At the start of this year’s paddling season, I found myself grappling with a double whammy of injuries in my right shoulder: a torn rotator cuff and a frozen shoulder. Combined, the two issues significantly impacted my ability to load up the kayak onto the car roof, let alone enjoy a good paddle. It would be several more months before I would return to kayaking.
If you’ve ever wondered what the options or prognosis is for kayakers with similar shoulder conditions (maybe even you!), read on. In this blog, I provide a firsthand account of the challenges posed by these specific injuries, detailing the surgical intervention, physical rehabilitation process and my subsequent return to kayaking. I also delve into the adaptive paddling equipment that played a crucial role in maintaining my connection to kayaking during the recovery period.
How I Tore My Rotator Cuff
When you’re in your 20s and 30s, you feel invincible. Jump off a high fence? No problem. Go on that 120-degree vertical drop roller coaster? Sure, why not.
When you’re in your 40s and 50s you still feel invincible, but the body sometimes has other ideas. Such was the case for me when a simple family outing to toss around a football next to Morro Rock at Morro Bay State Beach in California (shown here) resulted in a year of downtime. I don’t even remember there being a specific moment or pass when I injured my shoulder, but from that September day on I had a constant, dull ache. Over time, the ability to raise my right shoulder gradually diminished. Everyday activities like lifting the garage door, reaching in the cupboard for a coffee cup, or grabbing my purse from the back seat of the car became increasingly difficult. Kayaking was out of the question since I had pain and was unable to lift my arm past my waist.
So, I did what I’ve done for the myriad of other injuries I’ve had over the years, I went to see my favorite physical therapist, Dr. Jonathan Grisanti, Clinical Director of Movement for Life in Orcutt, CA. Dr. Grisanti worked with me post-operatively several years prior when I rehabbed a torn ACL and PLC in my right knee, an injury incurred during a game when a soccer opponent jumped feet-first into my knee instead of the ball.
Dr. Grisanti is not only well-credentialled (PT, DPT, OCS, CSCS all follow his name), he is extremely knowledgeable, not to mention just a nice guy. Any question I’ve ever thrown his way (e.g., why this exercise, which muscles are engaged, how many reps, etc.) was met with a detailed, science-based explanation.
Giving Physical Therapy a Shot
I didn’t know yet that I had a torn rotator cuff, but I did know I had persistent pain and couldn’t move my shoulder normally. At this point I didn’t have significant symptoms of a frozen shoulder, but I was having trouble sleeping on my affected side and was able to do less and less of my normal daily activities.
I got a referral from my primary doctor to begin seeing Dr. Grisanti, who by this time had moved from a nearby clinic to take over a practice that was now a 45-minute drive away. (As I mentioned, his expertise was worth the drive to me.)
After doing a comprehensive evaluation, he explained that – without an MRI – it can be difficult to ascertain whether pain is coming from a torn rotator cuff, an impingement or some other cause, such as tendinitis. We agreed that it was worth giving physical therapy a shot for a couple of months to see if would help the symptoms subside.
Cutting to the chase, it didn’t. Despite faithfully committing to the rehabilitative exercises Dr. Grisanti assigned and generally resting the shoulder area, after eight weeks I wasn’t feeling any relief. We both agreed it was time for that MRI.
The Diagnosis: Torn Rotator Cuff and Frozen Shoulder
Having had multiple surgeries in my lifetime, I always research the experience and reputation of area surgeons before deciding on whom to consult. Physical therapists are often one of my “go to” sources for referrals because they see the post-operative results of various surgeons coming through their doors weekly.
With my research complete and a recommendation in hand, I settled on Dr. James Kasper of Central Coast Orthopedic Medical Group in Pismo Beach, California. I forwarded my MRI results to his office, and at my first appointment I learned what I had already suspected: I had a complete tear in my right rotator cuff. Specifically, the supraspinatus tendon.
The rotator cuff is comprised of a set of muscles and tendons that encircle the shoulder joint, creating a protective sheath around the humeral head. It connects the humerus to the shoulder blade, enabling the lifting and rotation of the arm. There are four muscle tendons that make up the rotator cuff: the supraspinatus, infraspinatus, subscapularis and teres minor. I would later learn that my supraspinatus tear represented the most common one. In fact, Dr. Grisanti estimated that about 80% of his rotator cuff patients have this particular injury.
Further, Dr. Kasper said the MRI indicated I had two minor bone spurs on the head of my humerus that he could “clean up” during the arthroscopic surgery. He also conducted a series of physical assessments and informed me that, in addition to the torn tendon, I had a frozen shoulder. I had heard the term “frozen shoulder” before, but it’s one of those conditions that doesn’t sound all that serious until you actually experience it. (I thought the same thing about “restless leg syndrome,” but now I know better about that, too!)
Frozen shoulder, or adhesive capsulitis, is a condition that severely affects shoulder movement. It’s marked by persistent pain and stiffness in the shoulder joint, making daily activities such as reaching overhead or behind the back challenging. The condition progresses through stages, beginning with pain and advancing to increased stiffness, ultimately limiting the range of motion. The exact cause is not entirely understood, and it often occurs without an apparent injury, significantly impacting an individual's ability to move their shoulder freely.
Shoulder Injuries and Kayaking
In our blog, “Shoulder Injuries: Why Kayakers Are Prone to Them and What to Do About It,” we reported that shoulder injuries are common among kayakers, with research suggesting that they may account for a significant portion of all kayaking-related injuries. Shoulder injuries made up about 29% of all kayaking injuries among a group of Italian kayakers, according to a study published in the Journal of Sports Medicine and Physical Fitness.
Another study from the Journal of Orthopaedic & Sports Physical Therapy found that shoulder injuries accounted for about 36% of all kayaking injuries in a group of Canadian kayakers. Further research exists suggesting that competitive kayakers and sea kayakers also experience a significant amount of shoulder injuries.
While my own injury didn’t stem from kayaking, it did impede my ability to go out and kayak with a traditional paddle during my injury and recovery periods. I was, however, able to kayak with the assistance of the Versa Paddle System, which supported the weight of the my paddle while I paddled and whose downward-angled blades required a smaller range of motion. More on this later.
The Decision for Surgery
Knowing that I am an active person and still relatively young (age 57 at the time), my doctor recommended shoulder surgery to repair my issues. I readily agreed and asked that the surgery be scheduled as soon as possible so that I’d be on my way to recovery before summer.
Dr. Kasper explained that having both a torn rotator cuff and a frozen shoulder was a difficult combination from a recovery standpoint, and that it could take up to a year before I returned to normal functioning. The challenge is that the post-surgical recovery plan for a torn rotator cuff is primarily rest and immobility, followed by rebuilding strength over time. Recovery for a frozen shoulder, in contrast, usually involves keeping the shoulder moving and flexible so that it doesn’t seize back up. Despite these paradoxical objectives, he expected I would have a full recovery and be able to go back to my regular activities, including kayaking and yoga.
The surgery itself included debridement of the humerus, manipulation of the shoulder, and repair of the torn tendon. Debridement is a minimally invasive arthroscopic procedure to treat a range of conditions affecting the shoulder joint. It can include everything from removing loose tissue, debris or thickened bursa to smoothing down minor fragments on the shoulder joint to improve range of motion, as in my case.
Shoulder manipulation is another one of those terms that doesn’t seem to pack much punch, but boy does it! In this video, you can see how it’s done. The goal is to break up adhesions by moving the shoulder through various ranges of motion while the patient is under anesthesia.
The third part of the surgery entailed repairing my rotator cuff tear. Rotator cuff surgery varies depending on the nature of the injury. In my case, it required re-attaching the supraspinatus tendon to the head of my humerus bone.
Post-Surgical Shoulder Pain
Only on the day after surgery did I learn that rotator cuff surgeries with my combination of interventions could be “notoriously painful." To this day, I still don’t know if it was the manipulation, the tendon repair or the debridement that was the main driver of the pain, but the first 24 hours after the peripheral nerve block wore off were excruciating! I had been prescribed a combination of Cephalexin (to ward off infection), Nabumetone (an anti-inflammatory) and hydrocodone-acetaminophen (aka Vicodin, for post-surgical pain).
I was well aware that I should “stay ahead of the pain” by taking sufficient pain medication before the nerve block wore off, which is exactly what I did. Yet, despite taking two Vicodins before going to bed that night, I woke several hours later in such pain that I had to scream out to wake a family member to come into my room because it was too painful to budge even the slightest.
I’ve had two Caesarian sections and an ACL surgery on my knee, but those were a walk in the park compared to this. It was so painful that all I could do was whimper and cry those first few hours. I frantically called my doctor’s office at the crack of dawn, and they phoned in a stronger prescription for oxycodone-acetaminophen (aka Percocet) to my local pharmacy. Thankfully, that helped. Another 24 hours later the pain was still bad, but it was tolerable. By the fourth or fifth day, I had tapered off the pain meds completely.
Post-Surgical Physical Therapy
Two weeks after surgery, I went back to Dr. Grisanti to begin physical therapy (PT). My surgeon said normally he wouldn’t send someone to PT so quickly, but because of my dueling issues of a torn cuff and frozen shoulder – and his confidence in Dr. Grisanti’s expertise – it would be prudent to begin sooner, albeit carefully.
Dr. Grisanti reviewed my surgical notes and asked questions, such as how long Dr. Kasper had recommended I be in an arm sling (4 to 6 weeks) and what exercises he had me doing so far. I also had my share of questions for Dr. Grisanti, including what the goals of this PT were, how long it would take, and what I might expect along the way.
He advised me that the long-term goal was to slowly rebuild my range of motion while my rotator cuff was healing. Then, at some point down the road, I would begin strengthening exercises. In terms of any pain I might expect, he said that it would ebb and flow throughout therapy but that my pain would tend to go down as my range of motion improved. “There will be times down the road that we stretch it, which is a little more aggressive, and you may experience a bit of pain. But if you zoom out and look at the big picture, the pain will get better and better as time goes on,” said Dr. Grisanti.
He informed me I would begin with some very gentle, passive range of motion exercises. The first three exercises included a gentle pendulum swing of my arm while leaned over, another where I kept my arm down at my side and extended my elbow from bent to straight and back, and one where I used my healthy arm to lift my surgical arm straight out in front of me.
“Our fear is that we don’t want the shoulder to tighten up more – to get more frozen – so we want to get it moving. We’re not going to do anything crazy or aggressive because we also want to protect the tissue that (the surgeon) just repaired,” he said, explaining that the newly anchored tendon needs time to grow into the repair and heal.
Full recovery could take up to a year, but Dr. Grisanti explained that my day-to-day activities, such as sleeping, would consistently improve along the way. “It’s tough the first month or two as you come out of the sling. You can use your arm a little bit, but you don’t have a lot of function. Around six months tends to be the turning point, and then it’s one year for the full recovery,” he noted.
Physical Therapy…Continued
After two months of semi-weekly PT appointments with Dr. Grisanti at his office nearly an hour away (one-way), I reluctantly decided it was time to continue my therapy closer to home. He had given me the name of several capable physical therapists in my immediate area, so I made the transition to Dr. Nick Watson, PT, DPT, OCS, CSCS, at Movement for Life in San Luis Obispo, California. In Dr. Watson, I was lucky enough to find another, extremely well-qualified physical therapist who would help me complete my shoulder recovery journey.
We continued with a wide variety of exercises aimed at improving my range of motion, utilizing very lightweight dumbbells, stretches, bands and manual manipulations that Dr. Watson performed. The early sessions were followed by TENS treatments and icing, both of which I thought of as my “dessert.”
I was making slow, but steady progress and curious when I’d be making the transition to strengthening exercises. Dr. Watson explained that he’d like to see me get to about 80% of my full range of motion before beginning strength training, and that the latter would help me achieve the remaining 20%.
One of the many strengthening exercises I eventually began doing was to build my trapezius muscles, that area in the upper middle back between the shoulder blades. While the rotator cuff is responsible for some of the effort required to straighten your arm to 180 degrees, “about 60 of those degrees comes from the effort of the trapezius muscles,” Dr. Watson explained. “That’s why it's important to strengthen them.”
My final follow-up appointment with my surgeon, Dr. Kasper, was six months after my surgery. By that time, I was well on my way to regaining my full range of motion. I still had about 10 to 15% to go, but my progress was steady. I also decided to terminate my physical therapy at this time, primarily because I was consistently doing my PT at home and at the gym, but also because Dr. Watson was about to go on paternity leave. The timing just seemed right.
As I write this blog, it is now three months later (i.e., 9 months post-op) and I can say that I’m at about 98% of my full range of motion. It’s possible I may never get those final two degrees of motion back, but I can once again reach for an object on a high shelf and close my close my car’s rear hatch without wincing. I have no pain whatsoever, though I do feel an occasional “tweak” when I make a sudden or wide movement with my right arm. I’m no longer consistent about doing my stretching or strengthening exercises, but when I do go to the gym, I do a full circuit of my previous PT exercises.
The Role of Adaptive Kayaking Equipment Before, During & After a Rotator Cuff Injury
With such knowledgeable, talented physical therapists at my disposal, it seemed the perfect opportunity to get feedback on the potential role that Angle Oar’s adaptive paddling systems might play for people with shoulder injuries.
While nothing in this blog should be construed as medical advice, it was gratifying to hear their perspectives about the advantages that our Versa Paddle and Gamut Paddle Holder systems could provide to others like me.
For those unfamiliar, these two devices use one of several mounts that attach to your kayak to support the weight of the kayak paddle, eliminating stress on your shoulders, back and joints. The patented designs feature a fulcrum around which the paddle (either the Versa Paddle or your own) can rotate in all directions. Using a circular movement with your forearms, you can glide through the water with minimal effort. The Versa Paddle can be used straight or angled downward on both sides. The angled position requires a smaller range of motion and permits one-handed paddling, making kayaking possible for people with injuries, disabilities, amputations and other mobility limitations.
Benefits of Versa Paddle
“Weightless” Paddle Design Puts Less Stress on the Rotator Cuff
Dr. Grisanti explained that when you hold something (like a bowling ball) close to your body, it’s not as stressful on the rotator cuff because the biceps muscle does most of the work. However, when you start reaching out in front of you, that’s when the rotator cuff is more actively engaged.
Likewise, with a regular paddle, you’re generally holding the weight of the paddle out in front of you, which makes the rotator cuff more vulnerable. But because the weight of the Versa Paddle is supported by a mount, “you don’t have to be lifting the paddle at all, it’s more of a push-pull. I like that for you doing your recovery,” he said.
The Angled Position Is Good for the Hands and Shoulders
He also commented on the ability to angle the Versa Paddle downward to approximately 25 degrees on both sides, noting the advantages for those with certain hand or shoulder issues. When it’s angled “your arms are going to be down a little bit lower…and your hands are in a neutral position. That’s good for the hands, but for the shoulders, the further down (your arms are) the better,” explained Dr. Grisanti.
“So, if you were giving the option of using a straight paddle or an angled one, I’d go for the angled one because you’ve got your point of axis, or rotation, in the middle so your hands are down here (at the 3 and 6 o’clock positions) versus up higher. The lower your elbows are, the less stress on your shoulders. The further out you are, the harder it is.”
Ability to Paddle with One Hand and Protect the Functioning Limb
Another group who could benefit from the Versa Paddle is people with the use of one limb, whether that’s due to amputation, paralysis from a stroke, or a severely debilitated shoulder, for example. The paddle can be maneuvered with one hand such that when the right blade is being pulled back through the water, the left blade is in the air moving forward. Then, the left blade is pulled through the water for a stroke, and so on.
The Mounted Paddle Requires Less Shoulder Rotation
As I neared completion of my physical therapy with Dr. Watson, he, too, commented on one of the potential benefits of the mounted Versa Paddle system. He explained that for some people with shoulder injuries, the pain can be more acute when reaching back, as opposed to forward. “Reaching behind into the back seat (of a car), for example can be a pretty aggravating motion for an irritated shoulder,” he noted.
With a traditional paddle, there is a sweeping motion that starts in the front as the paddle is dipped into the water and continues past the plane of the paddler’s body toward the back of the kayak. “I think the mounted system is better for shoulder issues because you don’t move as far into that back stroke,” said Dr. Watson.
A Return to Kayaking
Not sure when I would be able to kayak again, I asked Dr. Grisanti early on when that might be. It would depend on several factors, including “clearance from your surgeon, how your recovery is going, how your strength is coming along, and how big of a rotator cuff repair you had,” he said.
About three and a half months after my surgery, I got the go ahead from both my surgeon and my physical therapist that I could return to kayaking (using my Versa Paddle system). “Don’t go out and paddle four miles or around Avila Beach Pier (on the Pacific Ocean) or anything,” cautioned Dr. Watson. He advised I might fatigue a little more quickly because I was still in the process of rebuilding my strength, but noted, “obviously the assisted device will help you with that weakness.”
And, of course, I didn’t do anything crazy. I had a short outing on a calm, nearby lake simply to “kick the tires” of my newly repaired shoulder. I had assistance loading and unloading my kayak from the roof rack, but once I got on the water, it was smooth sailing. I didn’t experience any pain, though admittedly I “babied” my shoulder just in case. I used the Versa Paddle in the angled position and found that I could use the hand-pedaling motion to easily propel through the water.
Normally, I move the paddle blade as far forward as possible to get the most energy-efficient stroke when drawing it back. I could still do that, but I relied more on my dominant left side to lift and push the right blade back and less on my recovering right side. In the end, the experience was an absolute joy, with no discomfort whatsoever, and it gave me great satisfaction to be back on the water.
Reflecting on the Journey from Injury to Recovery
Though the journey from injuring my shoulder to reclaiming my spot in the kayak was lengthy, it wasn't overwhelming. That’s thanks to my own positive attitude, the support of skilled professionals, and the availability of innovative adaptive equipment like Versa Paddle System. My return to the water signified more than just kayaking, it was the rediscovery of a passion and a powerful reminder that with perseverance and the right tools, we can navigate life's challenges and emerge even stronger on the other side.
Angle Oar's mission is to make kayaking accessible to more individuals, regardless of age, injury or ability, and to provide solutions that enable experienced kayakers to continue their passion for years to come. We provide adaptive kayak paddle systems, outriggers and other kayaking equipment to people with arthritis, shoulder problems, physical disabilities or limited upper body mobility.