7 March 2012
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.