19 January 2015

My climbing injuries book is up for pre-order!

Readers of this blog will of course know that I have been working on a book on climbing injuries for some years. It has turned out to be a much bigger book than I originally envisaged. It has been a huge project, but in a few weeks I will reach the finish line. The book is currently with the printers and some time in the next few weeks, many boxes of copies will arrive at my house. The final stages were a rather exhausting process, but I’m excited to release it and potentially help healthy climbers stay healthy and injured climbers to get back to the fray.

I’ll write a more detailed post about the content of the book when the stock arrives in early February. If you want to make sure you get a copy as soon as you can, we’ve put it up for pre-order in the shop here, and it’ll be in the post to you as soon as it arrives. I’ve also added the table of contents below so you have an idea of the breadth of the areas covered.

My aim was to write the manual on how to stay healthy as a climbing athlete that I wished I’d had when I was 16. The first priority was to base my writing on the cutting edge of sports medicine research, wherever it was available. The second was to include all the diverse aspects of injury prevention and recovery, and then present them in a way that allows you to see them in the whole context of your efforts to stay injury free. As with the world of training, too many injury texts focus on or overplay the importance of just one aspect of sports medicine.

Having spent around 4 years researching, thinking and writing the book, I do feel that if I’d had access to the information contained in it when I was a teenager, my health and climbing achievements over the past 20 years would have been significantly better. I hope the book can make this difference both for both youngsters who have yet to experience injury, and battle scarred climbers like myself.

Below is the table of contents, so you can get idea of the scope of the book. You’ll find the book in the shop here. 

Section 1: Make or break

Why the treatments you have tried aren’t working, and what to do about it.
How to use this book
The real reasons you are injured
Stress and injury
The reason you are still injured
The language problem
The practitioner problem
The sports medicine problem
The missing link
Exceptional use: the luxury of doing your sport badly
Your visit to the doctor’s

Section 2: Know pain, or no gain

Pain and how to read it
Seeing the patterns in your pain
What is healthy soreness?
Understanding your pain
Going beyond reading only pain

Section 3: Removing the causes of injury for prevention and treatment

Are you only treating symptoms?
What was the real cause?
The big four: technique, posture, activity, rest
Correcting technique
Correcting posture
How to rest
Warm-up and injury

Section 4: Rehabilitation of climbing injuries - treating both causes and symptoms

Acute rehabilitation
When to move beyond acute care
Goals of mid-late rehabilitation
Modern understanding of tendon injuries and recovery
Therapeutic activity - basic exercises
Therapeutic activity - climbing
Proprioceptive training
Walking the line of rehab ups and downs
Therapeutic modalities
Drug and other emerging treatments
When to stop rehab?

Section 5: Psychology of injuries: dealing with the anguish of injury
Face it: it really is that bad!
Take heart
Finding motivation

Section 6: Young climbers
What young climbers should know
Too much, too young: a warning
What parents and coaches should do

Section 7: The elbow
Golfer’s and tennis elbow
Brachioradialis/brachialis strain
Other elbow injuries

Section 8: The fingers
Different grips in climbing and consequences for injury
Pulley injuries
When and how to tape the fingers
Painful finger joints
Flexor unit strains
Dupuytren’s contracture
Other finger injuries

Section 9: The wrist
Triangular fibrocartilage injury
Carpal tunnel syndrome
De Quervain’s tenosynovitis
Other wrist injuries

Section 10: The shoulder
Shoulder impingement/rotator cuff tears
Biceps tendon insertion tears
Labral tears
Shoulder dislocation
Frozen shoulder
Thoracic outlet syndrome 
Shoulder and neck trigger points

Section 11: Lower body injuries
Foot pain in climbers
Plantar fasciitis
Heel pad bruising
Ingrown toenails
Sesamoid injuries
Hallux valgus
Morton’s neuroma
Ankle injuries in climbers
Cartilage/joint injuries
Ankle impingement syndrome
Achilles tendon pain
Knee injuries in climbers
Meniscus tears
Anterior cruciate ligament tears
Medial collateral ligament tears
Hamstrings tear

Section 12: Further reading
Further reading and references
Getting access to good care

The author’s tale of woe and hope

Glossary of key terms



15 January 2015

Hyperhidrosis and climbing

Over the years I’ve heard from a few climbers who suffer from hyperhidrosis (excessive sweating) of the hands. For obvious reasons, the condition is a major hindrance for rock climbing and causes much torment for sufferers who love the activity but are constantly hampered by severely sweaty hands.
I do not have the condition myself, but I definitely have more sweaty hands than average and I find that my indoor climbing performance has always lagged as much as a number grade behind my outdoor climbing grade. I cannot imagine how difficult it would be to deal with the condition as a climber, having dripping hands with the slightest exertion. 

Hopefully, most sufferers will already know about iontophoresis, but in case not, I thought I should write this post.

I am grateful to Bob Farrell who got in touch last year to let me know that discovering the treatment had completely transformed his climbing. He went from a state of despair about how to enjoy rock climbing to being able to enjoy good friction and dry hands on small holds, both indoor and outside in warm weather.

The treatment involves passing a small electrical current, supplied by an iontophoresis machine through the hands, for 15-30 minutes or so. The hands (or feet) have to be placed in a water bath to apply the current. Despite its remarkable effectiveness, its mechanism of action is still unknown. But it blocks the sweat glands in some way, temporarily. Several treatments are required to see the benefits, and top-up treatments are needed every few days or weeks (with individual variability) to maintain the effects.

But those effects appear to essentially solve the problem for a great majority of sufferers. Although I have not tried the treatment myself, it sounds from Bob’s experience and the evidence from other non-climbing sufferers, that all affected climbers should definitely try it.

It is available, at least in some places on the NHS. But most sufferers who try the treatment and have good results seem to just purchase their own iontophoresis machine and do their top-up treatments at home. Machines cost £3-400 for a standard model. 

There seem to be few side effects, although if you have cuts in your fingers from climbing, these will burn during the treatment, with the workaround of just excluding the cut finger from the iontophoresis bath during treatment

I hope this post provides some help to sufferers who have yet to hear of the treatment.

And another point about fear of falling

I’ve posted on this blog several times about fear of falling, and of course written a whole book section on it in 9 out of 10. But further elements of this complex issue of mental training continue to challenge so many climbers, certainly if the number of emails I get on the subject is anything to go by.

One aspect that just came to mind while reading another of these is the issue of focusing your mind too much on the problem of fear of falling in the process of trying to address it.

So the problem of excessive fear or anxiety in leading may arise subconsciously.  By the time you realise that it is actually a big limitation with your climbing, it may already be quite a large and engrained issue. So you need to stare it in the face and look at the roots of it to first understand its origin and then change your habits to reduce and eliminate it.

But the subtlety of how to approach this effort seems to be important. I notice that some climbers seem to view their fear of falling as a foe in which they are in a constant battle with. Given the time and difficulty involved in overcoming fear of falling for a proportion of climbers, I can completely understand why it must feel like this. Nevertheless, viewing it along these lines could become self-defeating.

Fear is a healthy and and entirely natural human emotion. Again we have to go back to the difference between the actual risk, and the fear we produce from it. Sure, we can swallow fear in a moment of truth. But this is not a training strategy. The training strategy is to alter the inputs that result in the fear. You’re not trying to squash the fear, you’re trying to change how you think, plan and act on the rock so the fear needs not arise. The fear inputs can be reduced either by resetting your sense of what is actually fearful, such as by gaining familiarity with practice falls, or by reducing the sense of uncertainty about your position on the rock, by learning all the countless tactical tricks of leading.

Although you must face the problem directly to get to this stage, you must be careful to maintain attention on the pleasure and satisfaction of leading, as opposed to a constant battle against fear. When people have asked me about the boldest leads I have ever done, I’ve always come back to the same basic idea that the desire to experience and complete the climb simply overwhelmed any fears I had, no matter how serious they were.

You must give active energy to thinking about why you are motivated to have the experience of leading difficult rock climbs. What positives are there. When these elements are front and centre in your mind, the fears are naturally pushed to the side, or rather put in their place.