Overuse injuries - a neglected responsibility
By Gordon Turner - Chartered Physiotherapist
Gordon Turner is the Manager of Glenmore Lodge Sports Medicine Centre, located within the Scottish National Sports Centre at Glenmore Lodge, Aviemore.
An injury at any time of year can be one of your worst nightmares. You may have a treasured trip to the Alps planned or may be looking forward to your first 7a route. Whatever your aspirations, an injury can be devastating, both physically and psychologically.
There are hazards in most aspects of climbing and we have a responsibility to take appropriate precautions to minimise risk of injury from these hazards. If you are unlucky enough to be injured then you must accept the setback as best possible. However if your injury is due to poor preparation or neglect, then I believe you have disregarded an important responsibility. Training is becoming more common within the climbing fraternity. If you do train regularly (for whatever purpose), it is worth noting that a high incidence of soft tissue injury occurs during training. You should also acknowledge that correct training is paramount to preventing injury. The subject of training is being addressed more widely now, with symposiums, articles and books covering the relevant details. I urge you to consider your training regime carefully and decide if it is safe and specific to your needs.
An area of increasing concern is overuse injuries. These types of injuries include tendonitis, bursitis, compartment syndrome and stress fractures. it is a misconception that these injuries restrict themselves to elite athletes. Indeed they are increasingly common amongst climbers. It can take a long time to recover, from what is all too often an avoidable injury. it can be much harder to treat and manage a long standing overuse injury, than to address the problem at an early stage - preferably before it shows itself. It is your responsibility to minimise risks . Remember, overuse injuries are avoidable , provided some basic precautions are followed. An overuse injury occurs when structures or body systems cannot withstand or adapt to repetitive forces. It is this repetitive microtrauma and repeated exposure of the tissue to low magnitude forces, which results in injury at a microscopic level.
It is essential to understand that basic physiological changes take place during all soft tissue injuries. Healing can be artificially divided into three stages - reaction, regeneration and remodelling. Every injury will pass through these stages in some proportion. Time scales will vary, but each stage can be influenced - for the better or the worse - by your actions. Overuse injuries follow a “pain cycle”. Unless this “cycle” is broken, chronic problems will occur.
Pain Cycle of Overuse Injuries
Overuse injuries can be broadly divided into 4 grades:
Type 1 = Pain after activity only.
Type 2 = Pain during activity, not restricting performance.
Type 3 = Pain during activity, restricting performance.
Type 4 = Unremitting pain.
Their causes, amongst others, may include mechanical imbalances; a history of previous injury; psychosocial factors, equipment, footwear or growth factors. A common joint affected in climbers is the shoulder. For example, mechanical imbalances are an alteration of structure and function, which manifests itself in a variety of combinations of muscle tightness or weakness and poor alignment of body segments. An alteration of muscle length due to poor training regime, poor posture or anatomical factors may alter the joint function - both neurologically and mechanically. This is commonly known as muscle imbalance.
The assessment of sports injuries is a complex task, requiring a professional approach. Diagnosis and the progressions of rehabilitation should be left to a sports medicine chartered physiotherapist or sports medicine doctor. Early, appropriate intervention is important and the majority of overuse injuries respond well to conservative rehabilitation and management. Delayed or inappropriate management of overuse injuries, can have a detrimental effect on your recovery time and future performance.
Many climbers are aware of the principles of acute soft tissue management, but few are aware of what to do if an overuse injury does rear its ugly head. A few basic principles are outlined below and it is worth following this advice in the early stages of an overuse injury.
Type 1:
- Reduce your workload by 25%
- Ice massage the injured part after training
- Introduce a stretching programme
- Warm-up the area prior to climbing
Type 2:
- Reduce your workload by 50%
- Modify your training regime
- Ice massage after climbing
- Stretching programme
- Seek thorough sports medicine assessment
Type 3:
- Complete rest from activity - active rest
- All others as Type 2
- Judicious use of non-steroidal anti-inflammatory drugs or injections
Type 4
- Exhaust all conservative methods of rehabilitation
- Seek expert opinion about surgical intervention
Finally it is essential that you think carefully about what may have caused this injury.
- Have you been following an intensive training schedule without appropriate rest days?
- Is your technique correct?
- Have you recently changed your footwear or equipment?
- Remember, there must be a reason for the injury - what is it? Once you discover this , you have addressed the crux of the problem and can take steps to correct it!
