We were having a blast skiing a Great Powder Day at Vail. It was the 3rd day of a big storm cycle, blue skies and endless tracks in 2 feet of light snow. Then my ski buddy and cousin got hurt. Using common sense, some medical know how (I am a Physical Therapist) and skills learned studying traumatic stress, we were back in the fun zone of a really fine day.
My cousin’s business in Vail enables him to ski daily. He skis hard, strong, fast and skilled. But, sometimes even terrific skiers find themselves in the wrong place with the wrong speed, with an unforeseen trajectory.
Today, Doug found himself in that kind of miscalculation. He sailed over a small drop off, bounced oddly and flew into an aspen. The tree was 4 inches or more in cross section where his right arm hit. The upper ½ of the tree and Doug ended up in the snow 40 feet above me.
In a little bit, Doug got downhill to me. He sunk down into the snow. Shock, nausea, right shoulder pain and eventually wrist pain had to be addressed.
We determined it was safe to take our time and see what settled out.
Nausea can be an indicator of the seriousness of an injury. It’s part of the stunned and damaged response. We began monitoring the severity of the nausea. I wanted to see it drop in intensity and start to cycle into shorter waves. Over the next 30 minutes that we sat together in the snow, it cycled into less intensity.
While we monitored the nausea we began assessing the sites of pain. Number one was the right shoulder. By appearance it wasn’t broken, shortened, or fully dislocated. I felt the top of the arm through the coat and it didn’t feel right. A shoulder should feel round but instead it felt extra boney. The ball shaped part of the arm bone was half way out the bottom of the shoulder socket. The muscles were clenched in spasm.
I said it might be necessary for a toboggan ride but we could see if the shoulder would reposition itself. If so, that would help the nausea. I gently supported the area at the shoulder and elbow. The muscles began a nearly undetectable back and forth movement as they started to let off of the clenching.
Muscles clench to limit movement in an injured area. They will clench in spasm if something is a little out of place. This protective response can interfere with jammed or partially displaced bones getting back to their rightful position. The process of this protective clench releasing is called Discharge. It began as we sat in the snow. In 10 minutes the shoulder was only 25% or so out of normal position.
Doug was feeling like we could ski to the lift and head up to the warming hut on top of Blue Sky Basin to get water and ibuprofen. We squeezed into a spot at the crowded picnic tables. He still didn’t feel well. He had no appetite, mild nausea, right shoulder pain and very limited arm movement. He took ibuprofen and we figured we’d see how he felt in twenty minutes when it kicked in. He could feel another wave of shakiness coming on and as it did the nausea quit. He laid his head on the table and let the process take over.
I encouraged him to “let the shaking happen. It is normal and a good thing to help reduce the shock”.
“Just let your body shake even if it seems like a lot of shaking.” He began shaking with visible strong trembling in his head, neck, and back muscles. I held his right arm lightly and encouraged him to let the shaking progress into the right arm which it did all the way to his hand.
The shaking was so intense that our tablemates became alarmed. I did my best to reassure them that we didn’t need ski patrol or any intervention other then time to let this natural process work itself out. They remained doubtful. I said “It’s like a woman shaking after giving birth.” That helped the women to our right. But the 2 guys on the left were convinced we were on the verge of a medical emergency with all of the bells and whistles.
Three of the upper ribs needed a little help to release. The upper one was twisted forward, the middle one was rigid and the lower one was cranked towards the back. This was likely how the ribcage squished on impact as it absorbed and dissipated the forces moving through. I gave each rib a little support with light contact in front and back to guide it into the direction it was torqued. More shaking happened and then it was all over.
Doug began moving his arm in full overhead circles completely pain free at the shoulder, all nausea was gone and he was back to his usual self. He exclaimed with amazement, “I can’t believe how good it feels now.”
So we went back out for the second half of the Great Ski Day until the lifts closed.
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