7 March 2012

Injuries: The problem with Lay-off


A traditional approach to a tendon injury such as commonly experienced by climbers is to include an extended lay-off of several weeks or even several months. There are several good reasons to consider a lay-off, and several not to lay-off at all, depending on the circumstances.
The basic rationale for lay-off is to allow the tissue some rest and a chance to recover from it’s severely compromised state. There are quite a few assumptions built into the decision to completely rest the tissue. First, that the tissue will really benefit from complete withdrawal from the sport. Unfortunately, this isn’t strictly true. 
In the earliest stages of injury rehab, where the tissue is extremely weak, inflamed and possibly swollen, even the lightest use risks further damage. However, this stage is extremely short - a few days or weeks at most. After this, lay-off is actually contributing to loss of tissue health. Even moderate activity tends to be enough to maintain strength in muscle or tendon. But inactivity causes it to lose strength rapidly. When the tissue is immobilised, the rate of atrophy is positively frightening.
A related assumption is that immature tissue that forms in those initial days and weeks after an acute injury will mature into tough tendon that will handle the forces you were asking of it when you were healthy. This isn’t true either. It was the training you were doing that made you strong. Only progressive training of the injured tissue will bring it up to the exceptional level of strength and toughness that you need for sport. If the lay-off is long enough for the tissue to mature without a good progressive rehab program, it will likely end up weak, the wrong length and vulnerable to re-injuring just as you start to get your momentum back.
Another dangerous assumption inbuilt into a lay-off program is that the painful tissue is the problem and that allowing this to recover will solve the problem. In a few cases this could be true, but in the majority, an underlying susceptibility forms a large part of the cause and lay-off will do nothing to remove it. For certain less severe injuries, simply addressing the underlying causes without any intervention to treat pain symptoms will be enough to put things right.
Who can help you identify those causes? Climbing, being such a technical sport needs an excellent coach with a thorough understanding of physiology, and the biomechanics of climbing movement to identify why your climbing movements are injuring you. Since your posture is probably contributing too, you need an excellent sports medic/physiotherapist who can thoroughly asses the mess of your wonky back and shoulders. If they are not too shocked by the horror of your shoulder movement, they will help you unload the stressed out muscles and tendons with proper alignment. Sounds like a lot of effort? Well, I guess you could always just hope the pain goes away by itself instead.
Now, what a heartening blog post I hear you think; forget lay-off, keep climbing and my injury will still recover? Be clear that despite it’s psychological challenge for keen sports people, lay-off is in fact the easy option compared to the work and discipline of recovering from an injury without lay-off. This is because changing habits is really hard and requires iron resolve that most people cannot sustain as long as they need to. Hence the high recurrence rate of injuries. People just try to do things as they always did (including the things that caused the injury). If you are ready to climb differently - at the level the injured part demands, working daily to correct your bad technique habits, tactics, postural faults and specific muscle weaknesses, then recovery without lay-off is the short cut to successful recovery. Most folk don’t have the discipline either to source the information on what they ought to change, or to put the work in and actually change it.
The detail of what things climbers should change has been my constant work over the last month as I continue to write my climbing injuries book Rock ‘til you drop. It’s been fascinating study so far.

27 comments:

AlanL said...

Certainly ties in with my experience.

I had a pulley tear two years ago. Went to my GP because he is a climber - otherwise I might not have bothered - and he said keep climbing, but two full (UIAA - he is German) number grades below what I was climbing at when I hurt myself. So, having hurt myself on a UIAA VII (around 6b), I spent six weeks doing mileage on V's, then went on a family holiday and did lots of swimming, hiking & yoga, then was back climbing at much the same level as before but with better technique and confidence from all the mileage.

Leon said...

When do you expect to publish your new book? After your first one (9 out of 10 climbers..) I can't wait for this one to land on my doormat!

Keep up the great posts.

Leon

Dave MacLeod said...

Alan - yeah a change of scenery with lots of different activities including lots of easier but still challenging climbs (for different reasons than small holds) is just about the best thing you can do to keep the psyche and heal fast. I have done exactly the same sort of thing myself many times. When I did a route called The Walk of Life (an E9 slab) My elbows had just been injured and I couldn't do a pull up. I probably would have struggled to do 6c+ at a climbing wall without pain but if I chose something that suited the situation I could still climb hard.

Leon - I'll publish it as soon as it's finished. No idea when that will be but after a long layoff due to amongst other things a young baby I'm making fast progress now.

Eric Hörst said...

Great piece, Dave. Your book will fill an critical void--I'm sure it will be a must-read for all climbers!

Jacquie said...

Thanks for this post - perfectly timed as I've been having problems for a few weeks now with a damaged flexor tendon. Looking forward to reading your new book.

Benjamin Eaton said...

Thank you for that treasure trove of knowledge.

Unknown said...
This comment has been removed by the author.
Unknown said...

Great write up.

I tore my hand last July and didn't touch rock or plastic for three months. After fully recovering, I seem to have strained a pulley in the other hand.

I often wonder if at 25 I'm simply injury prone, or if I possibly lack some technique to climb without stressing my tendons as much.

I've been told that possibly the reason why I have become injured so much is due in part to jumping 3 number grades in 2 years ending with 5.13. Perhaps my tendons have not been able to build up as most climbers have been climbing for much longer? Maybe also that smith rock is a tweaky place to call your home crag.

-Tara

Nathan Bradford said...

Well articulated. This is fundamentally different than what is commonthought. It impresses me the vast number of misunderstandings we have about our own machinery.

Ali said...

Hi there

I'm a 19 year old student climber from glasgow, who has been climbing (mainly bouldering) for almost 2 years now. I can climb around V4-5, or i could anyway. Recently my toes have become horrendously sore whilst climbing. I went to see a physio, and she told me to stretch my toes/legs. The joint on my big toe has basically seized up and it only moves about 10 degrees. The toe really hurts when any force is applied to it(it feels like a nerve or something), and I haven't been climbing for a few weeks now.
Have you heard of this before? I can't seem to find much information on it at all. I've just started ice bath treatment in the hope that this might work.

Thanks

Chri said...

Hi,
Great piece of writing!

Actually I have just been through 5 weeks of not doing any sport at all, due to a non climbing related accident. Now that I'm back I'm really motivated to climb again to get back into shape.
Would you say that 5 weeks had been long enough to weaken my tendons? I had opted to jump back in just where I had stopped, but after reading your post I am not that sure anymore...

Paul Bennett said...

Nice blog post. However, it left me with a few questions.

When you start out

"traditional approach to a tendon injury such as commonly experienced by climbers"

I firstly thought of pulley injuries; although I know many people with elbow and shoulder issues, pulleys seem to be something almost everyone has experienced (may I go as far as to suggest they're the most common climbing tendon injury?).

but this:

"Since your posture is probably contributing too, you need an excellent sports medic/physiotherapist who can thoroughly asses the mess of your wonky back and shoulders. If they are not too shocked by the horror of your shoulder movement, they will help you unload the stressed out muscles and tendons with proper alignment."

Again, are you suggesting impropoer posture etc. enhance the risk of pulley injury or are you more specifically thinking of elbow and shoulder tendons?

I'm really prone to them (A2, ring finger non dominant hand). The current injury is one of my most frustrating, not because I don't know how to manage it, simply because THIS time I thought I did everything right. I made changes to my training, I didn't flog the same problem repeatedly, I was ensuring hydration etc. and it just appeared after my best session for a number of years.

I'd be interested in reading your thoughts on the comments I've made. If it can help reduce my A2 woes then I'm in!

Bert said...

Dave, intriguing. I have been suffering from -what i think is- a tendon injury (inflammation?) in my ring finger around A0. This has been going on and off for the last year or so, mostly triggered by climbing loads on plastic. I have now taken a few weeks off from climbing (3 and counting), but the pain doesn't seem to diminish. Would you suggest starting (light) climbing again despite the persistent pain?

Thanks in advance!

aaron said...

Dave, amazing! Great post and great timing for me! My latest pulley injury (A2 or 3 I think) caused by crimping to much on a road trip - odd injury in that I felt nothing acute climbing (slight inflammation last 2 climbing days) but after the trip and couple days off it was very swollen and hurt to crimp...that was 8 weeks ago. I was actually continuing to climb and train hard on open hand holds (which don't seem to cause pain if im careful not to role up the fingers, as you might on small pinch). After a few weeks of slow progress (pain climbing reducing slightly), the climbing/training eventually caused inflammation to re-occur, leading to frustration and approximately 1.5 weeks off climbing all together. Reading your post reinforces my original strategy and I think I may head straight to the gym this weekend. I still hope to project boulders by April/May (involving hard crimping, V9/10), do you think I should play safe and abandon this, sport climb for spring/summer and return to hard bouldering (crimping) in fall? Or just use pain as my guide - i.e. if it hurts dont do it?

Thanks Aaron

Kyle said...

Hallelujah!

Rest is the most over-rated tactic in recovery. Tendons and cartilage don't really receive significant passive blood flow. Rather blood is pumped to the tissue as a result movement. So move those fingers and do everything that doesn't cause pain.

duncan said...

Interesting stuff as usual.

Most discussion of climbing (or other sports injuries) starts with the unstated assumption that pain is roughly proportional to tissue damage. Modern pain physiology teaches us that this is far from the truth, particularly in longer-standing injuries. Lingering pain from an old injury is usually put down to scar tissue; it’s at least as likely to be a neurophysiological effect (a softwear rather than hardwear issue). This is a probable reason why rest does not work for long-standing problems.

Will you talk about pain physiology and the disconnect between pain and damage in the book?

Unknown said...

Hey Dave, excellent insight into tendon injuries. I just have a quick question. I've spend most of my time bouldering, My grade is about V5/V6, and about 7c+ sport, But i live in Ireland so dont get out sport climbing much, as a result my endurance is a real weakness for me. I decided to take up the goal of a big wall climb in Yosemite, i'm thinking of Leaning Tower maybe. This is my first big wall, and in fact i have very little experience in Multi pitch (2 climbs several years ago) And i know my endurance needs alot of attention, so i know i have to go on alot of sport and Multi pitch trips, But im wondering what is the best way to go about training for this? What components of my climbing should i focus on? Any advice you can give will be really appreciated, thanks.

JRad said...

Hi Dave,

Very good argument. As modern science in pain and injury research is telling us, the earlier introduction of movement post-injury, the better. Injury healing is a mechanism of adaptation. The brain has priority to get new tissue laid down where the injury was. Unfortunately, the brain doesn't recognize the need for your goals, so scar tissue is usually the better choice. This way(even though the tissue is weaker) the brain would rather immobilize the area than have to worry about the quality of the tissue. We want to introduce novel and extremely progressive movement to the injury site to ensure that the tissue is laid down right and can respond to movement and load in the future. However, in agreeing with you, people just don't have the discipline to progress back into things. Also their view of progression is skewed. It is a lot more minute than one may think. But the science doesn't lie, get movement restored to the area as soon as possible. In addition, the brain will realize that these movements are not dangerous and will lower the overall threat response.

LachlanM said...

Dave,
Love your work and looking forward to the new book.
I recently broke 4 bones in my ankle and am looking at a protracted time off my feet. Probably a couple months in a cast and then another couple in a boot before rehab etc... I am trying not to get too down and instead I am trying to see this as an opportunity to work on some weaknesses. I am setting some goals and will begin focused on the hangboard and then maybe some pilates or something like that. The difficulty is that the ankle can bear no pressure whatsoever for the time being. Any suggestions???

Lachlan

John Wesely said...

I think the response to this post forecasts that your new book will sell like hotcakes.

Paul said...

To unknown Irish person....first of all, who are you? Chances are we've met. Second of all, for Yosemite aid walls your free grade doesn't matter a damn. Unless you plan to free it, in which case you'd probably need to be climbing around E7. To climb a wall you need to be a bit fit (nothing outrageous though), have jumaring, hauling, cleaning traverses, and belay management sorted, and have a good dose of bull headed stubbornness. Unless you want to free it (unlikely with limited multipitch experience, but stranger things have happened), its all about the ropework. Get a partner, get the gear, then aid and haul some trad pitches. Fair Head would be best, but its possible at any of the major crags. Difficult in the mournes though.

Look for technique posts on American forums by Pass the Pitons Pete. Get loads of gear. Practice the ropework (most important). Be stubborn and bull headed about getting up the thing. Don't worry about grades. When were you thinking of heading out? I'll be there for all October. I'm no expert on the matter, but if you want you can give me a shout at Paul.brennan42@gmail.com and I can put you in touch with people who know more.

karensfree said...

I feel the same as Tara (who commented above). I started climbing 1yr ago at age 28. I fell and hit the ground and damaged my muscles in my back. Since then i have not had more than a month or two without and injury. Maybe I am just injury prone but really think if I could find a physio and coach who could help me develop a strength programme for climbing I would see injuries disappear.

Karen

karensfree said...

I feel the same as Tara (who commented above). I started climbing 1yr ago at age 28. I fell and hit the ground and damaged my muscles in my back. Since then i have not had more than a month or two without and injury. Maybe I am just injury prone but really think if I could find a physio and coach who could help me develop a strength programme for climbing I would see injuries disappear.

Karen

Se77e said...

Hi! great this on-line coaching! really useful as it talks about true experiences rather than pure theory aspects....
What about an article about how to compensate the gap between muscles super fit thanks to climbing and other weaker muscles that may cause you injuries?!! for example as I'm not so tall I'm always stressing shoulders a lot cause have to do many streched moves than taller people.
good job anyway!
greetings from Italy :)

Drexel said...

Hi Dave,

This blog has helped me out with countless injuries and I appreciate it greatly. Recently I was climbing in the gym and did a powerful deadpoint into a small gaston. I didn't hit it very well and my fingers stacked in an open hand position causing excessive loading on my ring finger. I felt a small click and a shot of pain down my forearm. I immediately stopped climbing and thought I had injured my pulley again. I stopped climbing for a few days until I felt the inflamation had gone down. However after a week and a half I am almost positive it is not a pulley injury due to the fact that I can weight my hand in the crimp position with almost no pain. Instead, what hurts is if I climb open hand without the pinky. As soon as my pinky drops I feel sharp pain in the length of my arm. The information I have found leads me to believe it is a flexor unit strain, but I am having an incredibly hard time finding any information about this type of injury. I have started climbing again slowly and I seem to be able to climb fairly close to my limit (7C) without pain as long as I climb fairly static without my hand falling into the 3 finger open hand position. I wouldn't be concerned about it if it wasn't for how much it does hurt still when I do try to weight it open hand. I have been using the ice bath method as well as squeezing thera-putty, which seems to help. Any insight into this type of injury would be much appreciated and I wish you the best of luck in your recovery as well.

Sean Prendiville said...

Hi Dave,

Do you have any thoughts on how climbers should manage carpal tunnel syndrome and other repetitive strain injuries common to the sport?

Really looking forward to the new book!

Sean

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