Shoulder Injury – 9 Steps to Getting Back On the Saddle

A tumble off your bike almost certainly leads to an outstretched arm trying to cushion the blow. The result: shock from the impact travels up the arm to the collarbone strut and leads to injuries such as a fractured clavicle, or trauma to the acromioclavicular joint (ACJ) like that suffered by Erik Kleinhans in May, at Sani2C.

To date Eric’s shoulder is healing well but he wasn’t yet ready to take part in the UCI World XCM Champs, in Pietermaritzburg last Sunday, 29 June. “My surgeon hasn’t cleared me for racing yet, and I would hate to have to go through this surgery again!” Kleinhans commented a few weeks prior to the race. On the day of the race he said that he was sad to miss out, but happy to have been supporting Christoph Sauser, Nico Bell and of course, his wife, Ariane Kleinhans.

Here are some guidelines to getting the proper treatment and getting back on the bike as soon as possible, if you find yourself with a shoulder injury after coming a cropper. (Playing the hero could result in further damage to the ACJ and long-term rotator-cuff damage, so rather err on the side of caution.)

1. Get an X-ray (ideally consult an orthopaedic surgeon) so that a decision can be made whether or not you need
    surgery or if physiotherapy will suffice.

2. Wear a sling. It’s essential to support the weight of the arm and prevent it from dragging down and putting
    tension on the ACJ injury. Wear it for as long as you need. It usually takes about four to six weeks before you
    can get back to cycling.

3. Avoid bearing weight through your hand or elbow to prevent disrupting the injury.

4. Ice the injury to reduce the inflammation and swelling. Frozen peas work really well. Try to strap them on to
    add compression. Start icing for 15 minutes every one to two hours for the first 24 hours then repeat four to six
    times daily for nine more days. This will significantly decrease the frequency and intensity of
    shoulder pain both at rest and during rehabilitation.

5. Avoid heat as this can increase the swelling.

6. Avoid taking anti-inflammatories as they interfere with the inflammation and healing mechanisms of the body.
    Taking NSAIDs (especially during the acute post trauma period) may cause a delay in healing. Rather use
    simple painkillers as required.

7. Avoid overhead movement and any activities that include forward flexion or reaching across the body, as this
    compresses the ACJ.

8. Consult your sports physiotherapist for early pain-free mobilisation. This will help to prevent joint restriction,
    strengthen, improve stability and accelerate healing and repair. Your physiotherapist may strap your shoulder
    and ACJ to enhance support and stability for up to a month post-injury, which is especially helpful for
    unstable injuries.

9. Forget about the road or trail until riding is pain-free. In the meantime, get on the trainer or to the gym to
    maintain your fitness. Sit upright with your arm in the sling to avoid any load through the damaged strut.

These are general guidelines and your return to the road should be on the advice of your treating health practitioner.


The nine guidelines were extracted from the article ‘Hot Under the Collar’ by Tanya Bell-Jenje (MSc physio) in Ride Magazine, August 2012.
Tanya is the founding partner of Bell & Rogers Physiotherapy Practice (now Physioworkx with Bell Rogers & Harris), situated in Melville and Wilgeheuwel Hospital, Johannesburg.