Never Waste a Good Climbing Injury

A physiotherapist's guide to getting back on the wall

July 30, 2023

Climbing

MIN

Imagine this. You’ve just managed to pull through the crux move of your project, your right hand is crimping down hard and all you have to do is reach through to the jug and then you can top out. Your mates are shouting “Allez” like soccer hooligans, because they know you’ve got this.

Suddenly you hear a “pop” from your middle finger and all the strength disappears from your right hand. You blow off the wall like you’ve just been shot by a sniper.

That’s it. Pulleys blown. Off to see the physio first thing Monday morning. And all you can thinks is, “Will I be able to climb this weekend? How long before I can get back on my project?”

As a physio I have a love hate relationship with those questions.

Love, because it shows a strong desire to return to your sport. I know you will be driven to do the work and get back to training as quickly as possible.

Hate, because it’s not a simple answer and depends on so many things. The question you should be asking is: “HOW do I get back to climbing at the same performance level that I was at?”

Here are some of my tips on this complex topic:

Have a Plan (specific to you and your injury)

Once you have a diagnosis, discuss the treatment plan with whomever is treating you. And most importantly, how they see you getting back to where you were.

The plan must always start with stabilising the injury. You need to stop any further damage happening and allow the initial phases of healing to work their magic. If you don’t, your return to sport becomes an up and down battle fighting flare ups. I always tell patients, “slow at first means fast later”. Be patient.

You and the treating professional will need to know:

where you were in your training and performance at the time of the injury,
where you are, at any time, during the return to sport process and
where you want to end up. (hopefully the same place as where you were?)

Make sure you discuss the process with them. Having no plan often leads to weeks or months of wasted rehab and training.

Competitions or planned trips often add complexity to these questions. An injury sustained two weeks before a competition or a trip to Rocklands doesn’t always mean no climbing. It might just mean you have to come up with ways of protecting the injury. This may involve focussing more on your warm up before climbing and recovering better after each session, climbing different types of easier routes, or just using strapping and taping techniques.

Non-negotiables

Some injuries just need more time. They will not heal unless given a longer initial period of rest. Unfortunately, these injuries can’t be managed using pain as a guide. They are often still vulnerable, even though they’re pain free.

These include things like acutely painful tendons, stress fractures and injuries presenting with severe weakness or loss of sensation.

Also be aware of injuries that are highly irritable. By irritable I mean injuries that react negatively to minimal load and take time to settle down after each flare up. Don’t keep irritating these. Monitor their reaction and never push them too far.

But don’t stress, you can still train around these non-negotiables. Read the section entitled “In the meantime – Training vs rehabilitation” for some insight.

Address weaknesses

This is where the title “never waste a good injury” comes in. You’re limited to the amount or type of climbing you’re doing because of your injury. Use the extra time to work on your weaknesses. Maybe one of those weaknesses contributed to your injury? Maybe one of those weaknesses is stopping you sending that project.

Make two lists at the beginning of the “return to climbing” process.

1. What are you lacking in your climbing, not related to your injury? (e.g. flexibility, core strength).

2. What weaknesses could have led to your injury? (e.g. shoulder stability, hip mobility).

Discuss ways to work on these whilst injured with your physio or biokineticist. There is always a way. And get on it. Come back stronger. Never waste a good injury!

Climbing Tolerance

Now it’s time for you to get back to climbing and it’s often sooner than you think. This process is all about managing load on the injured area. The first step is to find out how much you can do without flaring things up. You need to do a tolerance test.

Unfortunately climbing is a whole lot more complex than running. We can’t just define your tolerance limit with time, distance or speed. Climbing involves too many factors.

Here you need to be clever and realistic. You need to be able to acknowledge how much load each type of hold, angle of wall and type of movement exerts on you, as well as how long you can climb for, how many moves you can do in a session, the time to recover between attempts and many, many more factors. As I said, climbing is a lot more complicated.

Your first session needs to be an experiment of what your tolerance level is. How much can you withstand without flaring the injury up? My suggestion is to start low - very low. As an example, climb slab, using technical controlled moves not dynamic moves and on bigger holds. Rest a few minutes between each climb and only spend 30-60 minutes climbing, then go do your rehab. Recover properly and assess how your session went. No flare ups means you can gradually start to increase the load each session. If there are flare ups after a low, low tolerance test, you’re probably not ready to climb yet - back to the rehab.

One way of thinking about it is to adapt the control chaos theory to climbing⁽¹⁾ . You want to start climbing again with control and progress slowly to chaos. Start with slab, controlled technical moves, holds that use more surface area of your hands and fingers, more straight line climbing (avoid shouldery moves, gastons, etc) and no dynos. Progress over time to more powerful, over hanging, dynamic moves and to smaller, more awkward holds.

How to Progress - Risk vs Recovery

As you heal the injured tissues build resilience as the load increases. To get it to move constantly and to the resilience needed for your climbing goals, you need to keep loading it. Not too little as then it slows down, and not too much, as then it flares up. So I use two basic rules to manage this process. They are:

1. Don’t load the injury to an amount that causes more than 3/10 pain. Three is safe and actually good, four is time to back off, five is to much – stop!

2. If the injury niggles to 3/10 but doesn’t settle back to your baseline within 24 hours, that’s bad. Retrospectively assess what you did and do less next time.

Control the pain at the time of exercise and make sure the recovery is good. If you’re flaring your injury up, back off to a tolerable level and try progressing again - slower this time. There is always a balance here between risk and recovery. Be aware of the loads you are placing on injured tissue and recover fully after sessions.

A remember that load management is not just about climbing exercises. Everything you do adds to the load on your body. Rehab, hangs, climbing, work stress, gym, shopping, etc. Be conscious of all the load on your tissues and manage it.

In the Meantime - Training vs Rehabilitation

I see injuries as a way to focus on weaknesses and return the athlete to training as quickly, safely as possible, and with minimal “fitness” losses. Training and rehabilitation have the same goals (increased tissue resilience and strength) and principles (progressively overloading tissue to cause an adaptation). Training and rehabilitation just start at different places on the exercise load continuum. ⁽²⁾

Use your recovery time wisely. Train those unaffected areas as you normally would and rehabilitate the affected areas. When the affected areas catch up, you will be stronger and fitter.

These suggestions are all very climbing specific, and with climbing being a very specific sport, my advice would be to find a Physiotherapist or Biokineticist who understands climbing to assist you. We’re very lucky in South Africa to have some very passionate, well-educated climbing Physiotherapist and Biokineticist. Ask at your climbing gym for a referral.

In the meantime, train smart and see you outdoors.

References