RE-EVALUATING PRIORITIES

Contemplating shoulder replacement surgery was definitely not among the short list of decisions I planned on making following DPT school. Job security? Board exam prep? Residency? Sure, all of those questions are to be expected. But how do you prepare to make a decision on an irreversible joint replacement surgery to a body part critical to your future career before it’s even started?


Joint replacement surgeries at 28 years old aren’t common, so what led to me even needing to make that decision? In a nutshell, what started as a shoulder dislocation and labral tear in high school began a gradual and unwavering progression to grade 4 (severe) osteoarthritis (OA).


The original injury required the placement of 12 anchors in the glenoid labrum of my shoulder, a structure who’s ultimate purpose is to provide increased stability to the otherwise extremely mobile shoulder joint. The joints in our bodies have a lifespan, and the way we move, load, and use them will influence each joint’s longevity.


Once I rehabbed and returned to playing from this first injury, I predictably reverted to my same 17 year old high school athlete priority list: impressing the girl, getting jacked, and winning. Joint longevity and injury prevention weren’t even on my radar, and unfortunately it stayed skewed in that direction through the rest of my playing career and into my early career as a strength & conditioning coach.


Throughout that progression, openly acknowledging pain and/or accepting physical limitations was foreign to me. I remained anchored in a stubborn and disconnected relationship with my physical body, rooted in the mindset that somehow I could “lift through it.” I’d half-ass mobility work, get physical therapy treatment for a couple weeks once in a while, and prior to starting DPT school even had a debridement (“clean up”) surgery. None of it ever moved the needle. The problem was I remained focused on an end result, and I never invested in actually addressing the faulty processes that got me there. I wanted the outcome of less pain and more mobility, but wasn’t willing to ever truly change my movement practice. Every behavior change I made was at a superficial, outcome based level. At my core, I still identified as that same 17 year old kid still trying to get jacked (and impress that same girl).


By the end of my final clinical rotation of DPT school the volume of manual treatment required crushed me, and I finally had to admit something needed to change. After various imaging reports and consulting multiple surgeons, the reality was stark: I had grade 4 (severe) osteoarthritis throughout my shoulder with two different 20 millimeter osteophytes (bone spurs). My surgeon compared the physical state of my shoulder to that of a man in his late 70’s.


Radiograph taken 5/2018 - red circles identifying osteophyte growth

Thus, the crux of the decision for me was not IF I had to have the surgery, but WHEN. As a graduating student my student health insurance didn’t expire for another several months, so I broke down the decision as such:

a) Have the surgery within a familiar healthcare system with far better insurance benefits and with the most recommended surgeon,

OR

b) Deal with the pain for as long as I could, start a career my body wasn’t physically prepared for and hope for the best… and then have to have the surgery within 3-5 years.


When packaged in such a dichotomous presentation, this decision looks elementary, yet it was anything but. I was hit abruptly with accepting my physical body’s fragility, and making a decision on a permanent alteration to my anatomy didn’t come easy. Yet, it graced me an opportunity to aggressively re-evaluate my priorities. As a young man with dreams to be a husband and father, suddenly the days that once seemed like a distant future were now at my doorstep and I was asking myself humbling questions. Will I be able to pick up and hold my future children? Will I be able to play catch with them, and protect them as they grow?

I’m almost 10 months out from surgery now. With my experience as a clinician and my own past surgeries, I know the one year mark is a common time-stamp before feeling back to “normal.” After living through a near decade progression of pain prior to surgery, I’m not sure what “normal” would be for me now.

I’m optimistic about how I’ll feel at that one year mark, but I’m also comfortable with knowing that one year mark won’t define me or my “success”. No one day will. Nor will any single metric. There will be good days and tough days years down the road, and defining success as any outward goal or appearance will no doubt set me up for disappointment. If I however, stay committed and patient with the process, develop and share a healthy movement practice with others, then how can we not succeed?


The process over outcome mindset is a daily struggle for me, but I’ve come across some amazing resources that have helped along the way. If anyone is interested please don’t hesitate to reach out. Mindset, like physical recovery, is fluid and evolving, and I’d love to connect and learn from anyone interested.


Thanks for the read. Much love y’all!


Nate

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