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.

Injuries: The problem with Lay-off

A traditional approach to a tendon injury such as commonly experienced by climbers is to include an extended lay-off of several weeks or even several months. There are several good reasons to consider a lay-off, and several not to lay-off at all, depending on the circumstances.

The basic rationale for lay-off is to allow the tissue some rest and a chance to recover from it’s severely compromised state. There are quite a few assumptions built into the decision to completely rest the tissue. First, that the tissue will really benefit from complete withdrawal from the sport. Unfortunately, this isn’t strictly true. 

In the earliest stages of injury rehab, where the tissue is extremely weak, inflamed and possibly swollen, even the lightest use risks further damage. However, this stage is extremely short - a few days or weeks at most. After this, lay-off is actually contributing to loss of tissue health. Even moderate activity tends to be enough to maintain strength in muscle or tendon. But inactivity causes it to lose strength rapidly. When the tissue is immobilised, the rate of atrophy is positively frightening.

A related assumption is that immature tissue that forms in those initial days and weeks after an acute injury will mature into tough tendon that will handle the forces you were asking of it when you were healthy. This isn’t true either. It was the training you were doing that made you strong. Only progressive training of the injured tissue will bring it up to the exceptional level of strength and toughness that you need for sport. If the lay-off is long enough for the tissue to mature without a good progressive rehab program, it will likely end up weak, the wrong length and vulnerable to re-injuring just as you start to get your momentum back.

Another dangerous assumption inbuilt into a lay-off program is that the painful tissue is the problem and that allowing this to recover will solve the problem. In a few cases this could be true, but in the majority, an underlying susceptibility forms a large part of the cause and lay-off will do nothing to remove it. For certain less severe injuries, simply addressing the underlying causes without any intervention to treat pain symptoms will be enough to put things right.

Who can help you identify those causes? Climbing, being such a technical sport needs an excellent coach with a thorough understanding of physiology, and the biomechanics of climbing movement to identify why your climbing movements are injuring you. Since your posture is probably contributing too, you need an excellent sports medic/physiotherapist who can thoroughly asses the mess of your wonky back and shoulders. If they are not too shocked by the horror of your shoulder movement, they will help you unload the stressed out muscles and tendons with proper alignment. Sounds like a lot of effort? Well, I guess you could always just hope the pain goes away by itself instead.

Now, what a heartening blog post I hear you think; forget lay-off, keep climbing and my injury will still recover? Be clear that despite it’s psychological challenge for keen sports people, lay-off is in fact the easy option compared to the work and discipline of recovering from an injury without lay-off. This is because changing habits is really hard and requires iron resolve that most people cannot sustain as long as they need to. Hence the high recurrence rate of injuries. People just try to do things as they always did (including the things that caused the injury). If you are ready to climb differently - at the level the injured part demands, working daily to correct your bad technique habits, tactics, postural faults and specific muscle weaknesses, then recovery without lay-off is the short cut to successful recovery. Most folk don’t have the discipline either to source the information on what they ought to change, or to put the work in and actually change it.

The detail of what things climbers should change has been my constant work over the last month as I continue to write my climbing injuries book Rock ‘til you drop. It’s been fascinating study so far.

Avoiding pulley injuries - the hard and easy ways

In the comments of my last post, John asked about how to avoid crimping all the time and hence reduce the build up of stress and microscopic damage that leads to pulley tears. 

Of course there is the short answer of ‘just openhand everything’ and you’ll get better at it. When it comes down to it, that’s what you have to do. It’s not easy to take the temporary drop in climbing grade while you gain openhanded strength. Most climbers who’ve not had pulley injuries yet are miserably weak at openhanding and really have to take a hit. But it’s your choice - it’s only your ego you have to beat.

I’ll make a very detailed case in Rock ‘til you drop not only for why you must do it, but all the ways you can make it easier on yourself. However, since you’ll have to wait a little longer for that, here are a few headlines for now:

- ‘It’s just training’. The biggest enemy of changing habits like crimping is that climbers are always trying to compete, even in training. When you go to the climbing wall, you cannot bear to do something differently to normal because you’ll have to take a grade hit for a while. And maybe your training isn’t going perfect anyway so you are trying extra hard to the standard you’ve become accustomed to. There is only one way around it; stand back and realise that you are just training. You are just pulling on plastic blobs. Who cares what the number is? If you think other people do, you’re kidding yourself. Sure it’s ok to compete once in a while. Climb openhanded most of the time, and allow yourself to crimp when it really matters. If you don’t, you’ll only have to later when your broken pulleys won’t let you do anything else.

- Get off the starting blocks. If your openhanded strength really is that spectacularly rubbish in comparison to your crimp strength, you could get yourself off the starting blocks by a little supplementary fingerboard work with a 4 finger and 3 finger openhanded grip. Use the protocol I described in 9 out of 10. After 10 or 20 sessions you shouldn’t have to take such an ego hammering blow when you climb for real with an openhanded grip. But don’t forget that the subtleties of the movement are realy quite different than when crimping; getting comfortable with openhanded needs both the strength part as well as actually learning how to climb with it on real moves.

- Know the score. A lot of people I’ve coached reckon they just aren’t cut out for climbing openhanded. They usually invent a reason like the shape of their hands or the length of their fingers. Rubbish. If it feels weak, it’s only because you’re weak. And the only reason you’re weak on this grip is because you don’t do it. I challenge anyone to climb solely openhanded for 20 sessions or more and still tell me it doesn’t work for them.

- Do it on easy routes first. Very experienced or expert climbers have a disadvantage in that their habits are very set and egos expect very consistent performance. But the advantage they have is that a lot of the movement decisions are quite automatic. Someone who climbs 8a+ can probably do a 7c while having conversation. So there is room on easier routes during warm-up or mileage climbs to concentrate on learning a new technique like openhanding. 

Crimp everything and you will suffer for it down the line. Don’t worry about it too much - most people have to learn to openhand the hard way (post-injury). But injury is arguably the most wonderful motivator for changing the way you climb. That’s what happened to me. At 17 I scoffed at openhanded climbing. 5 years of constant pulley injuries later I couldn’t believe how much better it is than crimping on the vast majority of holds.