Professional wrestler Griff Garrison, also known as Garrett Griffith, was lifting weights when he extended his arms too far and felt his left shoulder pop forward. He was practicing an Olympic-style overhead snatch position, which involved quickly lifting the bar overhead. Immediately, he knew he dislocated his shoulder joint.
Griff left the gym and drove to the ER, where they popped his shoulder back into place. A few days later, he saw Dr. Brian Waterman, chief of orthopaedic sports medicine at Atrium Health Wake Forest Baptist. Waterman obtained an MRI of Griff’s shoulder to assess the damage. The MRI revealed a Bankart injury in his shoulder joint, meaning the labrum (a thick piece of cartilage that lines the shoulder socket) was torn and causing instability. He also had a Hill-Sachs lesion, which is an indentation in the ball of the shoulder joint.
Due to Griff’s profession and high activity level, Waterman recommended surgery to stabilize his shoulder and reduce the risk of dislocation. Without surgery, Griff’s risk of another shoulder dislocation was 80%-90%.
“It’s very important to treat shoulder instability in younger patients involved in contact or collision athletics early to reduce the risk of future dislocation events,” explains Waterman. “Each dislocation erodes layers of the socket bone over time. You can’t build that bone back up. If the bone wears down too far, you need a bony solution, which requires a more difficult surgery.”
At 25 years old, this was difficult news for Griff to process.
“I was devastated,” he explains. “I got really pale. Then I left the room and got sick to my stomach. But my strong reaction to the news was the motivation I needed to move forward with surgery and rehabilitation.”
Before surgery, Griff worked with Olivia Abdoo, Division 1 physical therapy fellow with Wake Forest University, on prehabilitation exercises. (Abdoo now works as a physical therapy manager with the Ultimate Fighting Championship in Las Vegas, Nevada.)
“After an injury, patients often see a decline in function, range of motion and strength,” Abdoo says. “If you can address those things before surgery, outcomes related to quality of life and time to return to play are improved. We worked with Griff to help him gain as much strength and range of motion as possible before surgery, which supported a successful recovery.”
Minimally invasive surgery
Waterman performed an arthroscopic Bankart (labral) repair to stabilize Griff’s shoulder. This minimally invasive procedure involves securing tiny anchors into the bone and attaching them to the labrum. The anchors are the size of the tip of a pen and are made of shoelace-like material that can withstand significant stress. The procedure works like a zip tie to re-tension the ligament and reduce the risk of dislocation.
The 60-minute procedure requires five poke-hole incisions and results in less soft tissue damage, a shorter recovery and less pain.
Griff appreciated his care team’s bedside manner and calming influence, especially when he was coping with the idea of having surgery.
“Dr. Waterman wasn’t just a doctor doing his job. It felt like he was invested in helping me return to my career,” Griff explains. “My entire medical team wanted to help me return to doing what I love as quickly as possible. They always answered my questions thoroughly, which gave me peace of mind.”
Following surgery, Waterman recommended Griff start rehabilitation as soon as possible to preserve muscle mass, decrease scar tissue, increase range of motion safely over time and reduce pain.
Functional testing for objective assessments
Waterman and Abdoo relied on functional return-to-play testing during Griff’s recovery. Functional tests use advanced technology to check for sufficient stabilization, coordination, motor control, power and strength to determine if an athlete has the foundational capacity to do what’s required for their sport. The tests allowed Griff’s care team to obtain data as early as possible to track his progress and make objective decisions about his rehabilitation activities.
Abdoo used upper extremity-specific tests to objectively assess Griff’s condition and progress his rehabilitation as safely as possible. For example, four months into his recovery, Abdoo had Griff perform a single-arm hop test to help determine his readiness to return to sport. During the test, Griff got into a single-arm push-up position and hopped onto a 4-inch box using one arm. This test was used to assess Griff’s shoulder strength, stability and ability to tolerate impact.
“Our milestone-based assessment system offers a more objective way to evaluate the safety of returning to the ring than a time-based system,” says Waterman. “Our goal is to return the patient to preinjury function, reduce their risk of dislocation and limit surgical complications.”
Progressive reintroduction to activity
Along with extensive testing, Abdoo used a progressive reintroduction to activity to help Griff work up to his full activity level. Waterman created a post-op protocol for Griff’s recovery that was backed by evidence-based research.
Griff’s rehabilitation started with low-intensity exercises. Based on objective test results, Abdoo adjusted the volume and frequency of the exercises. For example, once he was cleared to start practicing his wrestling moves, he started wrestling for 15-minute sessions, two to three days a week. Then he progressed to training at the gym for 30-45 minutes, two to three days a week. Eventually, he began training at the gym with a partner.
“Griff’s rehabilitation was a true balancing act,” Abdoo says. “We had to allow his tissue to heal and his sutures to stick. At the same time, he wanted to push the envelope and recovery timeline, which meant we had to work really hard.”
Griff recalls, “Olivia was hard on me, but she wanted to keep me humble and prevent me from pushing it too far. She motivated me to give it my all during each physical therapy session.”
Collaborative communication, individualized care
Griff benefited from his collaborative care team at Wake Forest Baptist.
“Dr. Waterman has built a great team of experts who communicate and make decisions quickly and efficiently,” Abdoo notes. “It was easy to call or text Dr. Waterman and ask him questions about Griff’s care.”
Abdoo also worked with Griff’s strength and conditioning coach to ensure that Griff remained in peak physical condition, taking a holistic approach to his rehabilitation. This approach ensured that his whole body would be prepared to return to wrestling – not just his shoulder. They worked together to modify and test his exercises before he tried them in the gym. They also discussed nutrition and how it would impact his recovery.
According to Abdoo, one of the benefits of providing long-term rehabilitation is getting to know the patient personally.
“We can tell right away if the patient is having a bad day,” she explains. “We’re not just treating the body part – we’re treating the person. And we’re both progressing and growing together throughout the process.”
Waterman agrees, “Matching the treatment to the individual in front of you – and not using a one-size-fits-all approach – leads to successful outcomes.”
Stronger than ever
Griff was motivated to complete his rehabilitation in five months – one month earlier than planned. His shoulder stabilization surgery reduced his dislocation risk to 5% or less.
“His fast recovery speaks to his dedication to rehabilitation and his sport,” Abdoo explains. “He was motivated the entire time, which helped make me a better provider. He was an advocate for himself. That’s what truly got him back to his sport so quickly.”
Griff has returned to competing in the ring and traveling to wrestling events on the weekend.
“Life is going great, and my shoulder feels stronger than before I had surgery,” he says. “This whole experience has helped me become more patient with everything in my life.”
Griff recommends Wake Forest Baptist to other patients coping with a similar injury.
“Atrium Health is the best place to get treated,” he says. “They really know their stuff. They care about helping you get back to your sport or activity as quickly and safely as possible.”
Learn more about orthopaedic sports medicine at Wake Forest Baptist.