How To Control Cortisol To Keep Muscles (Part 1)

cortisol hormone organ body

Cortisol. It’s a weird name that I hear rarely. One time, in the gym, a guy told me to be careful about it. When I asked him what is it, he told me: “It’s the stress”. Follow this logic, we stress every day, it means each day we lose a little bit of muscle? It makes no sense. The first time I tried to learn about it, I didn’t understand anything. Cortisol is a hormone and you have to learn some medical things. I didn’t like this situation, because I wanted to know how to control cortisol to keep muscles.

This week, someone told me about cortisol and his explanation was very vague. I see that many people are afraid of it because they don’t understand it. It’s time to go deeper to understand Cortisol, because the body doesn’t create it to destroy itself.

What is its role

role

Cortisol is a stress hormone and it works like a type of alarm system in your body. It controls your fear, motivation, mood to handle dangerous situations. This hormone has several role:

Organize the energy of the stores

It organizes all type of energy that your body has to always be functional for a dangerous event. It means amino acids from muscle tissue, muscle and liver glycogen and fatty acids from body fat.

Stabilize blood sugar levels

When your blood sugar levels are very low, it helps to keep normal levels.

Boost your stamina and attention

Cortisol boosts Phenylethanolamine-N-methyltransferase (PNMT). PNMT is an enzyme that transforms noradrenaline to adrenaline. This method increases your adrenaline’s rate.

Boost the power of muscle contraction

This is a consequence of a high rate of adrenaline.

Boost the power of heart contraction and rate

It’s an effect of a high adrenaline’s level. Oxygen move better to muscle

Weaken the immune system

When there is a threatening situation, the body needs all the resources possible. For example, a fight. The high rate of cortisol will weaken the immune system to have the maximum of energy possible. When the rate decreases, the immune system has the full power back to repair the damage from the fight.

All these roles help you to get through an unsafe situation and survive. The thing is if the cortisol has a high rate for a long time, it can create problems in your body. Let’s see in different areas how cortisol can be bad.

Muscle Gain

gain muscle

A high rate of cortisol for a long period can impact muscle in a unhealthy way with these methods:

Muscle is less feed by food

Muscle receive fewer amino acids to create new tissue. Restocking of glycogen stores is decline too.

Boost muscle damage

There is a high level of protein damage (catabolism) than protein synthesis (anabolism). This is why we say “stress (cortisol) eat the muscle”.

Muscle take more time to repair

The immune system is very important to repair muscle. When a high rate of cortisol is recurring, it weakens the immune system.

Boost myosatin

Myostatin is a myokine, a protein created by the muscle and it limits its growth. It means when you have a high rate of myostatin, it limits your muscle gain.

On the long term it declines testosterone rate

Pregnenolone is a hormone that creates testosterone and cortisol. To have a high rate of cortisol, your body needs a huge amount of pregnenolone to make it. It means there will be less pregnenolone to create testosterone.

At the end of your training session, the level of your protein synthesis is big for around 24-30 hours. This is the period where your body repairs your muscle and add new tissue. When your immune system is fragile, your body uses these amounts of hours to only repair the breakdown you caused. Your body is not able to produce new muscle, it means you don’t gain muscle.

Recovery

fat loss weight

A long period of high rate of cortisol can impact your recovery in these ways:

Decrease the production of growth hormone

At night you have a natural spike of growth hormone and a high rate of cortisol disrupt your recovery. When your recovery is not optimal, you don’t progress.

Decline muscle glycogen storage

Gycogen is critical in the process of recovery.

Speed down the reparation of muscle

Growth hormone maintains, build and repair tissue. It means it also builds muscle mass. You gain muscle by repairing muscle. When the cortisol decreases the production of growth hormone, you don’t have results.

Increase adrenaline rate

Adrenaline (or epinephrine) is a helpful hormone before a workout session. It boosts your cardiorespiratory activity (more oxygen to the muscles). It also improves your metabolism, your mood, and your body is more reactive. Before to go to bed, it doesn’t help you to sleep.

Fat loss

The famous coach Charles Poliquin said that when you have too much cortisol, it stores your fat in abs. There is a problem here because cortisol has also as function to organize stored energy. Fat is a kind of energy for the body. It means cortisol doesn’t store fat, you know, fat is energy.

Another function of cortisol is that is a fat loss hormone when the rate is high while a short time. If the high rate is recurring, it complicated the action to fat loss.

Decline the transformation of hormone T4 to T3

A little explanation about these hormones. The thyroid is a gland in the neck. It creates three hormones: triiodothyronine (T3), thyroxine (T4) and calcitonin. T3 and T4 adjust the temperature of your body, your metabolism, and your heart rate. T3 usually sticks to protein in your body.

The thyroid creates a lot of T4 to change it in T3. T3 modifies the metabolism rate. When you have a high rate of metabolism, you burn more calories. In the case where your body has a low level of energy, the thyroid creates less T4. Fewer T4 means fewer T3 and the result is a low metabolism rate and the body burns fewer calories.

Do you remember what happens in a situation when your body lacks food? The cortisol rate is high to keep blood sugar stable and organize stored energy. This is a mechanism of the body to survive since the prehistoric era. Today is good because access to food is better. Unfortunately, cortisol can have a high rate because of other stress factors.

Insulin resistance

Cortisol boosts the blood sugar rate in a crisis event (lacking food, running away or fighting). These emergency circumstances allow the body to release glucose for energy. When people are sedentary and the blood sugar level is high, it’s not good. The level stays longer high and can drive to hyperglycemia. The body to avoid it creates insulin to decline the rate of blood sugar to a normal level.

Imagine a situation where cortisol’s rate is high a lot of time. It boosts the blood sugar levels and the body produces insulin every time. The result of this is insulin resistance. In the plan to lose fat, settle a caloric deficit is crucial. Unfortunately, insulin resistance and a metabolic rate low make the process more difficult. It can even create a surplus of fat.

Let’s be things clear, insulin alone doesn’t make you fat, it stores the elements of your food. It’s when insulin has a high rate that is tough for the body to use fat in a good way.

Insulin resistance means that the cells work badly with insulin. The result is the body needs to create more insulin to do the same task with the cells. When there is a huge amount of insulin, it takes more time to go back to the normal level. When there is a big quantity of insulin for a long time, the body has trouble to use fat.

It is the same thing for cortisol. Alone, cortisol doesn’t make you fat. It’s when cortisol has a high rate that is tough for the body to use it in a good way.

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-Steph

Throwing Injuries In Children

children baseball throwing injury Little Leaguer Youth Pitcher Elbow

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

In baseball, especially at the beginning of the season, there is an increase in elbow problems amoung young players. The most common elbow problem is the medial apophysitis named « Little Leaguer or Youth Pitcher Elbow ».

The elbow joint is composed of 3 bones : upper arm bone (humerus) and 2 bones in the forearms (radius and ulna). Muscles, ligaments and tendons keep the elbow joints together.

Little Leaguer Elbow

little leaguer Youth Pitcher Elbow humerus ulna radius medial apophysis epicondyle

This injury occurs when repetitive throwing creates an extremely strong pull on the tendons and ligaments of the elbow. The pain felt to prominence inside the elbow.

« Pitcher’s elbow » can become serious if the case gets worse. Repeated pull can tear ligaments and tendons of the bones. The tear can take tiny pieces of bone like when a plant takes piece of the soil when it uprooted. This can destabilize bone growth, which can create a deformity.

Symptoms

« Pitcher’s elbow » can cause pain in the elbow. If any of these symptoms occur, it’s recommended to stop the throws :

  • Elbow pain
  • Decreased movement amplitude
  • Locking or snagging in the elbow joint

Treatment

Elbow injuries by lanching movements can become complicated cases, if they’aren’t treated.

Non-surgical treatment

Younger children respond better to non-surgical treatment :

  • Stop throwing because continuing to do this can create major complications and may reduce a child’s ability to remain active in a throwing sport.
  • Use an ice bag to decrease swelling
  • If the pain continues after a few days of complete rest in the affected area or if the pain reoccurs when the throwing starts, stop the activity again until the child is treated.
  • Improve the technique of launched

Surgical treatment

Surgery is sometimes necessary for serious injuries, mainly for girls older than 12 years old and boys older than 14 years old.

Depending on the child’s injury, surgery may includes bone fragment removal, bone grafting or reattaching a ligament back to the bone.

Recovery time

The recovery time depends on the age of the athlete and the severity of the injury. If the injury detected early and the modification of the activity begins, there will be little time required for the athlete to start the sport again.

However, if the athlete continues to play despite the pain and other symptoms, it will take several months to heal the injury. Or it’s possible that the injury becomes permanent.

Prevent

The recommendation for a child to be safe is 15 for 8-10 years old, 100 for 11-12 years old and 125 for 13-14 years old. This involves training and competitions. To avoid pitching injury, young pitchers should play 3-4 inning each game.

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-Steph

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Manage Your Amino Acids

amino acids

What’s up ? This is THE stephane ANDRE !!! I watched a Jamcore DZ’s video  and I learned some good stuff.

To put it simply, protein is an assembly of amino acids which means that you have to eat protein so that your body can have amino acids. There are a total 20 amino acids, 8 are essential and 12 nonessential. Be careful, nonessential amino acids are also needed. When you see an amino acid with the word « star », it means that it’s an important amino acid to be in shape.

What we call essential amino acids are those that our body doesn’t not produce. That’s why you have to look for them from an outside source. This outside source is the food you eat in the form of meat, egg, fish, dairy product, etc. And it’s possible that the outside source is whey protein powder in concentrate, isolate or hydrolyzate form.

Each amino acid has one or more important functions that’s why I’m only going to talk about important functions to be in shape.

amino acids table

Essential amino acids

Here are the 8 amino acids :

Lysine

This amino acid transports calcium to your body and reduces the tryglycerin’s rate.

Isoleucine, Leucine and Valine are BCAA (amino acids star)

These 3 amino acids have the function of giving energy, repair muscle tissue, anticatabolic, helps in congestion (pump) and helps burn fat.

Methionine

This amino acid is an antioxidant, helps in burning fat in the liver.

Threonine

This amino acid creates elastin and collagen, it’s for the skin. This is beneficial for slowing down old age.

Phenylananine

This amino acid increases alertness.

Tryptophane (amino acids star)

This amino acid reduces appetite and promotes sleep. It’s also a precursor of serotonin, that is to say gives you a good mood.

Nonessential amino acids

Here are the 12 amino acids :

Histidine

This amino acid helps recovery and growth.

Arginine (amino acids star)

This amino acid is the Viagra of amino acids. It’s also the precursor of nitric oxide which helps with congestion.

Glutamine (amino acids star)

This amino acid helps to be focus, to have more energy and helps with recovery.

Aspartic acid

This amino acid increases testosterone but is not definitive. There has been a lot of scientific studies concerning this amino acid but unfortunately, it has not been 100% proven that aspartic acid naturally increases testosterone. This is why it’s interesting to read the latest scientific studies on amino acids because we’ll discover new things.

Gutamic acid

This amino acid is a neurotransmitter and it’s also used as a fuel of the brain.

Cysteine

This amino acid a detoxifier for the liver, fat burner and antioxidant.

Ornithine (amino acids star)

This amino acid derived from arginine. It increases your growth hormone, increases your sleep and gives you more vitality.

Glycine

This amino acid increases your energy and helps the synthesis of creatine.

Proline

This amino acid protects your joint.

Serine

This amino acid increases your energy, your memory and focus.

Taurine

This amino acid increases your energy, focus and endurance.

Tyrosine

This amino acid is important for the body because it regulates your hormones which are dopamine, epinephrine and adrenaline.

Amino acid derivatives

These amino acids are not part of the list of essential and nonessential amino acids because they derive from these 2 lists.

L-Carnitine (star)

This amino acid derives from Methionine and Lysine. This increase your energy, helps burn fat in your liver and burns fat.

Citrulline Malate (amino acids star)

This amino acid derives from Arginine which allows you to produce more Arginine in your body, helps to create more nitric oxide, more vasodilatation, more congestion, more endurance and more recovery buffer of lactic acid.

Choline and Inositol

These amino acids derive from Methionine and Serine. This helps in burning fat in the liver, helps to focus and it’s a fat burner.

amino acids food source

amino acids food source bcaa

If you don’t read my article about protein, click here.

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-Steph

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Rotator Cuff Tears

rotator cuff tear anatomy shoulder

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Rotator cuff is a group of 4 muscles and their tendons that together form a « cuff » around the head of the humerus (upper end of the arm). The 4 muscle, originate from the scapula (shoulder blade), are upraspinatus, infraspinatus, subscapularis and teres minor. Tendons of each muscle fit on the humerus tuberosity.

Rotator cuff’s functions :

  • Lift the arm

  • Turn the arm

  • Stabilize the humerus in the joint

Causes

rotator cuff tear anatomy

The causes of a rotator cuff tear can be an acute injury such as a fall or because of chronic wear with tendon degeneration. For people over 40 years old, the pinching of the tendon on the underside of the scapula may participate in tearing.

Diagnosis

Diagnosis of rotator cuff tears is based on an examination and/or diagnosis study such as a MRI (magnetic resonance imaging) to confirm the diagnosis. Diagnosis early on in the first symptoms and rotator cuff’s treatment can help to boost the treatment’s results.

Treatment

Goals treatment are to relieve pain and restore strength to the injured shoulder. Several tears in rotator cuff can be treated without surgery. Anti-inflammatory drugs, steroid injections and physical therapy can all be beneficial in treating the symptoms of a tear in the cuff.

Even though a full-thickness tear needs to be cured with surgery, it’s possible to use non-surgical treatments to have a satisfactory function in some cases.

Surgery

rotator cuff tear anatomy surgery

Surgery is recommended if there is persistent pain or shoulder weakness that doesn’t improve with non-surgical treatment. Often patients who have surgery indicate nocturnal pain and difficulty using the arm for lifting and reaching. Many will indicate persistent symptoms despite several months of treatment and limited use of the arm.

Surgery is also recommended for active people who use the arm for overhead work or sports.

Surgical options

The type of repair performed is based on the findings at surgery. A partial tear my necessarily only a trimming or smoothing procedure called a debridment. A full-thickness tear with the tendon torn from its insertion on the humerus is repaired directly on the bone.

3 techniques are used for rotator cuff repair :

  • Open repair (through a traditional incision)

  • Mini-open repair (partially assisted by a camera view, with a smaller incision)

  • Arthroscopic (performed with only a small camera inserted through multiple small puncture wounds)

Recovery and rehabilitation process

Whether for the treatment of non-surgical and surgical rotator cuff tear, rehabilitation has a very important role. Usually recovery is at least 6 months or more depending on the extent of the tear.

When there is a tear, there is frequently a loss of shoulder movement. An exercise or physical therapy program is needed to restore strength and improve shoulder function.

Although surgery repairs the defect of the tendon, the muscles around the arm remain weak and an important effort is necessary in the rehabilitation so that the procedure is a success. After surgery, a complete re-education can last several months.

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-Steph

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Overuse Injuries

overuse injuries sport injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

There are 2 types of injuries : Acute injuries and overuse injuries. Acute injuries are usually caused by a single traumatic event. Here are some examples :

  • Wrist fractures

  • Ankle sprains

  • Shoulder dislocations

Acute injuries are less common in sport than overuse injuries. Overuse injuries are usually subtle and appear over time, making them difficult to diagnose and treat. Here is some example :

  • Tennis elbows

  • Swimmer’s shoulder

  • Pitcher’s elbow

  • Runner’s knee

  • Achilles tendinitis

  • Shin splints

Why

Human body is extraordinary to adapt to physical stress. We’re used of thinking that « stress » is bad for our emotional well-being, but physical stress is simply doing an exercise or activity. This is beneficial for our muscles, tendons, ligaments and bones. This physical stress causes an internal process called remodeling. Remodeling process involves both the breakdown and the build up of tissue. It’s necessary to have a good balance between 2, if breakdown occurs more rapidly than buildup, an overuse injury occurs.

Causes

overuse injuries sport injury gym fail

Usually, it’s training errors that cause overuse injuries. These errors are too fast acceleration of intensity or duration or activity frequency. These injuries can also happen to people who return to the sport/activity after an injury. They try to make up for lost time as quickly as possible to reach the level they had before the injury. Doing an exercise with a good technique is important to avoid overuse injuries. When the exercise’s technique is bad, it creates overuse injuries. It’s for this reason that coaches, athletic trainers and teachers can play a preventive role so that athletes avoid overuse injures.

There are people who more easily have overuse injuries. An unbalance between strength and flexibility around certain joints predisposes some people to have this type of injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths and flat or high arched feet, also impact overuse injuries. There are also people who have weak links because of old wounds, incomplete rehabilitation of wounds or others anatomy factors.

Other factors must also be taken into account as equipment such as the type of running shoe or ballet shoe and terrain (hard versus soft surface in aerobic dance or running).

Diagnosis

Generally the diagnosis is based on the athlete’s history and physical examination. It’s recommended to make a diagnosis with a sports medicine specialist with a specific interest and knowledge of your sport. In some situations X-rays, bone scan and MRI may be necessary.

Treatment

overuse injuries sport injury ice

Here are some recommendations for treating an overuse injuries :

  • Cutting back the intensity, duration and frequency of an activity

  • Adopting a hard/easy workout schedule and crosstraining with other activities to maintain fitness levels

  • Learning about proper training and technique from a coach or athletic trainer

  • Performing proper warm-up activities before and cool down after

  • Using ice after an activity for minor aches and pain

  • Using anti-inflammatory medications as necessary

If symptoms persist, a sport medicine specialist may create a more detailed treatment plan for your specific condition. This may involve an exam of your training program and an evaluation of predisposing factors.

Prevention

Majority of overuse injuries can be avoided with a proper training program, common sense and learning to listen your own body. The quote : « No pain, no gain » doesn’t apply here. The 10% rule helps a lot to get things to the next level.

In general, you should increase the training’s intensity to a maximum of 10% per week. This allows your body to have enough time for recovery and response. This rule should be used to increase pace or milestone for walkers or runners. Or for the weights amount to increase for strength training programs. In strength training, add flexibility exercises and core stability exercises help tremendously to minimize overuse injuries.

It’s recommended to seek advice from sports medicine specialist or athletic trainer to prevent chronic or recurring problems. Your training program can also be modified to maintain fitness levels safety while you recover from your injuries. You must return to the sport only if an authorization is granted by a health professional.

Remember, it’s very important to warm-up before training and cool down after training.

Stats

3.5 millions of children are treated for overuse injures every year.

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-Steph

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Mature Athlete

mature athlete

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Physical exercises are for everyone, including the mature population. Exercises allow older people to keep a healthy body and maintain their independence. The main health problems of the mature population are arthritis, high blood pressure, heart disease, lung disease, depression and hearing and sight loss. With the exception of hearing and sight loss, all these health problems can be serious decrease with an adequate workout program.

All mature athletes should have a complete medical and musculoskeletal assessment before starting any workout program. Having a complete medical examination, medical advice and a workout program helps to avoid serious injuries and health accidents. These 3 things should meet the needs of a mature athlete to avoid disease, increase endurance, strength, body image and competitiveness.

Exercises are beneficial

It’s important that a qualified personal trainer create a specific workout program to improve strength, endurance, balance and flexibility. If the workout program includes sports such as golf or tennis, the technical knowledge of the golf/tennis instructors is helpful to avoid injury and improve performance. For results, workout programs must be consistent for at least 30-45 minutes, 3-4 days a week.

If physical conditions require correction, a cardiac or pulmonary rehabilitation program or physical therapy may be helpful before starting a workout program. These rehab programs should be taught to mature athletes at a fitness level where they could continue with their own workout program.

Exercise type for the workout program

physical exercise type

An athlete should use types of exercises based on his/her desire, pre-existing conditions and his/her ability to exercise without pain. For an athlete with lower extremity joint problems such as arthritis or instability, it’s recommended to avoid exercises with repetitive impacts like running. For athletes with an unstable shoulder, it’s recommended to avoid overhead exercises such as military press and pull-ups.

Using several types of exercise to improve strength, can allow better recovery of muscle and tendon tissue. If a mature athlete wants to make a sport that can aggravate a pre-existing problem on a muscle, tendon or bone, that athlete should be in a good condition before doing this sport. It’s recommended to decrease this sport’s frequency to reduce the painful symptoms.

What equipment to use

Having shoes that fit with the exercise and/or the sport is beneficial. If the person has a foot with significant deformity such as flat feet (fallen arches), using orthopedic shoes helps to reduce stress on the entire lower extremity. The symptoms of arthritis in the knee may be decrease by the use of specialized braces.

Prevent injury or discomfort during exercise

If there is discomfort during or after physical exercise, this should be analyzed to prevent it from starting again or getting worse. Over-the-counter painkillers and anti-inflammatory can be used in the short term if there is no interference with other medical conditions. It’s important to know that the use of ice, heat, massage and flexibility programs can decrease several symptoms caused by exercise.

There is more aggressive treatment with narcotic analgesic and/or cortisone injections but this should only be used to treat a specific lesion. This shouldn’t be used to allow an athlete to complete in the short term.

Summary

Creating a customized workout program with a medical professional and/or a qualified personal trainer helps a mature athlete to :

  • Keep independence

  • Increase physical abilities

  • Prevent injuries

  • Improve the quality of life

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food. Click here.

Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph