Climbing and Shoulder Injuries
Hi Steph,
given your level of experience and ability I presume you’ve had some injuries in your climbing career. Just wondering if you’ve had any rotator cuff problems and if so, what advice you could give to fixing them (I know patience is probably the best advice but I already know!). I have tendonitis of the supraspinatus at the moment. I have a great physio who’s a climber herself and since starting treatment with her I’ve noticed a big improvement. She reckons I’ll be able to climb again in about 2-3 weeks.
I’ve heard from other climbers that stopping climbing altogether is unnecessary though. Any experience with this? I know tweaked fingers won’t be affected too much by climbing juggy routes but your shoulders are used no matter what so I’m not sure what to think about giving up altogether. Between poor physio and fear of doing very bad damage I haven’t climbed now since September and with winter disappearing I’m getting very anxious to get back out on rock! Any advice would be greatly appreciated!
Take care,
Richard
Hi Richard,
Luckily I have not had any shoulder problems myself. But my best friend Lisa Hathaway is somewhat of an expert on them, because of her own experience and also because she’s just the kind of person who’s an expert on all kinds of injuries and training tidbits, as well as being a rad climber. So I asked her to share some information that I hope will help! 🙂
Hello Richard,
I’m Lisa, a friend of Steph’s. She has asked me to guest-post on the topic of shoulders. Unfortunately, I, too, have suffered shoulder issues—no fun for any climber! I had chronic dislocations of the shoulder which manifested as a damaged rotator cuff. After years of semi-successful rehans, that would eventually lead to another separation, I consulted for surgery. With no MRI, I went in for a laser treatment for the r-cuff, only to discover it was fine, if not overly loose by nature and I actually had torn ligaments in the front of the joint (I can’t remember which ones, sorry!!) They wanted to do an open procedure to repair the ligaments, but I opted for the laser “shrink-wrap” treatment to the R-cuff, and rehab, which has so far worked out! And I continue to regularly do support-muscle exercises to maintain the strength and health of all the little guys in the shoulder and back.
As I am sure you are well aware, as you have been consulting with a physio, the shoulder is a very complicated joint! It’s greatest boon—incredible mobility and all that comes with that—is also it’s greatest bane. And as climbers, we do not politely ask, but demand (maybe even with a metaphoric foot-stamp and crossed arms!) outrageous tasks from our shoulders. For climbers like you and me, that can result in dislocations (in my case) and over-use syndrome (in yours.)
Athletes in any sport are very adept at figuring out trickery to mitigate the circumstances and limitations of an injury and we will go on and on and on despite pain and consequences. I know plenty of climbers who have modified their styles and climbed rad routes with any number of misfortunes, from fused ankle, spines and fingers to detached ACLs (Jason Kehl on the FA of Evolution!) and sans finger (Tommy Caldwell on, well, you name it.) But shoulders are a different beast. We hang from them, reach from them, swing from them, prevent imminent falls from them. Extreme pain or instability in this joint can more directly affect one’s safety than most conditions we climb with if pain, impingement or instability results in a loss of grip or displaced joint. In severe instances, over use or trauma can lead to nerve damage in the neck and arms.
But even all that is not enough to stop us!
Quite honestly, personally and anecdotally, I am more familiar with impingements, tears and instability issues with shoulders. I am less familiar with tendonosis or -itis of the shoulder tendons. But as a long-time climber I’ve certainly dealt with more than my fair share of other -osises and -itises and have some tips to share—we’ll get back to that in a minute.
As far as your situation is concerned however, the first thing I would suggest (and it sounds like perhaps you have?) would be to assure you are confident of the diagnosis. It’s sounds like your physio is totally on top of things and the fact she is a climber is a huge plus. Often, medical professionals outside of the realm of climbing don’t really understand what we demand of our shoulders and the forces acting on them. People often hear “climber” and envision a well-clothed, cramponed and glacier-glassed person ascending a snow-slope with an ice axe carried below waist-level. Which you may or may not do, but I suspect you also hope to be swinging around on steep rock! And the difference is night-and-day when consulting medical help (for any of you who may be in a similar boat and aren’t as fortunate to have a climbing physio–when you consult, bring a video, photos or a magazine of what YOU do.) In diagnosis and treatment, a knee or an ankle can usually be treated the same despite the athletic demand, but endgame really comes to the forefront in a climber’s (or gymnast’s or … ) treatment for upper body joints. So, excellence of your physio notwithstanding, I would strenuously recommend an MRI to confirm your diagnosis if you’ve not had one. Athletes’ bodies are really good at inadvertently masking symptoms or leading us to misinterpret our symptoms.
Assuming your diagnosis is correct and you are not suffering from any tears or impingements, which would be a whole other conversation, we then get to treatment … and boy, what a can of worms that is for tendonitis. If you search for treatments for tendonitis, I’m sure you’ll find dozens upon dozens of recommendations, from complete immobility and rest to surgery to “grin and bear it.” And I’m sure following this, we’ll hear some advice from other climbers who have had similar maladies. But all I can do is tell you what I would do, as a completely-not-medical-professional and total-over-doer-climb-aholic!
Firstly, I would consider the root cause of this tendonitis. Normally, one gets tendonitis from over-use or from a biomechanic issue that may cause things to be “rubbed the wrong way.” My first question is: “How is your posture? Both in regular activity and climbing?” As a climber with shoulder issues herself who has never even laid eyes on you, I’ll lay a bet it’s a bit dodgy–only because that’s the case with most climbers, myself top of the list. And I don’t just mean hunching or slouching. When we climb, we tend to do so with rounded backs and shoulders forward. The best thing I ever did for my climbing was to revamp my posture to a yoga-esque “shoulders down and back.” I started this to help aid my instability—a down and back shoulder is a lot harder to yank from the socket, even with a raised arm, than a rolled forward shoulder. Upside: my lock off improved TREMENDOUSLY once this became my de-facto way to move, as it engages and recruits the larger muscles of the back. I like to envision squeezing a quarter between my shoulder blades when I am climbing on any terrain. I started this on the easiest of routes and warm-ups and now I can do it reflexively. Correcting your posture could help a tendonitis issue tremendously. I’d add the yoga, too. Nothing like a climber in a yoga class to show how adept we are at compensating with strength for poor posture! (Full disclosure: my posture is still pretty terrible in normal activity!)
Next, are you in constant pain or only when you climb? Does it get worse only when you climb? During or after? Acute or dull? As a life-long athlete, I have always adhered to the adage “run though irritation, never through pain.” Now, that may be bad beta, but just TRY to hold down a rabid runner/climber/skier! Telling the difference between irritation and pain can be tricky and one runs high risk riding this fine line of self-appraisal as we athletes can be amazingly self-delusional when it comes to laying-off. When I have had an -osis or itis (bicep, Achilles tendon, I-T band) as well as tendon and tendon pulley injuries and strains, I have lived by this adage and I know many others who have as well. ANd I believe it has helped my recovery each time. We operate under the (medically valid and vetted) opinion that with an over-use injury or a strain, regular activity that is carefully modulated is good for blood flow to the injured area and can promote healing. A chronic injury is not unlike, well, a wart!, and as such can be semi-neglected by our bodies’ response systems—as it’s not acute, it doesn’t get the attention it needs to heal. So if we jostle it a bit, the theory loosely goes, it gets the attention it needs. But don’t do big days or thuggy things, especially right away. Build your pyramid with a nice, wide, stable and sure base! Listen to your body and use restraint! After I had shoulder surgery, my doc said I could climb in 3 months. I went out on the exact day and I didn’t feel right–so I took three more months from rock climbing and just trained and rehabbed and after 6 months off, had my best season to date.
The other techniques I use when I have a bout of -osis are to heat or warm up the afflicted area prior to activity and then I practically sprint to my ice bags after exercise. There’s this odd idea amongst many athletes I know that ice is only useful in the 48-72 hours following an acute incident, but this is so not the case. Ice, your external anti-inflammatory that is site-specific, will help decrease your swelling, which should in turn with your physio and improved posture and yoga should help to alleviate your symptoms. I also like to take an herbal anti-inflammatory called Zyflamend after a grueling sesh. It was recommended to me by a climber-chiropractor and I find it helpful. Others will tell you to quit drinking coffee. I know numerous boys, too many to discount, who insist quitting coffee (and then drinking it again) alleviated their elbow tendonosis, only to have symptoms revisit upon consuming it again. I tried that with my bicep and experienced worsening symptoms daily! The aforementioned chiro recommended I get back on the black juice, as we are all chemically different and one mans bad ju could be a girl’s saving grace. Like I said–with these chronic issues, it’s a big ol’ can of worms!
So, in summary, from your friendly not-a-medical-professional fellow climber:
-confirm your diagnosis as all treatment is predicated from this! And you want to treat any and all issues.
-work on your posture, especially when climbing
-climb if you comfortably can, even through mild irritation, but don’t suffer, ever! And bear in mind, if you are protecting one joint and compensating in your movement, you could easily injure something else. That’s why they call them compensatory injuries!
-warm up thoroughly and even literally
-cool down properly and ice down
-consider an herbal anti-inflammatory after rigorous exercise
-do yoga and/or supplemental muscle group strengthening and stabilizing exercises
-consider diet modifications such as no caffeine, but don’t adhere to them if you feel worse
-tread lightly upon your return to activity and do small sessions.
-treat your shoulders like gold and lay-off if need be–they are really a make-or-break joint for a climber and you don’t want to end up with myriad other problems that could have been avoided by taking a year or so off.
I hope this helps and hope we hear back from you this spring – with good news and tales of happy pitches!
😉
Lisa
Steph- thanks for posting this…Lisa, wow this the best information for shoulder injuries I’ve ever read. I have subluxing shoulders which have bothered me since freshman year of high school. The past several years of climbing have significantly improved my shoulder health by reducing the frequency of dislocations but now they have started locking up and require a hearty pop to reset. As I have been progressing my climbing into larger and higher risk climbs, a dislocated shoulder carries significant risk. Surgery or laser treatment is in my near future and dependent upon health insurance. I’m glad to hear of your reasonable recovery time. The advice on changing your climbing posture will immediately be put into practice and is greatly appreciated advice. Glad to hear that there is other climbers out there making bad shoulders work.
Zac
Thanks Steph/Lisa,
that’s great advice, thanks.
-I’ve had an MRI so the diagnosis is confirmed.
-I’ve been working on everyday posture since I stopped climbing.
-I never had much pain, I was just afraid of tearing ligaments or doing something irrepairable.
-I’ve do Stott pilates and do a small bit of yoga, better make it more!
-I don’t even like coffee so no worries there!
Thanks for the advice, great to hear from a climber with experience of similar.
Richard.
Try active release or trigger point therapy. I’m surprised Lisa did not mention anything like that with her issues shes mentioned. But I do like she mentions Yoga! Yoga with massage is the only thing that has helped me with my issue’s all my life fighting or climbing! You can youtube trigger point and get a tennis ball or a lacrosse ball if your by your self and keep your money in your own pocket if your tired of going to a doctor like my self. 🙂
You body is a organic machine that is capable of healing it self no matter what the injury! Only awareness stands in your way and once you have that, your body will heal properly.
Thanks Lisa and Steph….actually I am recovering from a shoulder injury and haven’t climbed in about a month. Â Normal x-ray, some DX of torn lat/tri or longer term tendon issues, but anyway. The input about posture affecting shoulder strength is really helpful and not usually at the forefront of my mind……but I think it’s accurate based on my experience after a full dislocation some years ago.
Rest is not fun…but necessary, I guess:)
Dave
Lisa knows..
good luck!
🙂
hope you come back stronger like Lisa did!
What a wonderful, informative post! Best part, for me, a tip to improve my lockoff! Thanks, Lisa!
Lisa knows 🙂
This is a terrific post Lisa. I dislocated my shoulder years
ago climbing in Cornwall, and despite having surgery, I have not attempted to
climb again, until two weeks ago.. This time round, older, and only slightly
wiser, I’d like to find a exercise routine to improve shoulder stability. There
are so many resources on the web on this subject – but I haven’t found a
definitive one yet, and even my local physiotherapist had no more advice beyond
internal and external rotation with a theraband. Could you (or Steph) offer any
advice on a good resource?
Thank you.
P.S. Steph, I love your climbing videos! A real inspiration.
Thank you.
Â
What Steph said!
And think of a lay-off from climbing as an opportunity to get STRONGER!
(Of course, doing so with some restraint so as not to re-injure! ;-))
Hi John,
Steph and I will soon put together a post specific to this.
In the meanwhile (which, knowing us, won’t be long, as once we get a bee in our bonnets about something we can barely stand not acting on it immediately! ;-)) keep doing what you are doing.
The thera-band exercises may not feel like they are doing much, as even the most raucous thera-band sesh won’t exactly leave you feeling wasted, but they target the smaller, stabilizing muscles most of us don’t even know exist … until we find ourselves shock-loading an arm, especially in an already fatigued body, at which point we demand more than they can deliver, unless properly trained! You can also try simulating your thera-band exercises with a light (5-8 lb) weight or on gym machine (the ones w pulleys and cables, eg., Nautilus) per your therapists OK.
Also, and I’m sure you know this, but I’ll reiterate just in case, while rebuilding your shoulders, don’t ever climb (or do any “big muscle” activity) after your PT. Those little guys need recovery time, too, even if they don’t feel worked.
Hi John,
Steph and I will soon put together a post specific to this.
In the meanwhile (which, knowing us, won’t be long, as once we get a bee in our bonnets about something we can barely stand not acting on it immediately! ;-)) keep doing what you are doing.
The thera-band exercises may not feel like they are doing much, as even the most raucous thera-band sesh won’t exactly leave you feeling wasted, but they target the smaller, stabilizing muscles most of us don’t even know exist … until we find ourselves shock-loading an arm, especially in an already fatigued body, at which point we demand more than they can deliver, unless properly trained! You can also try simulating your thera-band exercises with a light (5-8 lb) weight or on gym machine (the ones w pulleys and cables, eg., Nautilus) per your therapists OK.
Also, and I’m sure you know this, but I’ll reiterate just in case, while rebuilding your shoulders, don’t ever climb (or do any “big muscle” activity) after your PT. Those little guys need recovery time, too, even if they don’t feel worked.
Agreed! I didn’t do a lot of “official” trigger point or massage, but I sure did use my thera-cane a good bit!
😉
Keep it up, Richard and hopefully you’ll be stronger than ever soon.
Steph and I are going to put together a shoulders-for-climbers exercise routine and we’ll post it soon.
Zac,
Good luck with your shoulders. Surgery can seem reallly scary, but ultimately, it may be the best thing one can do. And if your injuries (which sound a lot like mine) “qualify” for the laser treatment, that is great, as it is non-invasive and a shorter recovery time than an open procedure.
In the meanwhile, do all the “pre-habbing” you can! Keep the “recruiting muscles” fit and strong and use a modicum of restraint in your climbing endeavors.
Don’t neglect the stretching/yoga aspect of your pre-hab, as well as antagonistic (to climbing) muscle strengthening—that may help with your lock-ups. If you are like most rock climbers, you may be over developing your pulling muscles and you need to counter-act this. Yoga is great for this and there are some really great yoga podcasts out there, or videos. Though I recommend at least a few classes with a great instructor to insure your postures are correct. (Climbers, being strong, are fantastic at compensatory muscling through postures!)
 Thanks Lisa, I look forward to reading your post on the subject.
Thanks Steph and Lisa!
I have this issue right now, people say it’s bursitis, others say impingement, and even to rcuff tendonitis. Fact is I’m too broke for an MRI, so I accept that I might never know. Been doing active resting and small shoulder muscle exercise with the a 40 Lb resistance band, push ups and some stretching.
I love that you mentioned posture, I am revamping this in me, as well to the yoga ish posture.
But a new fear has arisen, fear of sticking any dynamic move with my right side (shoulder in question) so I’m turning to crack climbing.
Thoughts?
Thanks again.
Hey LIsa! Thanks for the awesome info. I was wondering if your chronic shoulder dislocations before your laser surgery were complete dislocations or subluxations?? I have had my shoulder subluxate I think chronically and am curious as to what I am getting into. I have had an MRA of my shoulder and it shows some vague tendonitis in the bicep tendon and supraspinatus and possible labral tear….The doc said that I have ‘multi-directional instability’ and said to keep climbing as long as it doesn’t hurt. I rested 6 weeks, then started out really slow and ended up with a coritisone shot to help with the diagnosis as well. That helped a lot with the pain, but I am still cautious as I can still feel things ‘move’ in my right shoulder when they shouldn’t be. This is a hard road and I thought this would make me even want to pursue other things like biking, which many encourage me to do, but no… I just want to keep climbing more and harder and make up for lost time. How do you stay sane and upbeat? Also, I am doing many PT exercises religiously that are helping with shoulder instability. I think it’s getting better, sorry for the long note, but it consumes me almost daily. Peace. Cali
such a great help and great to hear of others in the same boat as me – guess misery really does love company! Thanks a bunch 🙂
get better 🙂
Thank you so much for that. It really hit home.
Glad it could help 🙂
Does anyone have any recommendations for shoulder doctors(with climbing related experience) around the Yosemite area?
hey Cali, I am literally experiencing the same thing you are, I am having trouble with my left shoulder, It’s like the 9th time I dislocate it since I was around 16, now I am 24, I’ve read that surgery doesn’t help much, I’m attending a physician today, and see what is going on, if it helps I can keep you posted on my situation and I tell you I AM NOT GOING TO STOP CLIMBING, that said hope you get better!
[…] while googling on climbers injuries regarding my biceps injury, I bumped into one of your posts that you re-addressed to Lisa Hathaway on shoulder injuries back in January 2012. In her answer she mentioned that she once recovered from a biceps […]
If anyone does read these comment boxes, is there any way of putting me in touch with this informative, knowledgable women?! (i.e lisa)
[…] Steph I read an article about someone asking about rotator cuff problems and surgery. You referenced lisa a subject matter expert on this. She mentioned since it’s a rotator cuff […]
Great info! I dislocated my shoulder about 3 months ago when I slipped off a hold while doing a mantle. Now the easiest of grades seem so much harder, partially from a numbing pain when putting weight on the arm, and partially from fear of repeat injury.
Warm up and cool down is incredibly important, I now do my PT routines with a theraband before climbing. Seems to help my muscles on the injured arm from overreacting and stiffening up.