Rocking the Wall

by Constance Karwandyar, PT

If you’ve ever been inside Lakeshore Sport and Fitness at the Illinois Center in downtown Chicago, the first thing you’ll likely notice is the monumental rock climbing wall. Spanning 10 stories, this wall currently sits as the tallest indoor rock wall in North America! While humans have always been drawn to scaling heights, rock climbing as a common indoor sport only dates back to the 1980s. As the sport grows in popularity, so too, unfortunately, do the number of rock climbing related injuries that often go undiagnosed and untreated.

According to a recently-published article in PT in Motion magazine, some of the most common rock climbing related injuries involve the hands, elbow, and shoulder due to the pulling nature of the sport and strong need for finger and hand holds. Landing and falling related injuries are also common in the foot and ankle. Jared Vagy, DPT - dubbed “The Climbing Doctor” due to his extensive experience in both physical therapy and rock climbing - claims that 40% of rock climbing injuries are in the fingers. Strains to the pulleys of the finger are common due to the overuse of the flexors of the fingers and wrist. The pulleys on the palm side of the fingers work to hold the finger flexor tendons close as they slide back and forth when we curl and extend our fingers (think of the rings on a fishing pole that the fishing line runs through). A strain or rupture to one could cause bowstringing of the flexor tendons, difficulty with curling and extending the fingers, swelling, and pain.

An illustration of the flexor tendons in the fingers.
By Steve Graepel, www.rockandice.com.

As with any sport, injury prevention and education is a top concern for physical therapists.
Imparting specific and proper warm-up techniques to climbers is key to making sure they prime their entire bodies before they ascend any indoor wall or mountain face. Using larger hand holds on the first ascend allows proper blood flow to enter the upper extremities, especially in the hand and fingers. Climbers can also use a “downclimb” to work these muscles eccentrically, lowering themselves in a slow and controlled manner instead of repelling down the wall on the first climb. Properly warming up “pulling muscles” such as lats, biceps, and rhomboids will also ensure proper blood flow and tissue temperature before climbers begin. 

Even with proper warm-up technique, injuries do still occur. Rehabbing a climbing injury takes some critical thinking to identify the root of the injury and not just simply treat the symptoms. For example, if a climber experiences a finger injury, it is important to assess shoulder, core, and lower body strength, as a deficit in any of these categories can cause an over-reliance on the fingers during holds and grips. Additionally, working on upper body strengthening and stability training in a closed kinematic chain (hand on the ground, wall, or rock wall) as opposed to open kinematic chain (hand free in the air such as swinging a baseball or performing a bicep curl) can mimic the way the rotator cuff and scapular muscle have to work together on the rock wall.

Another key component to prevention and treatment is training the antagonist muscle groups (or the opposing/opposite muscles). As previously mentioned, climbers tend to overuse and overdevelop the forearm/finger flexors so working on strengthening the forearm/finger extensors to improve balance is important. Below you will find a few examples of how to strengthen finger extensors at home.

(L) Half Crimp Extensor Isometric, (R) Open-Handed Extensor Isometric

Resisted Finger Extension

As with any injury, thorough assessment of strength, range of motion, and body mechanics is key to a proper diagnosis and treatment approach. No two rock faces are the same, just like no two finger injuries are the same. If you have experienced a rock climbing injury or are interested in learning proper warm up and injury prevention techniques before your next climb, come see one of our experienced clinicians. Complimentary injury assessments are also available in-person or via telehealth.

References:

Ries, Eric. “It’s Lovely at the Top.” PT In Motion Magazine, June 2020

Ries. Eric. “The Free Solo Phenomenon.” PT In Motion, June 2020 

“Taking and Analyzing Risks with the Climbing Doctor.” The Prehab Guys Audio Experience 

podcast. Episode #47. 2 May 2020.

The Rockulus: Learn the Ropes. www.therockulus.com

Vagy, Jared. Climb Injury-Free: A Proven Injury Prevention and Rehabilitation System.

Growing Good Body Mechanics in the Garden

by Lauren Sweeney, Office Manager

Of all the places I like to spend time in the late spring and early summer, my garden is one of my favorites. Now that we've braved our last gasp of snow in Chicago (fingers crossed!), I'm ready to uncover my raised beds, turn my compost and get my seedlings started. In all the excitement of getting to grow things, though, it can be easy to forget to be good to our best gardening tools: our bodies. We often don't realize how hard we've worked outside until we're struggling to get out of bed the next morning.

At its core, gardening is no different than any other kind of exercise: it requires movement in multiple planes of motion, and can put strain on the knees and the back. As such, a warmup prior to gardening - a quick walk around the block, some stretches - can help prevent soreness later. As you are gardening, think about how your body is feeling: have you been crouching for a while? Doing a repetitive motion? If you find you're getting sore in one position or during one activity, change your body position or take a break. It can be tempting to plant those last five tomatoes and just be done, but switching to shoveling mulch or taking a water break can give your body the change it needs to get the job done.

As most gardening is done on the ground, knees can suffer. If you will be spending a while in a kneeling position, consider knee pads or a gardening pad to reduce pressure. If kneeling is difficult, a bucket or low chair can allow you to plant from a seated position. Gardening using raised beds can help reduce strain as well, as they do not require the gardener to get quite as low to the ground, and when shoveling or raking, be sure to keep knees soft (rather than locked).

Many gardening tasks also require a lot of our core and our backs, so it is important to be mindful of them. When moving heavy materials, such as stone or bags of mulch or soil, be sure to use proper lifting mechanics (bending from the hips, turning feet to move loads rather than twisting or lifting). If something is too difficult to lift alone, use a wheelbarrow or ask someone for help. Try not to overload shovels or trowels, and use a hose for watering instead of lugging around a watering can, especially for hanging plants.

When you are done for the day, finish up with some light stretching. And don't forget to take breaks for food and water! It is easy to misjudge the amount of work we have been doing when we are engaged in a task like gardening. If you do experience a new pain working outside, don't hesitate to stop in our office - we'd be happy to help you get back to enjoying your garden.

Resources:
https://www.moveforwardpt.com/Resources/Detail/gardening
http://www.rehab.msu.edu/wellness/garden.html 

The Home Stretch

by James Bansberg, PT

Some of the most common advice we receive when we complain about a newly discovered ache or pain is to just “stretch it out.” But what does that even mean? How long do I hold it? When should I do it? Do I just throw my leg up on a table for a couple of seconds and beg the pain to go away?

Most of what we know about stretching is either a myth or based heavily on outdated science. Worse yet, when speaking to various health professionals, their recommended duration for stretching can vary greatly, which can be confusing and sometimes discouraging for their clients. Luckily, a 2018 study by Thomas et. al has helped answer some of these questions. The study focused on most effective form of stretching for improving range of motion, as well ideal stretch duration and frequency.

Despite its vilification in recent media, the researchers found that static stretching was more effective than other forms of stretching for improving range of motion long term. This doesn’t mean that static stretching should be the only form of stretching utilized in a regular workout program, however. Other studies have discovered the benefits of other forms such as dynamic and ballistic stretching, especially prior to activity.

As for duration, there’s good news for the more impatient types: a 30-60 seconds hold was as beneficial as other, longer durations (60-120 seconds and over 120 seconds). Consistency, however, was key: the research showed stretching more than 5 times a week was more effective than 2-3. Interestingly, 7 days of stretching per week did not yield better results than 5 days, making the sweet spot between 5-7 days per week.

The final portion of the study looked at optimal time spent per week stretching to maximize mobility changes. Surprisingly, a minimum of 5 minutes was required for significant changes, with the ideal time being anywhere between 5-10 minutes.

Ultimately, some stretching is better than no stretching, and recent studies have found benefits to other forms of stretching as well as foam rolling. However, even stretching has a proper dosage, so it is important we utilize available evidence to guide our decision-making so that we are able to reap the greatest benefit. 

References: 
Thomas E., Bianco A., Paoli A., Palma A. The Relation between Stretching Typology and Stretching Duration: The Effects on Range of Motion. Int. J. Sports Med. 2018;39:243–254. doi: 10.1055/s-0044-101146.