Friday, January 21, 2011

being smart when dealing with an "itis"

I'm at the point where I can say that I have full control over my elbow pain.

Over the past couple of years, I had debilitating tendinitis. It took some time to develop.  Probably 15 years or more. At first it was barely noticeable, but eventually it grew to sharp pain - during activity and rest.

I was faced with some painful symptoms. But here is a list of what was really going on with me:
1. A tendency to overstress my connective tissue. Early on I had a desire to climb hard, so I climbed and trained as much as I could. Even with a full course load. Even with a full-time work week. Even with another sport.
2. Undisciplined use of my time. If I had time, I would push into deep fatigue finishing a climbing day or workout session. I would emphasize quantity, and I may have overlooked quality.
3. Inability to recognize occupational effects. I was taught to carry a comprehensive pack when guiding (stacked or coiled second rope on long routes, client's gear, practically the
old "ten essentials" at times). I climbed in the most comfortable shoes possible, often approach shoes. I often maintained a solid grip on the rope, even with a plaquette - and I have logged over a vertical mile of rock guiding on 5.8 and up in one week, and never deviated from plaquette belaying - can you say overuse?

My journey to managing my tendinitis involved ortho's and PT. But success in managing it came from my own analysis and treatment. Success came from treating symptoms to examining the stressors. Once I realized that curative treatment would require fundamentally changing my activities as well as a disciplined exercise therapy program, I was on my way.

Medial epicondylitis, often referred to as "golfer's elbow", is very common in climbers.  Difficult rock climbing creates severe stresses on our tissues. Unfortunately, many individuals may not have the full capacity to respond to these stresses, and overuse injury (an "itis") crops up. Tendonitis is inflammation of tendons, caused by overuse and/or injury. Tendinosis is more accurate with most affected climbers, since they are dealing with chronic tendinitis from overuse. I would argue that when we challenge our tendons with increased stress in an uncontrolled environment, we are causing some trauma, and we might tally this in the "injury" category. Coaches of incredibly well-trained D1 athletes carefully schedule high-recruitment work because it so closely toes the line of injury, yet we may expect ourselves to perform at this level in climbing several times per week. It's no wonder there are so many climbers out there with "band-aids", whether it be braces, wraps, anti-inflammatory meds, massage, ice, heat, e-stim, acupuncture, etc. These are all potentially successful methods of managing pain. But what is causing the pain? There are countless success stories of different climbers progressing at mercurial rates, but how many old climbers do you know who really pull-down and are "pain-free"?

There is an incredible amount of literature on palliative treatment for medial epicondylitis. I won't go into the specifics. Ultimately, with anyone that is a compulsive athlete, palliative treatment is a way to proceed further with an activity that is hurting the body. With Type-A exercisers, we can only expect further levels of injury. Remember: an "itis" is an injury, just not an acute injury. Do you want to treat the symptoms or the cause? Manage or Cure? Almost every climber I see with tendinopathy is managing symptoms and worsening the damage. Almost every climber that is getting worse is neglecting some combination of strength training, stretching, technique training, and programming. I'm not advocating logging routes, planning training 20 weeks out, bringing a notebook to the weight room, or anything like that. I'm proposing stepping back from the activity that is causing pain, and scrutinizing the sport to see how many different and unsuspected aspects are causing the injury.

In my case, if I truly want to guarantee that I will be pain free in my elbows, I know that I can do it. Just take out the heavy stressors, like climbing. But wait. I'm not giving up climbing or guiding. So my alternative prescription is: recognize the few routes or at least the few specific moves that are stressing the structures and causing an inflammatory response and avoid them; get functionally stronger; continue to improve all facets of technique from a biomechanical perspective; ditch approach shoes for routes where lack of edging and sloppy feet will tweak the elbows; continually focus on footwork; emphasize the use of momentum over slow, static movements; pay attention to continuous grip while belaying, especially when using a locking-assist or plaquette device; and place a premium on rest days when there is any sign of symptoms.

If I had to single out the two most important concepts at my current stage (98% pain-free), they are:
1. Acknowledge that my sport is hurting my body. Inflammation and pain are two pretty good signs that I am creating some sort of trauma.
2. Recognize that technique and application of force may mean the difference between reasonable and unreasonable stress on the tendons.
Solution: just be SMART, recognize what hurts and what doesn't, improve technical skill, and make the body stronger and more balanced.

If you want to participate in a sport for a lifetime, then you need to plan for a lifetime. You can keep applying little "fixes" or mask pain, but sooner or later your body will start to fall apart. The further down the road of overuse injury, the tougher it is to climb up the hill to pain-free living. Ultimately, overuse injuries come from poor preparation.

Here's a cool anecdote: Several years ago, I had the opportunity to watch Jorge Urioste climb several pitches on the 25th anniversary ascent of his Red Rocks route, Dream of Wild Turkeys (10a, 10 pitches). Anyone who has done this route knows that there are several thin spots and significant cruxes at the grade. It's seen some solos, but honestly, this isn't an "approach shoe" climb. His hands may have been on the crimpers, but I know his footwork got him up the climb. He has had some climbing injuries to his shoulder which make him focus on his feet - something that may have been a blessing in disguise to give him this kind of longevity in the sport. On Dream of Wild Turkeys, I watched Jorge climb very fluidly and controlled, and he was comfortable enough on several 5.9 slab sections to stop, balance on two thin, slabby edges for feet, lean a knee into the wall, and make the clip smoothly and relaxed with two hands. HUGE style points. Jorge is still out there making climbing look easy, at 73 years old. Let's hope that we all make the right choices so that we can enjoy the sport for a lifetime like Jorge.


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