Recovering from a Climbing Injury
In March 2008 Briana and I just returned from our first big trip climbing outdoors in New Zealand. After getting the taste for real rock in my blood, I decided it was time to join the local rock climbing gym. My office was near the gym so I was able to climb in my lunch break. Unfortunately I tried to do too much too fast and this choice would soon force me to take months and months off climbing and leave a large dent in my bank account.
When I started going to the gym at lunch I wanted to get as much out of my 50 min session I could. For the first couple weeks of my new schedule I was bouldering at the gym 3 times a week, and climbing at least once on the weekend. This schedule would prove to be too strenuous for my underdeveloped muscles and tendons.
After 3-4 weeks of this climbing schedule I started to experience severe pain in my left elbow. It was never debilitating, but while climbing I hurt to the extent that it would distract me when trying to stick hard moves. I mistakenly ignored the pain, believing myself to be young and healthy, I figured it would just go away. Over the next two weeks it continued to get worse at which point I started to do some research on climbing injuries. At that point I discovered that by ignoring it and continuing to climb I had probably compounded an otherwise tame injury.
I decided I would heed advice I read, stop climbing and see a doctor. The first doctor I saw was a general practitioner who gave me a mediocre exam and to the extent that there was any diagnosis at all suggested it may be tendonitis. He told me to rest it for 4-6 weeks. I heeded this advice but my arm never really healed completely. At 4 weeks I thought I would go climbing at the gym for a bit and see how I was feeling. The first climb was relatively painless, but by the end of our climbing session my arm was throbbing. I decided I should go back to the doctor and see what else we could do. This time around he told me to go see a physical therapist and to treat what he was still calling tendonitis.
During my initial down time I was doing my own research on climbing injuries and symptoms and I was beginning to doubt the diagnosis. Everything I had read about tendonitis suggested that appropriate rest is required for the tendons to heal and few people who do this don’t experience a full recovery in that time. Muscles typically build faster than tendons so injuries can occur quickly and easily. It sounded like the pain might have been similar but I was not experiencing the recovery expected. I decided to try to see an orthopedic surgeon. Luckily my health insurance was a PPO and I didn’t have to go through the wrong treatment before I was directed to see a specialist, as would be a likely scenario with an HMO.
My experience with the orthopedic surgeon was more what I expected and should have received from the first doctor. The surgeon sat me down until we were able to reproduce the pain. Through different pushing and pulling stressors we discovered the tendons were fine and I had a brachialis muscle strain. He also thought that physical therapy (PT) would be necessary and gave me the names of some local sports specific places. My insurance would prove to be less than stellar on this front.
Dealing with insurance companies is the most frustrating experience. Their websites are poorly designed and don’t provide you with any information. Calling them connects you with employees who genuinely don’t care and are unhelpful at best. It took me several hours on the phone to find the physical therapists my insurance covered. The one sports specific PT had a waiting list of 6 weeks. I was getting impatient with my arm and just wanted it to get better so I could keep climbing. I opted for the first PT I could find with an opening that week. In retrospect this was a big mistake.
I should have known better at this point that diagnosis is a necessary step for appropriate treatment. My first visit with this PT was analogous to my first doctors visit… “Oh you have an arm injury, well this is a typical treatment for something similar. So that should work for you too.” The treatment was the same each time. Heat, massage, electrodes, and ultra sound. There was never an attempt to see what caused the pain or what made it better.
It was my delusional optimism that led me to believe I was getting better. I just wanted to climb, and I didn’t care how I got there. After 6 weeks and little improvement, I just couldn’t wait to get back to climbing. And I slowly eased into it. Starting with one our two routes at the gym and keeping them super easy. Immediately after climbing I would ice and rest the arm and massage it to help combat the pain. This would be my climbing routine for the next 6 months.
Throughout this process I worked in an office sitting at a computer all day. I had inklings that my posture and desk position could be compounding the climbing injury. I tried several chairs, keyboards, mice and monitor positions until I found something that seemed to work.
In March 2009 a coworker joined the gym and we decided to go bouldering at lunch. I knew from my experience that I wanted to keep it easy and rest and stretch appropriately between climbs. I felt like I was finally starting to make improvement again. I was breaking the V3 barrier and starting to get into V4’s. This is where things got particularly strenuous for my arm and the pain came back with enough force to initiate another visit to the doctor. With my knowledge from the last year I decided it was time to go to an arm and upper extremities orthopedic surgeon. I had a lot of history for them to build on and I was hoping that I would get some new information from someone who had legitimate experience with climbers. The doctor I found had seen many climbers for their injuries. This gave me confidence that I would get appropriate treatment.
After my initial visit I felt like the doctor was aware of my concerns with poor medical attention at this point and what my goals were. He decided that the brachialis muscle was still the culprit and thought we should get an MRI done just to be sure. Here is where my insurance coverage and lack of communication would prove to be costly, at least this time it was just to my wallet and not my time and health.
It took about another 3 weeks for the MRI request to be processed and to get the results at the follow up appointment. The results were interesting. MRI’s are really cool.
The results surprisingly showed that all the muscles and tendons were in good shape. If they were going to make a decision based on the images, they would say there was nothing wrong with me. They saw no muscle damage. We got a clear picture of the brachialis muscle and it looked like normal tissue. This suggested that there were likely other problems.
It was about May 2009 and prime climbing season. And here I was again not climbing and scheduled for PT. I decided this time around that I would bide my time and get the good sports medicine physical therapist. I would find out later that I was seeing the same PT as one of the top female climbers of all time. This gave me hope. The first 2-3 weeks of PT we spent reproducing the pain. This included pullups, grip master, and anything else to get it to hurt. Then once we did that we worked on getting the pain to stop. This proved to be challenging since it turned out that the muscle was not the cause of the pain and it was instead a nerve running from my neck to my hand. This explained a lot since most of the pain I experienced post climbing was sitting at my desk in front of the computer. The treatment is primarily back and neck strengthening exercises to counter balance the muscles that are tweaking the nerve and irritating the muscle. The best thing I have found to combat the pain at my desk is sitting up straight. It’s an almost instant release of pain when I do this. I’ve tapered off my PT appointments to once every other week. To gauge progress and see what else can be done. At this point, I think the best thing for my arm is going to be getting away from the desk. I think as soon as we begin traveling in February all my problems will remedy themselves.
There were so many lessons I learned from this experience. The most important ones for me are:
1. Don’t ignore pain. If you feel something out of the ordinary it’s a good time to take a break. And if it’s bad enough see a doctor.
2. Don’t assume doctors know what their talking about. See a specialist if you can. If you can’t see a specialist, give the general doctor the tools they need to familiarize themselves with climbing. A good resource is One Move Too Many: How to Understand the Injuries and Overuse Syndroms of Rock Climbing
3. Dealing with insurance sucks, but dealing is cheaper than not having it.
4. The internet is a valuable resource for injury related information, but see a doctor for your injuries. Don’t assume you can let it heal and be fine.
After this experience I have a routine I follow before I climb. Most of my routine is found in any good training book or website about training for climbing. It includes warming up stretching and easy climbing. One resource that has excellent information is the Nicros training center.
The stretches in the injury section are what I start with before each session, in addition to the injury specific stretches I have worked out with my physical therapist. This is just my experience with injuries. If you have an injury consult a doctor and do your own research. This should help you get back to the crag in no time.