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
Unlocking Climbing Potential: Injury Prevention and Rehabilitation Wisdom with Anna Chang DPT
Ready to unlock the secrets to climbing injury-free? Join us as we sit down with Anna Chang, the visionary behind Onsite Physical Therapy, who started her own climbing specific physical therapy clinic after graduating in 2020. Anna shares her expert insights on injury prevention for climbers, recounting her personal experience with a finger injury and how early intervention can prevent minor tweaks from snowballing into major setbacks. Whether you're dealing with a persistent pain or just looking to stay ahead of potential injuries, this episode is packed with actionable advice from a true expert in the field.
Our conversation doesn't stop at injuries; we also venture into the critical role of the clinician-patient relationship in successful rehabilitation. Anna sheds light on the power of motivational interviewing and how it can be pivotal in reaching patient goals. We discuss the varying healing timelines for different tissues and the fine art of load management, all while referencing cutting-edge research on shoulder stability. By deeply understanding these nuances, you can better navigate the balance between pushing your limits and staying injury-free.
But wait, there's more for the climbing aficionados! We explore the often-overlooked aspects of hypermobility and how tailored physical therapy can enhance climbing performance. Anna’s diverse background, from Krav Maga to biomechanics, offers a unique perspective on strength and power training, fluidity in movement, and even nerve compression issues like numbness. Whether you’re scrutinizing your technique or strategizing your next route, this episode is your guide to climbing smarter, stronger, and safer.
Reach out to Anna for more information:
Website: https://www.onsightphysicaltraining.com/
Instagram: @onsightdpt
If you have listened to this podcast for any length of time you know that strength training is crucial for runners. However a major obstacle for many runners is not know what to do once they get to the weight room. This PDF seeks to change that. It will arm you with the tools you need to effectively strength train to get the most out of your runs.
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Hello everyone and welcome to yet another episode of the Art of Prevention podcast, and this episode goes on to, or continues, the climbing specific content that we've been putting out recently. So today I'm sitting down with a very special guest, anna Chang, and we're going to be talking about climbing specific topics. However, many of the topics that we do talk about, such as strength training and hypermobility, things like that will be something that everyone can take home and everyone can benefit from. We're going to be talking about a lot of actionable tips and tools that can be used both on the wall and off the wall to both prevent as well as mitigate injury prevalence. So, anna, thank you so much for being on the podcast today sitting down and giving me some of your time. Can you tell us a little bit more about yourself? I know that you're out in the Seattle Tacoma area and that you are the owner and operator and the person that started Onsite Physical Therapy.
Speaker 2:Yeah, so thanks for having me, nick. I have had the business for about three years now, started in 2021. And part of the motivation was that I had graduated from physical therapy school in 2020 and realized that the conventional health care system was not doing people in general, but then also climbers or athletes any favors, because we were just checking boxes and trying to meet certain numbers and I realized that it just didn't apply to athletes who wanted to do something more with their bodies than just walk out of the clinic. So I opened a cash-based business so that it can you know, we're cutting out the middleman, because I also realized that insurance companies are not always the biggest advocates for our patients. And you know, three years later I'm working at a clinic with a grasshopper board as a tool for movement assessments and then also traveling to local gyms and doing PT there.
Speaker 1:Awesome. I bet that's been a pretty fun ride and I bet a pretty rewarding ride too, because I've seen that as well, where people kind of get input into the system, get that kind of insurance based model of of really short-term care or really not that one-on-one specialized care. And with climbing we see a lot of really specialized injuries that we aren't taught about in conventional school. So you have to be really motivated to go out and do your own learning and stuff like that, and that's kind of how we met right, exactly, yeah, we learned that.
Speaker 2:I'm sorry we met at a con ed course right by, was it Kevin? At the climb clinic and Jared, jared, begge yeah. Yeah, yeah.
Speaker 1:Which was an amazing course, and I had Jared on a couple weeks ago and that was just a great interview as well and you started climbing while you were in PT school.
Speaker 2:Yes, yeah, so that was where I I was learning the general body mechanics of the human body, but then also my classmates were teaching me how to climb, one for stress relief and then two just because, you know, that was a thing that they had been doing for a long time. And I just I got hooked because I realized that it brought different types of people together and it just clicked at that time.
Speaker 1:And in our pre-recording phone call you told me you haven't really had any major climbing injuries. But one thing that's really even better than that is you've had some tweaks and you've been able to keep those tweaks from becoming really big setbacks and really, really big injuries. Can you tell me more about your process in doing that?
Speaker 2:Yeah, so that's, it's the type, the length of recovery. That's key. So let me tell you a story. I actually was a, you know, teaching fitness class at one of the bouldering projects and my partner was upstairs climbing. You know, he had already warmed up and had been climbing for about an hour. I went upstairs and I think I think the pinks are some whatever pinks are supposed to correlate with grades.
Speaker 1:Wise, but regardless we'll say it's v14, like your usual. Oh yeah, exactly um, yeah.
Speaker 2:So he asked me to help him figure out the problem. Um, because he was stuck and wanted some beta for it, and so I was like, sure, why not? I'm not gonna make it up this wall. And you know, I get up there and almost flash it, except I fall at the second to last hold and it was this tiny little crimp and my finger was tweaked. I had another word in my head, but you know we're trying to make this PG-13 here, but I think climbers can understand that when they come off the lawn, oh no, I'm injured, you know what's going on.
Speaker 2:Anyway, I actually had to go to Squamish a few days later and I wanted to be able to climb outside with all of the clinicians there and I was just panicked. I was like I I should have warmed up, I shouldn't have even tried this climb without even doing something. But just because I was careless for a single moment, I was injured for a few days afterwards.
Speaker 1:And what are some of the things? Like obviously you didn't necessarily start treatment like right away, like you didn't go and just start your progressive loading protocol on the hangboard or anything like that. What are some of the signs that told you, hey, I need to take this seriously and keep this from becoming a really big injury that would set me back and ruin my season, and things like that.
Speaker 2:Yeah. So pain is always going to be a huge motivator for us human beings. It's our nervous system telling us hey, you got to pay attention to this body part. So it was pretty painful. I my finger was swollen, my range of motion was limited, I couldn't flex or extend my fingers completely and me being a hypermobile person, like that is, I can see a huge difference already if I just can't even activate those muscles in the hand. So I realized okay, you know what, I just can't climb for the rest of the time, like I. I made a boo-boo, didn't warm up, I'm not going to push through it, and usually timelines are key here. So you know I don't want to give specific days or months for people because everybody heals at a different time, but that generally you know, if something so acute happens like you just got to call it there and not push through it, because then you know you're gonna, your journey to recovery is going to take much longer.
Speaker 1:Yeah. So I think some of the key points from what you told me were lingering pain after getting off the wall, so you have that like, oh yeah, like that hurt, and then you had lingering discomfort, and then also observing the area and seeing swelling redness, lack of function, so lack of range of motion or lack of strength. All of these are indicators that, hey, we need to like chill out, probably in the session here, see how we're feeling in the next couple of days. So what did you do over the next couple of days as far as working, range of motion and things like that, to set yourself up for success? So then you could still climb at a higher objective time, which would be that time in Squamish.
Speaker 2:Yeah, so it was helpful for me to know that, okay, I had definitely strained a finger flexor, um, knowing that was okay, I just need to deload, uh, not climb on any more crimps, um. But that didn't mean that I wasn't climbing in general. So I actually did go back the next day, um, to the gym and I worked larger holds, uh, jugs, slopers tend to be okay and then made sure that I told my body like, hey, you need to work those global muscles too. So my immediate response, as with anybody who can get injured, is that, okay, I just can't move at all, I need to rest, I need to lay in bed like a mummy and wait for this thing to recover. And that was, you know, it took a little bit of discipline to realize, okay, I'm going to give myself.
Speaker 2:You know these pain scales are not can be outdated, but they are very helpful. I use the visual analog scale for myself because it was objective, knowing that. You know I had emotions tied into having to go to Squamish, and so you know, visual analog scale can go up to 10, 10 being the worst pain you ever felt, zero being nothing Typically like. If it's that really acute injury. It can go anywhere from a seven to 10. I mean, and then when you're exercising so when I was doing range of motion and just kind of some finger glides I kept it at a three or four out of 10, because if it was at a zero or one which is what you know conventional physical therapy will have you expect like, okay, get rid of pain, shouldn't feel any pain at all, pain, pain, pain. Actually, you should feel a little bit because you're still activating that area, but you can keep it in a moderate zone.
Speaker 1:And I always like to tell my patients to use the traffic light metaphor, so like green would be zero pain during, zero pain after an exercise. A yellow light would be. You know, maybe you have a little bit of pain during, so going up to that three or four, but then after that exercise you don't have any lingering pain. And then a red light like you need to stop that exercise, going up to like a five to obviously a 10 on the pain scale or that lingering discomfort afterwards. And I think that's a.
Speaker 1:That's a big key for me, for a lot of people, cause sometimes people get pretty amped up while they're on a climb or on a boulder and they're all excited, like yeah, or like runners are even worse about this like yeah, I'm on my run and it's, it's great. And then it's like okay, how'd you feel after that you got off the boulder, after you got done with that run? It's like, oh, I felt terrible. And it's like, okay, well, that was a little too much. So we need to, we need to calm it down, we need to measure a couple of things for the next training session, and then were you able to climb in Squamish.
Speaker 2:I was actually, yeah, um still, and it helped that you know we were talking about finger injuries at the symposium, but um kept it easy. You know I didn't try too many hard boulders because you know there's the that's also a difference in climbing, where bouldering is going to be a lot harder on your body than you know rope climbing. And so you know I, even though I did climb every day that we were there, I tried to, you know, periodize so like reserve the days where I was fresh and I could commit enough time to warm up on boulders, time to warm up on boulders. Or if I knew there was a social event where all of us were going to go out, then I made sure that I had the discipline to say, okay, I'm not going to go do a big wall than that day before yeah, and I think that's something that's really important.
Speaker 1:I was actually talking to the other on-site on-site movement, aaron Simon, and that was a really fun interview and he talked about people that go out on these climbing trips and then they climb every day. But when they're climbing every day, they just climb until they cannot climb anymore. So in some instances, if you're really cognizant of the loads that you're placing on your hands and fingers, it seems like you can climb with a pretty high frequency, as long as you're mitigating risk by measuring what you're climbing and then being intentional about it. Is that sort of summing up what you're saying?
Speaker 2:Yeah, I would say so. I kind of think of it.
Speaker 2:It's really hard to talk in like polarizing terms, but you know, it's kind of an inverse relationship, right, where you can have high frequency but you got to decrease the load. Or you can have high load and you got to decrease the frequency. Part of that is based in a physiologic principle. So where you have your, let's say, slow, twitch and fast twitch fibers, right. Or people are like, oh, I'm going to stay in zone two because that's going to get my heart rate up and I'm going to be able to, like, get in shape that way. But the thing is they both have different levels of fatigue. So how I orient my sessions are is I will work on endurance for everybody. One is a good warmup to it's light load. Three, it's to see if people can take instruction pretty well, right.
Speaker 1:Nice, I love that.
Speaker 2:Especially for, like, repetitive motion. It's like you know, if you walk into my clinic and you expect to like tell me what is gonna happen, then I'm like well, why are you here then? Cause that's a little bit of a motivation interview that, like, a lot of clinicians miss because they're just like well, let me just see the numbers. Actually, I just went on tangent here.
Speaker 1:Well, I like that I like that interplay between, like patient and clinician and that is, like you know, establishing that relationship and doing those motivational interviewing techniques can be so crucial in motivating the interview and motivating the patient. So if you're a patient that's out there and you're like looking for advice or trying to get advice, like, listen to your clinician, but you know, also let them know what your goals are and they can cater your rehabilitation to those goals, and that's what motivational interviewing is all about. Oh, do you want a boulder? Okay, well then, we should work on a little bit of bouldering and we're going to get there. But first we might need to do some of this stuff and we might need to do some load management, which may include some low intensity stuff, if you cannot handle higher intensities at this time.
Speaker 2:Exactly, yeah, I mean typically there's. You can't do a whole lot to the finger itself while you know. If it's an acute injury, you can run some assessments and but typically people are restricted by pain. Um, I you, you can run some assessments and but typically people are restricted by pain. So the other goal is to make sure that you come out after the healing timeline, the typical healing timeline, and for muscles it's typically four to six weeks, right, um, and then for ligaments it's six to eight, and then for bones it can be eight to 12, right, just to keep the numbers easy, not to say that this is a hard you know.
Speaker 1:Yeah, I mean, like we said, you were able to climb in Squamish a couple of days later and that's because you had a pretty low threshold injury. It wasn't like you ruptured a finger flexor tendon. It's not like you had a chronic injury that then got worse by something like that. Oh, I strained my finger flexor, I need to do some load modification. And then, bam, a totally different healing timeline from the ones that we see in the textbooks. But that was the healing timeline that was adequate for your specific tweak. We can call it.
Speaker 2:I do want to talk a little bit about what load looks like for different people too. So we kind of started with the conversation like this. But load means whatever you like. We have the overload principle right. So your body will adapt its ability to meet the requirements of your exercise if you, you know, have the right timeline and you introduce the correct load.
Speaker 2:Any more than the like, the load that you've been used to lifting or you know, whatever max grade that you're at, will can tip you over into that injury prone zone. So, but if you're too light and you're just working, you know, external rotation with a band down by your waist, not to say that that's a bad exercise, but it's not necessarily meeting the demands of our sport. So, you know, there is an article I think it's out of the Czech Republic where our shoulder stability, the muscles that are necessary to activate, tend to come from 90 degrees of abduction, right, and then I can't remember the number of external rotation, but this means that our arms have to be up overhead in order to engage the right muscles for climbing.
Speaker 1:Yeah, and I mean that just makes a lot of sense. It's like if we want to have specific adaptation to impose demands. The Hans Selye principle I love like that was like a big piece of my undergrad training, was like a lot of exercise.
Speaker 2:physiology yeah, but you know I didn't have that background. So this is all really, really fun stuff to incorporate and then make it into like a palatable way for people to understand about their own bodies.
Speaker 1:Oh yeah, what was your undergrad in English, english what?
Speaker 2:Yeah, and then you went straight.
Speaker 1:Like you, took a couple of prereqs and then went straight to PT school to PT school.
Speaker 2:No, I worked for a little bit so I actually did so. The order was I graduated from undergrad early and then I realized, well, I want to go. I was one of those people that want to go to med school. And so I thought, well, I should probably work a little bit, figure out who I am, earn some money so that I can pay for these applications. And then actually I played to med school, not PT school. I was fighting at the time, so I was like I just want to fight and work.
Speaker 1:And then Like in the streets, or what kind of fighting style are you?
Speaker 2:doing it was Krav Maga.
Speaker 1:Okay.
Speaker 2:Do you know what it is?
Speaker 2:No Similar to like Brazilian jujitsu, or I'm just not super familiar with that stuff. Yeah, yeah. So, um jujitsu, it does use some jujitsu, but basically what it is. It's the israeli secret army created it and the goal is to get yourself out of a bad situation. So it'll take all the useful bits from different martial arts you got jujitsu, you got taekwondo, you got muay thai and you combine them to um, you know, read, have situational awareness, read, read what's going on, match whatever you're capable of for your physique and then, uh, train the untrainable area. So we, we targeted the eyes.
Speaker 1:I was about to say wow, that sounds a lot like climbing.
Speaker 2:And then you're like then we target the eyes, you know For sure.
Speaker 1:But I mean all of those things that you discussed are regarding like movement patterning and situational awareness. That all sound and like using your body type to your advantage on certain movements or opponents. That sounds all exactly like climbing. So it really sounds like it set the stage and sort of this foundational awareness for movement that you then took into PT school yes, exactly, and I mean I.
Speaker 2:this is why I get so frustrated, if you will, or emotional about when I hear athletes saying, oh well, you know, I just, they just watched me bend and straighten my knee 500 times if they got an ACL tear or you know, they massaged me and like, but that's not really teaching you how to use your muscles, and especially in the way that you need to get back to your sport. And so I have seen a lot of athletes who, like, it's been 10 years later and they're like, yeah, I would love to, you know, play soccer and they can't jump anymore because their bodies have healed technically but they haven't really, like, taught themselves how to to go back to that movement pattern.
Speaker 1:Yeah, I totally agree with you, and there are definitely levels to that game as well where it's like, okay, we can look at your full range of motion in some maybe post-op joint or post-injury joint like a knee.
Speaker 1:But then it's like, okay, well, how do you incorporate that joint now with the other joints above and below? And then how do you incorporate that into global with the other joints above and below? And then how do you incorporate that into global movement patterns, whether that be running or rock climbing or Krav Maga, brazilian jiu-jitsu, soccer, etc. So you want to have a therapist that knows at least about movement and watches you do your sport, watch as you do movements, and can pick out these little details and they can see like, oh, like maybe your knee isn't working very well because the hip isn't working very well or because the foot isn't working very well, etc. I think that's the one of the things that really separates or distinguishes like good from great in the physical therapy realm, because a lot of my mentors, some of the things that I see, is that they're like incredible at figuring out those little things. When did you get the hypermobility? Or when did you figure out that you had hypermobility?
Speaker 2:You know, I don't know, actually I would say it's probably a year into having my practice, uh, where I was had one patient who had Ehlers-Danlos and they had been diagnosed via genetic testing. So that's typically the only way for you to really confirm. But, um, you know, I was measuring their range of motion just because that was like their first visit and I realized that their elbows hyperextended, just like mine. So, um, that's interesting. And then all the injuries that they talked about happening. So you know, a lot of like hip flexor strain because they would hyperextend their knees, like that would. That would happen to me too. And I say strain because to me they never really felt like injuries. They weren't enough to like lay me out for a whole season but because and I think it's because I had the hypermobility to start with had the hypermobility to start with.
Speaker 2:So you know, typically in the order of operations for therapy there you want to address the pain right, and then you want to address, improve your range of motion, and then you can build strength, strengthen, typically like those three phases that PT focuses on, and then insurance cuts you off and you're like tired of going three times a week for six weeks, and so you know, but there's a fourth step out of there and I think Jared has like a triangle there. But for me it's always been power right or like the explosive, like return to sport aspect of therapy and I would always skip. So for me, you know, like the pain would be very, very short lived. Range of motion was always there. I would have to. I realized I had to work on strength training and that's when my body felt its best and then it's really fun to do power. So that's usually your sport.
Speaker 1:Yeah, and for, for those of you listening who maybe aren't aware, mobility or flexibility, both of these things exist on a continuum amongst us human beings. So you can be somebody who is right, smack dab in the middle and you have just normal mobility and you adhere to normal range of motion principles. You can also be somebody who's a little bit stiff, a little bit tight, like that's where I am, so I'm like a pretty tight person, and then you can be somebody who has hypermobility, or you're very flexible, very mobile, and then, on the clinical aspect or this clinical paradigm, if you will, for pathology or pathological quote unquote, you will for pathology or pathological quote unquote hypermobility would be Ehlers-Danlos syndrome and that Ehlers-Danlos syndrome is initially found through this thing called the Baton score or Baton criteria, where you look at the flexibility of joints. So if I'm taking my wrist and then I'm bringing and I'm trying to and I'm flexing my wrist forwards and then I'm trying to bring my thumb to my forearm, obviously like people with normal mobility are like me, who's like pretty stiff, there's no way you can get yeah, you're pretty dang close there. There's no way you would have to break my thumb in order to get it to touch my forearm, anna, you're like a quarter of an inch away. Somebody with Ehlers-Danlos syndrome is just easy peasy, just bringing that thumb all the way back, and then some other aspects of that score would be straightening the elbows.
Speaker 1:People with Ehlers-Danlos or hypermobility would be able to straighten their elbows past a straight line. Same thing with the knees, and then typically these individuals also can like stand with straight legs and then put, like their elbows or their palms on the floor, none of the, none of which I can do because I'm a little bit stiff. So when we have hypermobility, that sets us up for specific types of injuries. A lot of times it's be like dislocations and things like that, which I'm surprised that you never had. Any. Shoulder dislocations, oh well, there it is right there Bilateral or just one side, recurrently.
Speaker 2:Uh, let's see here. Uh, bilateral, but then I can I mean, I've worked on my shoulders enough so that they, like I, can still feel that separation. So usually, like we would do a distraction test to see how much separation between the collarbone and the humerus right there's, like a certain number where you can pull and then feel, okay, that's a lot of laxity.
Speaker 1:Yeah, and that that distraction test for people listening. Basically the person's just sitting up, the clinician grabs their humerus or their upper arm bone and then they lightly pull downwards. And people that have had a lot of dislocations are more susceptible to more dislocations. So you'll actually see that shoulder almost dislocate a little bit. It'll kind of like slowly come out of the socket, which is obviously not something that you want. And that clinical score is basically like as long as that shoulder is staying in there, you're probably okay, and if it's moving out of there really easily, then you might want to do a little bit more to check it out. So sorry for interrupting you there, but oh, that's very helpful.
Speaker 2:I like to. I sometimes just make it kind of like draw generalizations, because I am used to explaining these tests, but that's the O'Brien's test and I will say I want to interrupt and say like there, it's usually painless that motion, right? So a lot of times clinicians are looking for pain responses when that's not going to happen. Sometimes, like you know, you said oh well, you've probably haven't had any shoulders dislocations. I'm like well, actually I have, but it didn't hurt, so it's not injury, right?
Speaker 1:Kind of like what I just did Like oh, you're hypermobile, so cool that you haven't had any shoulder dislocations. You're like actually yeah.
Speaker 2:Yeah, yeah. So it's really really easy to skirt on their radar, um, because, especially if you don't know what you're looking for either, you know um.
Speaker 1:so you know what I found to be really ironic in my hyper mobile patients, people that are a little bit higher on that uh, by bait and score, or biting score is um, they always come into me and they tell me I feel tight, but I'm stretching a ton, and for me that's. I'm always like, guess what, you should stop stretching now and you need to do more strength and stability training and then, once you've done the foundational work there, then work on some power training and I'm like, look, I can tell you right now you are not tight. You know, like these people that are like a lot of them actually gravitate towards things like yoga and things like that because they're inherently like amazing at it, Because genetically they're just very mobile, right, Whereas me, I go to yoga class and I have a terrible time because the instructor is just like okay, we're actually supposed to be touching the floor now. And I'm like, yeah, you don't have enough blocks here to like let me touch the floor. So, like somebody like me who hates stretching, I have to do it every single day in order to get like closer to normal, like hip range of motion or hip mobility, Whereas somebody who's hypermobile, they gravitate towards stretching because they're just already good at it. What do they not gravitate towards?
Speaker 1:All the things that you said have been really helpful for you, such as the strength training piece, you know. So strengthening the musculature as opposed to just stretching it all the time, Like I mean, what's the muscle spindle or mechanoreceptor response to stretching? Oh, tightening up it's. You know, that's the, that's the literal neurological response to stretching something for a short period of time is those mechanoreceptors tell the brain we need to tighten this up and protect the area. So it's ironic that you kind of mentioned that you kind of gravitate more towards the strength training and power aspects, where I see a lot of people come in and they're like, oh, I feel so tight, but I've been stretching so much and I'm like, actually you need to do more strength training.
Speaker 2:Yeah, and that's definitely part of the education, I think. But I wanted to also. Let's see, why can't I remember things? It's the end of the world today.
Speaker 1:Yeah, I know I was like how about at the end of a long day of clinic, we do a nice recording.
Speaker 2:No, this is good, this is gets me fired up again. But what I, what I wanted to talk about too, is that like it doesn't have to be. I'm trying to disband the idea that you have to be lifting 300 pounds in order for it to be strength training. Right, a lot of my clients if they are hyper mobile. I kind of talk about the different types of muscles.
Speaker 2:Right, we got the slow twitch, the fast twitch, but even before that, when we're in the strengthening phase, you know you want to talk about the postural muscles versus the like ones that are concentrically, like the ones that you're contracting when you're actually trying to move, like the ones that you're contracting when you're actually trying to move, and a lot of times I mean on either spectrum, people on either spectrum can't really differentiate.
Speaker 2:It's like either okay, I'm going to stay stiff because I need to be, you know, posturally aware and I'm trad climbing 5'12 on gear and I just, you know I don't want to fall, so I'm just going to make myself into a rock versus, you know, the muscles that you need to be using for sport climbing, which I am biased towards because it's less hard on my joints than bouldering, although bouldering is just kind of huck for things. You know it's. It's being able to have that control over your muscles and activate the ones that you need that to, you know, strengthen and keep you in place or move you from point A to point B. And then the ones where you can deactivate right. A lot of times it's the upper traps for climbers, upper traps, scalenes, neck flexors, right finger flexors a lot of this flexion because we're just trying to stay on the wall instead of opening up and making sure that our hip, our center of gravity, which is typically our core and our hips, can stay close.
Speaker 1:Yeah, I always. One metaphor, something that I always tell my patients about if they're trying too hard or they're too stiff and thus they're lacking range of motion and lacking ease of movement is have you ever seen Roger Federer play tennis? Right, so if you ever watch Roger Federer play tennis which, if you haven't like, look up a YouTube video of him playing tennis, like right now, as long as you're not driving, or anything like that and what you'll see is probably the most relaxed tennis player, or like relaxed person in the court or stadium, and yet he's still playing and winning at the highest levels of tennis. So, like me, like if I'm trying really hard on a boulder problem, I stiffen up, exactly like what you're saying, like my upper traps, bring my shoulders up towards my ear and I get into these positions where everything just feels really tight because I'm working really hard to stay on the wall but also try and make these moves and generate a lot of force, whereas if I'd had more technical skill and was able to be a little bit more relaxed, maybe I'd actually have more proficiency in climbing and I'd be able to climb higher grades.
Speaker 1:So there is the technical aspect of, you know, still staying relaxed while still putting out a lot of force. So I think that a lot of like, especially like female climbers, exhibit this really really well. Like if you compare like margo hayes and all the videos that she's when she climbed la rambla, versus like watching the videos of chris sharma climb la rambla, like you see like quite different like ability there. Well, I mean, it's like the same exact climb but they just do it in two different ways, right, I mean, luckily for them, they were both like fairly not injury prone individuals, but you can just see kind of the manifestation of what you were talking about about being able to move really fluidly and almost seemingly like not try as hard.
Speaker 2:that's what it seems like, even though they're still trying really, really hard yeah, and that's the problem with a lot of our climbing movies is that the the parts that help people send their projects, are not glamorous.
Speaker 2:You know, it doesn't show them breathing with, you know, diaphragmatic breathing and making sure they're relaxing those neck muscles.
Speaker 2:It doesn't show them warming up, because warming up is off the wall you don't see like a pretty lake in the background background. But those are things that are what makes them pros and then also allows them to do it for their whole life and not just for that temporary. You know that short time, like short part of spring where the weather is nice, but to like continue on throughout the years, and I think that there's a lot to be said for that kind of process, much. And then don't even get me started about how, like the, there's the cognitive piece of climbing right. So we're always so focused on like, okay, I just need to be strong and be a strong climber, when really it's more about energy efficiency. So, if you can plan out your routes, if you can figure out the right beta, right, that's why I was able to get on that random pink climb and you know, do it first go. Um. But because I didn't warm up, my body, my mind and body were not matched up.
Speaker 1:Yeah, totally. And I think there are limitations to my, my Christian metaphor, because he has a ton of technical proficiency. I mean he's freaking amazing Right. But I mean, it just goes to show like different people's expression of technical proficiency can look really different.
Speaker 2:Yeah, and so typically, like in a session, I talked about starting out with endurance. But my reasoning for that? Because I see actually probably 80% climbers at my clinic. I say, you know we're not, I'm not going to let you get on the wall yet. Because I want to see what your technique looks like when you're fatigued. Because if it doesn't become second nature, it means that you're, you know, you're kind of pushing through some of the barriers that your body's putting up.
Speaker 1:And then setting yourself up for compensations and then overusing some muscles, overusing some connective tissues versus others, correct?
Speaker 2:Exactly.
Speaker 1:Now, what are your thoughts on hypermobility at the hip? Specifically, like we've seen, a couple of people get congenital hip dysplasia diagnoses later on in life. Uh, people like sasha sasha de julian and actually I've met a couple of climbers, like in rifle and stuff like that, who have had this happen and you know they get labral tears and things like that. So what are some of the things that you do to promote hip stability amongst your hypermobile clients?
Speaker 2:Well, I always start with the biomechanics of it. So let's break down. I'm an English major, so let's break down the wording of that diagnosis right. General meaning you're born with it, you're naturally predisposed. It's not something that you can control. It's just how your hips are shaped and how they move right, move right and typically our body seeks stability in order to move through life. So our hips are going to seek that stability in external rotation and a little bit of abduction right, so kind of that duck walk or like the toes are splayed out if you go further down the kinetic chain. So if that's the case, I try and work on the bigger muscles in the hips because when dysplasia happens right where right labral tears, that's a ligament you can't contract that. You can't make your labrum stronger. You know it can start to over the years it can start to create more friction with the bone. And then you know people don't talk about hip replacements for athletes because they think that that's the end of their career. They can't climb anymore, they can't do other things, and that's not the case.
Speaker 2:What we can do is strengthen the larger muscles around the hip to create that stability so that your pelvis is not moving willy nilly and you're not irritating non-contractile tissues. So, glutes, those are some big muscles right. You got your gluteus maximus, medius, minimus, and then hamstrings too, like if they actually attach to the bottom of the pelvis, and so a lot of times when we're using our legs, we are, we have to strengthen our hamstrings as well. When people say hip flexors, they are thinking about their psoas, or those muscles that are connected to their vertebrae, the transversus process of their vertebrae, and when really, our quads are hip flexors as well because they attach to the front of our hip. So the more that we can strengthen those, more that we can strengthen those, the more universal our hip stability can be. Um, another really common, ignored group, and so I call these global muscles right, are adductors. Um, men, do not. Do not stretch their groin muscles at all. I do. I got I got it.
Speaker 2:I have to, or else I have just like.
Speaker 1:I mean, people watch me climb and they're like wow, you really don't have flexible hips and I'm like, I don't like, do you stretch them like every day, like literally?
Speaker 2:every day, you know. All right, fine, you made an assumption and I made an assumption, so we're even.
Speaker 1:So yeah, adductor group super duper important, especially we. I mean what people classify as mobility, right, the ability to control range of motion, Use it to bring your body upwards or to do a high step. You not only need flexibility in muscles like the hamstrings and glutes, but also those adductors. But once you get that foot on the foothold, the thing that's bringing your body upwards is hopefully the strength in those muscle groups, which is exactly what we're talking about.
Speaker 2:Yeah, and so I would want to back that up even more. So, if you don't have the range of motion in those adductors, you know, because they're tight and we are using, we use them as stabilizers when we're walking around. Even though people are all about the squats, those adductors help stabilize us, especially when we're running too. Now, if you notice a lot of, like, hip tightness when you're doing STEM routes, that's typically a crucial okay. You know, yes, you need to stretch the hamstrings and quads, but really it's that let's see what's it called Coronal plane, frontal plane, that you need to be stretching in, and then, a lot of times, people have difficulty rocking over their feet too. So, even that side to side motion, transverse climbing or traversing why did I say transverse, traverse, climb, traversing can really help activate those frontal plane muscles a lot more than just, you know, stretching the quads and hamstrings.
Speaker 1:Yeah, and traversing, something you have to do quite often on routes. Yeah, and traversing something you have to do quite often on routes.
Speaker 1:Yeah, and people? Yeah, Sorry. And in your clinic you said that you talked about specifically how you set routes for your clients based on their movement weaknesses or even on some of their muscular weaknesses. What does that process look like? So how can somebody listening to this podcast set routes or find out what their weaknesses are on the wall and then set those routes so that they can mitigate the chances of injury later on and maybe even improve their performance?
Speaker 2:Yeah, it's kind of tricky because I still haven't quite figured out a system that I can tell other people to do. But you want to break down the body movement first. So let's, let's use some examples I like to go off of. I like to start by asking what kind of climbing movement is painful? Ok, because pain is the big motivator.
Speaker 2:So, heel hooks right If you think about the position that your legs are in, right, your hips are flexed, your knees are flexed and so hamstrings are responsible for hip extension and knee flexion. But when you close the chain so if your leg is not like hanging out in the air willy nilly, and you connect your heel with a rock, that changes those body mechanics and creates a lot more torque on the muscles. So typically, when people say, oh, I heard, you know, I heard a like I strained my hamstring a while ago because I was a sprinter then typically I they have tight hamstrings with their when they're heel hooking right, so they don't have a lot of that overhead mobility, and by overhead I mean at the hips. So people always talk about the shoulders being overhead, but you know, you can still try and get your legs up overhead oh, I try.
Speaker 2:Yeah, I don't really succeed all that much, but I try yeah.
Speaker 1:You talked about how the act action of muscles changes based on the fixed points. So open versus closed to chain. So when we're bringing our leg up, our hamstrings are actually lengthening, which would be like an eccentric control there, versus when we actually place the heel on a hold. Now they're working concentrically, our foot is in the air, now it's actually pulling our body towards that support point or pulling our body towards the fixed point, so then we can move upwards. So I really love that point, because I'm a big dns person and we talk about support points and like phasic and tonic movements and stuff etc. All the time. Um, so if somebody is dealing with like an inability to do, let's say like compression problems, what things would you work on with them?
Speaker 2:Well, first of all I would look at their body type, okay, so you know, unfortunately you just cannot change the length of your femurs, matter how much strength thing, so typically. And then I also think about what setting they're in. So, um, if they're both trying to boulder and they're, you know, six foot above, you know it's going to be really hard. You're going to have to get that flexibility from your hips and you know your shoulders are going to be fine, um, because typically we're used to moving our arms in that open chain movement. Um, compression on ropes is going to be way different, because you can actually incorporate some different techniques to make sure that your body is a lot smaller, right? Um, people climb the way that they know how to climb and then they pick the problem.
Speaker 2:That's the variable part. But they don't really understand that the strength training and the injury prevention aspect is being able to have your body be that fixed point and, like you know, addressing a lot of that variability. So I like to call it like being the calm within a storm. You know, so, if we're working, compression moves typically heel hooks for taller people can get your hips in closer to the wall, and then it also creates a lot excessive knee flexion, which you know you don't really need your whole length of your leg to climb a compression climb Right Versus toe hooks tend to be more lengthening, which will be good for shorter climbers which will be good for shorter climbers.
Speaker 1:Okay, nice. One thing that we also wanted to talk about was numbness and tingling in the hands after climbing. Tell me a little bit more about that and why you wanted to talk about it today.
Speaker 2:Okay, well, I mean, there's numbness and tingling, so it's the nerves talking at you. Okay, where that nerve is can be dependent. So typically in climbing it's coming from the brachial plexus or from the neck, or you know. So, if I think of nerves as rivers and the signals that they send down to your hands and fingers are going downstream. So if there's any sort of blockage right with a tight muscle or you know some kind of movement pattern that's closing down the vertebrae, then it can say okay, this nerve is not getting enough blood flow, it's not getting enough information from my head to my extremities.
Speaker 2:Typically, I see a lot of like ulnar nerve distribution. So, um, because we have the most and this is where we start to combine a lot of the topics that we were talking about this hour, which is great, um, but I see a lot of ulnar nerve um, apprehension. So, uh, basically, their pinky and their fourth finger tend to lose a lot of sensation. Um, because we are using our hands to stabilize on slow bursts. You know, we are creating a lot of tension in our hand intrinsics, which also, you know, can result in that numbness, tingling. There's different levels of severity. There can be, you know, in the moment where you hit something and then you hear kind of like you feel kind of a zap, or it can be intermittent, like it's insidious, where you know you've been belaying for about an hour, you've been looking up at your partner and then when they come down you're like, okay, well, I can't feel my hands anymore, and that is more of a case of cervical radiculopathy.
Speaker 1:So cervical meaning the neck right, and then radiculopathy meaning it's radiating towards those histamines yeah, I think that's such an important point is like so many different things can cause numbness and tingling in the hand. So if you just type in on google like numb hand or numbness in the hands, what's probably going to come up is carpal tunnel syndrome. And I've had people come in and see me and they're like oh yeah, I think I've got just a case of carpal tunnel syndrome. I'm like well, first of all, this is the wrong aspect of the hand. This is you're talking about numbness and tingling in your pinky and half of your ring finger. So that would be a different nerve.
Speaker 1:So carpal tunnel is the median nerve and then the ulnar nerve is going to go through the tunnel of guillotine and then a couple of other regions at the elbow. But the big thing that a lot of people miss is that it can all come from the neck, and I think that's such an important point because as climbers, we're in sustained positions with the neck, whether that be looking up and belaying for long periods of time with the neck, whether that be looking up and belaying for long periods of time, or we're doing a ton of overhead movements that can tighten up things like the scalenes, the pectoralis minor, and also tension a lot of these different nerves, like the ulnar nerve. So that's just such an excellent point, like just because you have numbness and tingling in your hands doesn't necessarily mean that that's where the true issue lies. That's just where you're feeling the symptoms.
Speaker 2:Yeah, I totally agree, nick, and this is where you want to make sure that you're checking with a licensed professional. It's very, very hard to diagnose numbness and tingling on Instagram. It's just not flashy enough. You can't really talk about the symptoms and then be like, okay, well, yeah, I checked these boxes, because it can be very situation dependent as well, and so seeing somebody who can see how you move and then also not just with that isolated side, but also just in general how your body is moving, can really create a lot of solutions for you.
Speaker 1:Yeah, and then I mean we've also had the case of like exertional compartment syndrome, where the compartment that those nerves live in, ie the forearm, is so tight and when you get really pumped like, it tightens up that compartment and a lot of people with exertional compartment syndrome will have increased pressure in that compartment and it will press on the nerve and actually cause numbness and tingling in those distributions too. So, yeah, you're so right in saying that like if you're someone dealing with numbness and tingling, you've got to have somebody look at it. Like this isn't something that you can go and like you know, like Instagram your way out of. Or like get Dr, like you know, like Instagram your way out of. Or like get Dr Google's advice and fix. Like. It can be situationally dependent. It can be contextually dependent. There can be many causative factors in many locations that can impinge the nerves and cause things like numbness and tingling in the hands.
Speaker 2:Yeah, and I do also want to talk about how another option when you do see you know your primary care or is people talk about surgery. Right, if you have carpal tunnel, people are like, okay, well, let's just go into that specific spot and relieve the pressure. And it's like, why don't we go up the chain? Still right, we go up the chain, still right. Surgery tends to should be one of the last resorts, or at least dependent dependent. So I'm trying to protect my license here. But typically there are other options out there and you know, try to talk in person and one-on-one. That's going to be key.
Speaker 1:Then kind of Googling your own symptoms and seeing if you can get like a casual analysis over oh yeah, and it's not only me that agrees with you, but the clinical practice guidelines also agree. Like, if, if you're having numbness and tingling, surgery is not the first option and it should not be the only option, unless you've severed your median nerve. Like you're going to want to do six to 12 weeks of conservative management where you're properly assessed first of all and then properly treated with you know, there are a bunch of different ways that you can treat those different things that are beyond the scope of this podcast, bunch of different ways that you can treat those different things that are beyond the scope of this podcast. But you want to do these correct things and there are steps to this. You know, just because you have numbness and tingling in your hands doesn't mean, oh, I got to go see the hand surgeon. Like, well, hand surgeons do hand surgery, so you want to go to a really good physical therapist, conservative chiropractor you know people that do sports medicine as opposed to going straight to a hand surgeon or something like that.
Speaker 1:We call that like entering through the opposite end of the funnel, like and we see this all the time Somebody has numbness, they let it go on for a couple of months and then they go to the surgeon as their first option and it's like, first of all, that's like really expensive, like why would you do that first?
Speaker 1:And then, second of all, it's like all that they can do is do an injection or surgery or refer you to someone like a physical therapist or someone who practices sports medicine, and it's like you could just go to that person and get the rehabilitation necessary and the diagnosis necessary, so then you can hopefully avoid ever getting surgery, because once you cut something open with a knife, you cannot go back there. You know, and my ankle is one place that I've gotten surgery and it's like, yeah, my surgeon did an amazing job, but that ankle is never going to be the same. You know, I just tried to run two days in a row and guess what? It felt like shit. That ankle is never going to be the same. You know, I just tried to run two days in a row and guess what it felt? Like shit.
Speaker 2:But you know, it is what it is. I like that. Yeah, but actually I want to call you out on that because I think that there is we can manage expectations right. So you know, for your ankle to get the same range of motion that had before, probably not, especially if you have any like hardware in there, but if you can use the muscles around it and learn to use the bigger muscles to like help get you from point A to point B. Fine, you know, that's, that's your way out.
Speaker 1:Oh yeah, I mean, it definitely gets me around, you know.
Speaker 2:All right.
Speaker 1:So we've talked about a lot of different things.
Speaker 1:We're coming up on an hour, which is usually where I like to you know, halt these, you know. But at the end of each podcast, I always like to wrap up with talking about some of the topics that we discussed, but I always like to talk about an ounce of prevention, and I bring up this nerdy story about Benjamin Franklin when he started the volunteer fire department in Philadelphia, and his famous quote is an ounce of prevention is worth a pound of cure. And it's really the point of this whole podcast, right? What are some actionable items and what are some actionable information pieces that we can convey to people so that then we can hopefully prevent injuries from ever occurring in the first place? So, anna, we talked about hypermobility, we've talked about strength training, numbness and tingling in the hands, setting routes based on weaknesses, as well as a couple of other topics such as injury mitigation or keeping tweaks from becoming significant injuries. So, amongst all of those topics, what is your ounce of prevention for climbers that are trying to prevent injuries from happening?
Speaker 2:I would say that you want to constantly create a checks and balance for yourself, right, knowing your strengths but also understanding your weaknesses and working on it, because eventually those weaknesses can become your strengths with some time and some patience towards yourself. So I said time and patience, but also discipline, because you have to actually do it. You have to be motivated to do these exercises. You cannot rely on any other source to push you to use your own body. So really, you know whatever you can do to be more proprioceptively aware right In the moment, when you're climbing or when you're off the wall and you have like a routine that works and you know that, okay, I'm not going to get injured, then that's what is going to work for you. But if you don't, then seek help Like it's not, it's not that shameful and if anything, you're going to come out a better climber that way.
Speaker 1:Definitely Well, anna, thank you so much for sitting down with me today. How can people find you, whether it's on Instagram, or how can they find your website if they want to work with you, etc.
Speaker 2:Yeah, so I've got. I'm on Instagram. It's on site DPT, right for doctor physical therapy, or you can see my website at onsite physical trainingcom. I'm very approachable, so you know. If you just have random questions, feel free. I will try and answer the best of my ability. If you just have random questions feel free.
Speaker 1:I will try and answer the best of my ability. Awesome Well, thanks again, anna, and I look forward to chatting with you again. Thank you, nick. 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.