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About Seth Hosmer
Dr. Seth Hosmer is the founder and owner of Health & Performance Chiropractic, and has been working with endurance athletes for over 10 years. (more about Seth)

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Finally Feeling Better

We're at day 5 after surgery, and things have taken a turn for the better. The pain is down significantly, and I no longer need the prescription medications. I have my first follow up with the ortho on Friday...hopefully he'll tell me to get rid of the sling, and that I can start doing some basic ROM exercises. We'll probably take some x-rays at that visit to see how everything is looking, so I'll post a picture of them if I can.

As an aside, there has been some news in the press recently about acetaminophen (tylenol). Evidently, it is the #1 cause of acute liver failure in the US with about 56,000 cases each year. Most of the cases seem to occur because people combine medications and don't realize that they are exceeding the recommended maximum daily dose of acetaminophen (4 grams). This was interesting because the medication I was taking for pain contained 325 mg of acetaminophen, and at recommended dosing I was getting 3900 mg of acetaminophen per day. If I had taken any extra tylenol, I would have exceeded the 4 gram per day limit.

All medications have warnings on them, the problem is that most people do not read them. In my post-surgery haze I might not have either...but my wife is an MD and she made note of this .

Anyway, remember that just because something is OTC doesn't mean that it can't be harmful if you exceed labeling recommendations.


Plan = healing

Day 2 after surgery is much better than Day 1. Day 1 was spent mostly watching TV and feeling useless. Every time you move it hurts. The pain killers make you sleepy and so reading doesn't really work. Very thankful to be feeling much better today.

So, the surgery itself...according to the surgeon went well. There were evidently more pieces in there than were evident on the x-ray, including one stubborn piece that would not go back together. The surgeon said he expects the healing tissue to help pull it back where it belongs, so fingers crossed on that one. My follow-up appointment is in a week, so we'll know more then and I hope to have an x-ray to post that shows the hardware.

Typing is difficult so I'll end it here, thanks again for all the get well soon wishes.

Scheduled for Shoulder Enhancement Surgery

The surgery I mentioned in my previous post has been scheduled for Thursday afternoon. The surgeon said that the procedure is fairly straightforward, but it is difficult to estimate healing time and how long I will be in a sling until he gets in there and sees exactly what is going on. With any luck the pieces will come together well and healing will be rapid. His best estimate at this point was about 3 weeks in a sling. He also made a point of saying that the first few days - especially the first night after surgery - were going to be fairly unpleasant, so I'm not looking forward to that. I'm going to try and do everything I can before that to be ready. Thoughts include:

  • Preparing a chair to sleep in. I remember last summer when I broke ribs (thank you PIR STXC) sleeping lying down wasn't possible, and I ended up sleeping in a recliner.
  • Get all the complimentary medicine together. As mentioned in my initial post, things like cold laser, wobenzym, kinesio tape etc can be very helpful for resolving pain and swelling. I am hopeful that this will help me avoid relying on regular medicine after the first few days.
  • Movies! Not sure what I'll feel like at the time, but I've got a good mix all ready to go including bike videos, educational/chiropractic stuff, and regular old movies. When le Tour starts, I'll also have that.
So, hoping for the best! Thanks again to all of you who have written or called and wished me well.

Would you like that in Titanium or Stainless?

First of all, I'd like to thank everybody for the Get Well Soon wishes that have been coming my way! The OBRA community really takes care of its own! The shoulder has been feeling reasonably good, and here is what it looks like 8 days out:

That yellowy skin unpleasantness isn't due to the iPhone camera settings
or a failing liver, just the body cleaning up after all the swelling.




I've spent the last few days thinking about it, and I am going to do the surgery option. The outcome is far more certain, and I'd like to have full pain-free use of my shoulder. Of the two procedures, I'm going to do the one that is most likely a bit more painful while it heals, but the hardware comes out after a while.

Presenting: the acromion Hook Plate,
available in either stainless or titanium


As you can see from this artist's illustration, the gleaming implant is holding everything together so it can heal. At the very end, there is a hook that reaches under the acromion process, which is why this option can be a bit more painful as you heal (irritation to the acromion) and why it must be taken out (can erode the acromion). But, like I said, the option of leaving the hardware in isn't a good one for me as they can be irritating with backpacks etc. Having a 3-month old baby at home and many shoulder rides in my future, the decision was easy!

In addition, the shoulder thus far has not been very painful. Which means I've been doing most of my usual daily activities, which is to say I am not resting or immobilizing my shoulder. I actually did a 2h fixed gear ride yesterday out the Springwater. It was good to get out there, but I think that if my shoulder doesn't hurt after surgery I'll be tempted to use it...which would potentially cause problems for healing.

With any luck, I'll have the surgery Thursday or Friday of this coming week. We will have some modified treatment hours at work for a few weeks while I recover, but I have arranged for coverage by other Chiropractors. I will still be there, I will just have some help for things that I am unable to do with the broken wing.

The implant is available in stainless steel or titanium. I'm thinking Ti. I wonder if I get to keep the implant after it is taken out.



Opinion 2: Surgery

I had my second ortho consult yesterday, and he also recommended surgery. He took more time to answer my questions, but I didn't like the sound of his procedure as much as the first consult. With the second ortho, he wants to leave the hardware in forever, and that can lead to discomfort at the surgical site when wearing a backpack, etc. Ortho #1 is doing a procedure that requires a second surgery to take out the plate...but at least the hardware is gone. I'm going to stew on it for the weekend, but I will probably go with option #1.

It is difficult to decide whether to even do surgery because I am not in much pain now and able to do most things that I need to. However, with the relatively high rates of non-union with this type of fracture, I think it makes the most sense to get the surgery done. The basic tradeoff I see is the guaranteed expense and discomfort of surgery yields a relative certainty of a good outcome quickly. Leaving it to heal on its own has less discomfort and expense in the short term, but may still leave me needing surgery after a few months, or a poor fracture union.


First Ortho Opinion: Surgery

I went to see a shoulder specialist today, and he recommended surgery. I am going to get a second opinion Friday, but given the characteristics of the injury and likelihood of problems, surgery seems like a good option. The hardware will be in for a few months, then pulled out. No racing for a while. Hoping I can at least ride soon. The Ortho said there is nothing I can do right now that would make anything worse before surgery so I was thinking about hitting Tabor tonight...that probably would have been a mistake. Anyway, hopefully I'll get it all sorted out soon.

Third time is a charm

So I decided I would get an x-ray of my shoulder so I'd know exactly what I was dealing with. It doesn't take a Radiologist to read this film:


The image popped up on the LCD screen as the Tech was shooting another film and I said to her, "Is that MY clavicle?!" (whose else would it be?) Based on how I was feeling, I just didn't expect the film to look like that. But there it was. I went to work today and did my usual thing with only minimal pain...so don't let "pain be your guide" regarding whether you have fractured a bone or not.

So, no racing for a while. Hopefully with continued treatment and a lot of tape I'll be able to ride my bike soon. Driving to work is no fun either.

Doctor, heal thyself: Update

So, we're around 24h post injury here, and the shoulder is recovering well. It is still hard to say exactly what is going on until I get an x-ray tomorrow, but I felt decent today all things considered. Shoulder ROM is improving. The picture below shows one of the cold laser treatments I was doing today - this is one of about 8+ I did today:

Much of the swelling is gone now, as you can see below:

Contrast that to the pictures in the prior entry - remarkable decrease in swelling and pain. I cleaned my race bike today, and aside from a few cosmetic things, it is looking good. A mild dent in the top tube just gives a bike character. I took the bike for a ride around the block to make sure that it seemed like it was OK, very glad that it seemed OK. I took the MTB out around the block too and rode off a curb to see how that would feel...I'm not completely to terms yet with missing the Test of Endurance next weekend. I am hoping that somehow I can still do it. If the x-ray does not show a fracture tomorrow and things keep progressing, maybe I'll give it a shot. Full muscle strength in all directions by then or TOE is a no-go.

Doctor, heal thyself

There is a saying in cycling about broken clavicles: "There are those that have, and those that will" (break their collarbone). Over the years, yours truly has had a shoulder separation, and broken clavicles on two separate occasions. For those of you that have had both broken a collar bone and separated a shoulder, you know that the clavicle typically heals in a matter of weeks and feels pretty good, while a separated shoulder hurts for months, and I'd take a broken clavicle over a separated shoulder any day of the week.

Which brings us to the Mississippi Crit last night. It was a fun, fast race with lots of primes. With two laps to go, a rider went down in turn 1, and two of us right behind him went down too. Fortunately everybody was basically OK, but my shoulder did not feel good. Having experienced the joys of both clavicle fractures and AC separations previously, this felt more like the latter. Thankfully, my go-to Chiropractic Physician Dr. Noel Snodgrass was willing to meet me at his office for some quick treatment. This is where we took this picture:


As you can see from the picture, something is wrong with my right shoulder. Directly after the crash I checked it out and it seemed OK. Dr. Mike Murry was also on the scene last night and did some poking and prodding of his own, and the consensus at the time was a separated shoulder, most likely grade 2.

Dr. Snodgrass did some assessment of his own, but it became increasingly difficult to tell anything because everything was so swollen. We did some cold laser and kinesio-tape, both of which have been tremendously helpful on prior clavicle injuries. With my last clavicle injury (fracture) in 2004 I did treatment with cold laser etc within 12h of the injury and was back on the bike in less than a week, swimming in 3 weeks, and did a triathlon 5 weeks out. So, by treating the injury less than 2h after it happened, I was hoping that we would make good progress in short order.

Dr. Snodgrass graciously allowed me to bring home his cold laser so I could continue treatment. I did one more treatment before bed and then got up 2x at night to do more treatment.


Results Speak for Themselves. The picture above shows my shoulder this morning around 11:30, 16h after the injury. The swelling is down markedly and is feeling pretty good. Mobility is definitely not happening, but we'll work on that later today.

So, the reason for writing the post is to talk about what can be done for this type of injury to speed the healing process. The standard treatment for something like this is PRICE (protect, rest, ice, compression, elevate). All of these things can help, but it is hard to compress or elevate a shoulder. There are several other things that I have been doing that seem to help with the injury, and I have seen similar results in my practice and with other athletes:

  • Cold Laser, starting as soon as possible. Cold laser is an FDA approved treatment which speeds the healing process and has been shown especially effective for acute swelling. With an injury like this, much of the pain comes from the swelling itself, so bringing down the swelling goes a long way.
  • Kinesio-Tape. This stuff has been around for a long time, but had its "coming out" party at the Beijing Olympics. Who can forget the beach volleyball players with taped shoulders? This stuff also helps with swelling and support. In Lance Armstrong's book, he talks about the "magic tape" they were using, it was kinesio tape (k-tape).
  • Wobenzym. This is a combination proteolytic enzyme product. Proteolytic enzymes were the go-to anti-inflammatory before NSAIDS came on the scene. The good thing with proteolytic enzymes is they are natural and have no side effects.
  • Arnica. I've used it for years. Products like Traumeel have had double-blind placebo controlled studies done that show that they decrease inflammation and pain better than NSAIDS. Another natural product.
  • Ibuprofen. Works great for this type of thing.
  • Hammer Nutrition Tissue Rejuvinator. Another combination product with proteolytic enzymes, glucosamine, chondroitin, MSM, Type II collagen, etc.
So, it might seem like a lot of work to do all this, but basically I am taking some medicine, doing cold laser every couple-few hours, and working on maintaining my shoulder ROM. There is some clicking in the shoulder currently, so maybe there is a fracture? I may get an x-ray tomorrow. My current best guess is a grade 2 AC separation, torn upper trapezius grade 1 and a non-displaced distal clavicle fracture. The good news is that I can still do everything I need to, including changing our baby's diaper :-). Not sure when I'll be back on the bike, but I'm thinking the Test of Endurance is off my calendar. Was really looking forward to that and had registered weeks ago. Ah well, next year.





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Mt. Tabor, round 1


For 6 weeks in the summer, the roads around Mt. Tabor are closed to general traffic to allow bike racing. Portland is blessed with many local events to choose from, and Mt. Tabor is one of the best. Though we lost our weekend edition this year due to a public works project, a patch of fresh tarmac laid down last week allowed us to start the series June 10th. In the Senior Men's Race, HPChiro/Hammer Nutrition animated the race early, attacking through the first corner and establishing a break. Pictured above are Seth Hosmer (HPChiro/Hammer Nutrition), Austin Arguello (Hammer Nutrition/CMG) and Steven Beardsley (Gentle Lovers). The trio managed to stay out front for 6 laps and a few primes before being swept up by the field. By halfway through the race, HPChiro/Hammer Nutrition riders again had control of the race, with Kyle Valenta and Patrick Marzullo riding at the front.


In the last few laps of the race a break established itself that stuck through to the finish including HPChiro/Hammer Nutrition rider Kyle Valenta who finished second. Aaron Coker, fresh off his May PIR series win, won the field sprint for 4th.
Full Results Here. Special Thanks to Jon Gornick for the photos.
This weekends' racing includes the Cirque du Cycling Crit and the Alpenrose Heartbreaker.




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Dr. Weil Breathing Exercises

No, it is not the latest wonder drug or scientific breathrough. Instead it is a time-tested old-school way to improve your health and relax your mind. Shamelessly copied from the Dr. Weil website:

The Art and Science of Breathing

Three Breathing Exercises

"Practicing regular, mindful breathing can be calming and energizing and can even help with stress-related health problems ranging from panic attacks to digestive disorders."
Andrew Weil, M.D.

Since breathing is something we can control and regulate, it is a useful tool for achieving a relaxed and clear state of mind. I recommend three breathing exercises to help relax and reduce stress: The Stimulating Breath, The 4-7-8 Breathing Exercise (also called the Relaxing Breath), and Breath Counting. Try each and see how they affect your stress and anxiety levels.

Exercise 1:


The Stimulating Breath (also called the Bellows Breath)
The Stimulating Breath is adapted from a yogic breathing technique. Its aim is to raise vital energy and increase alertness.

  • Inhale and exhale rapidly through your nose, keeping your mouth closed but relaxed. Your breaths in and out should be equal in duration, but as short as possible. This is a noisy breathing exercise.
  • Try for three in-and-out breath cycles per second. This produces a quick movement of the diaphragm, suggesting a bellows. Breathe normally after each cycle.
  • Do not do for more than 15 seconds on your first try. Each time you practice the Stimulating Breath, you can increase your time by five seconds or so, until you reach a full minute.

If done properly, you may feel invigorated, comparable to the heightened awareness you feel after a good workout. You should feel the effort at the back of the neck, the diaphragm, the chest and the abdomen. Try this breathing exercise the next time you need an energy boost and feel yourself reaching for a cup of coffee.

Exercise 2:
The 4-7-8 (or Relaxing Breath) Exercise

This exercise is utterly simple, takes almost no time, requires no equipment and can be done anywhere. Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.

  • Exhale completely through your mouth, making a whoosh sound.
  • Close your mouth and inhale quietly through your nose to a mental count of four.
  • Hold your breath for a count of seven.
  • Exhale completely through your mouth, making a whoosh sound to a count of eight.
  • This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply.

This exercise is a natural tranquilizer for the nervous system. Unlike tranquilizing drugs, which are often effective when you first take them but then lose their power over time, this exercise is subtle when you first try it but gains in power with repetition and practice. Do it at least twice a day. You cannot do it too frequently. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. If you feel a little lightheaded when you first breathe this way, do not be concerned; it will pass.

Once you develop this technique by practicing it every day, it will be a very useful tool that you will always have with you. Use it whenever anything upsetting happens - before you react. Use it whenever you are aware of internal tension. Use it to help you fall asleep. This exercise cannot be recommended too highly. Everyone can benefit from it.

Exercise 3:
Breath Counting
If you want to get a feel for this challenging work, try your hand at breath counting, a deceptively simple technique much used in Zen practice.

Sit in a comfortable position with the spine straight and head inclined slightly forward. Gently close your eyes and take a few deep breaths. Then let the breath come naturally without trying to influence it. Ideally it will be quiet and slow, but depth and rhythm may vary.

  • To begin the exercise, count "one" to yourself as you exhale.
  • The next time you exhale, count "two," and so on up to "five."
  • Then begin a new cycle, counting "one" on the next exhalation.

Never count higher than "five," and count only when you exhale. You will know your attention has wandered when you find yourself up to "eight," "12," even "19."

Try to do 10 minutes of this form of meditation.

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Carb Loading, Simplified

I went to the WSCC NW Chiropractic Symposium this weekend, and one of the speakers was G. Douglas Andersen. He presented a wealth of information on sports nutrition, based on recent research. One of the topics was on carbohydrate loading, a summary below:

Carbohydrate loading originated in the early 60's, and consisted of 3 days of hard exercise with low dietary carbohydrate (CHO) to deplete your CHO stores, which was followed by 3 days of rest and high CHO intake. The idea was that your depleted muscles and liver would supercompensate and draw in extra CHO and you'd start your race with extra energy. The problem should be obvious: training hard for 3 days with low CHO is risky right before your key event.

In the 80's, intense exercise was replace by 3 days of exercise taper with normal diet followed by 3 loading days (commonly 2 days light exercise and 3rd day rest).

A study in 1997 showed muscle glycogen can remain elevated 3-5 days provided activity is low following loading. Prior to this, it was assumed muscle glycogen was similar to liver glycogen, dropping rapidly.

In a 2002 study, 1 day of inactivity with a high CHO intake (10g/kg body weight) consisting of high glycemic index CHO elevated glycogen roughly the same amount (90%) as 3 days did.

So if you were to boil this down to some very simple instructions, eat extra carbs the day before a big race. And remember that when you store CHO, you also need extra water (carboHYDRATE, get it?).


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HPChiro/Hammer Nutrition Racing Results



The OBRA Team Time Trial Championships were this past weekend, and the HP Chiro/Hammer Nutrition team earned a podium spot again for the fourth year in a row. The course is a 7 mile loop with a few turns. This was the biggest turnout I've seen in the past few years with some 160 teams competing across the various categories. Full race results can be found here.

In other racing news, the team won the PIR series for May with Aaron Coker showing his sprinting form is warming up for the OBRA Crit Season. With the warm weather and sunshine the fields have been fast. Good times!

In other cyclng news, HP Chiro/Hammer Nutrition rider Quinn Keogh was also the guest of honor at a LiveStrong benefit on May 24th. Quinn will also be attending a LiveStrong event in Seattle where he will be sharing his story about battling cancer, as well as talking to others with similar experiences.