My client is 23 years old, plays soccer, is quite strong and well built. Five days ago, he sustained a hairline fracture to his collarbone while surfing. I was wondering if you could outline for me the exercises he should be performing to rehabilitate the injury. He is a very keen weight lifter, and I fear he may push himself too much too quickly.
Hairline fractures, as seen by X-ray, are difficult because they seldom decrease an athlete's work output. The collarbone (clavicle) is a common site for injury. Everyone tweaks them whenever they fall, make heavy contact or get pounded into the sand by large surf. What is the location of the fracture? Is it in the middle or toward one of the ends? This could make a training difference and susceptibility to an increased grade of fracture. If your client has no pain in the shoulder girdle on ROM in all directions, then he is going to train. The questions, in my mind are: what test exercises to do, at what intensity, and what are the chances of a complete fracture?
Surfing and soccer are totally different sports. Surfing requires a good deal of upper body strength and endurance, torso strength and agility. The paddling portion of surfing will irritate the fracture if it is "opening." It will be a sharp pain, so it will get his attention. This might be a good test exercise (ROM with an easy load and slow pace). If no problems occur, go to a faster pace and so on until he can paddle hard for several sets of 20 to 30 seconds. It is a good workout for the shoulder girdle. Next, get him to do some good old push ups. Have him start in the prone position and crank out a few sets of 10. If there's no pain, then you can expand into all different angle push ups. Use the exercise ball for increasing instability, much like his board when in the water. Check the PTN Exercise Library for some great photos of stability ball training. Dumbbell shrugs are next on the test list. Start light and get full ROM with each set of eight to 10 reps. Increase the weight until fatigue or pain. If there is no pain, then everything is somewhat sound, and the usual training routine can start.
Soccer is generally looked at as not requiring an extensive amount of shoulder girdle strength. It can be further defined as more aerobic and anaerobic running patterns with leg-hip-torso strength needs. So your client's training here would consist of fieldwork and shoulder movements for blocking and sprinting. After a good warm up, test your athlete with some 30-meter sprints. Shoulder-arm action on all out sprints is usually significant and presents a torque and jarring phase to the clavicle. If he passes the surfing phase, I will guess this to be no problem. The last question is, what if he falls? If he gets through all these things and does not present any pain or problems, then his clavicle is not fragile. When the X-ray shows closure of the fracture, then he is ready for a full contact pounding.