24 April 2007

Layoff vs slow return to activity

One of the main worries climbers have after getting an injury is whether to take a complete layoff from climbing activity and how long that layoff should be. Some reading about rehab in sport will tell you that extended layoffs are very bad news not only for losing form but also recovering from the injury. Here is quote from a review of strength training in sports rehab which really rams home the point:
"it is now clear that during the remodeling phase, occurring theoretically from the 21st day after injury and even lasting 300 to 500 days, the collagen tissue remodeling can only take place efficiently when put under stress (or load)."
The initial layoff (up to three weeks) allows the acute phase of the injury to pass (that is inflammation causing swelling, tenderness and lots of nasty chemicals in the wound). Beyond that, it takes training for the injury to respond with improvements in exactly the same way as normal training, except of course that it is starting from a very low load capability. What has to be remembered is that sporting function is not normal function. If you layoff for a long period, an injury will recover to the point it can handle what is being asked of it (i.e. lifting kettles, tapping keyboards in some people's case!). You would'nt stop climbing for six months and then jump back on your hardest grade would you? So if you have an injury where the capability of the damaged tissue drops to a very low level, you shouldn't let it languish at that level and then expect it to suddenly perform a massive jump in standard by starting normal climbing again.
The bottom line is, rehab from injury is (beyond the initial phase) analogous to normal training, with progressive overload to stimulate the tissue to respond. All the aspects of normal training also apply; monitoring of progress, regular and stuctured exercises, careful lifestyle support (which in this case will include rehab treatments like Lewis reaction icing, stretching and maybe friction massage).

10 comments:

Dax said...

Ta for the blog. I'm just in the process of recovering from a shoulder impingement condition so I'm interested to hear your views.

Continuing your blog, what's your opinion on when you should start to actually get back to training/climbing after an injury in terms of the pain you might feel either during training, before or after?

It's always easy to just think "sod it" I'll train through the pain but that may not always be a good idea.

So how long should I wait before starting the training again? Until the pain goes completely?

My own feelings are that I should wait until the pain has gone completely. Then train lightly using Ice/anti-inflammatory pills when necessary and being prepared to back off if required.

Any thoughts on returning to activity and the pain that might be encountered? Or is it just impossible to give a generic answer to this kind of question?

Just curious :)

Dave MacLeod said...

You should NEVER train through increasing pain and there is almost never a justification for taking anti inflammatory pills. 'rehab' training, where you are training the injury to recover should cause a little pain, but not too much. Its impossible to describe that in words obviously, but you should with experience be able to tell the difference between pain that gently stresses the injured part and pain that indicates overstressing it.

If you wait more than a few weeks of layoff with many soft tissue injuries the pain (& the underlying injury) is essentially likely to get worse rather than better because it will develop a short and weak scar, prone to injuring even worse than before as soon as it is stressed again.


So, the tasks are:

1. To make sure you know the difference between training for performance in your sport and training to rehabiliate your injury. You should'nt focus your training on sport performance goals until the injury is in the final stages of recovery (unless it doesn't affect the injury e.g. mental training).

2. Choose good rehab exercises and perform them well, while listening to your injury carefully to get the intensity correct and taking good general care of yourself (sleep, diet, stress).

3. Forget about pills as they cause you to get false information from the injury and blunt healing in the long term.

4. Only use 'cold' ice in an acute (just happened) injury to reduce immediate sweling and pain. Using it later on reduces blood flow and therefore healing. 'warm' ice techniques are a different matter and should be used as much as possible.

5. Do your homework. Don't just take the opinion of your physio on the best rehab exercises. If they don't specialise in your sport, they might not know much more that you! Look through the journal archives of scientific publications like the BJSM or university sports medicine/rehab texts. Beware of the internet unless you know and trust the source of info!!!

P. James Dennedy-Frank said...

Interesting posts. Quick question: what is Lewis reaction icing? Thanks.

-James

Dave MacLeod said...

http://www.davemacleod.com/articles/pullyinjuriespage2.html

I've written some info about with regard to finger pulley injury rehab on the above page.

-for some reason blogger's comments pages wont display long urls. just go to my article page and click on 'finger pulley injuries'. The info on icing is on the second page of the piece.

Dax said...

Thanks for your thoughts on this topic - much appreciated.

I'll have to have a good old think about your comment ".. you should with experience be able to tell the difference between pain that gently stresses the injured part and pain that indicates overstressing it" I have a feeling that's the crux of the issue for me and I guess, as with a lot of things in life, it'll be a case of "you'll know when you know".

As for the individual actions points .. I'm on it!

Cheers,
Dax

Dax said...

FYI

This has worked well.

The exercises at http://www.climbinginjuries.com/really helped. I'm back climbing outdoors :)

Anonymous said...

question on finger treatment (same right hand ring finger as the videocast)... i think i may have got a slight tear in the A3 pulley and im curious as to whether it will ever heal properly in order for me to improve on where i left off and become stronger than before. i have given it the waterbath treatment (though not as frequently as suggested) and have layed off from climbing for a good while (3 weeks or so). i have tried climbing on it after waiting and it hurts again, could i cause chronic damage if i do this too often? would be awesome to get your view on the situation!

Dave MacLeod said...

I have recovered from multiple partial ters in pulleys in every single one of my fingers and climbed much harder. So the answer is yes, of course you can recover from pulleys.

Remember that three weeks is nothing in tendon healing time. Three months is more like it. Don't expect the pulley to be healed in three weeks, you have to start back very gently and build back up over time, determined by the pace it recovers at.

I am writing a book on this subject right now - so more later.

Be careful though with self diagnosis. Are you sure it's only a partial tear? If you can afford a scan and a session with a specialist, get one!

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