual events of subluxation could possibly worsen the damage. But by that point I had been through at least a dozen since my original dislocation, and that I was pretty much at risk at all times since minor everyday movements could cause my shoulder to sublux. But she also assured me that she wouldn’t recommend surgery unless she thought that it would help me.

I left the doctor’s office depressed and skeptical. I knew that I had A LOT to think about.

About two months after joining Masters in August of 2011, I started thinking about competing in some meets. I wanted to put in some time and get into decent shape beforehand, so I decided that I would start swimming meets when the short course yards season came around. The first SCY meet was at the end of January 2012, so that would give me a full six months to train first. I also planned to swim at local SCY meets in February and March, which would help me get ready for our Association Championship meet in April.

So I started putting together a training plan, which pretty much just involved gradually increasing my weekly practices over the upcoming months. I had a vacation planned at the end of February, but by March I wanted to be swimming 5 days per week before tapering for the big meet in April. I didn’t have any set goal times or anything, I just wanted to see what I could do.

Soon January came around and I started to get pretty excited for my first USMS meet. A few days before the meet, I felt those familiar butterflies in my stomach as I prepared my packing list. Extra towels – check! Backup cap and goggles – check! Deck coat and sweats – check! Powerade and bagels – checkitty-check! I was definitely nervous but pumped.

I had signed up for 100 fly, 50 free, and 50 fly. My goals were to just make my seed times. 100 fly was up first –eep! My teammates were at the end of the pool cheering hard for me at the walls. Things started off great, but then the last 40 yards….well, let’s just say that I survived. I ended up going a 1:08, which I was happy with. I remembered that during my senior year of high school - two years after I had quit club swimming – I had gone a 1:07. So I felt pretty satisfied, until I saw my splits! I split a :30 and then :38. Ouch! Obviously I was a bit excited and I didn’t quite have the racing endurance I needed yet, but I knew there was lots of room for improvement.

Up next was the 50 free…the ol’ splash n’dash. After that 100 fly, my nerves just melted away so I was ready to have some fun. And it was totally fun….until the end of the race. Without thinking about it, I finished the race hard with my left arm outstretched. As soon as my hand hit the wall, I felt the tear and pop in my shoulder. I quietly mumbled obscenities as I exited the pool and walked over to the warm down area. I was totally shaken, and as soon as I jumped in the tears started flowing.

I hadn’t really given my shoulder injury much thought in a while, since it had been maybe 8-9 months since my last subluxation event. Maybe I just wanted to forget about it, or maybe I was distracted from it since starting back with Masters, or maybe I was in some level of denial. But suddenly I was harshly reminded of it, and it felt like a smack in the face. I guess it had finally dawned on me that my injury might not allow me to do what I had come to love again over the past six months, and I felt crushed.

But, I calmed myself down, picked myself up, and swam the 50 fly about 20 minutes later. I went a :29.4 – not bad for partially dislocating just a few minutes earlier. It was a nice consolation prize, but I left the meet with an overwhelming and devastating feeling of uncertainty for my future in the pool.

During the summer of 2011, I seriously started toying with the idea of joining a Master’s program. Earlier in the year, I increased my gym visits and upped my weekly swims to ~3,500 yards. I ended up losing 20lbs and was feeling great! I had a subluxation event earlier in the year, but at that point it had become ‘no big deal’, and I wasn’t going to let it get me down.

I had thought about joining Masters in the past, but all the local teams had crappy practice times at either the butt-crack of dawn (no way Jose) or during the lunch hour (a no-go for this 9-5er). Plus, many of the city area teams were quite small and often just swam as a group with no coach on deck, and I knew that wouldn’t be very motivating for me. I was very much looking for a team atmosphere and a coach that would tell me what to do, lol. The team that had an on-deck coach and a reasonable evening practice schedule was a 20+ minute drive out to the suburbs, and to me that seemed like such a huge time commitment given that my work commute was also 20+ minutes in the opposite direction.

However, I was about to turn 30 and I got that feeling of having to do something ‘crazy’ again. I sure as hell wasn’t going to pick up the old skateboard, so I took the plunge and showed up for my first Master’s practice at the beginning of August 2011.

When I got there, I was caught off guard because a) the pool was outdoors; and b) it was set up for long course meters! I hadn’t swam long course in like, 15 years! The coach asked me about my background and how often I was currently swimming. I told him about my shoulder injury, and he told me to not over-do it and to adjust the sets if needed. Then he assigned me to Lane 4, right in the middle. I found myself in a lane with people much older than myself, and I thought, “Well then, here we go!”

I don’t know if it because I was younger or if it was because I wear swedish goggles (maybe both lol), but the people in my lane pretty much made me lead. I hadn’t had a real team practice or swam long course meters in forever and they wanted me to lead!? First, I remember thinking that the pool seemed never-ending, and second I was having a hard time with the digital clocks because I was so used to having the visual of a hand-clock. I wasn’t getting much rest so I really had to think hard to calculate those send-offs correctly lol. So that practice was a real physical AND mental challenge for me, but I made it. All 4200 meters of it. I think I got home and took a three hour nap…and when I awoke, I must have inhaled at least 2,500 calories.

The next day, as tired as I felt, I got up and went to the 9am practice. Two weeks later, I found myself completely hooked, back in my element, going 3-4 days per week and loving every minute of it.

My first instability event occurred exactly one year later, in June of 2009. I was at my work gym using the weight machines, doing my usual routine, when I reached up to begin a wide lateral pull-down set at 50lbs. As soon as I started the pull, I felt a rip, crunch, and a pop in my shoulder. I immediately let go of the bar and thought to myself “what the hell was that?!” As soon as I asked myself that I knew what had happened. I was a bit shaken, but there wasn’t a lot of pain. When I got home I told my husband that I thought I had re-dislocated my shoulder.

The next day, my shoulder was pretty sore. The weakness, coldness, and pins and needles all came back. It was only at this point that I went on the internet and started researching shoulder instability. I learned that my shoulder had ‘subluxed’ (i.e., partially dislocated) and then reduced on its own. I also learned that this was fairly common for people who had experienced a traumatic dislocation previously. So I didn’t really feel the need to go in and see the doctor, as I felt like there wasn’t much to be done besides ibuprofen, rest, and to start up those tubing exercises again.

But of course, the following weekend I was at my pool, testing my shoulder out, lol. It felt much like after I had dislocated it the previous year, so I just took it easy. Again, not a lot of significant pain, just the soreness and nerve issues.

I won’t go into deal about all my subluxation events, but here’s a brief description. From June 2009 to June 2011, I think I experienced almost a dozen subluxations, occurring when:

-Putting on a shirt
-Reaching out to close my car door
-Reaching back to grab my seat belt
-Reaching out to stretch (You know, that big yawn/back arched/arms in the air stretch you do when you sit up in bed in the morning? This one happened a few times before I finally learned to only do this with my right arm in the air, lol.)
-Reaching up to change a light bulb, and then sneezing
-Leaning down to tie my shoe, and then pulling ‘too hard’ with the final tug of the laces

As you can see, every day activities could cause a rip/crunch/pop/subluxation situation for me. Eventually I learned to just try and keep my elbow close to my body. But, I just carried on. Over these years I continued to swim ~2500 yards, once a week. I knew that swimming itself wasn’t causing these events, so I just took it easy in the pool whenever I needed to. Every once in a while, I’d swim a 50 or 100 of backstroke to check on “the click” to see if it still existed (yep), and pretty much just lived with it.

I saw the Ortho doc a few days after my shoulder dislocation in June 2008, and he pretty much just told me to keep the sling on for a few weeks, referred me to physical therapy, and gave me clearance to go back to work. I actually don’t remember much from that appointment at all. Now that I look back on it, things should have went down very differently. I should have been asking LOTS of questions….but back then swimming was only a peripheral part of my life, so I didn’t really think of it.

So, I went back to work a few days later. I work a desk job so nothing traumatic or anything. I do remember that it was hard for me to keep my arm in that damned sling….it actually hurt to NOT move it! It felt much better to change positions and move it around occasionally. If anything my shoulder felt less pain if I kept my arm down at my side. After a week and a half I pretty much abandoned the thing.

Sleeping was difficult. I’m a side sleeper, so not being able to sleep on my left side made for some restless nights. To this day I still can’t fully sleep on my left side, and I will feel some pain if I sleep on that side for too long.

My first visit to the physical therapist was short and sweet. It was about two weeks after I saw the Ortho doc, and I was feeling OK. He tested my range of motion which was just fine. Of course my shoulder was still very weak, and I still had some numbness, the “cold” feeling, and occasional pins and needles shooting down my arm, but nothing was overly painful. Overall, he seemed quite impressed with my strength and flexibility for having dislocated only a couple weeks prior. “You’re young, you’ll be fine,” he said. He gave me some tubing and a series of exercises to do - all of which were familiar to me since we did them all the time back in my age group days. I asked him when I could swim again, and he said to give it at least six weeks and to ease back in slowly. And that’s the last I saw of him. Again, looking back, I should have been way more involved in my treatment and rehab process. But at the time I had no idea what this injury would mean to me in the future.

Six weeks later I was back at my local pool. I had just watched Phelps go 8 for 8 in Bejing and I was rearing to get back ASAP! I had only been swimming 2000-2500 yard workouts once per week before my injury, so I just started back with a bit less yardage. I don’t remember any overwhelming pain – just a lot of soreness/weakness and my stroke feeling weird because of it. It was a little painful to breathe on my usual right side, so I just switched to the left. Everything seemed OK otherwise, until I attempted some backstroke and first experienced “the click”. Whoa! Never felt that before. My shoulder clicked with every stroke (right before the hand entry), so I just avoided backstroke from then on. I wasn’t really painful per se, but I knew it probably wasn’t good.

Fast forward to May 2008. At this time I was married, living in Portland, Oregon, and had been working my first 'real' job at the state Public Health Division for about two years. I was swimming once a week at my local pool, but I was starting to feel a bit old at the ripe age of 26. I felt like I needed to do something crazy, so I decided to take up something that I’ve always wanted to learn: skateboarding.

Things started off really good. Six weeks into it, my balance was much improved and I was feeling really comfortable cruising around at some fairly good speed, and I hadn’t hit the ground once yet! A friend of mine decided to take up skateboarding with me, so on the weekends we would hit up deserted parking lots and cruise around. One sunny evening in June, we were out at Swan Island cruising around the huge FedEx parking lot. I was cruising around, and I remember that I was headed towards a wet patch that the sprinklers had created. Well, least to say, I didn’t make it through that wet patch. It tripped me up for some reason, and I fell spot on my left shoulder.

I immediately knew I had dislocated it. Mainly due to the obvious popping sensation that I had felt, plus I couldn’t move my arm. I was on the ground, and I couldn’t get my arm to move to get myself back up. Then, the pain came. HOLY HELL! And my friend was nowhere to be found. I knew she must have been waaay over on the other side of parking lot, so I laid there and waited…and waited….and waited. It felt like 15 or 20 minutes before I knew that if I wanted medical attention any time soon, I would need to get up and find her. So, I took a deep breath, and managed to get up. Holding my arm as pain went searing through my body, I hobbled to the other side of the parking lot and found her.

After I finally got to the hospital, it was still a good two and a half hours worth of waiting before my shoulder was put back into place. First, I had to wait my turn in the jam-packed ER. Then, I had to get X-rays to confirm that my shoulder was *actually* dislocated before they would give me pain meds (WTF!). Finally, I was prepped with an IV, as they knock you out so they can get your shoulder back in more easily. I was all ready to go when the doctors came over. But then they told me that I looked “more flexible” than average (thanks to swimming??), and that they were going to try to reduce it without knocking me out. I had to lie on my stomach with my arm dangling over the edge of the table, and it was only 2-3 seconds of intense pain before they got it to pop back in. Most relieving feeling ever!!! I was sent home in a sling and was told that the Orthopedics and Physical Therapy departments would be calling me soon. I thought to myself, “Well, I guess I get a few days off work, and I have pain meds, so thats not too bad!”

A few days later, I found myself sitting in my living room flipping through the TV channels, when I came across the ‘live’ airing of the 2008 Olympic swimming trials on NBC. I looked down at my arm in my sling, and then the realization came. I then thought to myself, “Oh F*&%, what have I done?!”

Thought I'd write up a bit about my swimming backgound first for some context before I get into all my shoulder mumbo jumbo....

I started swimming at an early age. Both my parents had relatives that had drowned, so I was put in lessons as soon as I was out of diapers. At age five, I joined WAVE Aquatics (then known as Totem Lake Swim Club), located in Kirkland, WA. My mom actually wanted to sign me up for synchronized swimming, but they didn’t accept kids younger than six. So swim team it was (thank goodness).

My age group ‘career’ was fairly short and sweet. From ages 10-14 I won several state and regional championships (fly, IM, and free...dont ask about breastroke lol), and placed well at a few Zone meets. When I was 12, our 400 free relay ranked #1 in the NAG top 16. Right after I turned 13, I broke the minute in the 100 fly, which was probably the highlight of my swimming career. I remember at the time my goal was to swim for the University of Washington, and make the Olympic team for Sydney 2000. A kid can dream, right?

However, around that same time, my parents got divorced. It was pretty ugly, and I was an only child in the prime of my adolescence. It was also expected that I move up and start training with the Senior group, which was rough for me because I was very attached to my friends and my age group coach. I remember my emotions were all over the place, and I was crying at a lot of practices and swim meets. Long story short, I couldn’t handle all the change, and it showed in my lack of improvement. So, right after I turned 15, I hastily decided to quit swimming. Just like that. No one around me seemed to question that decision, including myself. I continued to swim high school season up until I graduated, which was actually a lot of fun without all the pressure. I did still manage to make a few finals at the HS State meet, but of course I never came close to my old club times.

Every once in a while I would drop in on the team for a visit since they practiced at my high school pool. I'm pretty sure they all thought I was pulling an Anthony Ervin because I was all 'alternative' looking (this was Seattle in the 90s, what would you expect? lol) and I'm sure I smelled like cigarette smoke (soooo cool, right?). But really, I stayed out of any real trouble and had a part-time job. My grades stayed decent and my parents made it clear that I was still going to college, despite my lack of enthusiasm for it. When I was applying for college, I was actually offered small scholarships to swim at two in-state colleges, but I passed on those.

After I graduated and went off to college and then grad school, I never let swimming get too far away. I swam for PE credits, and on my own when I had exhausted the number of PE credits I could get each year. I also had worked as a lifeguard and taught swimming lessons at the local athletic club. I think in the decade after I graduated high school, the longest time I went without having at least a once a week swimming routine was about 6 months. So, I have always held on to my identity as a swimmer.

November 12th is the day, about 2 months from now. I am going to attempt to blog about my experience, since so many other forums and blogs out there were quite helpful for me while I was researching my condition and treatment options. I'll make another post soon to give some background on my initial dislocation injury, subsequent instability events, my recent return to the sport via USMS, and finally what prompted me to finally go with surgery. Stay tuned, I know this should all be very, very exciting.