Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
The Climbing Doctor's Guide to Injury-Free Training and Sending with Jared Vagy
Embark on a journey to the peaks of rock climbing wisdom with Jared Vagy DPT, the Climbing Doctor, as we tackle the paramount topic of injury prevention and management. Jared unfolds his narrative, from an injury-laden student to a trailblazer in climbing medicine, shedding light on the growth of this specialized area and the collective efforts across the climbing community to uphold climber health. Jared is a Professor in the DPT program at University of Southern California. He has also lectured worldwide about various topics, and he now specializes in treatment of rock climbers. Jared is author the author of multiple books in climbing medicine such as Climb Injury Free. He is also the host of an awesome podcast: The Climbing Doctor Podcast.
As we ascend further, our conversation grips onto the often-overlooked intricacies of finger and hand injuries. Pull up a chair as we recount tales from a course in the rugged terrain of Colorado, where we witnessed firsthand the critical impact of finger placement on training outcomes. Discover with us the potent effects of meticulous hangboard training techniques, and grasp the importance of climber-specific regimens that prioritize individual nuances in finger health. It's a gripping discussion filled with insights on how each climber can tailor their approach to fortify against the perils of injury.
The final ledge of our discourse offers a panoramic view of actionable strategies to shield climbers from harm's way. I emphasize the core tenets of training and movement optimization, illuminating the necessity for understanding body dynamics to boost performance and avert injuries. From the pages of "Climb Injury Free" to the digital expanse of The Climbing Doctor's online resources, we share a treasure trove of knowledge for climbers and healthcare providers alike. Whether you're a seasoned pro or a burgeoning novice, these expert tips are your gear for a safer and smarter climb.
Jared's Instagram:
@theclimbingdoctor
Jared's Website:
theclimbingdoctor.com
The Climbing Doctor Podcast:
https://theclimbingdoctor.com/the-climbing-doctor-podcast/
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Hello everybody and welcome to the Art of Prevention. And as always, I've got a very, very special guest. You know, one of my mentors and someone who's certainly taught me a bunch about a specific sport that I really enjoy, which is rock climbing. And I actually got into rock climbing as my quote unquote safety sport after getting injured running all the time, and I've been pretty lucky in the fact that I really, knock on wood, haven't gotten injured rock climbing very much, and usually it's just little tweaks and things like that. But today I've got Jared Vagey, the climbing doctor, with me and we're going to talk a lot about climbing injuries.
Speaker 1:But specifically, how do we mitigate or reduce the risk of climbing injuries? And, jared, I know you've been climbing for a really long time. You were climbing during physical therapy school and actually had a couple of injuries during that time period as well, which really helped you dive into and become almost like the father of like conservative climbing management in. I should probably clean up how we say that right In the United States. I mean, we've got Volker Schoffel doing amazing stuff over in Germany, but as far as somebody who really is progressing the field of climbing medicine, I'd say that you're one of the people at the top of my list at least.
Speaker 2:Now I mean, the good thing is there's now a lot of people right that are really, I think, pushing the sport on the clinical end from injury prevention management. So I'm lucky to be, I'd say, one of those people.
Speaker 1:I went to one of your live courses in golden and gosh. I was using some of the stuff that you and Kevin Cowell taught me, like literally this week with a climber, um, and that course was a blast.
Speaker 2:It's, and I think that you know, as, as I go along in this, in this field, in this profession, it's really the collaborations that I really gain a lot of meaning from, because for so long I was practicing in a silo. It was literally me seeing climbers, with no other information except some research study. And now it's really cool to just have so many colleagues that I love climbing with too and we get to go climbing, have fun, teach some courses, so it's really good times.
Speaker 1:Yeah, and people are psyched like going to that course, like so many people, just really excited about what they do and excited about working with climbers. So when you were in PT school you know you've got a pretty classic story, I think, about what got you psyched about specifically climbing medicine, right?
Speaker 2:Yeah, and you know, I've told this story, you know, hundreds of times and the crazy thing is that every time I tell it, I like relive it, like it's because it's really. You know, this is truly what happened. Like I was in physical therapy school. I was super psyched on climbing. I was living at my grandma's house and I didn't have a hangboard but she had like really old molding on the door and I was like just hanging from the molding. You know, strengthening my fingers, getting super strong, climb like six days in a row, all those good things that you know. We now know not to do.
Speaker 2:And, yeah, so I drove out to. This is when I was in physical therapy school. I drove out to Joshua Tree. There's a route called course and buggy, pretty classic test piece, pretty psyched on, got underneath it, you know, made my way up feeling pretty good. Legs started shaking, arms started shaking, got to the exit move and in a moment as I pulled the exit move, got to the exit move and in a moment as I pulled the exit move, felt a pop in my finger and my shoulder and I tore my rotator cuff and tore a pulley at the same time.
Speaker 2:So, yeah, so, as I mentioned, that was when I was in physical therapy school. I should have known better and really that's what it started with trying to figure out these injuries for myself and then eventually figuring out for others. You know writing some books and putting some content out, and now really the key is, you know, can I spread a lot of this information, not just the climbers but other clinicians who are treating climbers and some of the knowledge I've got gotten through? You know treating climbers for the past 10, 15 years.
Speaker 1:Yeah, I think also, your knowledge is going to be super helpful for coaches as well, and you know the people that have a lot of direct access to a lot of up-and-coming and youth climbers, because I know a lot of. You know youth climbing, you know the, you know we want to spark that love of climbing and not have a career of climbing, whether that be a professional or recreational career, cut short due to something like a you know, a really significant injury that they may sustain.
Speaker 2:Now, yeah, and coaches. I think it's such an important part of you know the health of a climber and I've learned more from climbing coaches, I think, than anyone, because understanding movement, understanding training, understanding these nuances, like, the more time I spend with high level climbing coaches, the more I understand climbing. And I think you bring up a good point is that's really a huge part of prevention is coaching and taking care of yourself, both mind and body.
Speaker 1:So let's say that you were a climbing coach right now and you were able to hop into a time machine and talk to second year PT student Jared naive but super psyched, six days on at J tree. What kind of stuff would you tell him? You know you and your past. I know there's always like the gift of injury and all this, all this amazing stuff has come from that injury that you had pretty impressive injury too, by the way. I've had a lot of injuries but it sucked.
Speaker 2:It was like a double whammy, yeah I'm right, I don't.
Speaker 1:I can't think of a time when I had two major injuries happen at the same time, though. Um. So kudos to you, what a good job you did, you know, oh yeah super exciting.
Speaker 2:But the good news is, you know I rehabilitated those injuries. So knock on wood. You know have been, have been doing well so far.
Speaker 1:But all right, so I'm in the time machine going back to my old self yeah, yeah, yeah, and you're, whether it be six weeks ahead of that injury or the day before or whatever, whenever you could go back. Maybe include some like timeframe too. Like maybe, oh, I would go back to six weeks prior to that injury and prior to that trip, or oh, I would just go back to the night before and tell myself to get some sleep. Like what kind of stuff would you tell previous Jared to hopefully reduce the risk of that injury?
Speaker 2:Well, here's one challenge, because there was that injury which was climbing and then rewind, four years four, six years prior to that. And I had a similar career, life-changing injury, running track and field in college, where I tore my hamstring multiple times, actually six or seven times in a season, and that whole string of things. I think, you know, if I were to go back and look at these two separate injuries and try and find some thread, I think my thread was being so psyched on the sport, whether it was track and field or climbing, and training. More than doing the sport and training what I was doing, like hanging from my grandma's doorframe, like that's kind of what you'd say. The equivalent these days would be like fingerboarding, right, like six days of fingerboarding in a row until you couldn't do it anymore.
Speaker 2:But I think it brings back to. You know, I was young and I didn't look at the timeline, I didn't look at. You know, to get these gains that I really want, I need some patience and I think I definitely over-trained at that stage. Um, and where right now I'm probably under training and you know, you know, maybe I need to move the needle a little bit the other direction. Um but um, but yeah, I think the the psych level, um and a lot of climbers have this right is is really hard to keep that in check, uh, with all the additional things that you think you can do to supplement your, your climbing, your running or whatever your sport is.
Speaker 1:Gosh, I, I, I totally agree. And that definitely hits home with me being a previous, you know, track and cross-country runner myself having, you know, all kinds of injuries in all kinds of places, many of those recurrent. And, yeah, sometimes the best form of quote-unquote discipline that we can have is really dialing it back. You know, sometimes, you know, for some individuals it's easy to go out for a super hard training session and then get really like high, like arousal levels and high levels of psych, I'm trying to say, and then the next day be like you know what I'm, I'm feeling a little tired, but I could think I could go and just crush another workout and you keep that cycle going.
Speaker 1:And this is one thing that can feed into multiple comorbidities from, you know, musculoskeletal injury, but also can be a precursor to something that I think is, you know, rightly so, like getting a lot of news and attention, which would be relative energy deficiency syndrome as well. Yeah, attention which would be relative energy deficiency syndrome as well, yeah, which we know there's been this really large undercurrent of red s in the climbing world that has now come to light a lot more with a lot of the things that, like volker schoffel is doing, and a lot of the great people like usa climbing have been doing, to look at some of the tendencies and propensities towards relative energy deficiency in climbers. So yeah, dialing back that psych would definitely be one thing to do. Any other advice that you'd give yourself?
Speaker 2:Yeah, I mean, I think, on the level of dialing back the psych, it's really hard to, let's say, you trained really hard one day and your arms are wrecked and your fingers are wrecked and you're trying to figure out the next day. Like what I do now is I have all these different options, like I have, like workout A, b and C, you know, for the upper body. I have today's a yoga day. I'm going to do yoga or I'm going to do a run or I'm going to do some type of cross training. That gives some variation and I think, not having that zero to a hundred miles per hour like speed of more, having all these different options to pick and choose from, so you're not always trying your hardest.
Speaker 2:It's like, oh, I'm doing a volume day, I'm going out and just climbing a bunch of routes, having fun or making sure that I have a smile the whole time I'm climbing, I'm joking around with my friends or whatever it is. So I think, having these options that you're really comfortable with and saying, okay, my body feels like this, my mind feels like this, I'm going to have this type of day and be able to select that um really helps, and whether that's within the sport. You know I'm bouldering, I'm going to speed climb today or you know I'm going to.
Speaker 2:yeah, good luck on that, you know I'm going to you know I'm going to, I'm going to climb some routes or something like that and having that variety, um. Or you know, slab climbing I'm going to say slab day, oh man. Or having these different options of yoga, mountain biking, running. I think, holistically, that really helps. I think where there is the challenge is performance, is this fine line between injury and then excelling or performing, and I think that to perform at a high level you do have to straddle that line. But if you're climbing trying to have fun and trying to make a sustainable life sport, I think straddling that line should come a little bit lower and adding in these other components of some cross training and things like that. So that's what I would tell myself. Now. The question is, would I listen? That would be the better question, but that's what I would tell myself now.
Speaker 1:Yeah, sometimes adherence is always like one of the most difficult things with patients, and especially people who are their own worst patients, which is ourselves.
Speaker 2:Yeah.
Speaker 1:You mentioned your kind of rudimentary hangboard setup. You know, hanging on a doorframe performance, but also as a means to hopefully strengthen connective tissues in the fingers so they can have an increased capacity and resilience for when they are climbing outside. Now, you know, with the popularity of climbing has also come a lot more just information and we now have, you know, we've got minimum hangs, we've got density hangs, we've got overcoming isometrics, yielding isometrics, 10 fives for strength, we've got repeaters, we've got all these different ways in which we can train our fingers. Can you give us some commentary on, you know, some of the nuances in what we should be looking at with some of these different protocols and maybe some of your favorite protocols that you may use or give to clients for injury prevention?
Speaker 2:yeah, I mean, I think I'll start this with saying I see a lot of climbers clinically I'm a physical therapist, right, they come in. Over 40 of them are finger injuries and so that's likely the injury you're going to have from handboarding or fingerboarding too, and so that's likely the injury you're going to have from handboarding or fingerboarding too much. If it's a shoulder injury from fingerboarding too much, you definitely need to change how you train. But most of the time it's a finger injury. And I am less concerned with someone doing repeaters. Is someone doing density hangs? Is someone doing this protocol or that protocol doing density hangs? Is someone doing this protocol or that protocol?
Speaker 2:I don't actually care about that.
Speaker 2:I think that's in the realm of a climbing coach and then I can mitigate the overall time under tension and the overall intensity of what they're doing.
Speaker 2:But what I care most about is what is happening when they fingerboard.
Speaker 2:And I can tell you that, after watching thousands of climbers fingerboard, you have no idea what your fingers are doing when your hands are overhead.
Speaker 2:And I don't know if you remember, like when we were in that in the course in Colorado, in the lab, like we had a lab set up and we had, you know, a bunch of finger boards and everyone was hanging and we had a bunch of clinicians looking at climbers fingers and the amount of variability in where climbers fingers are going while hanging on the same exact 20 millimeter edge is ridiculous. And whether that is associated with injury i'm'm not sure right, but I can say having climbers come in, the more variance I see in a symptomatic hand so a hand that has their pain, you know, in the finger or sorry the more let me rephrasease that in a climber that comes in and has pain in their finger, I see more variance in their finger position in that hand versus their other hand seven times out of ten right, and so this is something where how a climber is hanging to me makes the biggest difference yeah, and we're not really trying to play weatherman and like predict.
Speaker 1:You know? Oh, of course you know. You have this obvious finger split in between your index and middle finger on your right hand. Of course that's why your middle finger got injured. We're just saying, we're just correlating these things and saying, well, like let's do some other tests and see if there's an insufficiency in some of your intrinsic hand muscles, etc. That could have been one of the things where, if you apply more load, this could be the weak point in the chain.
Speaker 2:Yeah, and that's exactly. I think the best way to describe it I couldn't describe it better Is a climber with no pain. They're typically not coming in to see me. They'll see someone like a coach or someone for performance, right, but a climber with pain. Whether it's the pain that's causing the load differently or whether they loaded differently over time and that's what's causing that pain the chicken or the egg what I can clearly say is you're hanging this way, let's say your finger is split, let's push those fingers together, hang again. Does that change anything? And if that makes them stronger, they can hang longer, or decreases their pain, then we are in the right direction. We just have to figure out why they have that variance and there's plenty of variances, that don't matter. But when someone has pain on one side and we see that, that, you know, gives us a further investigation.
Speaker 2:So I'm not big on. Like Climber comes in, they're like. I'm doing seven, three repeaters. That's my program. I have pain in my finger or whatever it is. We don't have to change your program per se. Let me see what's happening when you hang. There are some basic principles and we could probably spend like hours talking about just the nuances of you know time under tension and how long should you load and all those different things.
Speaker 1:and let's not even talk about the different unleveled edges and all like every single nuance right, and we spent a whole day on just fingers and we were all like I mean, there was more to talk about at the end of that day, in that course, you know no, you mean in the yeah, the course in colorado, right, yeah, and so, oh man, when I first, when we first taught that course, yeah, there was, yeah, there's.
Speaker 2:That was the trimmed down version per se. Um, but but what I can say, which is quite interesting, is, you know, you're well aware of, there's two different types of isometrics. There's isometrics that, for example, hangboarding, where you're isometrically holding, you're holding, you know, one position, but because of your body weight, your fingers are opening up. So that would be, you know, for example, it's called a yielding isometric. Your fingers kind of yield with that pressure, and Tyler Nelson's done a very good job, lots of podcasts describing this in detail. And you have the opposite, where you have something fixed, and for this I would say, you imagine there's like what I normally do is I set up like a lashing strap and a portable fingerboard, like attached to a pull-up bar, and that's not moving at all, and the climber's elbows fixed on a table, and then the only thing they're doing is flexing their fingers downward against that fixed object, and so that's, you know, what we would then call an overcoming isometric. You're trying to overcome that fixed object and there are differences between those two that I do talk about quite a bit with climbers that are injured or looking to prevent injuries from potentially occurring.
Speaker 2:Obviously, you have more passive elements when you're hanging and you have some more active elements when you're engaging your fingers, you know. So the yielding isometric is more passive and passive tissue is getting stressed, stressed, and then the overcoming is a little bit more active. It's more concentric, but either, aside from that, it's the variability I find so important. So, if you can give your fingers different stimuli, do some overcoming, do some yielding, utilize different sets and reps, utilize different holds and make yourself a little bit more holistic. That will prevent overuse injuries.
Speaker 2:Because what's overuse? That is, using the same exact hold, the same exact position for the same exact time and duration multiple times, for the same exact time and duration multiple times. And uh, there's some quote on what's insanity and that's a little bit of insanity is, uh, is not changing and varying your training load. So I don't know if that was a mouthful, but I'm kind of on the kind of the line of just do a bunch of different stimuli to your fingers under controlled load, when you're non-fatigued, and you're going to be able to then give yourself the most resilience in, you know, in different environments.
Speaker 1:Um so yeah, and I love the idea of variability when it comes to training for climbing, and you mentioned that. You know a lot of people are already on the hangboarding train. You know we're training our fingers when we're on the wall. We're training our fingers when we're off the wall. However, some days we go into the gym and it's like, oh, my fingers feel like crap today, like I really don't want to do this.
Speaker 1:Or you mentioned cross training earlier as well, and one form of kind of cross training would be just resistance training, like strength training, which I think kind of is a little bit undervalued by a lot of climbing populations, partly because we want to be really specific to climbing and we want to get better at climbing, and one of the best or the best way to do that is to go climbing right. However, there are other things and other types of training that we can utilize to improve our climbing skill and potentially reduce the risk of injury, and that would be something like strength training, right? So what kind of strength training do you think would be beneficial for climbers? I know people could say like, oh, weighted pull-ups obviously would be a great thing to do, or working some of our small muscles, like our rotator cuff. What kind of stuff do you think about when you think of strength training for rock climbing?
Speaker 2:Yeah, I mean, I think the key is I've had plenty of people come in and they've initiated prehab programs or strength training programs for prevention and they've hurt themselves doing the programs, which is like, oh no, that's like the last thing that you want, right. Um, and so one of the things that's important, you know you want to target the appropriate muscle groups and those are either the ones you use for climbing or the ones you don't use for climbing. That's essentially like our two groups and you could say agonist, antagonist, but really in the end the key muscles we utilize when we climb are in our upper body, are typically pulling muscles right Typically, unless you're doing like mantle marathon and you're using your triceps quite a bit but we are using all of our oppositional or other muscles when we climb just in other ways. And so one of the things I teach climbers quite a bit is we do want to use some of our same muscles we use climbing, but use them in a different manner, so giving them a different stimuli. So, for example, when we're climbing we're pulling down you know, our arm down and back a lot of times. You know it's using, like, our lat muscles and it's using our middle trapezius to kind of pull our shoulder blade back, and if we're identifying an injury prevention program and we're not trying not to overload the tissues, one potential option would be to do something completely different using those same muscles.
Speaker 2:So, for example, like a letter t exercise, where you're kind of bent over, your arm is straight and you're pulling back into letter t. That does not look like climbing, that is completely opposite of like what you're actually doing. If you make a letter T when you're climbing, you're literally falling off the route, unless you're like in a dihedral. But that may be some type of sustainable low level exercise that is not going to over fatigue the muscles that you use or utilize with climbing. So those are exercises that I think are quite helpful. Utilize with climbing. So those are exercises that I think are quite helpful.
Speaker 2:And then, on the contrast, you do need to train the movement you are using when you're climbing. And so that's then when you have adequate rest and you're able to load significant weight. Why not get some rings, put your body inverted, kick your legs on a chair, you know know and work on some unstable rowing, you know, kind of pulling your, your chest up, you know you're kind of inverted a little bit and maybe throw some little portable fingerboards, rock rings on there, and now you've got something that really simulates climbing and really work on form, technique, position, thinking about those muscles. And now you have plan a and plan b. Right, you have your. I'm training these muscles, I'm fatigued. So here's a very safe, non-overused stimuli and, oh no, I'm very well rested. Here's something that really hits those, that's climbing specific so. So I find that it's helpful to have both of those, and some people may say a letter T is garbage, like doing that is worthless and that you know, maybe it improves your posture but it does nothing for climbing.
Speaker 2:But I think stimulating those muscles in different ways actually goes a lot further than people think.
Speaker 1:Yeah, and then also, you know, keeping the body close to the wall. You know, I know some people will talk about that vacuuming type of style I think aiden roberts will talk about this where they almost, like, suck their chest and hips into the wall but you have to engage those same muscles that you're using in that t exercise in order to bring your body close to the wall. So a lot of these different movements that we can utilize for strength training can be really just climbing in disguise, you know, such as your, you know, inverted ring row exercise. I mean, if you're having difficulty with roof climbing or roof boulder problems, gosh, what a great way to be in a specific position where you're still working against the plane of gravity, in that same orientation, and you're strengthening your shoulder girdle. You're still working against the plane of gravity in that same orientation, and you're strengthening your shoulder girdle, you're strengthening your core, etc.
Speaker 2:Yeah, and it's scalable, right, Because you can go 25, 35, 45, you know, or say, hey, jump on a roof and find two jugs and kind of pull back and forth. Yes, you can absolutely do that, but it's a little not as practical, you know, to consistently reproduce, so yeah, so there's a bunch of options and opportunities, but I think for climbers, coaches, clinicians, you know listening that having exercises that look and feel like climbing and exercises that don't is kind of a good thing to have both and be able to juggle both of those as needed.
Speaker 1:Yeah, I actually had a patient recently who was trying to get back into climbing. Previously it was a pretty high level climber, like climbing 513 and rifle. I talked to him before this and, you know, made sure that we could talk about some of the things in his case and we did that just nice, like endurance, hang at 90 degrees on jugs, and he was complaining of shoulder pain and I just saw his shoulder, you know, creep up and then to the side pretty classic sign, something that you were talking about. At the very least even he could see the asymmetry side to side as he fatigued. Now, in the short term when he was doing weighted pull-ups he could literally.
Speaker 1:He was like, well, I mean, everybody can do five pull-ups, you know, and I'm like, well, you know, I know some people, you know, and he was able to train and do a pull-up with a 45 pound plate. But then when we challenged his endurance, we saw some of his stabilizing muscles really like fatigued quite quickly and then doing something like an IYT exercise, you know, he was really like fatigued really fast, something that you wouldn't expect for somebody that had such a capacity with something like a pull-up. So then I threw up and I've thrown in some DNS stuff and his coach is changing up some of his programming as well to work on some of those accessory muscles. And I think actually they're doing some, some t exercises too, until all the haters of the of that exercise you know yeah, it's interesting.
Speaker 2:It's like the the entire injury prevention, performance, rehab, injury reduction, like this whole scene. Uh, through the years you goes through these ups and downs of, oh, don't do this, don't do this as terrible, this is the best thing, and then everything like comes back full circle. Um, oh, wall angels. Wall angels are terrible. That's not like climbing, it's like actually some benefits and maybe it's not like climbing, but you know those other 20, you know 16 hours maybe during the day when you're sitting at your office chair. Uh, that may open up your shoulder girdle a little bit more. So, anyway, yeah, I think it's interesting, kind of, um, and you mentioned that there's a difference between strength and endurance and being able to test and see that and what you're mentioning, that 30 second hold, seeing the scapula elevate, is, yeah, you see that all the time, and especially towards the end of like someone's endurance cycle and so like it's like 25, 26, 27, 30 seconds, you start seeing these compensations come out.
Speaker 1:So that's quite interesting um, speaking of things that have ebbed and flowed, I guess, in popularity, one thing, especially with amongst climbers, is like core exercises. So some people really put a lot of emphasis on training the core and strengthening the core. Some people you know maybe don't put very much emphasis at all when it comes to core exercises. I mean, you could write a whole book on core exercises themselves and some of the crazy stuff you see people doing in the gym for core exercises and core exercises range from doing stuff like crunches to Russian twists, to all stability exercises to deadlifting. I mean deadlifting is a great thing for the core, right? What's your opinion on climbing, quote unquote core training what things should we emphasize and what are some of your go-to exercises, jared?
Speaker 2:Yeah, I think when we think of the core, the best way I think about it is we have the top, you know the diaphragm right. We have the bottom, I think about it. And we have the top, you know the diaphragm right. We have the bottom, the pelvic floor, we have our oblique musculature and our maybe quadratus lumborum or some of the spinal muscles on the side, and then we have the front, which is the stomach, and the back, which is the extensors. So you have a box right, all different sides, and so core training is quite complicated. And I think especially you know, nick, with your background, we both have a fascination, I think, with DNS and you know a different way or different methodologies, and developmental. You know positions, looking how you know babies move and how they kind of transition and roll. I think is actually quite unique perspective on core and climbing and you've gone through that training quite elaborately. I know you were in Prague right For a course.
Speaker 1:Yeah, that was a really fun time going out there. And actually, you know, I don't know if it's something in the water over there in the Czech Republic, but one of the best climbers in the world is also from the Czech Republic, and so is dynamic neuromuscular stabilization. So I don't know, maybe they've got the core dialed over there.
Speaker 2:Um yeah, well, so yeah, on a dynamic neuromuscular stabilization, or DNS. Um, what's? How would you sum that up, like how that relates to the core and climbing, and I'll kind of build off of that with my thoughts. But how would you tell someone that's like? What are they talking about? What's that acronym mean? What is you know?
Speaker 1:Oh man, and that's that's a really good question, because oftentimes people look at some of the DNS or dynamic neuromuscular stabilization material and they're like what do you mean? Like you're just rolling around on the floor like a baby and that's like it couldn't be further from the truth. I mean, dns is a lens of assessment and treatment and there's no recipe in DNS, just like there's no recipe in good coaching. There's no recipe in good physical therapy either. You look at the individual in front of you and you do an assessment based on how they move, some of the injuries that they've had, and then you try and incorporate, like what that person needs.
Speaker 1:So in some individuals, you know, I do have a patient that I'm working with right now who's a really strong climber. They were climbing like 514 in rifle and a couple of years ago they had a very significant back injury and ended up getting a microdiscectomy, which is a pretty severe back injury. And then they started seeing me after they got another flare-up and for them I was looking at how they moved and how they stabilized their core and for them they were disproportionately utilizing some of their back muscles, so the back end of that core cylinder that you were just talking about. So you know some people will, like you, definitely throw stones at me saying that and saying like, oh, you know, you're just looking at the movement patterns, like there's no evidence to support that whatever. But I can tell you something that he told me was that my back always feels tight. Every single day my back feels really tight and if I climb really hard then it feels even tighter. So I gave him some exercises. One of them that I see that is commonly utilized but, you know, maybe not done in the best way, would be like the dead bug exercise. So this guy way, you know, bring your rib cage down a little bit and have a nice neutral position of your spine and also breathe into your stomach so you can generate some intra-abdominal pressure, which is what we use to stabilize our spine from the front.
Speaker 1:And pretty much immediately when I gave him those cues, his whole body started shaking. Yeah, like the classic, like his central nervous system is trying to coordinate this movement in a way that he wasn't used to. And then what were his complaints when he did traditional core exercises such as planks and things like that? Oh yeah, I was doing those for a while, but my back always hurt while I was doing them and that's because you know one could theorize some other reason or something like that, but in my opinion it's because he was using those back muscles to stabilize during those quote unquote core exercises.
Speaker 1:But when those back muscles stabilize in those core exercises they clamp down on the vertebrae because muscles work by shortening. So when he used them they stabilized his spine, but they stabilized through a compression strategy which in DNS we would call like an open scissor type of position, where you're over utilizing the posterior chain muscles in the back of your back, I guess in the back of the core, to accomplish whatever task you're trying to do. So we're working through a couple of exercises with that and you know, something as simple as a dead bug can take this extremely strong 514 climber and then we can find that functional threshold really fast to the point where he's really shaking yeah, and I think what you describe really well is you're focusing on the movement and the quality of the movement and, you know, putting climbers in specific positions, whether it's you know, the DNS positions.
Speaker 2:we're talking about thinking about that almost like box or cylinder, normalizing all sides of it and then moving the limbs, because essentially that's what we do when we climb, is we have some type of stability in our midsection and then our limbs will move in our midsection and then our limbs will move. Now the challenge is, when we climb, we're not always 100 rigid in our, in our, in our torso, and that's where then we have to build in some level of spinal motion, you know, with limb motion. So I think, maybe in a simplest form, is make sure that the cylinder or the box all sides are equally contributing, make sure you can have an exercise where you move your limbs while keeping that stable, and make sure you have an exercise where you can move that area while you move your limbs. And if you've done that, you're going to have some hardcore exercises that translate to climbing, and you've pretty much checked a lot of boxes.
Speaker 1:Yeah, I completely agree. It's kind of like you know, if you're weak in something, then try and train some of those weak points up to the point where it can maybe become a strength or at least improve your functional threshold. Yeah, all right, we're at about 38 minutes. I've got. You know one way that I usually like to finish my episodes Jared, unless you have a little bit of time to talk to me about growth. Plate injuries.
Speaker 2:All right, let's hit the growth plate. What's the?
Speaker 1:growth plate. We'll hit them quick.
Speaker 2:And is the last thing is it a rap song? Is that how you normally close your?
Speaker 1:It's a rap, but with a W and not an R-I-T.
Speaker 2:All right, what do you want to talk about? Growth plate wise.
Speaker 1:Gosh. So you know, I was actually a coach when I was in chiropractic school. To, you know, get a mostly to get a free membership at the gym, to be honest, but to get a little bit of side cash and stuff like that. And one athlete came up to me one day and they were like you know, nick, I've got this. You know, pain in the back of my finger and it was so severe I could barely even hold a pencil while I was in class and you know the parent wasn't really psyched on me for whatever reason. So they talked to some other people and they said, oh, it's just an annular pulley injury. However, we know you know I saw the eyebrows kind of move on that you know Kids don't really have the same rate of annular pulley injury as an adult.
Speaker 2:However, they are susceptible, they think they do. There's a study by Rachel Myers and colleagues that showed that youth climbers think that every finger injury is a pulley injury. Oh, that's kind of, yeah, it's great, it was a survey that went out to youth climbers and basically, and their knowledge, and so basically, yeah, they think that it's anything that they have in their finger. They're not educated on it. Maybe something different?
Speaker 1:And you know, in an adult person, someone who has had fusion and closure of their growth plates they're done growing, they're not susceptible to an injury to that growth plate because it's literally fused. So but when we're dealing with youth and people that are growing really quickly, you're much more likely to sustain an injury to that growth plate to which, you know, to the point at which you might have actually deformity in that finger that may last for the remainder of your lifetime. So it's something that we, as you know, athletes whether you're a youth athlete or you have youth athletes like if you're a parent and if you're a coach, you've really got to be on your a game when a kid comes to you with finger pain, specifically on the back of their finger, because that's oftentimes where growth plate injuries one occur, but also where they will feel that injury. So what are some signs for a coach or a parent that you can say oh, you need to go and see a provider for this and they need to take at least an x-ray, maybe even an mri?
Speaker 2:Yeah, hands down, youth climber, hand in the back of the middle finger, in that middle joint, go see a pediatric specialist or go see a physician, get an x-ray. But here's the thing the x-ray may be negative. It's fairly common for the x-ray to be negative with an early stage growth plate fracture, and so then you have to monitor training load, make sure you have full range of motion before you start climbing hard again. But one thing on the x-rays I tell us to the parents all the time that come in is there's different x-ray images that you can get, different fields of view, and typically they'll have standard x-rays that they order, and so they'll order, you know, just plain film x-rays. They'll get this lateral view, but we need to ask for oblique images, and oblique images is something that you could say, you know, as the parent to the youth climber. When you go in to see the position, you can show a research article by Brotchi and colleagues that utilize this. But anyway, the oblique view or oblique image can pick up a growth plate fracture that may be missed from the lateral view, and I've had that a bunch of times. And then, if that happens, pretty simple there's an article by Rachel Myers as well and colleagues, that says exactly the step by step process Once you've rested, regain full range of motion, it doesn't hurt.
Speaker 2:Process once you've rested, regain full range of motion, it doesn't hurt. Week one, two, three, all the way to week eight to come back climbing into competition at full level. And there's a very well laid out research protocol. Um, if you have some show notes, maybe I can drop you the link to link that article in the show notes. And and that's that's pretty much super simple pain in the back of your middle knuckle and the middle finger or any of them. Get an x-ray, make sure it stops hurting before you start climbing hard again. Get your full range of motion. And here's your protocol.
Speaker 1:Perfect, I think if you're a coach, I'll drop that in the show notes.
Speaker 2:And if you're a coach that's listening to this, you need to find that article and you need to know that article. Uh, for maybe, not if, but kind of when this happens, you know, yeah, and I'll drop you that article. And then there's another good article, um, on imaging, and talking about this is the one that I give parents to give to the physician, to be like, hey, can we please get some oblique images? It's best practice. I don't know why you're not doing those. So yeah, that last part you know yeah so I just sent those over.
Speaker 2:You can put those in the show notes. Oh perfect.
Speaker 1:Awesome. All right, jared. There's a way that I like to wrap up every episode, and that's by starting with this really nerdy story about Benjamin Franklin when he started the volunteer fire department in Philadelphia and he stated that an ounce of prevention is worth a pound of cure, which is kind of the point of this whole podcast. I don't want everybody to go to the gym and make your entire gym session surrounded by, like, injury prevention exercises. You know going to the gym and do three hours of you know prehab exercises and things like that.
Speaker 1:But, as we both know, a little bit of prevention and a little bit of you know the right things can go a really long way in risk reduction. So we've talked about a lot of different things today. We've talked about being overly psyched, we talked about hangboarding, we talked about strength training, core training, epiphyseal growth, plate fractures all these different things. But if we had to sum up this episode into a couple of minutes, what would you tell the climbing athletes, the climbing coaches and some of the clinicians that treat climbers? What would you tell them for their ounce of prevention for today's episode?
Speaker 2:If you're super psyched on climbing, do less and keep it variable. If you're kind of psyched on climbing, probably do a little bit more and listen to this episode a few times. Go step by step. If you're just not into climbing, you're just getting off the couch. You got to do it a lot more. It's all about finding it's like Goldilocks right. You got to find just that right amount and you know, I think it's really important that we talked about all these different topics.
Speaker 2:Like we talked about fingerboarding, we talked about strength training, we talked about fingerboarding, we talked about strength training, we talked about core, and the one thread through all those topics was movement and observing movement patterns, seeing how somebody moves, and that was mentioned like with you know every single one of those topics. So I think you know, in all seriousness, like climbing is a sport that's all based on movement and there's tons of different movement patterns that you can go through, and so just gaining a deeper understanding of how your body moves and how you can change and modify it on and off the wall, I think goes a really long way. And maybe don't be so stupid and hang from your grandma's doorframe for six days straight.
Speaker 1:That's a clinical pearl right there for everybody that everyone can appreciate. Jared, I know that you've got an awesome book, Climb Injury Free with a lot of information in it, but where can people find you to get more information?
Speaker 2:but where can people find you to get more information? Yeah, so obviously the book is is packed with exercises and rehab programs. But really, you know, go to the webpage, go to the climbing doctorcom D O C T O R. There are tons of free articles up there. If you go to the blog, nick's got one of them on on ankle sprains and how to rehabilitate it, and so if you have an injury and you kind of want to learn a little bit more about it, or if you are trying to prevent certain injuries and you want to learn a little bit more about it, just go to the blog, click on top and there's a wealth of articles from all different clinicians from all over the world, and so that's really, I think, a great resource.
Speaker 2:And there's a YouTube channel, there's an Instagram, there's a podcast, whatever. There's a podcast. Yeah, podcast is great. Next thing, beyond that, the podcast, there's a TikTok page. That is like nobody ever goes to it. So if you want me to keep putting stuff on there, maybe go there and like it or something, but I haven't figured out the TikTok thing honestly. Like I haven't figured that out. Instagram doing okay on, but TikTok not sure what's going on there. So you can find me plenty of places, just the climbing doctor, you can check it out.
Speaker 1:Awesome. Well, I highly recommend everyone go and check out these. Honestly, the amount of resources that have been compiled on jared's website, youtube channel, instagram page and I guess tiktok as well I mean it's growing every single day and gosh, I mean there's no I I haven't gone through all of it. I mean I'm just waiting until I have a couple of spare hours to go through that Evan Ingersoll article on climbing modification.
Speaker 2:Oh my God, it's, so good, it's so good.
Speaker 1:So if you only can look at one thing, you know, don't look at my ankle sprain article, cause nobody cares about that. Maybe we'll get people psyched on ankle sprains when.
Speaker 2:I look at it when they, if they sprain their ankle.
Speaker 1:That's the thing, yeah, yeah but uh, jared, thank you so much. I know that you're an extremely busy guy. I see you in pretty much every realm of physical therapy and especially with climbing. So thank you for taking the time out of your day to go on this podcast and talk to us a little bit about injury prevention and giving us some of your key insights about injury prevention. So we'll talk again soon and thanks again.
Speaker 2:Thanks for having me on, it was fun.
Speaker 1:I hope that you enjoyed this episode of the Art of Prevention podcast. I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy and or benefit from some of the information in this podcast, please be sure to like, subscribe and share this podcast, or please give us a five-star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No patient is formed, and if you are having any difficulty, pain, discomfort, etc. With any of the movements or ideas described within this podcast, please seek the help of a qualified and board-certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, etc.