On Injuries

by Nina Thatcher

As endurance athletes, most of us have been injured at some point in time. I’m no stranger to injuries and over the years have learned a lot about my body and what it takes to get to the start line healthy. Below, I discuss my experience with shoulder surgery from diagnosis to recovery.

Confront your injury and diagnose quickly. A few weeks after IMLP 2008, I was at a masters practice and experienced some sharp pain in my left shoulder. I didn’t recall having any pain prior, although it is highly likely I had pain in the final weeks leading up to IM and just didn’t feel it.

I figured I’d just take some time off and recover from IM and let it heal. I went to an ART doctor and didn’t get better. I’d go to the pool and try to swim for 30 minutes and felt continued pain. I went to another doctor who diagnosed me with swimmer’s shoulder (rotator cuff tendonitis) and I then started up with physical therapy and got an injection and still I didn’t feel relief. This continued for six months and finally I decided I needed a better diagnosis and I went to get an MRI.

Lesson #1: Don’t waste time trying to heal something when you don’t know exactly what’s wrong; diagnose immediately.

Surround yourself with people you trust and those that support your end goal. I finally had my MRI in hand and the radiologist had noted a substantial tear in my labrum. The shoulder doc disagreed and said it was unclear as to whether or not there was a tear. In fact, he went as far as to tell me that I was getting older, I should choose a new activity and he did not recommend surgery. Clearly, I disagreed. I took my MRI files and overnighted them to a friend, Dr. Cuff and consulted with him. He agreed that I had a clear SLAP (Superior Labrum from Anterior to Posterior) tear and the solution was to operate.

Three days later, I flew from NYC to Florida and had my labrum repaired. As it turns out it was a medium size SLAP tear from 10-2. Surgery was the right choice and Dr. Cuff, a shoulder injury specialist, was an excellent surgeon.

Lesson #2: Surround yourself with the right professionals that have the same end goal as you do. In my case this was to get healthy and continue doing what I love to do.

Recovery takes time; be patient. When I had my surgery in February 2009, I was planning to race IMLP in July. I was told I’d be able to swim four months post-op. What I didn’t realize was that there was a difference between being allowed to swim and actually being able to swim. When I first got back in the water, I could hardly bring my arm around for a stroke. I was really surprised, because in my mind, I was going to be back to swimming in four months. Not so quickly!

I was very diligent with my at home exercises and with my physical therapist. It took me a few different PTs before I finally found a good one. Finding a good physical therapist is far more important than I realized. Range of motion is crucial in the early months and you can’t get there alone.

Five months after surgery I was only swimming about 20-30 minutes two times a week and I was crawling along. This was quite humbling as I’ve been a swimmer for over 20 years and everyone at the pool was passing me. This required a lot of patience. July quickly arrived and it was clear that my shoulder was not in any condition to swim 2.4 miles. Coach KP and I decided that there’d be more races and healing this shoulder properly was a priority.

I continued with aggressive PT even five months post-op because I was still not happy with my range of motion and had actually developed some subscapular and bicep tendinitis just from the little bit of swimming that I was doing. My strength and range of motion were not where they needed to be. I continued going to physical therapy and doing my own PT sessions through six months post-op. The most crucial areas of focus for me were subscapular and rotator cuff muscles.

I did my first race (70.3) seven months after surgery and was actually still quite sore going into the race. Luckily the swim was a down river swim and I got through it even though I’d not swum more than 30 minutes going into the race. Having been a swimmer, I was able to pull it off although I did learn that swim fitness matters. Even though I was top 3 out of the water, I suffered the rest of the day!

Lesson #3: Recovery takes time and often expectations need to be adjusted real-time. Making smart decisions and being patient will ultimately enable you to reach full health. I thought I’d have my swim back in four months and it was actually at least 10 months before I was back to swimming with no pain and picked up where I left off. It often takes 10-12 months to get close to fully recovered.

Think big picture. As endurance athletes we often tend to get stuck on a goal race or a specific season. When you’ve got an injury it’s hard to see beyond your immediate goal. One thing I’ve learned from my recovery from shoulder surgery and other injuries is that these setbacks are small if we keep our minds focused on the bigger picture. I’ve swum at Stanford masters for the past 10 months and just completed my first ironman post-surgery with no shoulder pain whatsoever.

I was able to do this because I was patient; I surrounded myself with the right support system and made smart decisions along the way. When I was recovering, there were days when I wondered if I’d ever really be able to return to pre-injury activity. Looking back, this is just a small time period in my life and it was worth taking the time to have surgery and recover completely. Several studies estimate the patient satisfaction rate for labral surgery to be around 90%, and about 75% of high level overhead athletes are able to return to their sport of choice.

Lesson #4: Keep your long-term goals top of mind and don’t give up.

Nina Thatcher is an age-group triathlete living and training in the San Francisco Bay area. Nina began competing as a swimmer at age 5 and continued to compete through the collegiate level until 2000. She started her triathlon career in 2003 and has never looked back. In late 2007 she began working with Kevin Purcell and is currently training for her fourth ironman. During the past three years, Nina has worked with Kevin to shave 1:12 off of her ironman time. When Nina is not swimming, biking or running with her husband, she is busy working at Google and also raising money for cancer research.