Category Archives: Climbing

Ankle Sprains

What is it?

This is an overstretching or tearing of the ligaments on the outside of the ankle joint and foot.  The ligaments most commonly involved are the anterior talofibular ligament  toward the front of the ankle, the calcaneofibular ligament directly to the outside of the ankle, and less commonly the posterior talofibular ligament toward the back of the ankle.  This is the most common type of ankle sprain, noted as high as 85% of all ankle sprains, and occurs when the foot rolls to the inside with weight bearing activities.  This can occur while hiking on uneven ground especially with a heavy pack or when falling from a boulder problem and landing on the edge of the crash pad.1,2,3  Climbing shoes that are excessively small can also contribute to this injury.4  There has been an increased risk of ankle sprains with bouldering and sport climbing.5

What does it feel like (Symptoms)?

Significant pain and swelling is typically noticed on the outside of the ankle and it may be difficult to walk or bear weight on the ankle.

Prevention

There is a high rate of recurrence after the initial sprain so preventing this injury from occurring is key.  There are four key factors involved with preventing this injury:

  1. Range of motion and flexibility:  Assess and address as needed any differences between the left and right ankles for dorsiflexion, plantarflexion, inversion, and eversion range of motion as well as gastrocnemius and soleus flexibility. (See below)  A lack of dorsiflexion specifically has been shown to increase the risk of spraining the ankle.1,3
ankle dorsiflexion – pull your toes towards your nose
Repeat 10 times, 3-4 times/day in a pain free range.
ankle eversion – move your foot up and out
Repeat 10 times, 3-4 times/day in a pain free range.
ankle inversion – move your foot towards the big toe side
Repeat 10 times, 3-4 times/day in a pain free range.
ankle plantaflexion – push your toes down like you are pushing down on the gas pedal
Repeat 10 times, 3-4 times/day in a pain free range.
gastrocnemius stretch – keep the back knee straight and shift your weight forward until you feel a stretch in the back calf
Hold for 30 seconds and repeat 2-3 times, 2-3 times/day in a pain free range.
soleus stretch – bend the back knee and shift your weight down into the back foot until you feel a stretch in the back calf
Hold for 30 seconds and repeat 2-3 times, 2-3 times/day in a pain free range.

2. Strength:   Assess and address as needed any differences in ankle eversion, inversion, and plantarflexion as well as hip abduction and extensor strength (see below).1,3

ankle eversion strengthening – move your foot up and out
Repeat 10-15 times for 2-3 sets, 3 times per week in a pain free range.
ankle inversion strengthening – move your foot towards the big toe side
Repeat 10-15 times for 2-3 sets, 3 times per week in a pain free range.
single leg heel raise – raise up onto the ball of your foot
Repeat 10-15 times for 2-3 sets, 3 times per week in a pain free range
hip abduction strengthening – move your leg out to the side and return to midline
Repeat 10-15 times for 2-3 sets, 3 times per week in a pain free range. Feel free to add resistance.
hip extension strengthening – move your leg back and return to neutral
Repeat 10-15 times for 2-3 sets, 3 times per week in a pain free range. Feel free to add resistance or try a single leg bridge instead.

3. Balance and proprioception:   Proprioception is a joint’s ability to tell where it is in relation to the rest of the body.  Deficits with proprioception can cause the foot to land in a way that increases the chance of a sprain while walking, hiking, or landing from a boulder.6  The best exercises to address this issue are performed while standing on one leg.  The progression of these exercises from easiest to hardest is to stand on one leg on even ground with the eyes open for 60 seconds.  If this is easy, try either closing the eyes or standing on an uneven surface such as a wobble board, Bosu ball, or better yet: a slack line. As this becomes easier, stand on the uneven surface with the eyes closed.  Adding a single leg quarter squat to this can make it even more challenging.1-3,7-9

single leg stance – close eyes or stand on an uneven surface to make more challenging
Hold for 60 seconds, repeat 2-3 times, 3-5 times per week.
single leg quarter squat – stand on 1 foot and squat down in a pain free range making sure your knee is in line with your toes and your pelvis stays horizontal (doesn’t tip down when lowering)
Repeat 10-15 times, 2-3 sets, 3 times per week in a pain free range.

4. Crash pad positioning:   Spotters should always have a sense of where the climber will fall and to place the pad so the climber will fall in the middle of the pad as opposed to on the edge.  While in the gym or outside, make sure all the pads are connected and there are no spaces where the climber’s foot could land in between pads.

Treatment

This injury should be medically evaluated to determine the extent of the injury including any fractures or dislocations.  The Ottawa Ankle Rules were developed to determine if an X ray is necessary.20, 21   An X ray is indicated if any of the following are present:
1. bony tenderness along the back side of the bottom part of the fibula or lateral malleolus
2. bony tenderness along the back side of the bottom part of the tibia or medial malleous
3. bony tenderness at the base of the 5th metatarsal
4. bony tenderness at the navicular
5. Unable to walk at least 4 steps

bones of the foot and ankle

The use of crutches (or walker/cane) and functional support using a brace, wrap, or taping while gradually increasing weight bearing may be required if the pain is causing significant limping.  In an acute injury situation, pain is the body’s way of telling you what to do or not do in order to allow it to heal.  Inflammation is a crucial phase of the healing process, where dead or damaged tissue is removed and special cells are called on to lay down new tissue.  Research is showing that blocking the inflammatory phase of the healing process (with NSAIDS, for example) can actually slow the healing of bone and soft tissue.11-19  That being said, decreasing pain and inflammation should be considered for the first 3 days after the injury if 1. pain is preventing you from sleeping (check here for the importance of sleep) 2. pain is unbearable (stress hormones will be released which can slow the healing process) or 3. there is extreme swelling, theoretically damaging healthy tissue that wouldn’t have been damaged due to the injury.

There is a high rate of recurrence after an initial ankle sprain and many people develop chronic ankle instability, so it is important to address any of the key factors that may be limited due to an ankle sprain including:2

  1. Range of motion/flexibility:    Assess and address as needed any differences between the left and right ankles for dorsiflexion, plantarflexion, inversion, and eversion range of motion as well as gastrocnemius and soleus flexibility. (See figures in the prevention section above as well as a figure below for a  stretch for the tibialis anterior muscle.)  Also, practice tracing the alphabet in uppercase letters with your foot.1-3  When these motions have been regained with minimal pain, strengthening can be initiated.
tibialis anterior stretch – point your back toes down and straighten your knee
Hold for 30 seconds, repeat 2-3 times, 2-3 times per day, 3-5 times per week

2. Strength:   Assess and address as needed ankle eversion, inversion, and plantarflexion as well as hip abduction and extension strength (See the figures in the prevention section above).1-3  Progress to the single leg stance and single leg quarter squats as seen in the prevention section above and add the following lunge.

Forward lunge – step forward, drop straight down, return to start, repeat on the other side
Repeat 10-15 times, 2-3 sets, 3 times per week in a pain free range

After these exercises can be performed pain free, squat jumps can be added with progressively increasing the height of the jumps and advancing from two legs to single leg as strength increases. These exercises will help the climber prepare for landing while bouldering.
3. Balance and proprioception: See details under the prevention section above
4. Trigger points:   Check for any trigger points, especially of the peroneal muscles as stated above

peroneal trigger points
peroneal self trigger point/myofascial release
Hold gentle-moderate direct pressure for 2-3+ minutes on any area that feels tight or tender and feel for a release
Repeat 2-3 times per day

 

5. Functional support:   Bracing and taping for stability have both been shown to decrease the risk of recurrence after the initial ankle sprain.2,3
6. Joint mobility:   Joint mobilizations, including mobilizations with movement, typically performed by a physical therapist, chiropractor, or osteopath, have been shown to be beneficial when range of motion is difficult to regain.1,3,10

 

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.  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 Kaminski TW1, Hertel J, et al; National Athletic Trainers’ Association. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013 Jul-Aug;48(4):528-45.
2 Chinn L, Hertel J. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010 Jan;29(1):157-67, table of contents.
3 Lin CW1, Hiller CE, de Bie RA. Evidence-based treatment for ankle injuries: a clinical perspective. J Man Manip Ther. 2010 Mar;18(1):22-8.
4 Buda R1, Di Caprio F, et al. Foot overuse diseases in rock climbing: an epidemiologic study. J Am Podiatr Med Assoc. 2013 Mar-Apr;103(2):113-20.
5 Schöffl V, Küpper T. Feet injuries in rock climbers. World J Orthop. 2013 Oct 18;4(4):218-228. eCollection 2013. Review.
6 Sefton JM1, Yarar C, et al. Six weeks of balance training improves sensorimotor function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2011 Feb;41(2):81-9.
Herman K, Barton C, et al. 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. doi: 10.1186/1741-7015-10-75. Review.
Schweizer A1, Bircher HP, et al. Functional ankle control of rock climbers. Br J Sports Med. 2005 Jul;39(7):429-31.
McKeon PO1, Ingersoll CD, et al. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008 Oct;40(10):1810-9.
10 Travell J, David S. Myofascial Pain and Dysfunction, Vol 1: The Trigger Point Manual. Williams and Wilkins, Baltimore, 1983. pp.355-367.
11 Skjong CC1, Meininger AK, Ho SS. Tendinopathy treatment: where is the evidence? Clin Sports Med. 2012 Apr;31(2):329-50.
12 Hess GP, Cappiello WL, Poole RM, et al: Prevention and treatment of overuse tendon injuries. S p o r t s M e d 8 : 371–384, 1989.
13 Bondesen BA1, Mills ST, et al. The COX-2 pathway is essential during early stages of skeletal muscle regeneration. Am J Physiol Cell Physiol. 2004 Aug;287(2):C475-83.
14 Lu H1, Huang D, et al. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. FASEB J. 2011 Jan;25(1):358-69.
15 Arnold L1, Henry A, et al. Inflammatory monocytes recruited after skeletal muscle injury switch into antiinflammatory macrophages to support myogenesis. J Exp Med. 2007 May 14;204(5):1057-69.
16 Smith C1, Kruger MJ, et al. The inflammatory response to skeletal muscle injury: illuminating complexities. Sports Med. 2008;38(11):947-69.
17 Mishra DK1, Fridén J, et al. Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function. J Bone Joint Surg Am. 1995 Oct;77(10):1510-9.
18 Cottrell, and O’Connor, P. Effect of Non-Steroidal Anti-Inflammatory Drugs on Bone Healing. Pharmaceuticals, Vol 3, No 5, 2010.
19 Magra M, Maffulli N. Nonsteroidal antiinflammatory drugs in tendinopathy: friend or foe. Clin J Sport Med. 2006 Jan;16(1):1-3.
20 Kerkhoffs GM1, van den Bekerom M, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012 Sep;46(12):854-60.
21 Vuurberg G1,2,3, Hoorntje A, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.

Tennis Elbow

Anatomy and Injury

common extensor tendon
common extensor tendon

Tennis elbow (lateral epicondylitis) is an irritation of the outer layer of the bony lateral epicondyle (bone on the outside of the elbow) as well as of the common extensor tendon, specifically the extensor carpi radialis brevis.1-4  This injury is typically due to repetitive use of the muscles of the common extensor tendon that extend the wrist (bend it backwards) and that help stabilize the wrist during gripping motions.  Specifically for climbing, it can also occur through repeated finger flexion and gripping movements such as with face climbing, finger jams, the use of ice tools, and rope maintenance.  This is due to the wrist extensor muscles working to keep the wrist in a neutral position as the fingers are flexing.5,6         Tendon overuse injuries (especially when they have been around for 3+ months) are now more accurately called tendinosis, or in this case epicondylosis, rather than the previous label of tendinitis, or in this case epicondylitis, due to studies that have been done on the cells and tissues.  Instead of inflammatory cells, which would be found for tendinitis, the problem has been seen as a disorganization of the tendon tissues.  The disorganized tissues resemble a clump of cooked spaghetti on a dinner plate as opposed to healthy tissues organized in a parallel fashion like uncooked spaghetti noodles in a bag.  All of this is important because the treatment changes from targeting inflammation, which may not be present, to targeting the tissue disorganization.2,4,7-13

This is a very painful disorder that is felt with any gripping or grasping motions as well as with resisted wrist or middle finger extension and passive wrist flexion.  The pain is felt on the lateral epicondyle (outside of the elbow) and can radiate pain down the back of the forearm.  Grip strength is also typically decreased.7,8,14-16

Prevention

The keys to preventing this injury are:
1. Warming up properly:  For climbing specifically, roughly 120 moves or 4 routes/8-12 boulder problems of easy climbing is recommended before attempting climbing near your maximum level of climbing difficulty.17,18.  

2. Gradually ramping up training:  Has the climbing, or other related activity, increased significantly from normal frequency or difficulty?

3. Maintaining good flexibility by stretching the muscles that are being used:  Static stretching after climbing (or repetitive gripping motions) is the best time.  Hold the stretch for 30 seconds for 2-3 repetitions, 2-3 times throughout the day.

wrist flexor stretch
wrist/finger extensor stretch

4. Trigger Points/Myofascial restrictions:  Check for any trigger points (spots that feel tight or tender) at the end of the climbing day or after any activities requiring repetitive gripping/grasping motions.   Hold direct pressure on those spots for 2-3+ minutes.  Below are some options but feel for other spots in the surrounding area.

extensor carpi radialis brevis trigger point
extensor digitorum trigger point

5. Body awareness:  Is there any pain on the outside of the elbow during or after climbing or after any activities requiring repetitive gripping/grasping motions?  If so, consider modifying your activities so as not to continue to aggravate the injury.

 

Treatment

Much time and frustration will be saved, not to mention pain, by addressing the above symptoms as soon as possible.  A challenging aspect of tendon injuries is that they typically take longer to heal than muscle injuries.19  Due to the decreased blood supply to tendons in comparison to muscle and bone, tendons receive less “contractors and workers” to repair the damaged area.  This is a reason to not let this get out of hand and to cultivate awareness of any activities throughout your day that may be contributing to the symptoms.  A massage therapist once told me that switching from a squeeze bottle to a pump for her massage lotion/oils almost immediately cleared up a long bout of her tennis elbow symptoms.  Its amazing how seemingly minuscule activities can produce huge effects when they’re repeated a hundred times or more per day.

There have been 40 or so treatments studied for this injury!8,14,15  A few of the treatments that have shown the best results, are the most common, and can be performed at home will be discussed and described.  In the initial phase of healing, it is important to avoid making the injury worse.  This means listening to the signals the body is sending (pain) and allowing the natural inflammatory process to do its job of removing dead tissue, repairing damaged tissue, and laying down new tissue.  Crosier, Foidart-Dessalle, et al state that creating increased pain has been noted to slow healing progress with this injury.  They further note, “Our position is that pain must be interpreted as an alarm signal and that if the injurious effects of the repetitive motion continue, tendinous suffering may persist or even worsen.”20  On the other end of the spectrum, not using the arm at all, or immobilization, has been shown to decrease the healing progress as well, because it slows new tissue formation.20  Listening to the body and using pain as a guide will increase the ability to find the balance.  The first goal is to maintain range of motion in the elbow and wrist.

Some of the treatments that have been successful with this injury are:
1. Static stretching of the wrist extensors: 1,8,21  This stretching helps the new tissue being laid down during the healing process to line up in the proper way to allow the elbow joint to move without restrictions.  Hold the stretch for 30 seconds for 2-3 repetitions, 2-3 times throughout the day.

wrist/finger extensor stretch

2. Myofascial release: 4  (see “trigger points/myofascial restrictions” section above) Although the common extensor tendon and muscles coming from those tendons were specifically targeted in the research, it may help to also check for trigger points of the muscles of the common extensor tendon, extensor carpi radialis longus, triceps brachii, brachioradialis, supinator, and supraspinatus. Trigger points in these muscles can refer pain to the outer elbow.  The goal is to find any area that feels tight or tender and to hold direct pressure on those spots for 2-3+ minutes.

3. Eccentric strengthening of the wrist extensors:  It is suggested to start this after the acute phase (10 to 14 days) when the damaged tissue has been removed and the new tissue has been laid down. 1,8,15,20,22   With eccentric strengthening, as opposed to concentric strengthening, the muscle is actively contracting while it is lengthening. This type of strengthening is thought to increase tendon strength and, due to the muscle lengthening aspect, help the new tissue fibers that are being laid down during the healing process to line up properly.  Furthermore, the type of collagen found in healthy tendon (Type 1 collagen) has been found to increase and excessive tendon thickness found to decrease with eccentric strengthening.3,8,10,23,24

eccentric wrist extensor strengthening start
eccentric wrist extensor strengthening end

 

Concentric strengthening of a muscle is actively contracting the muscle while it is shortening.  This type of strengthening has been shown to be beneficial as well 3,7,8 however, the lengthening or stretching aspect does not occur as with eccentric strengthening.  Furthermore, eccentric contractions have been found to produce more force while requiring less oxygen and energy than concentric contractions and therefore will produce increased strength of the tendon with less waste products as opposed to concentric strengthening.11,25

4.  Other:  Various types of joint mobilizations/manipulations and taping have been suggested, some of which may be performed at home:9,16,26  Healthcare practitioners such as physical therapists, chiropractors, and osteopaths can evaluate the injury and provide instruction for these services, if appropriate.  Furthermore, other areas (shoulder, neck, etc) can contribute to elbow symptoms, which can be evaluated by a physical therapist or other practitioner familiar with optimal alignment and movement strategy evaluations.

An interesting note with this injury is that it typically resolves on its own within one year’s time.  Furthermore, although corticosteroid injections significantly decrease symptoms initially (the first 6 weeks or so), symptoms have been found to actually worsen and recurrence rates are higher compared to no treatment at all from 12 to 52 weeks.26,27

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.  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. Wen DY, Schultz BJ, Schaal B, Graham ST, Kim BS. Eccentric strengthening for chronic lateral epicondylosis: a prospective randomized study. Sports Health. 2011 Nov;3(6):500-3.
  2. Nagrale AV, Herd CR, Ganvir S, Ramteke G. Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial. J Man Manip Ther. 2009;17(3):171-8.
  3. Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis–a systematic review. J Hand Ther. 2012 Jan-Mar;25(1):5-25.
  4. Ajimsha MS, Chithra S, Thulasyammal RP. Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch Phys Med Rehabil. 2012 Apr;93(4):604-9. doi: 10.1016/j.apmr.2011.10.012. Epub 2012 Jan 10.
  5. Rooks MD. Rock climbing injuries. Sports Med. 1997 Apr;23(4):261-70.
  6. Moore K, Dalley A. Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, 1999. p. 746.
  7. Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci. 2011 Nov;116(4):269-79. doi: 10.3109/03009734.2011.600476.
  8. Waseem M, Nuhmani S, Ram CS, Sachin Y. Lateral epicondylitis: A review of the literature. J Back Musculoskelet Rehabil. 2012;25(2):131-42.
  9. Shamsoddini A1, Hollisaz MT. Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow. Trauma Mon. 2013 Sep;18(2):71-4. doi: 10.5812/traumamon.12450. Epub 2013 Aug 13.
  10. Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013 May-Jun;12(3):175-82. doi: 10.1249/JSR.0b013e3182933761.
  11. Skjong CC1, Meininger AK, Ho SS. Tendinopathy treatment: where is the evidence? Clin Sports Med. 2012 Apr;31(2):329-50. doi: 10.1016/j.csm.2011.11.003.
  12. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J. Bone Joint Surg. 2005; 87:187Y202.
  13. Bass, E. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012; 5(1): 14–17. Published online 2012 March 31.
  14. Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 2004 Dec;38(6):675-7. Review.
  15. Viswas R, Ramachandran R, Korde Anantkumar P. Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. ScientificWorldJournal. 2012;2012:939645. doi: 10.1100/2012/939645. Epub 2012 May 2.
  16. Vicenzino B. Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Man Ther 2003;8:66-79.
  17. Schweizer A. Sport climbing from a medical point of view. Swiss Med Wkly. 2012;142:w13688.
  18. Hockhoelzer T, Schoeffl. One Move Too Many… Druckerei Sonnenschein, Ebenhausen, 2003. p. 109.
  19. Holtzhausen LM, Noakes TD. Elbow, forearm, wrist, and hand injuries among sport rock climbers. Clin J Sport Med. 1996 Jul;6(3):196-203.
  20. Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007 Apr;41(4):269-75. Epub 2007 Jan 15.
  21. Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013 Nov;47(17):1112-9.
  22. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J. Shoulder Elbow Surg. 2010; 19:917Y22.
  23. Woodley BL1, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med. 2007 Apr;41(4):188-98; discussion 199. Epub 2006 Oct 24.
  24. Alfredson H1, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360-6.
  25. Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Rel Res 1986;208:65–8.
  26. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: r andomised trial. BMJ. 2006 Nov 4;333(7575):939. Epub 2006 Sep 29.
  27. Smidt N, Van Der Windt DA, Assendelft WJ, Deville WL, Korthals-De Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002; 359:657–62.

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.

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.1-5

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.8-14  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.8,11,13,17-19  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 my 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 
1. Tear a 4-inch piece of athletic tape from the full width of the roll. 2. Tear from each end to leave a 1/2″ bridge connecting the two ends.
3. Place the middle section along the palmer side of the joint in the middle of the finger. 4. Wrap the section of the finger closer to the hand first.
5. Bend the taped joint to 30 degrees and wrap the other section of the finger.
Ready to rock.
  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.6,8,11-13,18,26

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.