Post Rotator cuff surgery / Goode power vest

[swbca]

I was talking up a kettlebell exercise that greatly improved my back issues, but now just learned swinging a 50 pound weight around with 1 hand 200 times a day progressively ripped a large rotator cuff tendon about 60%. I think the damage was done in the last few weeks after doing this exercise for the last 15 months. I have been told not to do anything until surgery to avoid making it worse.

 

The rule of thumb apparently is about 6 months post-op before resuming normal-light physical activity.

 

With the shoulder injury experience of skiers on this forum, could the Goode power vest be an aid to just get on the water for some light free skiing somewhere before a 6-12 month recovery period. When I broke my wrist skiing in my 30's I could do a deep water start with both feet in with only 1 hand, but there was no point because one hand isn't good for much once your up.

 

**EDIT . . This isn't primarily a medical question. Trying to learn if the Power Vest could be used to ski casually (not a slalom course) with minimal tension on one arm/shoulder.

[ctorthopa13]

So just clarify……

 

1. Recent RCT (rotator cuff tear)

2. Diagnosed high grade partial tear by MRI.

3. No surgery as of yet

4. Wanting to ski using power vest

 

Any Glenohumeral joint arthritis?

 

If not you should strongly consider having it repaired before it becomes a complete retracted tear with atrophy.

 

Retracted atrophy = eventually needing a reverse total shoulder replacement.

 

 

[swbca]

@ctorthopa13

 

Yes to these 3 items.

1. Recent RCT (rotator cuff tear)

2. Diagnosed high grade partial tear by MRI.

3. No surgery as of yet

 

A trace of joint arthritis

 

4. Surgery immediately . . . Never personally seen a Power Vest, so asking if the vest could be used for free ski cruising with little tension on one shoulder Post Op. I know I would have to be cautious. I don't want to wait until summer of 2023 in Minnesota to put on a ski.

[lpskier]

Surprisingly, you can pretty much slalom fine with a torn rotator cuff. I’m reasonably sure you could start skiing with a Power Vest reasonably soon after surgery. HOWEVER, any sort of fall that tugs on your arm could set you back months or even re-tear what you just had repaired.

 

In my non-medical opinion, if you want to ski this summer, put off repairing the shoulder until October. Get a cortisone shot and you’ll feel pretty much fine. You may need a second injection in July. If you decide to get it fixed now, I’d write off skiing this summer. In the big picture, getting it fixed is probably the smart call.

 

We all want to get going as soon as possible. If you get it fixed, don’t be foolish. Let the shoulder heal. Get a cute physical therapist. Your wife will just think you are being diligent.

[VONMAN]

@swbca Sounds like you will need surgery and if true you will be down for six months. Trust me I know, left shoulder done in 2003 and right shoulder done in 2009. Start skiing after six months, full recovery one year. Call me if you want to talk.

[swbca]

@lpskier Haven't seen a Power Vest, To avoid getting stuck with the handle in a fall I assume its your muscular grip that connects you to the handle . . not something like the bent reinforced gloves that have caused shoulder injuries.

[Rednucleus]

Go ski when your doc and PT say you can, not before. If you take a surpise fall, you could undo all the surgeon's hard work, and the next repair will not be as good, and you will lose even more time on the water. Get it done sooner than later. Fnally, there is some evidence that cortisone injections can make later surgeries less successful/not heal as well.

[swbca]

@Rednucleus That's the plan and not making things worse with cortisone.

[ctorthopa13]

So I follow up on my last post. First off not giving any medical advice however I am an orthopedic PA. and specialize in shoulders, hips and knees.

 

I have gone through two rotator cuff repair surgeries personally and the rehab is most of the battle.

 

First and foremost partial high-grade rotator cuff tears have a significant risk of complete tears as I stated with retraction. There are plenty of studies out there to show that the efficacy of Cortisone injection may reduce the pain however it also put you in for the risk of weakening the rotator cuff tendon in completing the tear. As well as risk after surgery for re tear.

 

My recommendation is to seek out a orthopedic surgeon that specializes in rotator cuff repair particularly arthroscopic. They also performs newer techniques for repairing the rotator cuff.

 

Good luck! If you have any further questions I am happy to chime in anytime.

[swbca]

@ctorthopa13 I understand it can only get worse by delay causing further tear, pullback of disconnected parts and something about fat replacing the void. So I am being careful and getting it done asap. The surgeon does the shoulders for various sport teams and is known to be good. Thanks

[lpskier]

@swbca Nope. Clincher style gloves are used on the power vest, not normal gloves.

 

I’ve had two full thickness tears and two repairs. There are worse things in life.

[JayShower]

Slightly off topic but I feel like there are a lot of skiers here who have injured their rotator cuffs, does anyone have advice for how to prevent these injuries?

[skierjp]

The deep water start is not the issue, it’s the one handed reach at the buoy that is the problem. I was skiing in a little less then 6 months. I had a complete tear. No bicep injury.

[Rednucleus]

@JayShower Easy - don't age and don't use your shoulders

[swbca]

@lpskier I read through a thread a few months ago with comments from at least 1 skier that had a serious shoulder injury from some gloves that have components designed to replace or enhance your intentional-muscular grip on the handle.

 

Is that what you mean by Clincher style gloves ? I don't know what I am missing. What is the safety feature to make sure that grip enhancement releases when the skier falls ?

[swbca]

@skierjp I can't say you are wrong about the one handed reach causing shoulder injuries, but not everyone has had that experience.

 

I never skied on a stock ski and was shaping and tuning ski's almost daily. For many years I ran 20 passes in one or two outings every day weather permitted. Hand blisters were the only problem with all that skiing over decades.

 

My current shoulder problem started when I fell hard on ice while snow skiing a few years ago. I made that injury serious in the last month with over-strenuous use of a kettlebell exercise. And, of course age is factor.

[skihacker]

Clincher was the brand name of the fist version of these gloves, there's a dowel sewn into a strap at the end of the middle 2 fingers, the strap runs down to the wrist wrap, i think both masterline and radar make a version now, pro lock maybe? Usually see bigger guys use them to help with grip especially for deep water starts. The risk could be an extra half second before the handle is gone during a crash,

[swbca]

I know you weren't' trying to be exact about .5 seconds, but there are only 2.7 seconds from one ball to the next, so things happen fast.

 

In the context of this discussion, I would like to assume the Power Vest gloves are safe. But if it has a glove that delays getting rid of the handle, without more information, it sounds like something to avoid. Anyone with personal experience with the vest, or have more info ?

[skihacker]

At the end of the day it's up to you, there's a hundred plus ways of getting hurt skiing, most of them you can't predict or control, but if you can't ski without clinchers or a power vest it gets even more complicated. Plenty of guys with back issues are quite happy their powervest, plenty of husky guys get a lot of benefit from the clincher style gloves, it's up to tou to weigh the risk/reward.

[swbca]

Can't weigh the risk as you suggest because I don't know if the specific design of the Power Vest gloves presents the risk of a delayed release. I assume not, but I won't buy one on that assumption when some clench style gloves have caused injuries when the didn't release until they were yanked out of a skiers hand. Maybe I have PTSD from when I put my hand through a handle when my ski hit a ball and I rolled forward, breaking my wrist when I was stopped and the handle was going 36mph.

 

I think I'll go do something else before I get tagged with 'girl shaking her head.gif'

[skierjp]

@swbca maybe I didn’t explain myself correctly. I’m not saying that caused the injury. I’m stating that after surgery the reach at the buoy puts you at risk and you will feel pain for a few months when you start skiing. When I had my surgery the deep water start was a concern but after the first set it was not a factor. Also pre surgery with a torn rotator cuff the reach is where you can do more damage and feel more pain.

[swbca]

@skierjp I probably read it too fast . . thanks

[lpskier]

@swbca yes, that is what I mean. I am not a fan of Clincher-style gloves.

[Bruce_Butterfield]

@swbca as someone else stated, it’s not as much the deep water starts or the skiing but a fall pulling on your shoulder that presents the highest risk of reinjury once you start skiing. I don’t think the power vest would help and the clincher style gloves may provide additional risk. ( I have never used a power vest or clinchers so take that for what it’s worth)

 

Personally I think the best way to get back on the water sooner is slippery slalom ( run the slalom course on a trick ski). You will be using the same “ski muscles” but at much lower intensity so you can build back to ski shape gradually and much more safely. If you are not a fan of trick skis, running the course on jumpers or a pair of combos is second best.

 

Delaying surgery as lpskier suggested is a mixed bag. You do run the risk of making the tear worse or having considerable pain after skiing or at night. I would regularly hit the ice pack immediately after skiing and would frequently be unable to sleep without an ice pack on. Everyone is different so up to you if delaying surgery to September makes sense.

[swbca]

@Bruce_Butterfield I have the last talk with the surgeon on Wednesday, but I doubt if he would think waiting to end of this summer would be a good option. I don't know if this is a general requirement, but a friend who just had the surgery had to wait an extra several months until the last cortisone shot had dissipated before he could have the surgery.

 

I want the lowest risk solution that will preserve the greatest number of ski days that remain in my future. I feel great at 76 but I suspect my 12 year old dog will outlast my ability to ski the way I would like. I am losing an entire season no matter what I do and my dog doesn't have that many years left.

 

You mentioned falling being a greater risk than the stress of skiing. That answers the question about using a power vest to get an earlier post op start with skiing. When considering risk, I don't fall free skiing sort of like airlines don't crash . . . so forget the power vest. When you don't have tournaments on your calendar free skiing is great.

[skierjp]

The first time I skied after surgery was straight in the course 22/34. I ran it. There was a stupid bird standing on every buoy. One advantage I had was my PT was a tournament skier so he had me doing additional exercises. I did PT a minimum of 3 times a day every day for 6 months. The killer, I was in a sling with the padded pillow for 8 weeks. Only after that could I lay in bed and sleep. Yes, I slept in a zero gravity outdoor chair for 8 weeks. After that I bought a Sleep Number bed with the adjustable head and feet. The Shoulder would be about a 7 out of 10 for aggravation and pain my Achilles was a 10 out of 10. If I new that would ever happen again I would quit skiing.

[skiboyny]

I have to give you a lot of credit @swbca you have had a long time off, are looking at missing a season, and are still looking to continue at your age. I doubt I would make the same decision, In as much as I do love the sport, there seem to be diminishing returns as the body ages.

[Bruce_Butterfield]

@swbca as I think about the is more, waiting until fall may be a viable option. That’s basically what I did last year but it was around June when I realized surgery was inevitable. ( I did ski the day before the surgery :)

 

However instead of a cortisone injection, you may be able to get significant improvement with a targeted exercise program. Exercise won’t do anything for the actual tendon but it can strengthen the smaller supporting muscles in the shoulder and lesson pain and reduce risk of additional injury. There are several good PTs on this board (broadcast help from a PT) who can point you in the right direction or you can hit YouTube for rotator cuff exercises. Better yet try to see one in person. These will mostly be very light weight, high rep, very controlled movements as opposed to your kettle ball stuff.

 

You can also get a shouldersphere. https://www.shouldersphere.com/. Using this delayed my first shoulder surgery by 2-3 years.

 

Of course take the advice of your doc and PT over mine?

 

Good luck!

[dchristman]

Here's a good Power Vest thread from a few years ago to keep you entertained:

 

https://www.ballofspray.com/forum#/discussion/14901/if-you-are-over-40-why-not-use-a-powervest

Here's Dave Goode's video explaining it:

 

[VONMAN]

@swbca Many years ago (35) I used Clinchers great for locking onto a handle. you release by opening your hand flat. However when you fall you must remember that, but when you panic your reaction is grip the handle tighter, bad news if you do. No Clinchers or Goode power vest. Get the surgery, you can do the P T at home (I did). Listen to your doctor, do not try to accelerate your P T with your own added workout. You could undo all the doctor fixed. Your arm will atrophy, but in six months you can be skiing, not the course. But you will be able to ski. It took me a full year to build all my strength back. At 71 I wouldn't even think of swinging a 50# kettle ball. My main exercise is now half hour of freestyle in a lap pool everyday I don't ski.

[swbca]

@Vonman @ctorthopa13 I have been thinking about ways to avoid some of the atrophy without involving the shoulder after surgery. I would think hand/forearm strength exercises should be ok, if its just squeezing a ball, or one of those sprung load hand devices.

 

Slalom skiing in correct form doesn't actually require significant shoulder strength to articulate and hold positions, but apparently the muscles hold the shoulder together, so would the tension from moderate pulling across the wake or deep water starts require additional muscle fitness in the shoulder to prevent damage 6 months after surgery ?

 

Right, these are Questions for the Doctor

[VONMAN]

@swbca Just passing on my personal knowledge and experience. In 2003 when I had my left shoulder done I also had to have my bicep reattached didn't see that coming until the operation. The MRI didn't show it, and it ended up being a four hour surgery. I did exactly what the Doctor gave me for PT. And to this day I can still rip with no problems.

Injuries are like a box of Chocolates, you never know what you got till you open it up. Good Luck.

[Mazda]

@swbca

This is my experience: tore 2 rotator cuff tendons (1 full, 1 partial) and had reconstructive surgery. The pain immediately after surgery was much worse than anticipated. Like others on this chat, I couldn’t lie down to sleep and slept in a recliner for more than 1 month. To answer the initial question, I don’t think it’s a good idea to ski with a rotator cuff tear, even though I know some who have. I think it depends on the severity of the symptoms. Personally it was out of the question and I knew only surgery can fix my problem. Exactly 6 months after surgery I was skiing again. Initially with a Goode power vest as I was too scared to start otherwise. It took me around 10 sessions to get my confidence, got rid of the power vest and have been skiing ever since with no shoulder issues. Post surgery It’s very important to keep shoulder immobile for at least 6 weeks, and then follow diligently your rehab program. Not to discourage you, but those first sessions of rehab were extremely unpleasant. It takes 6 months to recover and be on the water again. Good luck and I really hope to be skiing into my 70s also.

[swbca]

@Bruce_Butterfield You suggested I could start skiing on a trick ski to keep the load light at first when I am able to resume skiing. You haven't seen me trick ski; If I got up on one it wouldn't be for long.

 

(though I won my only lifetime trick entry with a 2-ski front to back, back to front, 360, front to back wake, back to front wake and 360 wake. Second pass, fell on a 1 ski attempt at 360 wake) We saw a tournament along the highway in Marin County California while vacationing. A guy loaned me his tricks skis . . Kris wasn't there, though Merrill LaPoint loaned me Kris's Maharajah. I don't think I placed in Slalom, I couldn't make it turn good enough to make 22 off. Maybe it was 18 off. When did they change to rope lengths ?

[Bruce_Butterfield]

@swbca the trick ski is only one option that I have used coming backs from several injuries over the years. If you want to get in the water sooner, get the biggest surface area ski you can find and go as slow as you can. If you can get a 72” fat boy ski and not drown at 20mph you will be able to ski with much less stress on a weakened body.

 

Anything you can do to start gradually will get you on the water sooner.

[swbca]

@Mazda @Bruce_Butterfield I apologize for overlooking a basic question. Rotator cuff problem seem to be very common with the skiers. What causes the injury ? I never hurt my shoulders water skiing. I had a minor issue from snow skiing and then made it much worse in the gym years later.

 

In 4 hours, I will be seeing the surgeon to decide on when it should happen. As some suggest, maybe he will let me wait until August, so the 6 months of rest can happen off-season.

[MISkier]

@swbca my only significant shoulder injury while skiing occurred during a crash. I actually ended up doing a complete (unintentional) front flip at the wake and held the handle with my left arm through the entire rotation until the crash on the other side. That caused the problem. So, I can see a shoulder injury in a crash situation, especially an OTF. A sudden stop and fall at the turn buoy with a yank of the handle can probably also cause one.

 

When I had my injury, I could not lift a glass of water up from the counter with my arm outstretched to my side. I did not seek treatment and rehabbed it myself after a long rest. That was 17 years ago. It's probably not 100%, but I do not notice any impediment to my skiing from that. The other shoulder has also sustained some minor damage as well. I do get a twinge of pain reaching backward with that arm, but not while skiing.

[skierjp]

One way to check is…, let your bad arm hang straight down along your side with your palm facing back. Now bend your elbow 90 degrees so that the back of your hand is touching the small of your back ( near your belt line). Now try and push you hand horizontally away from the small of your back. The pain should be intense.

[Bruce_Butterfield]

@swbca I’m not a doc, just an aging athlete with my share of injuries over the years and learned what I could as I went along so I will share what I know. If a real doc or PT want to chime in, I’ll gladly take a back seat.

 

There are 4 tendons that make up the “rotator cuff”. The most common one to injure is the supraspinatus at the top of the shoulder joint. There are 2 ways any of these tendons “tear”: either an acute injury that rapidly tears something or plain ole years of wear and tear. The supraspinatus is relatively wide and flat, perhaps 3/4-1” wide. One of the best descriptions I’ve heard of a tear is like wearing a hole in your jeans that just gets thinner and thinner until there is a hole that keeps getting bigger. The repair is to suture the hole back together.

 

In your case, I suspect you already had significant wear and tear, then it doesn’t take much force in a slightly awkward way to increase the damage, but that’s just a guess. A 20yo could probably done the exact same kettlebell swings with no issues.

 

It’s also common for us chronically gifted folks to rupture the long head of the biceps tendon and fully separate from the shoulder joint. This results in a good chunk of the biceps to drop toward the elbow and have a very obvious “Popeye bicep”. For non-athletes it’s common to do nothing and live with it with minimal lifestyle impact. For an athlete it is obviously important to fix it. That is what drove my first surgery - ruptured the tendon while skiing that required surgery and “by the way doc, when you are in there fix anything else that needs to be fixed”. His words were that I had a massive tear in the supraspinatus. I had had pain in that shoulder for probably 15 years so no big surprise.

 

Someone else had asked how to prevent rotator cuff injuries. IMO the most important thing is to strengthen the smaller stabilizing muscles in the shoulder. This is the light weight, high rep, controlled exercise I mentioned earlier. The only other ways are not do any activity or not get old?. I focused on these exercises several off seasons and had significantly less pain the following season. But it’s like brushing your teeth- you need to do them regularly.

 

One good explanation is here

https://www.shoulder-pain-explained.com/supraspinatus-tendonitis.html

 

Goggle or search for exercise for rotator cuff and you will get lots of good examples.

 

[RGilmore]

@swbca Clincher-style gloves do not have a built-in rigid hook, so they will not hang onto the handle on their own unless you intentionally are trying to grip the handle. If you relax your grip the handle will go away on it's own (with help from the boat). The glove simply increases your grip by creating greater friction between the glove and the handle surface.

 

They DO come with a dowel at the fingertip end, to seemingly create sort of a hook effect, but I have always removed that dowel, with no apparent loss of efficacy. IMO, it's primarily the seat belt-width, coarse-weave strap wrapped closely around the handle that increases grip friction by increasing surface-to-surface contact - and then transferring the load into the wrist band to which it's attached.

 

https://www.h2oproshop.com/products/radar-vice-glove

[swbca]

The Verdict

I received the second opinion from the Surgeon that has more tools in his kit. He said there is not enough left to sew things together and have it be durable. There is soft tissue attrition with age in addition to the tear. He talked about some more complex methods. One a cadaver cartilage transplant to separate bone from bone, the other involved a transplant from somewhere in my arm and takes 18 month of immobility and wasn't really intended for water skiing.

 

He examined my right shoulder and said there is a tear that is about the same as the left. That shoulder was never injured or symptomatic. Many of you guys already learned that shoulder's don't last as long as people.

 

He told me to go ski and come back in a couple of months to tell him how its going.

 

Cortisone ?

@lpskier @Bruce_Butterfield Some have mentioned Cortisone when surgery isn't an option, or before surgery.

 

I still haven't figured out what happens to a shoulder as tears get worse + age and continued use. If the Cortisone prevents the pain, what function is lost as the condition gets worse ? And, is it something so bad that a person should avoid activity now to prevent years of hell after 80 ?

[Horton]

The Power Vest is an awesome tool if you need it. I am a huge fan.

• You do not have use clincher gloves but the idea that you can not let go is false. If you remove the dowels from the strap there is almost not resistance to the handle leaving the glove.

• The oddest thing is the deep water start. It takes a few starts to get used to then it is easy.

• It is critical that you adjust the straps to just the right length – not hard but important.

• Once you get used to it you can ski forever. It is almost no work at all.

• It does make it hard to get into a very good stack. When I wear it I am unable to get my hips up as far as I like. If I was injured ( or when I get super old ) I would 100% use it.

 

[skierjp]

@swbca that sucks but…., both of my surgeries where I had MRIs never told the whole story. They even injected a fluid to highlight the MRI. I’m just curious how the DR is so confident in his findings. I would try and find a DR the works on professional athletes. When I went to my DR for the consultation I brought videos of skiing and a page of questions. One question was about scoping or cutting. His reply was if the DR wants to cut he doesn’t know what he’s doing. The other was why should I pick you? He never even stuttered. He said because I’m the best. He did say PT is the deciding factor on the outcome. I never had any success with cortisone. I think they will only give you so many injections anyway. Good luck.

[Bruce_Butterfield]

@swbca cortizone is a high strength localized anti-inflammatory. If you have pain AND it’s due to inflammation, a cortisone injection can help. The downside is that too much cortisone can weaken tendons so it should be used conservatively. If you don’t have a lot of pain avoid the injection.

 

I still think a good PT program is your best bet. Strengthen the smaller stabilizing muscles and help the shoulder alignment to reduce stress on the damaged parts.