In August 2025, I crashed my mountain bike on a descent in the Alps. I attempted a jump, overshot the landing, and came down hard on the inside of my elbow.
From the GPS track, my speed at the point of impact was 35.3 km/h, and I travelled somewhere between 12 and 15 metres.
The initial on-site assessment (physical exam only) suggested a detached infraspinatus and a torn - but not full-thickness - supraspinatus. Surgery was considered likely. I decided not to roll the dice locally and instead booked follow-up with my doctors back in the UK. French surgeons have a reputation for detaching the biceps tendon during shoulder surgery, and I wasn’t keen to add that variable.
Two days later, I managed to make things worse. I slipped on freshly mopped, greasy tiles and knocked the same elbow, further injuring the shoulder.
Pre-surgical assessment
By the time I had a full assessment in the UK, things had progressed.
Active forward elevation: 0–80 degrees
Passive elevation: 170 degrees
Active abduction: 0–160 degrees
External rotation: 50 degrees
An MRI showed a large full-thickness rotator cuff tear involving the entire supraspinatus and infraspinatus. The tear measured 4 cm anterior–posterior, with tendon retraction to the level of the glenoid margin- also 4 cm. The subscapularis and teres minor were preserved. There was no significant muscular atrophy or fatty infiltration, suggesting the tear was new, with post-traumatic inflammation noted.
I definitely experienced some degradation between this assessment and the surgery itself.
Surgery
Post-operatively, the reality was worse than the scans suggested:
- Massive rotator cuff repair
- 5 cm retraction in both supraspinatus and infraspinatus
- Severely frayed biceps tendon
- Small nick in the labrum
The repair required six Swivelock anchors, and the surgery took around two and a half hours. Two of the fixings broke during the operation due to the high bone density in my arm.
During surgical prep, I was told that given the degree of retraction, there was roughly a 30% failure rate. That number felt uncomfortably high.
Why I used HBOT
I went looking for ways to reduce that risk. Only two things seemed to meet a reasonable standard.
The first was a complete nutritional strategy. I removed alcohol entirely, used Cronometer to ensure all micronutrient requirements were met, and supplemented with creatine, glutamine, arginine, citrulline, ornithine alpha-ketoglutarate (OKG), phosphatidylserine, and HMB.
The second was hyperbaric oxygen therapy (HBOT).
HBOT shows up in PubMed primarily via animal studies. One example involved New Zealand white rabbits with surgically created full-thickness supraspinatus tears, treated with 100% oxygen at 2 ATA for 2 hours per day over 5 days. The HBOT group tolerated significantly greater maximal force than controls.
After discussions with two hyperbaric clinics, I decided to proceed. I did one session pre-surgery - mostly to acclimatise so my first experience wouldn’t be immediately post-op - and five sessions in the two weeks following surgery. Sessions were 90 minutes.
I did my first post-surgical HBOT session directly on the way home from hospital.
Effects
The effects were noticeable from the first session.
Without any strengthening, the analgesic and anti-inflammatory effects were very strong - stronger, initially, than the dihydrocodeine I’d been prescribed. I was given two weeks of DHC with instructions that it could be continued for up to three months if needed. In practice, I only used it for three days, including the day of surgery, and stopped naproxen on day five.
Given the effect, I continued HBOT at roughly twice per week, completing just over 20 sessions in total.
This made a real difference to physio. I could push harder, reaching levels that would normally require a couple of days off - but time HBOT sessions so that I didn’t need to back off at all.
Rehab progress
Overall, my physio progress has been about four weeks ahead of a typical return-to-sport timeline:
- Assisted active ROM at 6 weeks instead of 8
- Active exercise at 8 weeks instead of 12
- Back on the mountain bike at 3 months
At 18 weeks post-op:
- 140 kg deadlift
- 22 kg dumbbell press (vs 32 kg on the right)
- 36 kg kettlebell farmer’s walk, 3 × 45 m
Physio assessment at 16 weeks
(Right arm operated on; measurements taken four weeks apart.)
I was up to the 40th percentile vs population for external rotation strength within 16 weeks.
Optimal shoulder ratio is 1:1 external to internal rotation.
-
External rotation:
- Right: 126 N (previously 68 N, 1st percentile)
- Left: 150 N (previously 132 N, 46th percentile)
- 16% difference (previously 48%)
-
Internal rotation:
- Right: 153 N (previously 79 N, 2nd percentile)
- Left: 187 N (previously 170 N, 77th percentile)
- 18% difference (previously 54%)
Rate of force development:
- ER: 66% L>R
- IR: 78% L>R (not significant)
Press-up deficit: <0%
Surgeon’s assessment
At four months post-op, my surgeon noted that I had almost full range of movement with good strength and had already returned to sport in a controlled way. Given the severity of the injury, he felt the progress was remarkable.
Comparison with previous shoulder surgery
I’ve been through this before. I previously had a labrum stabilisation and large rotator cuff repair on the other shoulder.
This recovery has been far more linear. The previous repair ultimately succeeded, but strengthening was slower and included a setback around four months with a small partial re-tear of the supraspinatus.
This time, range of motion has progressed dramatically faster. At four months, I’m at 95%+ ROM with only a small hitch, which I expect to resolve by five months. Previously, it took a full year to reach this level. My confidence in the strength of the repair at four months now matches how I felt at a year post-op on the other shoulder.
Scarring
Arthroscopic scars are small anyway, but at four months these scars are already lighter than those from my previous surgery five years ago. By one month they were almost invisible.
(Photos speak for themselves.)
I'll begin uploading each protocol in more detail over the next few weeks.