What’s Hurting Our Johnsons?
What’s Hurting Our Johnsons?
a Carolina Paddler Article
Written by Alton Chewning
In the last year, two members of our club, Steve Johnson and Dave Johnson, suffered shoulder injuries while paddling. Both are recovering now and back on the water. Their journeys share many turns: previous trauma, a sudden injury, a demoralizing break from paddling, a lengthy recovery, and a cautious return to the river. We’ll explore the path of Dave and Steve’s experiences, first by taking a visit to the CCC website.
On the CCC site, under Members>Handbook (PDF) you’ll find a primer for new members. There’s lots of good information for novice paddlers, including this section on shoulder dislocation.
Shoulder Dislocation
Whitewater paddling can cause a variety of injuries: broken limbs and noses, sprains, cuts and others. A common injury, particularly among kayakers, is a dislocated shoulder, A shoulder dislocates when the ball of the upper arm pops out of the socket of the shoulder. It is usually very painful and under normal circumstances should only be “reduced” (put back in place) by a doctor.
Shoulder dislocations are frequently caused by poor paddling technique. A typical case is when a paddler extends his arm away from his body, rotates it rearward on a brace, turns his head in the opposite direction and receives a jarring blow. All paddlers should take the time to learn proper paddling technique and methods of avoiding shoulder dislocations.
First aid field treatment is to put a sling on the arm and then tie a swath bandage around the body to keep the arm immobilized. The patient should be evacuated, and although he can usually walk, he should not be sent out alone: pain from a shoulder dislocation can induce shock.
Paddlers venturing into remote areas may want to discuss methods of reducing a shoulder dislocation with their doctor. This is especially true of those who have suffered a dislocation in the past, since they are more likely to have it happen again. The longer the shoulder remains “out”, the harder it is to put back in.
The Handbook makes several points. Poor technique contributes to shoulder injuries. The pain from these mishaps is intense. Reducing (putting back in place) a dislocated shoulder is difficult and ideally should be done by a doctor. If a doctor is not soon available and the pain is excruciating, then the shoulder should be reduced as soon as possible. This is best done by someone with appropriate knowledge and ability–whether a fellow paddler, a bystander, or the paddler him or herself.
Dave Johnson
David Johnson was on the Ocoee in October for the final release of the year. With him was Matt Cox. Both had paddled the Middle Ocoee many times throughout the late summer and fall. Other members of their group had paddled the day before and then headed home. Dave and Matt were going to do a quick lap and then start their six-hour drive home. They formed a group of just two but many other paddlers were on the Ocoee this Halloween weekend. Dave tells the story:
Diamond Splitter
“We had just run Tablesaw. I went first and both of us made it to the eddy. Matt ran in front of me for Diamond Splitter. Above Diamond Splitter is a little eddy, right above the drop. You can scout from there. I watched Matt go through on the right side. I was little too far right when I started down. It’s shallow there and rocky. My paddle caught in something at the same time I hit the breaking wave at the bottom. The combination of the paddle stopping and my boat moving forward caused my arm to be jerked behind me on the right. My arm went one way and my body another. Out came my shoulder. It was an uneventful moment. I wasn’t doing anything like a heroic high brace.
I tried to roll up and could not. I didn’t understand what had happened. I was barely able to swim over to river left. I came to rest on this rock that was underwater, but you could still straddle it like a horse. My paddle and boat had gone on down. Matt, at that point, understood that something was wrong. He collected my boat and was sitting in an eddy.
I was sitting on this rock wondering what to do next. There were people coming down so I yelled, “Over here, need some help.” This one lady comes over. I told her, “My shoulder’s out. I can’t get it in myself. Please help me.” I was distressed. She parked her boat and waded over to me. She gets behind me on the rock, “riding the same horse.” I know how to put a shoulder back in place, so I start talking her into doing it. I couldn’t do anything without getting it in. It was my right shoulder and I am right-handed.
She’s behind me. I can’t turn around and she can’t get it in. At this point, with the stress of the situation, or just the pain, I started to pass out. I told her, “I think I’m going to pass out, can you keep a hold of me, so I don’t fall over and drown.” She did and I passed out. Probably 45 sec. to a minute. Then the rest of her group and a commercial raft came down. They picked me up and took me over to another rock and laid me down so they could get my shoulder back into position.”
The first time around.
This was not Dave’s first experience with shoulder dislocation. Early in his boating career he paddled a C-1. While doing a roll he popped out his left shoulder. Dave had never suffered a severe break or other trauma. At first the pain wasn’t too bad, but he remembers, “It’s one of those things that slowly gets worse and worse. All the muscles and tissue tensing up around it. The space the shoulder occupied is filling up with blood. Soon, it was hurting like crazy.”
Dave went to a hospital where they gave him heavy medication and then reduced the dislocated shoulder. Two hours had passed since he tried the faulty roll. He doesn’t remember much from this dazed time but afterwards he vowed to learn how to replace a dislocated shoulder. As you recall from the handbook explanations, once a shoulder has been dislocated it is prone to happen again. Dave didn’t paddle for six months after this first dislocation.
Second time.
Back on the Ocoee rockbed, Dave was now being attended by a group of kayakers. They were able to reduce his shoulder, easing the worse of the pain. A commercial raft offered to carry him down. At Hound Bone rapid, the Class II after Splitter, Matt was waiting with Dave’s boat. Someone else had found his paddle. Matt and others stashed Dave’s boat near the road, and he followed the raft down.
Once back to his car, Dave evaluated his situation. He had feeling in his fingers. If they had no feeling then it was a further problem, perhaps nerve damage. The pain was manageable, so Dave decided against going to the ER. Matt drove them back to Durham.
Steve Johnson
Steve Johnson’s paddling progression was a little unusual–kayak fishing to play boating. Two years ago, in 2022, Steve was at the White Water Center in Charlotte on Easter Sunday. (Is there a pattern here, Steve’s injury at Easter, Dave’s at Halloween?) Steve recounts the circumstances:
Biscuits and Gravy
“I was in Biscuits and Gravy, the final rapid on the Wilderness Channel, learning how to do spins. Had done a spin and stopped the spin in a side surf. I put my right paddle downstream as I side-surfed. Leaned a little too far downstream and tried to do a quick paddle brace. My right-side blade caught the outflow current and stretched me. I fought it. If I had relaxed it probably would have been better. All in a matter of a split second, the paddle blade pulled one way and the kayak stayed in the hole, pulling the other way. [The opposing forces] were wanting to pull me out of the box. Trying to pull my elbows above my shoulders. I fought to keep my elbows low when I should have let go of it or relaxed my hips, but I fought it. In a matter of a second, I felt the twinge in my shoulder.”
The box Steve is referring to is the “paddler’s box,” the zone of motion that protects the paddler’s body, particularly the shoulders. From an overhead view, the chest, arms and the paddle shaft form a square or rectangle, a “box.”
Steve recalls, “The boat’s in a hole. I was ready to flip. I was going to have to roll. Instead of rolling I decided to brace. It was too far. I should have let it go, flip and roll. The brace put a lot of strain on my body. I don’t think my elbows went above my shoulders but getting near your shoulders is still danger territory. With that much pressure and strain from the water, my elbows felt it.
I got off the course at that point. I had driven to Charlotte alone, so I had to drive myself home. The day of the injury I had full motion. I did what I had to do. I could feel a stabbing pain in my shoulder, my right bicep. A sharp pain but not terrible. The next day it had set in. I could barely lift my arm above my head.
From past experiences I knew it was bad. I was going to be in for a long-term healing process.
Seeking Help.
Immediately following the accidents Dave and Steve both avoided seeing a doctor. Life had other demands, and each had experience with shoulder injuries.
Steve explains, “I didn’t go to the doctor. I had this type of injury in the past. I had been to the doctor three times then. I knew I should go. Everything felt the same as in the prior experience. I’m stubborn and didn’t go. “
Dave adds, “Once the shoulder is back in place it hurts a lot less. It was very sore. I did not have a lot of use of the shoulder, but luckily, my job is at a computer. I was fortunate that I don’t have a job that is very physical. Otherwise, it would be a different ball game.
Steve’s first impingement.
Steve’s first time being injured was more of a slow onset. A condition brought on by “a combination of weak shoulders mixed with poor paddling form, particularly with my roll. I would reach out too far with my paddle in the roll. My elbows probably came above my shoulders. That would put a lot of strain on my shoulders. It was a slow downward progression. I got to a point, four or five months into paddling, where I thought, “This is not right. This hurts too much. Then I decided to see a doctor and take a break.”
The diagnosis was a shoulder impingement, not a dislocation. Let us now consult Dr. Google:
Impingement is the medical term for pinching or rubbing together inside a joint. It causes pain, especially when you move. Shoulder impingement happens when the top outer edge of your shoulder blade or scapula pinches your rotator cuff beneath it.
The rotator cuff tendons and bursa reside in the narrow space between the top of the upper arm bone (humerus) and the top of the shoulder blade (acromion). When the arm is relaxed at your side, there is enough space. But when the arm is moved away from the body, the space gets narrower.
In a healthy shoulder, this narrowing, or compression, does not cause any pain or irritation. In an unhealthy shoulder, this compression can cause irritation, resulting in pain and inflammation. The inflammation and swelling take up more space, causing symptoms to continue. This is called shoulder impingement.
The swelling in a shoulder is often brought on by one of two conditions. Tendinitis is swelling or irritation of a tendon. Four tendons support your rotator cuff and help it move your shoulder joint. Rotator cuff tendinitis makes these tendons swell and the swelling causes shoulder impingement.
Bursa are the fluid-filled sacs that line some of your joints. A bursa between your rotator cuff tendons and acromian [the bone at the top of the socket] normally cushions the space between them. Bursitis, the inflammation of bursa, can lead to shoulder impingement.
Steve’s take on impingement, “My best understanding of shoulder impingement is when muscles are strained in such a way that the shoulder becomes unstable. Mostly muscles hold our shoulder socket in place. Not so much an actual joint. If those muscles become strained or unstable there is a nerve that can be pinched in your shoulder. Specifically, when you raise your arm high, there is a nerve that pinches. It will send a stabbing pain down your bicep. That’s what happened to me.”
The doctor gave him a steroid shot. Steve admits, “It gave me a false sense of security. I got back to paddling within a month and then reinjured it. My advice is, ‘Don’t do the steroid. It doesn’t fix it. It just makes it feel better.”
After allowing the impingement to heal again, Steve went back to the same doctor. The doctor said no further steroid shots. This time he gave Steve a list of scapula shoulder exercises to do to strengthen his shoulder. Steve sighs, “I wish I had done that initially.”
The scapula exercises gradually worked. The full recovery for this first injury was about a year and a half. “I had three or four years of good paddling afterwards. Then the next time happened at the WWC.”
Doctors and Diagnoses
Dave realized he would eventually need to go to a doctor, to get a base assessment of the injury, to know his situation. “If I needed surgery I wanted to get on that quick.”
When Dave did go, the doctor did x-rays and nerve checks and confirmed there were no broken bones. Dave recalls. “Certain fractures are common with dislocations. The doctored ordered an MRI procedure.” The accident on the Ocoee happened in late October. Dave went to the doctor in November but couldn’t have an MRI scheduled or see physical therapists until January.
At the January MRI, Dave learned he had torn his “Supraspinatus tendon,” the top one. There are four big muscles around shoulder. There’s one on the top of the shoulder that deals with arm elevation and external rotation and that’s the one I screwed up.
We ask the internet doctor for a definition:
Dave also had a torn labrum. He explains, “Basically, with the ball and socket of the shoulder, the socket is on your shoulder, the ball is on your arm (the humerus). I had an anterior dislocation where your arm goes forward to shear the cartilage partially off the socket.”
The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. The shoulder joint is composed of the glenoid (the shallow shoulder “socket”) and the head of the upper arm bone known as the humerus (the “ball”).
The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation.
The Treatment
Dave shares, “The orthopedist told me, ‘The labrum will never heal properly. There is not a lot of blood supply in connective tissue. It may heal. It may adhere back to where it once connected, or it may not adhere as completely. It’s not going to heal fully.’” Dave shrugs, “Therefore, I’m more vulnerable to subsequent dislocations, in the same direction.
They told me the rotator cuff kind of tear is conducive to healing. With physical therapy I’d be okay. They encouraged a steroid shot, ‘so you can actively participate in PT.’ I had the shot and see a physical therapist twice a week. It’s been a positive, the routine.”
Steve’s Comeback.
Steve: I mostly feel secure with my shoulder. Sometimes I get a little tingle in my shoulder that has me worried a bit. I take a step back; take a break and try to figure what I’m doing wrong. Like doing stern squirts for example. It would stop bothering me then. I learned if it was bothering me, I was probably doing something wrong. I need to step back, relax, figure out what my paddling form is. If I have poor form, a back-deck roll is especially bad for it.
It’s easy to get into a position where your arms are over your head when doing a back-deck roll. You want to stay in a push-up position. Keep your elbows tight to your body. If you’re in good form, it won’t hurt at all. In a way this has taught me better form. I have immediate feedback if something’s wrong.
It’s left me feeling a little uneasy at times. Doing something I shouldn’t be doing. It’s never been 100% after that first injury. It definitely killed a lot of things. I need to be careful and pay attention. If it starts to show up and I need to back off. Step back.
Better fitness is key.
Dave shares, “I wasn’t in bad shape to begin with. I like to run now. You can’t neglect your overall physical health. You need to focus on full body flexibility and core strength, so this doesn’t happen again. The PT put a hurting on me in a good way so strong musculature and core strength supports the rest of you. I’m making progress. I’ve been diligent about my regimen.”
Dave admits he could have been in better shape and maybe this injury would not have happened. “I knew that going into this. I wasn’t living it. Most movements in paddling start with your core, not your arms. You have to internalize this. “I’m not going to be able to muscle my way through this.”
Steve says, “Scapula exercises are my physical therapy without the therapist.”
The injury in the head.
The Johnsons’ pain wasn’t just in their shoulders. Steve: “It wasn’t easy being out of the paddling world. The first time wasn’t as bad. I still had several hobbies at that moment. I hadn’t been in kayaking long enough to start getting rid of things, other hobbies.
The second time was worse. When I got back into kayaking after the first injury, I knew I really enjoyed it. I had sold off my autocross cars, sold my project cars, sold off a lot of the hobbies so I could devote more time to kayaking.
My time was invested in kayaking. With the second injury I didn’t have a whole lot left. Less to do. Without my main hobby, I bought back into some of my previous hobbies. Now I’m trying to reorganize other hobbies and balance them with kayaking. I bicycle and unicycle. Zach Schiada and I were talking about unicycle shuttling. In summer, Zach and I will be shuttling the Lower Haw in board shorts.
Dave: I’m not going to lie. Being hurt sucks. Your energy has to go somewhere. I have several paddle groups. Anna and I are one small group. A couple of other groups of three or four. I stayed active with some people through CCC doing the website. [Dave is the CCC Webmaster.] I’m not paddling every weekend like I used to. Stayed at home more. Did other exercise. Did other work I had ignored.
PT and Running has filled in as a physical release. I do yoga regularly. I’m getting into it. Yoga helps spread out the body’s flexibility and balance.
Steve: I’ve learned I need more than just kayaking.
A new form of thinking.
With the rehabilitation of their bodies, Steve and Dave had to adjust their minds. The fear of another shoulder injury lingered. The solution is to practice good form.
Steve: “I still do enders but more conscious now. I feel like I’ve gotten better since the break. Puzzling but there is psychology behind that. If you spend more time thinking about something instead of doing it, you can still improve through analysis, the mental process.
One thing, I will commit to a roll a lot sooner. I don’t feel like I have to save it. If I’m not in a good position to brace, I’ll roll. It’s a mindset I had early on If I’m going to be playboating I’m going to be upside down.
I grew up knee boarding so being upside down on a knee board strapped in, needing to figure out, without being able to see, where the kneeboard strap is. Being able to get out and get back to the surface. I’ve been doing stuff like that since I was kid so being upside down in the water isn’t new. Learning confidence in my roll is the thing. Once I had that, it’s not a big deal.”
Dave: “I’ve been paddling some in the last few weeks. Did the Upper Haw first. I can roll. On both sides. Started in pool a month ago. Mentally I was very delicate with it. I’m trying to be matter of fact about it. Understanding the technique.
You know your paddle strokes come from your feet and from your core and hips. It’s not a pull with your arms.
In general, to be safe you have to stay in the box. You don’t want to let your elbows go behind the torso. And you don’t want to let your hands come above your shoulders. When paddling, stay in the box. Paying attention to that.”
See you on the river.
Steve admitted. I’ve hung in there. It’s definitely a mental hurdle. Maybe more a mental thing, even though there are physical challenges.
I’ve kicked around… if play boating is not in my future, then I’ll take up photo-boating. Get a creek boat. Not now but it’s in the back of my mind. If I don’t feel like my shoulder can handle all the playboating I would start going that route before I get taken off the water completely.
Dave says, “We are planning some trips coming up. Part of me, is like, what if I blow a shoulder out as I’m leading a trip? There is a part of paddling you can’t control.
Here is a takeaway. If I had been one of those people who paddle alone, it could have been really bad. I had people to drag me off the river when I blew my arm out.
I don’t know if I could have self-rescued. There are ways to get your own shoulder in and I would have tried them. But I ended up on the opposite side of the river from the road. I hadn’t gotten all the way to the bank. I was being pushed under water. On the verge of passing out. Could have passed out and drowned. If no one had seen me, I would have had to wait for the water to turn off and go down so I could walk out. It would have been bad, in a real pickle.
So, takeaways: learning what to do to reset a shoulder. And another reason not to paddle alone.”
SOURCES:
-www.hss.edu
https://www.hss.edu/conditions_shoulder-labrum-tears-overview.asp
-www.topdoctors.co.uk
https://www.topdoctors.co.uk/doctor/supraspinatus-tendon-tear/
-MyClevelandClinic.com https://my.clevelandclinic.org/health/diseases/shoulder-impingement-rotator-cuff-tendinitis
-carolinacanoeclub.org
https://www.carolinacanoeclub.org/files/99