6 February 2015

Make or Break: Don’t let climbing injuries dictate your success

For the past 4 years or so, I have been working on a book about climbing injuries. It spells out in detail how to treat them once you have them, based on the evidence from high quality scientific research and practice. More importantly, it discusses all the things we do in our climbing routine that cause our future injuries and prolong those we have already caused.

I have titled the book ‘Make or Break’. This is because becoming an expert in understanding the causes and treatments of climbing injuries will be make or break for your climbing career. As Wolfgang Gullich said, “getting strong is easy, getting strong without getting injured is hard”. In my first book, 9 out of 10 climbers make the same mistakes, I suggested that many aspects of training for climbing are not rocket science. Keep showing up, pulling on small holds, pushing the limits of your motivation and learning from others and you will get stronger fingers and get better at climbing.

It will be injuries that will get in the way of your progress, and if you let them, they will dictate how far you get in climbing. The research suggests that nearly all climbers get injured at some point. Finger injuries are most likely, followed by elbows and shoulders. Of course there are countless bits of our anatomy that can break if suitably mistreated. When you get one of these injuries, you need to be the expert, because unfortunately you cannot rely on anyone else to make sure you recover. This is not because doctors and therapists fail to do a good job (although they sometimes do). It is because there is no single source of advice on the vast array of things you must do to make sure you recover well and prevent future injuries. The climbing coaches, physiotherapists, otrhopaedic surgeons etc. that you will see will all give you pieces of the jigsaw puzzle, but it is you who must put them together.

Claire MacLeod dispatching our pre-orders the other night.

During the process of writing the book, I have discovered many pieces of hard scientific information and subtle concepts I wish I’d known when I was 16. They would have saved me so much of the pain and psychological torment of injuries that climbers everywhere share at some point in their career. There are many strands of information in the book. It is a handbook on how to take care of yourself as a lifelong climbing athlete. In this blog post, I will briefly outline three messages that will give you a flavour of what you will find in the book:

1. Tendons don’t like rest, or change.

Surprisingly, sports medicine research still has a lot to learn about tendons and how they heal and respond to training. However, there have been several big steps forward in the research over the past decade or two. The only problem is, new knowledge in sports medicine takes years or even decades to filter through to the advice you receive. Consider the following quote

“In general, it takes approximately 17 years to get 14% of research findings adopted into practice. Moreover, only 30–50% of patients receive recommended care, 20–30% receive care that is not needed or that is potentially harmful and 96% may receive care with the absence of evidence of effectiveness.”

I was shocked too when I read that. I was aware through my own experience that the advice I’d been given to recover from my own climbing injuries was often at odds with research I’d read. But to discover the extent of the lag between research findings and advice given to sportspeople is depressing. We only have one life and we cannot afford to receive outdated advice. Unfortunately, the internet hasn’t made the task of unearthing reliable advice any easier. Scientific journals remain hidden to most behind a paywall, while the same poor quality, outdated and non-specific advice drowns out the few reliable sources.

One of the shifts in understanding from the past decade is that slow-onset tendon injuries such as golfer’s elbow do not respond well to complete rest. In fact, it often makes the condition worse. Moreover, many of the adjunct treatments often offered - stretching, massage, ibuprofen may do little to contribute to healing, and only affect pain. Instead, the most promising treatment has been large volumes of exercise of a specific mode (eccentric) and at a level which causes some pain. Much of this seems counterintuitive at first sight, which is why a detailed understanding of what happens in injured tendons is so important. 

Some practitioners in sports medicine are still working to a pre-1990s concept of tendon healing and will advise you to heal your injured tendons by resting them completely. In contrast, modern research has found that the best way to heal injured tendons is to use them, but only in a way that is specific to the nature of the injury. Tendons do not like rest or change. The successful formula is to provide constant stimulus to tendons to maintain their health. But if you want to change that stimulus, such as by training harder, you must do so very carefully, using all the cues from the body that you can listen to.

Section 1 of the book discusses in detail the limitations of the sports medicine industry and how to get the most out of it, and section 4 details the modern understanding of tendon injuries and how to successfully treat them.

2. Know pain, or no gain

Above I hinted at the difference between the pain level and the healing status of an injury - a crucial concept for any sportsperson to understand. Understanding of the nature of pain has been another area of science that has advanced hugely in sports medicine. It is not enough to be able to listen to your body. You need to be able to decode the messages and see the patterns in them. This is both a science and an art.

Climbers need to be able to differentiate between healthy soreness from training and activity, and damage that demands action. They need to be able to take understand how various treatments affect pain from their injuries and what this means for their daily decisions on how much activity to expose them to. They need to understand how many aspects of their environment and psychological state amplify or suppress pain sensations from their daily activities. Pain sensations are an essential measure for climbers to monitor, but without detailed knowledge of how it works, it is very easy to interpret those messages from pain wrongly.

Section 2 of the book is entirely devoted to understanding pain.

3. The luxury of doing sport badly will not last

A young body can withstand a surprising amount of abuse. But the relentlessness of sport and training amplifies the effect of small imbalances or errors, and it doesn’t take long before these accumulate to the point of injury. Balance is the key word here. One area of sports medicine that has come on a fair bit in recent years has been the recognition that athletes need to develop strength in a balanced way, taking care to strengthen muscles on both sides of joints. That is a good development, but it is not enough.

Balancing of the stress imposed by training for climbing needs to come in several other ways too. Matching increases in training intensity with improvements in the quality of rest is one way. Improving technique and the design of the training progression to spread that stress is another. 

Sections 1, 3 and 4 deal with these concepts and the specific details that climbers should be aware of which commonly result in climbing injuries.

Repeated forceful internal rotation of the arm (the right arm on this move) is a big part of climbing. So it is no surprise that the internal rotators of the arm at the shoulder become dominant. You may well get years out of a healthy young shoulder without feeling a thing. But the resulting impingement syndrome affects so many climbers. If you'd rather prevent it, it's not hard to do a little work to keep the shoulder joint working well. And if you are already suffering, you may be able to reverse it quite quickly, unless you've really tried to ignore it for too long!

Maintaining awareness of the foot during hand movements is a core skill in climbing injury awareness. Slipping feet are a important cause of many finger and shoulder injuries. Do your feet slip too often? Do you know what to do when they do slip? Correct your climbing technique and you can push your body a lot harder before it starts to complain.

Finally, there is the psychological challenge of injuries which is hugely underestimated by both climbers and their friends and families. In sections 1 and 5 of the book, I present the idea that we should see the injuries we suffer as a crucial message that something must change in our way of approaching climbing. By seeing the injury as an opportunity to go back to basics, to understand what must change and make that change, we can not only improve our climbing, but enjoy the process rather than endure it.

I hope the book will help many climbers prevent their future injuries or overcome existing ones. You'll find the book in our shop here, dispatching worldwide.


Jos Dehaes said...

Looks like my book is on the way :-). Thanks for writing this.

Steven Thomas said...
This comment has been removed by the author.
Steven Thomas said...

The book is awesome, got my copy and have been reading it at a fair pace, I love learning about this kind of stuff, beggining to think I chose the wrong degree :P. I know it's not related massively to the book, but if you have time Dave I would be interested in reading about your thoughts on climbing shoes, the pros and cons of downturned and flat shoes and how they relate to your insight in 9 out of 10 about pulling yourself into the wall with your feet. Thanks, Steve

Unknown said...

HI Dave,

Just want to thank you for this well written book (haven't been able to read it cover to cover yet). As a member of the Cochrane Collaboration I appreciate the effort you have put in the include a firm evidence-base in this book.
Especially in a field (rehabilitation, physiotherapy and sport medicine) where evidence is difficult to produce due to an array of difficulties (small treatment populations, heterogeneity of affected individuals/ outcome measures or injury description, difficulty in blinding and compensating for confounding factors to name a few).
The book gives a good overview on what is done but also indicates well the area's where more research would be favourable.
Too many often rely on hear say and hypes so thank you keep up the good work

Hector Arderius said...

Thank you very much for writing this book! I read it from cover to cover (Just skip the young climbers section...). It is being a geat help to recover and manage my multiple injuries. For future editions, I just missed more examples of rehab exercises for finger injuries, like eccentrics, etc, like shown in the elbow section. Ayway, nice work, ground breaking material