20/08/2013 | 4 comments
Darren Roberts from Peak Performance Fitness has just given us this great insight into the difficult decisions and times that a pro rider has to deal with when facing those inevitable injuries. After his recent shoulder troubles at the Mountain of Hell race Dan Atherton is the subject of this particular case, but there’s a lot that all of us could learn from this story…
Dan Atherton is no stranger to injuries, and I’m no stranger to getting him back from injury. In 2010 Dan suffered a catastrophic break to his C1, in fact it was shattered. Not only that but his C2 was fractured in two places and he also had two skull fractures. Just a couple of mm’s either way with the fractures and he would have been dead.
What happened and how is in this video;
It was incredible to watch him push through this injury, in terms of mental toughness Dan is the epitome of this attribute. Whenever I’m asked who is the most mentally tough athlete I’ve come across, its Dan all day every day. Bearing in mind I’ve worked with international rugby players and world class athletes in many sports – mentally Dan is made of steel. He had to put huge amounts of work in, which he did diligently for 6 months.
Dan getting his knee checked out by Doug (while Doug was still at Sale Sharks) whilst recovering from his broken neck in 2010.
But we got him back and less than 6 months later and after some of the most intensive rehab and training ever – he was riding a bike again.
Athy back on a bike less than 6 months after shattering his neck.
However as with all action sports athletes injuries are the cost of doing business and something I’ve discussed at length in a previous post. Dan had torn his labrum in the 2011 season, which we scanned and decided to ‘train’ through. However with his switch to enduro he’s had a loss of upper body mass and with simply not as much muscle on his shoulder as he had from his Dh/BMX days – the joint became more vulnerable. He had a number of partial dislocations, even during Mountain of Hell which he still managed to finish 3rd – an impressive feat made even more remarkable with a dislocated then relocated shoulder!
Just the week before this incident, I’d discussed Dan’s shoulder at length with team fitness coach Alan Milway and we’d both made a plan to ‘corner’ Dan when he returned to UK to address his shoulder. Alan was brought in to work with Atherton racing as my time is split amongst all Red Bull UK athletes and they needed someone on hand multiple times per week. Milway is a great guy, very knowledgeable with great sports science horsepower. We work well together on the over-arching plan for the guys and the broader ‘performance rationale’. Anyway, the dislocation during mountain of hell meant I told Dan he had to return to UK immediately to address this properly, otherwise we’d be looking at a more serious dislocation requiring significant surgery and extended recovery time. As always we went to elite world class physio Doug Jones who has treated almost all Red Bull UK athletes at some point over the last 6 years and knows them extremely well.
Examining the offending shoulder with Doug Jones of Harris & Ross.
The upshot was Dan needed an op, the question was could we manage this through S&C till the end of the season? This is one of those extremely difficult sporting decisions athletes and coaches have to make. Do we try and push through, which means he can finish the season? With the cost of that being a potential worse episode requiring much more surgery and recovery. Or do we have surgery now so he’s 100% for 2014 season? The cost of that being he my miss the rest of 2013 season, but could potentially be back for the end of the 2013 season depending on how rehab goes.
Dan discussing the options with Doug
Ultimately, the fact that we’d already pushed through a labrum tear, his episodes of dislocation were becoming more frequent and less painful each time – meant we were doing more and more damage to the shoulder. Whilst we’ll always take an ‘aggressive’ strategy, you also have to think about long term – so it was decided to take the surgery now. We have a couple of options for shoulder surgery – Prof Len Funk and also Dr Mike Walton who works closely with Len as well as Sky Pro Road. With the decision made the operation was booked for 48 hours later, with MRSA swabs and CT scan done the very next day.
Dan being examined by Dr Mike Walton
It’s worth understanding a number of points here – all recognisable to anyone in professional team sport as this is standard practice, but which is maybe not so obvious to anyone else;
- The executive decision to tell the athlete to stop racing and to fly home
- Prompt examination by elite physio the next day with full, frank and clear options relevant to racing
- Swabs happened very next day including CT scan to check for any bony damage, examination and consultation with Dr Walton who came in especially
- Operation booked for day after swabs
- Rehab planned and set up for 72 hours post operation
This is how it should be, the athlete does not need to think about anything other than being on time for the appointment and understand the options to be able to make an informed decision which is all about their return to sport. We take care of everything else because these decisions are hard enough without having to worry about all the logistical details and waiting to make ‘standard’ appointments. These specialists are booked weeks and sometimes months in advance, however we get the athlete to who they need to see IMMEDIATELY. This prompt intervention will have a massive impact on the result you want in these circumstances – and the only reason why the majority of the extreme sports athletes we work with are even still competing despite having career ending injuries.
I drove Dan to hospital, and despite the speed with which we can make these things happen there is an inevitable mountain of paper work to complete!
Dan looking super happy – the arrow is a crude but effective fail safe to ensure the correct body part is being worked on!
The marathon paperwork-fest and rudimentary pre-op tests.
Getting wheeled down to theatre.
I’m fortunate enough in my role to have a great relationships with the medical teams which allow me to actually go into the operating theatre with our athletes. It’s an incredible learning experience to be able to watch these operations and surgeons in action.
Can’t beleive they didn’t let me ‘have a go’.
Dr Mike Walton working his magic, the arthroscope is in the posterior part of Dan’s shoulder while Mike is attaching an anchor near the biceps tendon.
Bankarts Lesion, the upper left of the picture is Dan’s humeral head, directly underneath you can see the tear.
Bankarts repair – you can see the 3 repairs clearly.
This is the SLAP tear, left hand side of the pic is Dan’s humeral head – and you can see the SLAP has already ‘folded over’ on itself as the Bankarts repair has already been carried out. At the top of the picture you can just see the biceps tendon.
Humeral head on the left and the thick tendon coming from the top of the pic is the biceps tendon. The SLAP has been repaired – and it was extremely tricky to do so due to putting the anchors to the right of the biceps tendon as you look at it. To the left of the biceps tendon you can see the clear tube which the instruments travel down to carry out the repair.
Out of theatre, ready to start re-hab!
The operation was totally successful, and from the pictures its clear why we needed to carry out this work now rather than crossing our fingers and hoping for the best for the rest of the season. Dan needs a couple of weeks in his sling, but from this point on, it’s about RTR (return to racing). Which means a slow, sometimes painful and always intensive training regime to ensure Dan returns fitter and stronger than he’s ever been.
In part II – Dan’s rehabilitation starts – Rehab, can be a dark and lonely place – but it’s where champions are made…