So here we are 10 weeks post op with Dan Atherton – and I think it’s fair to say we’ve had a ‘reasonably’ successful rehab phase! It hasn’t been easy, no injury is easy to deal with and the work that Athy has had to put in has been considerable. He had some significant tears which needed repairing – however it is extremely satisfying as a performance team to have such a positive outcome so far.
It’s worth underlining though some key points as to how we got to this point;
- Telling Athy to put his bike down and immediately fly home for assessment as soon as it was apparent there was a problem
- Prompt diagnosis with clear options on how to move forward from Doug Jones and myself
- Once the decision had been made for surgical intervention, this was carried out within 48 hours
- Surgery was carried out by a top sports surgeon – Mike Walton
- Rehab Started within days of the operation with Doug and myself
- Dan was in excellent physical condition pre-op and was training hard in the gym up to the day before his operation
- A civilian may be in a sling for up to 3-4 weeks, we were easing Dan off the sling after the first week
- Rehab sessions were progressive, aggressive – but under the strictest of control
- The whole programme was built around what Dan ‘could’ do, not what he ‘couldn’t’ do
- Everyone being aligned to the same goal – Return to Sport
- We are roughly 6 to 8 weeks ahead of what you’d expect to see in a civilian recovering from the same operation
- Athy was 100% committed to the process and trusted the team in place implicitly to get him back
Athy training with pro skateboarder Korahn Gayle the day before his op
Team fitness coach Alan Milway has worked alongside me every step of the way with Athy. This meant I was able to simply provide over-arching goals while Alan filled in the detailed sessions. I was able to sign Athy off for the types of movements and work he could do, Alan running with that in the detail. Having a great S&C coach like Alan delivering the weekly sessions with Athy was integral to his fast recovery.
Team fitness coach Alan Milway pushes Athy through the next phase rehab – Return To Sport
Dan had done all the hard yards with therabands, low resistance work and pool work – so returning to some strength work and high intensity was a welcome change in the programme. Pushing things as we do, you have to be careful that you’re not creating compensations elsewhere. His left shoulder constantly wants to ‘hitch up’, which if left unchecked turns into neck, back and even more shoulder issues – he’s had enough neck problems in his career! Whenever you work at the margins of your ability, technique and form slip, this is even more important to watch for in this rehabilitation phase. If you allow technique and form slip too much, you’ll be creating problems elsewhere.
Trunk strength is vital for all athletes – you can’t fire canons from a canoe!
It’s easy for the athlete to think they’re a lot further on than they actually are – so unilateral work is vital to ensure both sides are working as they should. With such a significant trauma to the shoulder not only from the dislocations but the operation itself, proprioception work is also vital to the recovery process. Proprioception refers to how well you are aware of where your body is. When you walk upstairs you don’t need to look at your feet to know where they are, you have a ‘sense’ of where your feet are in relation to the stairs. The more highly trained you are, the more developed sense of body awareness you tend to have, however injury can massively affect this – so it’s not just about fitness or strength. Training your body to ‘learn’ where a particular bodypart or parts are without looking at them is integral to not only rehabilitation but any training. In Athy’s case, if his brain isn’t 100% sure where his shoulder is when it’s being moved around by his arm when riding a bike – this causes the muscles to either overwork or not react as they should. Either way, this can lead to further injury and problems.
Proprioception work, on both shoulders
Each injury is unique, and individual to that athlete. Athy could injure his right shoulder in exactly the same way and we could follow a very different treatment path and outcome. As I keep mentioning, this massively accelerated recovery process was under the strictest of supervision with a professional athlete who knows their own capabilities. Right now Athy is at the transition phase of being returned to sport/competition. At this point a footballer or rugby player would be looking at some time in a reserve game before playing a full reserve game. Then onto some time in a first team game before playing a full game. With action sports athletes we don’t have that facility, but we can choose certain races and events for them to test themselves out on, if available. The danger is they want to win, they only know how to go flat out – so managing their expectations and enforcing it as part of the rehab process is always difficult!
It’s obviously great to see Dan back on a bike, it’s required a huge amount of hard work and attention to detail. We’re also not finished yet, this process is not over until Dan crosses the finish line with his left shoulder intact – a race will be the ultimate test.
Below is a some amazing GoPro footage of him doing a ‘warm up’ run on his DH bike on the infamous quarry line…
Athy drops in for a ‘warm up run’ 10 weeks post op
In the final part of this story – Dan returns to racing…..
Dan starts his rehab – in the days before the operation.
If at all possible, you want to manage an injury conservatively – this means non surgically. No operation is completely without risk, and as soon as a surgeon puts a scalpel to an athlete there is no going back. Of course we mitigate against those risks by using the best surgeons with the best facilities, this reduces the risk to almost nothing. With Dan, surgery was unavoidable – the tears were not going to fix themselves. Another dislocation was going to result in more catastrophic damage along with a much more comprehensive surgical repair and the extended recovery time that goes with it.
Knowing this, Athy’s rehab started before he’d even had the operation. The goal is to ensure you head into theatre as strong and as fit as possible. Quite often athletes detrain for a period through inactivity because of injury – until the decision is made as to how to move forward. This means they are operated on in an already detrained state, meaning that post op they’re even more detrained which simply creates more work in the return to sport process. For Dan, he was smashed in the gym in the days before the operation.
Dan trains with me and pro skateboarder Korahn Gayle the day before his operation
A standard protocol for rehab from a Bankarts repair might look something like this;
- 3 weeks – In a sling, keep wounds clean, active assisted movement in safe zone
- 3-6 weeks – Wean off sling, progress active assisted range of movement, scapular stabilisation exercises
- 6-12 weeks – Regain scapular control, increase ROM, strengthen, increase proprioception with open and closes chain exercises, sports specific training
- 12-18 weeks – Staged return to sport
The plans of course are much more detailed than that – but broadly it will look something as described above. Dan is currently just 3 weeks post op, but he’s at week 6 on his rehab plan.
Clearly this is a massively accelerated programme – however that is what we’re experts in and what we’re here to do. Dan wants to return to fitness as soon as possible and that’s what we’re doing, but not unduly so. Something to explain now is ‘staged return to sport’, for athletes in teams sports like football & rugby this means playing in the reserves building match fitness. Then coming on for ‘x’ minutes in a first team game. For Athy, there is no reserve team or simply turning up to an enduro and only doing part of it. So myself and Alan Milway will have to be creative when it comes to the RTS part. End stage rehab and RTS is very tricky due to the volume and intensity – of course more on that when we get there.
At 2 1/2 weeks post op, Dan has a review with surgeon Dr Mike Walton and of course physio Doug Jones. We are pushing the limit of what’s possible in terms of timescales with Dan’s shoulder – but it’s being done under the strictest of supervision. Anyone trying to do this accelerated programme themselves would end up back in hospital
Getting Dan’s shoulder back under control and ensuring the muscles around his scapular are working
Receiving manipulation from Doug – pain!
Challenging Dan’s shoulder using an FKPro
Obviously there’s only so much you can do in a gym with rubber bands, which is why we also use things like an FKPro to challenge movement and build strength. There’s also another vital tool in the performance tool box to ensure Dan doesn’t detrain whilst working his shoulder – the pool. The pool is an underused and vital tool – it may seem like it’s a nice session to go and have a splash about. But it soon becomes a performance playground of pain and misery for the athlete!
The water allows Dan to use his whole body, without putting his whole bodyweight through his shoulder
We film as much as we can, to feedback to the athlete and also provide reference points to look back on and compare
Explosive plyometric jumps and simple leg kicks – try these yourself in a pool, they are not pleasant
Challenging the shoulders and trunk by maintaing a position in the water
As mentioned – this is an incredibly accelerated programme, due to the strictest of supervision and of course Dan’s peak physical condition pre-op. It may seem like we’re being overly aggressive, however we’re taking the utmost care not to overstep the mark and Dan’s feedback is vital in this. Dan is an incredibly experienced athlete, he knows his own body extremely well. He knows the difference between pain, muscles soreness or something else – so his feedback is absolutely vital. With a young and inexperienced athlete there is the danger of ‘under reporting’ – they’re in pain but don’t say anything or simply tell themselves to get on with it. Or they mistake the discomfort of healing and rehab as something else, so the training is backed off needlessly. Would we push so hard with a younger less experienced athlete? Maybe not, but we’d still be way ahead of the curve of a normal recovery time. Dan also has the perfect mindset for this type of thing, you tell him what to do and he follows it to the letter. Some athletes fall into the trap of doing a combination of what they like and what they think they should do – then wonder why they’re not improving. So with Athy we have a perfect storm of an athlete in excellent pre op physical condition, massive experience to feedback accurately, mindset of steel and of course a team around him to execute the accelerated rehab plan.
2 1/2 weeks post op – You’d be pushed to tell which is the op scar and which is a zit! The skill of surgeon Mike Walton
Every athlete is different, and every injury is unique to that athlete. However when an athlete commits to the process as Dan has, great things are possible. I’ve asked Team fitness coach Alan Milway to write up Dan’s training programme as if nothing is wrong with his shoulder. It’s better to write a normal training programme, which will need some tweaks than try and build a new programme from the ground up constantly thinking about his shoulder. With a normal training programme written, you’ll probably find 90% of it will remain unchanged. As I’m sat typing this at almost exactly the 3 week post op point, I know Athy is smashing himself on the turbo. From this point on, it doesn’t get easier – Athy just works harder and gets stronger….
In part III Dan gets on the pain train to Struggletown as more intense strength training kicks in….