Category Archives: Blog

Evidenced-Based Wellness Recommendations

Healing is a multifaceted process.  When someone comes to me with back pain, for example, there are often other topics that come up.   “How does it feel to be injured?  How are you sleeping?  How does the injury affect your job, family, recreation?  How’s your diet and hydration?”  I’ve often wondered about the evidence behind some of the recommendations that are suggested from various experts or we see in articles or on the internet.  I’ve put together a handout, with citations included, for my patients about some common topics that come up in my clinic.  Below, I’ll briefly discuss my reasoning for adding each topic but here is the handout if you want to just skip to the business.

The Healing Process:  I think its crucial to have a basic understanding of what happens in our bodies when we have an injury.  This knowledge helps us understand that healing is a process, not an event.  It also helps us make decisions when trying to decide if and how a given intervention (exercise, manual therapy, surgery, medication, injections, anti-inflammatory modalities, etc.) will meet our goals both in the short and long term.

Sleep:  We spend roughly a third of our lives asleep.  Its easy to look at sleep as a waste of our waking lives and something we should try to fight (“Joe Shmoe is successful because he gets 4 hours of sleep a night”).  An overwhelming amount of research shows the incredible importance of sleep for all aspects of our lives.  A fascinating and in-depth read about this topic is Why We Sleep by  Matthew Walker (I hope Joe Shmoe checks this out).  Some people have been dealing with disrupted sleep for so long they think its normal or that nothing can be done.  Not so!  A psychotherapist with expertise in cognitive-behavioral therapy for insomnia can be of great help.  And here’s a list of evidence-based sleep hygiene tips.

Nutrition:  We’re learning more and more about how foods affect our beings and the healing process.  Recommendations change based off of new information and proper nutrition for each individual is often based on many factors that are unique to that person.  I frequently urge people to consult with an expert in nutrition.  Ask them questions about what you’ve heard or read about.  That’s what they’re there for.

Hydration:  Have you ever wondered if there’s evidence behind the recommendation to drink eight eight-ounce cups of water a day?  I have.  Turns out there’s not, but there has been research done regarding this topic.  I provide this information in the handout, and there are also lots of individualized caveats to consider.

Stress:  The fight or flight response is hugely important if you come face to face with a mountain lion while on a previously enjoyable jog in the mountains (that’s pretty extreme I know, but you get my point).  Many of us are living in a low-level fight or flight situation throughout each day, whether it be due to less-than-ideal relationships, work, or prior unresolved conflicts or traumatic events.  Hormones are released which are beneficial in short-term situations but wreak havoc on our bodies and lives when they’re constantly in our systems.

Volunteering:  I joined the Rotary Club (there are an infinite number of similar organizations who’s goal it is to serve their communities in meaningful ways) many years ago because I thought it would be a productive way to try to balance out the horrible things that we sometimes do to each other as human beings.  That’s why I continue to be a member.  The benefits I reaped (learning how to organize, speak publicly, work with people of differing views, gain the confidence to do things out of my comfort zone because I realize I’m a part of something bigger than myself, etc.) far outweigh my capacity to give back.  I was also pleased to see the solid evidence that volunteering benefits the helper in concrete physical ways as well.

Flexibility:  This topic got the ball rolling for me with the writing of Beyond Tape.  I was starting to see internet musings conveying the pointlessness of stretching and felt it would be beneficial for me to compile the actual evidence.  There are many benefits of stretching for both young and old.

Strength:   In my experience, many older folks are under the impression that strength training is a young person’s activity.  Not so!  This mindset tends to be a major player in the downward spiral that can, but doesn’t necessarily have to, happen as we age.  “If you don’t use it, you lose it” is for real.

Aerobic Activity:  It’s hard to make a lifestyle change and starting a walking, biking, or swimming program is nearly impossible without concrete goals.  We’re fortunate to have research that gives us solid guidelines to go by.  It’s important to see these guidelines as long term goals rather than something we should be doing right now.  I frequently suggest a person leave their front door, walk 5 minutes, and come back.  Add 5 minutes next week if it feels right to you.  Pat yourself on the back, you’ve made a start, and that’s the hardest part.

As always, let me know if you have questions or if you’d like to see additional topics added.  And please always feel free to let me know if I’ve missed anyone that you think should be on a list of practitioners I’ve provided (see the nutrition section of the handout).

Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

 

 

 

 

Plantar Fasciitis

Anatomy and Injury

calf muscles – gastrocnemius and soleus

The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel bone to the ball of the foot.  Along with many tendon injuries that have long been called tendinitis and are now labeled as a tendinosis, this diagnosis is now thought to be more accurately termed plantar fasciosis.  This is due to studies of the tissues where disorganized fibers within the tissues are found rather than inflammatory cells.  What does this mean in the real world?  Treatments targeting inflammation, although questionable even if inflammation was present, are pointless as there are no signs of inflammation after the first couple of weeks of this injury.  Thus, the key to resolving this issue is helping the disorganized fibers in the plantar fascia on the bottom of the foot to become more organized.1,2,3,4 Although this injury can be caused by a single traumatic event (stepping on a hard object, such as a stone…or walking in ill-fitting shoes around the LAX airport parking lots for 4 hours because you forgot where you parked, which was a good reminder for me about the iphone camera), its typically a repetitive use injury such as walking, running, or hiking farther than normal. Other factors like old or poor footwear, walking on different surfaces than normal, injuries “further up the chain” (knee, hip, low back) causing gait abnormalities, and a lack of flexibility can play a role.

Symptoms

Significant pain is typically noticed on the bottom of the heel when getting out of bed and upon standing after prolonged sitting.  Pain is also noticed with walking and prolonged standing.

Prevention

1. Footwear: Replacing walking, hiking, or running shoes every three months or 500 miles has been recommended to prevent this injury.5 Being properly fitted at a reputable shoe store (we’re lucky to have Sage to Summit and Eastside Sports in Bishop) for your specific foot type is also a good idea.
2. Stretching:   Plantar fascia and calf stretches are key to keeping a normal length to these structures so they do not irritate the attachment point on the bottom of the heel.1,2,6 (See pictures for stretches below in the treatment section)
3. Preparation:   Get the body ready for unusually long walks, hikes, or runs by gradually increasing distance and elevation gains or losses.  Using appropriate footwear, such as shoes with good arch support for people with low arches, can help prevent irritation of the plantar fascia.
4. Trigger points/myofascial restrictions:   Periodically check for any trigger points/myofascial restrictions in the gastrocnemius, soleus, and muscles on the bottom of the foot.2  The goal is to find any spot that feels tight or tender and hold direct pressure for 2-3+ minutes while feeling for a release (you may notice the pain lessen or the tissues soften).  See the treatment section below for pictures of treatment examples.

gastrocnemius trigger points
gastrocnemius trigger point referral to the foot

Treatment

This injury can turn into a very long rehabilitation process if it is ignored (months or even years!).  The areas on which to focus include:
1. Avoid any activities that increase the pain as much as possible.  Consider temporarily switching your walking/running routine to cycling or swimming and avoid walking barefoot.  Walking, hiking, or running shoes should be replaced after roughly 500 miles.6
2. Range of motion:  Pump your ankles (bring your toes towards your nose and then push them towards the floor) 10 times prior to standing after you have been lying or sitting for prolonged periods.

pull your toes towards your nose
push your toes towards the floor

3. Stretching:   Plantar fascia, gastrocnemius, and soleus stretches will help the disorganized fibers to line up properly to heal the area.1,6,7  Hold the stretches for 30 seconds and repeat 2-3 times, 2-3 sessions per day.

gastrocnemius stretch (stretch is felt in the calf of the back leg)
soleus stretch (stretch is felt in the calf of the back leg)

4. Trigger points/myofascial restrictions: Assess for trigger points in the gastrocnemius, soleus, and muscles on the bottom of the foot.2,4,8

gastrocnemius sefl trigger point release
soleus self trigger point release

5. Night splint:   This is a splint worn at night to keep the plantar fascia and calf muscles stretched out.  Research has shown that they can be beneficial.  It was previously difficult for some people to wear through the night due to discomfort trying to sleep with the foot wrapped in a brace, however they have greatly improved in comfort over the last several years.1,6,7,8

6. Other:  Additional variables (joint mobility, footwear, posture/alignment, workplace or daily activity contributions, deficits in other areas of the body such as the knee/hip/low back etc.) can contribute to these symptoms and having an evaluation from a knowledgeable physical therapist can be beneficial.

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for further information and tips specific to climbing and plantar fasciitis as well as other foot disorders.  Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

References:

1. Schwartz EN, Su J. Plantar Fasciitis: A Concise Review. Perm J. 2014 Winter;18(1):e105-7.
2. Renan-Ordine R1, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernández-deLas-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50.
3. Bass, E. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012; 5(1): 14–17.
4. Ajimsha MS1, Binsu D2, Chithra S2. Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial. Foot (Edinb). 2014 Jun;24(2):66-71.
5. Glazer JL. An approach to the diagnosis and treatment of plantar fasciitis. Phys Sportsmed. 2009 Jun;37(2):74-9.
6. Davies C. The Trigger Point Therapy Workbook. New Harbor Publications, Oakland, 2004. pp.223-226.
7. Chinn L, Hertel J. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010 Jan;29(1):157-67, table of contents.
8. Beyzadeoğlu T, Gökçe A, Bekler H. [The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis]. Acta Orthop Traumatol Turc. 2007;41(3):220-4. Turkish.

Kids and Climbing Injuries

As coaches, parents, and healthcare providers, we have the opportunity to look after the best interests of our kids and to influence their decision-making processes toward a sustainable and healthy climbing career and life.  Important and helpful research has been done about various topics of avoidable dangers to kids who climb, especially at an elite level.

  1. Growth plate fractures
growth plate
growth plate

What is it?

Fractures at the growth plates of bones of the fingers, especially the middle and ring finger appear to be increasing.  Growth plates are places within the long bones of the body (fingers, humerus, femur) where growth of the bone continues to occur until the body is fully developed. If the growth plate is fractured, the bone may not develop properly, and deformities can occur.  The growth plates typically close between the ages of 13 and 17 years.  During this period before growth plate closure, the skeletal mass increases significantly, which is a problem for climbers because the growth spurt adds more weight to the body, which in turn makes it more difficult to pull oneself up the rock.  Additionally, the growth plates are two to five times weaker than the surrounding connective tissues.  Therefore, during this developmental stage, there is a combination of the weak point in the fingers, the growth spurt, which increases weight, and a subsequent increase in finger strength training intensity to counter the increased weight.  All of these factors lead to the increased incidence of fractures in kids, which can potentially have long term consequences on their climbing careers and other finger related activities in the future.  The fractures are not typically due to a single traumatic incident but rather occur over a period of time due to repeated micro-traumas.

What can we do?

Educating kids about the importance of notifying their parent, caregiver, trainer, or coach of any pain they notice in their fingers is crucial so they can be evaluated by a medical professional who is preferably familiar with climbing-related injuries.  Morrison, Shoffl, et al state that “Climbers who delayed reporting joint pain, ignored medical advice and continued to train intensively, especially on the ‘‘Campusboard’’, experienced permanent deformity of the affected finger with some loss of range of motion.”4  A further training recommendation is to focus on more volume (higher reps with less intensive climbing) and technique with a variety of climbing types rather than intensity and strength.  The more efficient the climber, the less strength and brute force is needed.  Furthermore, there are suggestions to consider avoiding intensive finger strengthening and boulder competitions for kids 16 and under.1,2,3,4

  1. Eating Disorders

In climbing, it is easier to propel yourself upward if there is less weight working to keep you on the ground.  However, for kids who are not yet fully developed, trying to maintain a body weight that is below their natural level can negatively affect the development of their skeletal and neuroendocrine systems as well as their metabolism and even the changes that occur during puberty.  This desire to maintain a lean physique, especially when below one’s natural weight, also has the potential to lead to the development of eating disorders.  Eating disorders are typically more prevalent in women, however, they occur in both sexes in the general and climbing populations.4  Progressing to an eating disorder usually occurs gradually and can have serious long term, potentially fatal effects which may include osteoporosis and/or cardiovascular, digestive, and kidney disorders.  Furthermore, the psychological effects of eating disorders are devastating and long lasting.  The primary tool for prevention of eating disorders is education, and it is recommended to begin educating kids on this subject as early as 9 to 11 years of age.  Additionally, red flags signaling unhealthy methods of weight loss include “starvation, fasting, frequently skipping meals, overeating, and binge-eating followed by purging, as well as the use of diet pills, laxatives, diuretics, and even excessive exercise” as mentioned in an excellent article by Coelho, Gomez, et al.5  If any of these signs are noticed, getting the climber professional help as soon as possible can help prevent potentially irreversible consequences.

As a former high school and college wrestler, I find that eating disorders are much more prevalent then the general population realizes.  In the beginning, there’s a slippery slope involved, rather than big flashy red flags.  You skip a meal here or there, you start exercising intensely without proper hydration or nutrition, you experiment with eating a big meal and purging it afterwards, and on and on.  If the person is fortunate, its an experiment that leads to the realization that these methods aren’t healthy, decrease performance, and just aren’t worth it.  But sometimes it leads down a long hard road of struggle and misery.  Our kids need us to be aware and to guide them on their paths.

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing injury related topics.  Subscribe here to get the latest posts and like my facebook page for updates and more information.  My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

1 Schöffl V, Morrison A, Schöffl I, Küpper T.  The epidemiology of injury in mountaineering, rock and ice climbing.  Med Sport Sci. 2012;58:17-43.

2 Schöffl V, Popp D, Küpper T, Schöffl I.  Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009 and 2012.  Wilderness Environ Med. 2015 Mar;26(1):62-7.

3 Woollings KY, McKay CD, Kang J, Meeuwisse WH, Emery CA.  Incidence, mechanism and risk factors for injury in youth rock climbers.  Br J Sports Med. 2015 Jan;49(1):44-50.

4 Morrison AB, Schoffl VR.  Physiological responses to rock climbing in young climbers.  Br J Sports Med 2007;41:852–861.

5 Coelho GM1, Gomes AI2, Ribeiro BG2, Soares ED1.  Prevention of eating disorders in female athletes.  Open Access J Sports Med. 2014 May 12;5:105-113.

 

Finger Flexor Tendon Pulley Injuries

Anatomy

The flexor tendons (flexor digitorum superficialis and flexor digitorum profundus) that run along the front of each finger are encased in a continuous sheath of connective tissue.  Along this sheath, there are five thickened areas that create annular pulleys (A1, A2, A3, A4, and A5) as well as three to four cruciform pulleys.  These pulleys keep the tendon close to the bone when flexing the fingers and provide stability as well as allow forces to be transferred from the muscles in the forearm to their tendons in the fingers.1,2,3,4,5

finger and wrist flexors
finger flexor pulley system
finger flexor pulley system

The crimp grip increases the risk of pulley injury because of the increased forces that are able to be exerted.  The force is especially high on the pulleys, especially the A2 pulley.  A closed crimp grip (using the thumb) exerts even more force, which is why it is used so often especially with smaller holds.1,6,7

open crimp grip
closed crimp grip – thumb is added

Injury

Damage to the flexor tendon pulleys is the most common climbing injury.8,9,10,11,12,13,14  The grading scale regarding the severity of flexor tendon pulley injuries is as follows:  1. Pulley strain 2. Complete A4 or partial A2, A3 tear/rupture 3. Complete A2 or A3 tear/rupture 4. Multiple ruptures or a single rupture with lumbricalis muscle or collateral ligament trauma.  A grade 4 injury requires surgery to prevent long term damage, such as a flexion contracture (the inability to fully straighten the finger).15,16

Often a “pop” is heard followed by significant swelling and pain (at the base of the finger for A2) when trying to extend (straighten) the finger.8,11,13,17,18,19  Pain is also noted when trying to flex (bend) the finger and bowstringing may be able to be detected by resisting finger flexion at the distal phalanx (fingertip) if A2-A4 are ruptured.1,13

torn pulleys with bowstringing tendons in a crimp grip

Prevention

  1. Static Stretching – Holding a stretch for at least 30 seconds after a climbing session and on rest days helps to decrease injuries. (For references and more information, see my article titled “Static Stretching for Rock Climbing”.)
wrist flexor stretch
wrist/finger flexor stretch
  1. Warm up – This is a combination of an aerobic warm up (hiking, jogging, cycling, etc.), dynamic stretching, and the sport specific warm up of easy climbing for 100-120 moves (8-12 boulder problems or 3-4 routes).17,20,21 (For more information, see the article titled “Rock Climbing Warm Up”.)
  2. Taping (H taping) – This way of taping has been shown to decrease the risk of reinjury when a pulley tear or sprain has occurred previously.10
H taping 1
H taping 2
H taping 3
H taping 4
  1. Climbing technique and body awareness – Proper footwork technique and avoiding intense dynamic movements may help to decrease the risk of pulley injuries by reducing excessive grip force and thus placing less stress on these structures.22 Listening to your body and allowing an injury to fully heal before returning to climbing helps to prevent reinjury.

Treatment

Having the grade of tear diagnosed medically helps to determine the treatment as well as to rule out damage to nearby structures.  Grades 1 to 3 pulley ruptures do not typically require surgery.  Surgical repair is recommended for Grade 4 ruptures due to the increased risk of fixed flexion contractures (an inability to fully straighten the finger).1,6,8,11,12,23,24  Some authors have also recommended surgical repair for grades 2 and 3 especially for elite-level climbers.25

Initially, one to two weeks of immobilization with a finger immobilization splint or a “pulley protection splint” is recommended for grades 2 and 3 pulley injuries (no immobilization is required for grade 1).4  After the immobilization period, H taping (see picture in prevention section above) is recommended to protect the pulley while gentle range of motion exercises are begun.

finger flexion – bend the finger until a stretch is felt, hold for a second or two, and repeat 10 times
finger extension – straighten the finger until a stretch is felt, hold for a second or two, and repeat 10 times

The taping is recommended for three months with grades 1 and 2 injuries and six months for grade 3 injuries.  Once full and pain free range of motion of the finger has returned (usually one to two weeks after beginning these exercises), gentle strengthening can be initiated with a hangboard or other strengthening device that allows for controlled movements and the ability to modify the force on the injury site if pain is noted (use the feet to decrease the force on the fingers when using a hangboard).   A crimp grip should be avoided for at least six weeks after the injury.  Movements or exercises causing pain at the site of injury should be avoided as this is the body’s way of indicating that it is being re-injured.  A gradual return to climbing can be initiated when no pain is noted with any of the gripping positions you plan to use.  These can be tested on the hangboard or chosen device.  Full return to activity is realistic in six weeks for grade 1 and 2 injuries.  For grade 3 pulley injuries, a gradual return to climbing may be able to be initiated at six to eight weeks and full functional return by three to four months minimum.6,8,11,12,13,18,26

Some additional treatments are:

  1. Checking for trigger points in the wrist/finger flexors as well as gentle massage to the flexor tendons and pulleys to prevent scar tissue formation
Flexor digitorum superficialis/profundus trigger points 1 – apply direct pressure to any tight or tender spots close to the X and hold for 2-3+ minutes
Flexor digitorum superficialis/profundus trigger points 2 – apply direct pressure to any tight or tender spots close to the X and hold for 2-3+ minutes
  1. Ester Smith, DPT at grassrootsphysicaltherapy.com goes over a solid treatment protocol for this injury on her blog (also featured in trainingbeta.com). This is a great research option for a grad school thesis in areas with high populations of climbers – hint, hint to the students out there.

 

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing injury related topics.  Subscribe here to get the latest posts and like my facebook page for updates and more information.  My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

 

1 Kubiak EN, Klugman JA, Bosco JA.  Hand Injuries in Rock Climbers.  Bulletin of the NYU Hospital for Joint Diseases • Volume 64, Numbers 3 & 4, 2006.
2 Bovard R.  Pulley Injuries in Rock Climbers (letter to the editor).   Wilderness & Environmental Medicine.  Allen Press Publishing Serv;Spring2004, Vol. 15 Issue 1, p70.
3 Schoffl V, Heid A, Kupper T.  Tendon injuries of the hand.  World J Orthop 2012 June 18; 3(6): 62-69.
4 Schneeberger M, Schweizer A.  Pulley Ruptures in Rock Climbers: Outcome of  Conservative Treatment With the Pulley-Protection Splint-A Series of 47 Cases.  Wilderness Environ Med. 2016 Jun;27(2):211-8.
5 Zafonte B, Rendulic D, Szabo RM.  Flexor pulley system: anatomy, injury, and  management.  J Hand Surg Am. 2014 Dec;39(12):2525-32; quiz 2533.
6 Warme WJ, Brooks D.  The effect of circumferential taping on flexor tendon pulley failure in rock climbers.  Am J Sports Med. 2000 Sep-Oct;28(5):674-8.
7 Schweizer A, Hudek R.  Kinetics of crimp and slope grip in rock climbing.   J Appl Biomech. 2011 May;27(2):116-21.
8 Crowley T.  The Flexor Tendon Pulley System and Rock Climbing.  J Hand Microsurg (January–June 2012) 4(1):25–29 DOI 10.1007/s12593-012-0061-3.
9 Schöffl V, Popp D, Küpper T, Schöffl I.  Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009 and 2012.  Wilderness Environ Med. 2015 Mar;26(1):62-7.
10 Schoffl I, Einwag F, Strecker W, et al.  Impact of Taping After Finger Flexor Tendon Pulley Ruptures in Rock Climbers.  Journal of Applied Biomechanics, 2007; 23:52-62.
11 Schöffl V, Hochholzer T, Winkelmann HP, Strecker W.  Pulley injuries in rock  climbers.  Wilderness Environ Med. 2003 Summer;14(2):94-100.
12 Schöffl VR, Einwag F, Strecker W, Schöffl I.  Strength measurement and clinical  outcome after pulley ruptures in climbers.  Med Sci Sports Exerc. 2006 Apr;38(4):637-43.
13 Schöffl VR, Schöffl I.  Finger pain in rock climbers: reaching the right differential  diagnosis and therapy.  J Sports Med Phys Fitness. 2007 Mar;47(1):70-8.
14 Pozzi A, Pivato G, Pegoli L.  Hand Injury in Rock Climbing: Literature Review.  J Hand Surg Asian Pac Vol. 2016 Feb;21(1):13-7.
15 Schöffl V, Hochholzer T, Winkelmann HP, Strecker W.  Pulley injuries in rock  climbers.  Wilderness Environ Med. 2003 Summer;14(2):94-100.
16 Smith LO.   Alpine climbing: injuries and illness.  Phys Med Rehabil Clin N Am. 2006 Aug;17(3):633-44.
17 Schweizer A.  Sport climbing from a medical point of view.   Swiss Med Wkly. 2012;142:w13688.
18 Rohrbough JT, Mudge MK, Schilling RC, Jansen C.  Overuse injuries in the elite rock climber.  Med Sci Sports Exerc. 2000 Aug;32(8):1369-72.
19 Merritt AL, Huang JI.  Hand injuries in rock climbing.  J Hand Surg Am. 2011 Nov;36(11):1859-61.
20 Hockhoelzer T, Schoeffl.  One Move Too Many…  Druckerei Sonnenschein,  Ebenhausen, 2003.  p. 109.
21 Schweizer A.  Biomechanical properties of the crimp grip position in rock climbers.  J Biomech. 2001 Feb;34(2):217-23.
22 Koukoubis TD, Cooper LW, Glisson RR, Seaber AV, Feagin JA Jr.   An electromyographic study of arm muscles during climbing.  Knee Surg Sports  Traumatol Arthrosc. 1995;3(2):121-4.
23 El-Sheikh Y, Wong I, Farrokhyar F, Thoma A.  Diagnosis of finger flexor pulley injury in rock climbers: A systematic review.  Can J Plast Surg 2006;14(4):227-231.
24 Klauser A, Frauscher F, Bodner G.   Finger Pulley Injuries in Extreme Rock Climbers: Depiction with Dynamic US.  Radiology. 2002 Mar;222(3):755-61.
25 Bouyer M, Forli A, Semere A, Chedal Bornu BJ, Corcella D, Moutet F.  Recovery of rock climbing performance after surgical reconstruction of finger pulleys.  J Hand Surg Eur Vol. 2016 May;41(4):406-12.
26 Holtzhausen LM, Noakes TD.  Elbow, forearm, wrist, and hand injuries among sport rock climbers.  Clin J Sport Med. 1996 Jul;6(3):196-203.

Static Stretching for Rock Climbing

The topic of static stretching is a prime example of why I wrote Beyond Tape.  I was starting to see more blog posts stating things like “there is absolutely no research that shows static stretching can help to prevent injuries”.  From time to time, we all regurgitate information that we believe to be true (whether it be related to health, politics, education, etc.) but do not always have clear examples of why we believe what we believe aside from hearing it from a source we trust (professor, coach, politician, news source, etc.).  I wondered, “Am I doing that?” and “Do these people know something I don’t?”  I went back through the research to organize the solid studies showing that a statistically significant decrease in musculotendinous injuries (sprains and strains) occurs when static stretching is used.1,2,3,4,5  There are also research results that call into question the benefits of static stretching for injury prevention.6,7,8  However, these conflicts are resolved in almost all cases when looking at the types of injuries and types of activities that are studied.   For example, stretching will most likely not prevent injuries such as dislocations or fractures that occur due to a traumatic event.  Another important point is that the research showing benefits of static stretching has been done with activities that require explosive movements or the athlete using the end ranges of movements, such as soccer.  In contrast, I think it is reasonable to argue that static stretching may not be beneficial for injury prevention for activities such as long distance running where end ranges and explosive movements are not typically used.  The bottom line is that static stretching is recommended for musculotendinous injury (strains and sprains) prevention with climbing due to the facts that these types of injuries are highly prevalent in the climbing population and that climbers are frequently testing end ranges of motion, especially in their shoulders and hips, as well as performing explosive movements especially with bouldering and sport climbing.

What is static stretching, how should I do it, and what stretches are best for climbers?

Static stretching occurs when a muscle is held at its end range for a prolonged period of time.  Research shows that a minimum of 30 seconds is best for muscle lengthening1,9,10,11 and holding for 1.5-3 minutes or more can additionally help release any myofascial restrictions that may be present.12,13,14,15

Check out my rock climbing warm up article for the reasons why static stretching is best used after climbing and on rest days, as opposed to before climbing.

The following are examples of important stretches for climbing specifically due to either the repetitiveness of some motions (finger/wrist flexors), the explosive nature of movements that use certain muscle groups (finger/wrist flexors, latissimus dorsi, hip extensors), and/or the likelihood of reaching into the end ranges of certain body parts on a regular basis (shoulder and hip joints).

  1. Wrist/finger flexors – used to grip the rock with all types of holds
wrist flexor stretch
wrist/finger flexor stretch

2. Wrist/finger extensors – used to stabilize the wrist and oppose the wrist flexors

wrist flexor stretch
wrist/finger extensor stretch

3. Pectorals – pectoralis minor contributes to rolling the shoulders forward in the typical “climber’s back” posture

pec minor stretch
pectoral stretch

4. Latissimus Dorsi – used extensively in the pulling motions of climbing and also contributes to rolling the shoulders forward in the typical “climber’s back” posture

latissimus dorsi stretch

5. High step (hip adductors, extensors, internal rotators) – lack of flexibility can limit climbing ability and cause significant strain on the muscles in their most lengthened position

high step stretch – hip extensors, adductors, and internal rotators

6. Spinal twists with shoulder horizontal adduction – lack of spinal flexibility contributes to excessive motion at the shoulder and hip joints; this pose also stretches the muscles of the posterior shoulder which is used extensively in pulling

 

spinal twist with shoulder horizontal adduction stretch
spinal twist with shoulder horizontal adduction stretch

 

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing injury related topics.  Subscribe here to get the latest posts and like my facebook page for updates and more information.  My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

1 Woods K, Bishop K, Jones E.  Warm-Up and Stretching in the Prevention of Muscular Injury.  Sports Med 2007; 37 (12): 1089-1099.
2 Hartig DE1, Henderson JM.  Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees.  Am J Sports Med. 1999 Mar-Apr;27(2):173-6.
3 Cross KM1, Worrell TW.  Effects of a static stretching program on the incidence of lower extremity musculotendinous strains.  J Athl Train. 1999 Jan;34(1):11-4.
4 McHugh MP1, Cosgrave CH.  To stretch or not to stretch: the role of stretching in injury prevention and performance.  Scand J Med Sci Sports. 2010 Apr;20(2):169-81.
5 Amako M1, Oda T, Masuoka K, Yokoi H, Campisi P.  Effect of static stretching on prevention of injuries for military recruits.  Mil Med. 2003 Jun;168(6):442-6.
6 Pope RP1, Herbert RD, Kirwan JD, Graham BJ.  A randomized trial of preexercise stretching for prevention of lower-limb injury.   Med Sci Sports Exerc. 2000 Feb;32(2):271-7.
7 Arnason A1, Andersen TE, Holme I, Engebretsen L, Bahr R.  Prevention of hamstring strains in elite soccer: an intervention study.  Scand J Med Sci Sports. 2008 Feb;18(1):40-8.
8 Thacker SB1, Gilchrist J, Stroup DF, Kimsey CD Jr.  The impact of stretching on sports injury risk: a systematic review of the literature.  Med Sci Sports Exerc. 2004 Mar;36(3):371-8.
9 de Weijer VC1, Gorniak GC, Shamus E.  The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours.  J Orthop Sports Phys Ther. 2003 Dec;33(12):727-33.
10 Davis DS1, Ashby PE, McCale KL, McQuain JA, Wine JM.  The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters.  J Strength Cond Res. 2005 Feb;19(1):27-32.
11 Bandy WD, Irion JM, Briggler M.  The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles.  J Orthop Sports Phys Ther. 1998 Apr;27(4):295-300.
12 Ajimsha MS1, Binsu D2, Chithra S2.  Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial.  Foot (Edinb). 2014 Jun;24(2):66-71.
13 Barnes JF.  Myofascial Release:  The Search for Excellence.  Paoli, PA:  Rehabilitation Services, Inc., 1990.  Print.
14 Standley P.  In Vitro Mechanical Strain Modeling of Myofascial Release.  Date: 11/3/2011.  http://www.osteopathic.org/inside-aoa/events/annual-aoa-research-conference/2011-research-conference/Documents/10-30-2011/1—10-30-2011–BiomechanicalRegulation-of-Cell-Function—-Standley.pdf (presented at the 2011 Research Conference of the AOA).
15 Cao TV1, Hicks MR1, Zein-Hammoud M1, Standley PR2.  Duration and magnitude of myofascial release in 3-dimensional bioengineered tendons: effects on wound healing.  J Am Osteopath Assoc. 2015 Feb;115(2):72-82.

The Rock Climbing Warm Up

Maybe not the most exciting part of climbing, but one of the most important for keeping you on the rock and off the couch.  We’re all excited to get to our projects.  When warming up, many of us are hoping to hit that sweet spot between performing enough easier climbs to get us ready for more challenging routes/problems but not overdoing it on the warm up and blowing our chance to give a serious effort to the goals of the day.  Thankfully, Schweitzer provided us with a solid range of routes/problems to work off of.  His study from 2001 showed that roughly 100-120 moves, or 3-4 routes/8-12 boulder problems, were required for the finger flexor tendon pulley system to show an increased amount of pliability.  This means that the tendons are better able to tolerate the loads that are being placed on them.1,2,3  So, the recommendation is 3-4 easy routes or 8-12 easy boulder problems before attempting climbing near your upper limit. Warm up routines and their relation to injury prevention have yet to be researched specifically in the climbing community (hint, hint for any doctoral students out there looking for a thesis topic), however, the evidence  from sport-specific warm ups and warm ups with the three components listed below shows a correlation between warm ups and decreased injury rates for various sports such as soccer, basketball, football, as well as with military recruits.4,5,6  Furthermore, a basic aerobic warm up, such as light jogging for as little as five minutes, hiking to the climbing area or jumping rope in the gym, has been shown to increase flexibility and prepare the body for the upcoming activity.7,8

The Business:  3 parts to the warm up

  1. A mellow aerobic activity – light jogging or cycling for 20-30 minutes or the approach to the climbing area (although, even as little as 5 minutes has been shown to increase flexibility and prepare the body for the upcoming activity)7,8
  2. Stretching – dynamic stretching (stretching through motion), as opposed to static stretching (holding a stretch for prolonged periods), is best used during the warm up. Static stretching has gotten a bad rap as far as injury prevention and treatment, which I’ll discuss in a later post, but there’s some evidence that it decreases performance when used immediately prior to competition.9,10,11,12  There is however some evidence that dynamic stretching can help to improve immediate performance,13,14 which is why I recommend dynamic stretching during the warm up.  Dynamic stretching can be worked into #3 below, or here are 3 examples of helpful dynamic stretches for climbers:

High Step

Wrist flexors/extensors

Latissimus Dorsi

  1. An activity specific to the sport being perform – this is your 3-4 easy routes or 8-12 easy boulder problems

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment (currently sold locally in Bishop stores, on my website, and soon to be on Amazon) for more information about warming up, stretching, and other climbing injury related topics.  Subscribe here to get the latest posts and like my facebook page for updates and more information.  My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

1 Wright DM, Royle TJ, Marshall T.  Indoor rock climbing: who gets injured?  Br J Sports Med 2001;35:181–185.
2 Hockhoelzer T, Schoeffl.  One Move Too Many…  Druckerei Sonnenschein, Ebenhausen, 2003.  p. 109.
3 Schweizer A.  Sport climbing from a medical point of view.   Swiss Med Wkly. 2012;142:w13688.
4 Fradkin AJ1, Gabbe BJ, Cameron PA.  Does warming up prevent injury in sport? The evidence from randomised controlled trials?  J Sci Med Sport. 2006 Jun;9(3):214-20.
5 Woods K, Bishop K, Jones E.  Warm-Up and Stretching in the Prevention of Muscular Injury.  Sports Med 2007; 37 (12): 1089-1099.
6 Herman K, Barton C, Malliaras P, Morrissey D.  The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review.  BMC Med. 2012 Jul 19;10:75.
7 Samson M1, Button DC, Chaouachi A, Behm DG.  Effects of dynamic and static stretching  within general and activity specific warm-up protocols.  J Sports Sci Med. 2012 Jun 1;11(2):279-85.
8 O’Sullivan K1, Murray E, Sainsbury D.  The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects.  BMC Musculoskelet Disord. 2009 Apr 16;10:37.
9 McHugh MP1, Cosgrave CH.  To stretch or not to stretch: the role of stretching in injury prevention and performance.  Scand J Med Sci Sports. 2010 Apr;20(2):169-81.
10 Winchester JB1, Nelson AG, Landin D, Young MA, Schexnayder IC.  Static stretching impairs sprint performance in collegiate track and field athletes.  J Strength Cond Res. 2008 Jan;22(1):13-9.
11 Gergley JC.  Acute effect of passive static stretching on lower-body strength in moderately trained men.  J Strength Cond Res. 2013 Apr;27(4):973-7.
12 Simic L1, Sarabon N, Markovic G.  Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review.  Scand J Med Sci Sports. 2013 Mar;23(2):131-48.
13 Little T1, Williams AG.  Effects of differential stretching protocols during warm-ups on high-speed motor capacities in professional soccer players.  J Strength Cond Res. 2006 Feb;20(1):203-7.
14 Myers, T.   Fascial Fitness: Training in the Neuromyofascial Web.    IDEA Fitness Journal, Volume 8, Number 4.  April 2011.