what are some of the common causes for shoulder injuries in climbers?
With the growing popularity of climbing, both indoors and out, there are a growing number individuals developing overuse injuries associated with this activity. As many front range climbers know all too well, training has become a huge part of this once fringe activity. With the popularity of climbing gyms, newer climbers are getting stronger and progressing faster. In addition, many weekend warriors are now training multiple days in the gym in addition to their outdoor climbing. This quick progression and increased volume of climbing can lead to many overuse injuries.
One of the most common overuse injuries I’ve seen amongst climbers is shoulder impingement. So what is shoulder impingement? In simple terms, shoulder impingement is a condition that occurs when the bone of the upper arm, the humerus, compresses the rotator cuff against the top of the shoulder blade, at the acromion process. This condition is termed subacromial impingement. With repetitive overhead motions, this compression creates irritation and inflammation in the muscle being compressed leading to pain, loss of function, and possible tearing of the muscle if left untreated.
common symptoms of shoulder impingement include:
so why are climbers susceptible to shoulder impingement?
With the repetitive nature of overhead reaching and pulling, climbers have a high likelihood of overdevelopment of large muscle groups such as the latissimus dorsi, rounded shoulder posture due to tight pectoral muscles and weak scapular stabilizers, and weakness in the small stabilizers muscles of the shoulder. These imbalances are also common with newer climbers utilizing improper techniques with hang board training, poor engagement of the scapular muscles when hanging from the arms, and quick progression into high volume and high intensity climbing.
so what should you do if you have pain similar to that described above?
An important first step is rest and activity modification. While no climber, myself included, wants to be told to take rest days, continued climbing through pain can leading to further pain, inflammation, and loss of function. If symptoms are minor and your are continuing to climb, some aggravating positions to avoid can include:
In order to speed up the recovery process, proper evaluation by a physical therapist will help to identify the condition, its cause, and provide the guidance necessary to create an effective treatment plan. Physical therapists can utilized techniques including soft tissue and joint mobilization, cupping, dry needling, and develop appropriate corrective exercise routines to normalize the mechanics of the shoulder. These techniques can help to speed the recovery process and avoid long term issues that can develop from chronic shoulder impingement.
In the event of minor shoulder pain that has recently develop and resolves quickly after completion of activity, some simple mobility and strengthening exercises may be an effective self treatment. Some good starting points are:
As most climbers know, the only thing better than climbing is more climbing. With this basic understanding of what that annoying shoulder pain may be, the proper individuals to see for assessment and treatment, and simple self care exercises that can also be used to help prevent muscle imbalances means less time in pain and more time enjoying the amazing climbing the front range has to offer.
You may have noticed some of the publicity surrounding these mysterious dark bruises on some of the Olympic athletes or even on some of your own friends around town. You might have heard about “cupping” or seen videos on the internet involving Chinese ceramic or glass cups and fire. If you’ve ever wondered about trying it or if it could help you in your injury recovery or sports performance, read on!
What's the difference between "MFD" and cupping:
While cupping has been an important part of Eastern medicine practices for thousands of years, in the PT clinic we do Myofascial Decompression (MFD). Myo = muscle, Fascia = the connective tissue surrounding and supporting the muscles. We have adapted these tools used in Eastern Medicine for its “negative pressure” (decompressive) properties for our use within Western Medicine and combined it with our deep knowledge and understanding of musculoskeletal anatomy and tissue physiology. In traditional Eastern medicine practices, the cups are placed deliberately on Chi energy meridians.
With MFD, we first perform movement assessments and determine restrictions in range of motion, muscle imbalance, and movement inefficiencies. We place the cups deliberately on targeted myofascial points, much like is done during other massage and manual therapy, and we can control the amount of vacuum with a handheld pneumatic pump (no fire!). We may also ask you to make specific movements during treatment to target these muscular and fascial issues. So in our PT clinic, we don’t do “cupping” in the traditional sense.
What's the science?
Studies have shown that the individual cups and the negative pressure generated within them can induce biomechanical stresses on soft tissue in a different direction from other manual techniques commonly used in therapy. If you think about foam rolling or massage, most of these stresses are compressive, while the cups create decompression, or “lifting/separation” of the tissue layers. These stresses can then stimulate physiologic changes in the tissue; in cases of myofascial restrictions where collagen cross bonding and scarring has occurred, it makes sense to use decompression to create space and separation of tissue for improved nutrient and fluid exchange. Recent MRI studies have shown that we can even affect fairly deep muscles with the vacuum generated within the cups, and that these changes actually last over time (not just temporary), especially when reinforced with PT exercises!
What about afterwards?
Make sure to hydrate! Recovery is much like after a deep tissue or targeted sports massage; let yourself heal. It’s important to train your muscles to move correctly in their new range, so make sure to keep up with your exercises as instructed by your PT!
We all get bruises. Sometimes we know where they come from and sometimes we don’t even realize we’ve gotten them. So what is a bruise and what do the phases of colors they go through mean?
The most common type of bruise involves an injury to the small blood vessels below the skin’s surface. Blood pools below the skin and you are able to see the color of that blood showing through the skin. You can also get bruises to bones, muscles, etc. in the case of deeper injuries or surgeries. Most bruises will heal within 2 weeks although some may take longer depending on the size.
What is the rainbow of colors the bruise will go through?
How can you treat a bruise?
After the first 2-3 days, you can gently massage the affected area to encourage blood flow. Gentle movement of the affected body part can also encourage blood flow and healing. If the bruise is painful, taking an over-the-counter medication such as Tylenol or Advil can help relieve symptoms.
When should you seeek out medical attention associated with a bruise?
If it affects the function of the related body part
If it worsens rather than healing within the first 2 weeks
If the bruise is significant and has no identifiable cause
If there is a suspected fracture
If the size of the bruise increases notably
Elana Gordon, PT, DPT
ANSWER: It depends
Yoga is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India. Yoga is one of the six orthodox schools of Hindu philosophical traditions. There is a broad variety of yoga schools, practices, and goals in Hinduism, Buddhism, and Jainism. The term "yoga" in the Western world often denotes a modern form of Hatha yoga, yoga as exercise, consisting largely of the postures called asanas.
Is Yoga safe?
In order to teach Yoga you have to study five areas:
Studies have found the incidence of pain in Yoga practitioners caused by Yoga is more than 10% per year - which is comparable to the rate of all sports injuries combined among the physically active population.
There is some evidence that regular Yoga practice is beneficial for people with high blood pressure, heart disease, aches and pains - including lower back pain - depression and stress.
The National Center for Complementary and Integrative Health (part of the NIH) suggests the above findings, however they note "Although there has been a lot of research on the health effects of yoga, many studies have included only small numbers of people and haven't been of high quality. Therefore, in most instances, we can only say that yoga has shown promise for particular health uses, not that it has been proven to help".
Created by Joseph Pilates in the 19302, Pilates was first called Contrology and inspired during WWI while held in camp for four years. Joseph was a nurse-physiotherapist and his goal was to create lifelong sustainable exercise at a low cost. Pilates recognized that the brain controls mobility and stability of the body. Specific muscles are used in a functional sequence at controlled speeds - emphasizing quality, precision and control of movement. Complex movements are broken down step-by-step to internalize the pattern.
Regular practice should lead to:
Yoga and Pilates compared
Similarities: strength, flexibility, fitness, importance of breath
Differences: Pilates emphasizes core strength while yoga emphasizes flexibility
So should I do yoga or Pilates?
Depending on classification it may make sense for you to do one or the other, or both, or possibly neither!
How do I know my low back pain classification?
See an expert at Altitude! All our physical therapists are experts in identifying movement patterns and dysfunctions as well as classifying the best way to treat your low back pain!
Caitlin Barritt, PT, DPT, OCS
Simply put, the deep neck flexors are the equivalent of the core for the neck. When we think about our core, we often are referring to our abdominal muscles in the trunk. These mostly support our low back or lumbar spine. The good news is that we have similar supportive musculature for our neck - the deep neck flexors!
There are two main muscles that make up the deep neck flexor group: the longus capitis and the longus colli. In as lay terminology as possible, the longus capitis muscle attaches from the base of the skull to the front side of vertebrae from C3-C6 and the longus colli muscle runs along the front of the spine from C3 down to T3. Any rehabilitation that is focused on improving a forward-head / rounded shoulders posture or any rehabilitation from a neck injury should include some form of exercise for these muscles. The typical exercise is something we call the “chin tuck.” I often refer to this as “the sit up for the neck.”
The challenging part of this deep neck flexor group is being able to isolate and access it without recruiting other neck musculature. When you truly look at the anatomy of the neck, you can see that this deep neck flexor group is named such because it lies “deep” to the esophagus and trachea. This is where the challenge of access comes into play because there are many muscles that work easily but are “superficial” to the esophagus and trachea. These muscles are used for swallowing, talking, chewing, etc. So, in physical therapy, we need to teach our patients how to turn those muscles off and turn the deeper ones on!
We learn in physical therapy school that strong deep neck flexor muscles are able to hold a chin tuck and lift position for 30 seconds. In my 8 years of working as a physical therapist, I can attest that upon initial evaluation of these muscles I have never had a patient be able to do that. With practice and guided exercise, my patients are able to strengthen this unique muscle group and this ultimately leads to improved stabilization of the neck. This equals significantly less neck pain and improved posture.
Most of our patients understand the importance of core strengthening to help maintain health and reduce injury in the low back. The same holds true for the “core of the neck.” If you have any questions or feel like this is an area of your routine that you are missing, any physical therapist at Altitude would be happy to help you properly learn how to strengthen this deep neck flexor group. It’s a small group of muscles but they sure are important!
Lisa Corken, PT, DPT
Muscle strains are a very common orthopedic injury. A muscle strain AKA a “pulled muscle” happens when a muscle is overstretched or torn. This can occur due to overuse, excessive muscular contraction, fatigue, etc. Muscles that are commonly “pulled” include hamstrings, calves, quads, and low back muscles.
Bob Cranny, PT