Rock Climbing Neck Injuries 4-Point Neck Extension Core Strength Reaches

Start in 4 point position on your hands and knees with 4 feet Resistance bands tied diagonally from opposite wrist to ankles. Keep your posture in neutral with your low back core engaged and prevent your shoulder blades form collapsing.

Begin with a neck warm up by flexing your head and neck down by bringing your nose to your sternum. Slowly bring your head back up extending your neck and rotating it to the left side. Repeat this for 5 reps to warm up for both sides.

Then after your 5 reps for each side add left finger, hand and arm reaches with right hip heel extensions. Repeat this for 10 reps on each side for 3 sets daily.

This is a great functional core neck strengthening exercise for rock climbing training and performance. It’s designed to help you retrain and optimize your best neck movement and strength patterns.

If you have any bad or questionable pain or discomfort, discontinue this exercise and consult your local physiotherapist before continuing. 

Karl Domes RMT Profile Video

Hi there. I'm Karl and I love working as an RMT. It's a very cool job. It's such an honour to be able to work one-on-one with people, to collaborate on building goals together and on making a plan to achieve those goals. And it's a pretty cool feeling to go home at the end of the day, knowing that my time and energy was spent on improving someone's quality of life. 

I'm naturally a very curious person. And so I really enjoy the aspect of piecing together clues with the patient as we explore what's going on with their body and how things are connected and what we can do together to help them live in the way that they feel good about. 

I love working with people from all sorts of walks of life. And I find it really cool when there's, you know, a certain limitation in an area or pain in an area and there's pieces that we can put together to figure out what might be going on. How the body's connected and how we can work with that, to get someone back running, walking, enjoying their life, hiking, skiing, whatever it is that they want to do.

Insync Physiotherapy has been such an awesome place to work. I actually specifically sought out Insync Physio because I wanted to work in collaboration with physiotherapists. I love knowing that a lot of the patients that I see are seeing physiotherapists here as well. And so we can communicate with each other about how to work as a team to help that patient meet their goals. It really feels like there's a circle of care that are supporting patients on their journey here. And that really resonates with me. 

Insync also has a strong culture of learning and mentorship. And as I said, I'm a very curious person. So to be able to work somewhere where there's really great conversations, mentorship sessions, I'm constantly being challenged to think in new ways. And there's a lot of support too, in terms of my own professional journey and my own interests and learning more about them. 

Outside of work, I love using my body. I love cycling. I love running. I love hiking. Skiing. Vancouver is such an incredible city to enjoy the outdoors and something I recently discovered that I love doing, which I was a bit surprised about, was swimming in the ocean in the middle of winter. So that cold water plunge 8:30 AM on a January morning turns out something that really gets me going. But any way that I can get outside and enjoy the beautiful outdoors is wonderful.

So I look forward to meeting you and can't wait to start working together.

Rock Climbing Neck Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto he's the owner of the chief cook and bottle washer. Not really. He's the big chief at Insync Physiotherapy in Vancouver and North Burnaby. And we're going to talk about rock climbing neck injuries today. How are you doing Wil? 

Wil: I'm doing well. Thanks. And I have actually washed bottles for a job once before, so. 

Mark: Me too actually. So, rock climbing neck injury. So this doesn't seem like it would be a very common thing. How common is injuring your neck while rock climbing? 

Wil: Well, you know, it's interesting, it's more related to sort of the chronic issue and I guess you could classify it as repetitive strain. And there's a couple of different aspects to it.

So one of the common ones that you know, if we put a label to it, we call it the belayer's neck. So for people who like basically, you know, belay and they climb like this, and they're always basically shortening up those muscles. Now there's a few aspects of belayer's neck. And then just in general, people who are like climbing really hard, but aren't doing a lot of mobility work to really make sure that they're recovering the full mobility of their neck and their spinal joints and their associated areas that around the neck. Because there's a lot of muscles that attach from the neck to the shoulder and then from the neck to the upper back and all that stuff.  

Mark: So the symptoms would be pain, I would assume. 

Wil: Pain and stiffness. Those are the biggest ones. And occasionally it can get bad enough where you have like a radiating pain or nerve pain. So that's where it gets a little bit more extreme where there's like a sort of a pinched nerve. 

Mark: And the causes are basically, like you said, it's chronic it's from looking up all the time or maybe not having great biomechanics for other things because you haven't worked on it. And so you're using your neck in a way that it's not really meant to be, or trying to compensate using your neck muscles. Is that. 

Wil: Yeah. So what happens is that there's an imbalance once again. And you have a lot of tightness in certain muscles, and sometimes it's tight in the front too. And obviously really tight in the back. And so what ended up happening is that you don't get the proper extension in your neck and you're actually pinching in and only moving in limited joints and extension through the neck when you should be extending throughout every segment in your neck.

So that's important to understand because then when you're looking at the muscles that they get really tight. Then it contributes to that effect. And so what we need to really help people understand, like climbers understand you know, the mobility work to get that moving, even when it doesn't feel symptomatic is really important to do. Especially if you're an avid climber or especially if you're a competitive climber and someone is looking at increasing your training level to really hit personal goals. 

Mark: So someone comes in. They're a rock climber. They've got neck problems. How do you diagnose it?

Wil: Yeah. So one of the main things, I was saying earlier that you know, that you can get from like limitation and the movements and the mobility, and the pain could also be coming on a little bit more where it's more than just stiffness and soreness. Now it becomes like, Oh, pain, I can't even like look up. To even like radiating pain down the arm where they may not even have pain in the neck. So we need to differentiate and figure out which one of those are, right. So we have to look at, is it coming from the joint? Is that why you're getting the issue. 

Most likely, it's a combination of that with the imbalances in the muscles. And then if it's a pinched nerve, we have to figure out okay, which areas. And then start to alleviate that. Because we want to make sure that we start to get that moving properly as well, so it alleviates that.

Mark: So depending on what the diagnosis is, that determines what the course of treatment is going to be. 

Wil: Absolutely. And then just a little bit more on the whole, like radiating pain and the nerve pain, you know, if we find something that's a little more serious, something that we think that requires more medical diagnosis or getting to have your family physician to take a look at it. It's important because maybe there's some going on there where it's affecting the nerve health. And so when we assess that and examine it we can determine how much is it being affected in the nerve. 

Mark: And in terms of, because climbers want to get back climbing right away again, how soon can they get back to it typically?

Wil: Pretty soon. I mean like you can still keep climbing. Like I'm treating a climber right now, who's had a past history of a pinched nerve. But no longer has that, but presents with some symptoms of weakness related to the pinched nerve, which he doesn't even know about, which is interesting. And still climbing. Still training hard and addressing this issue. So that's an example from one that I'm treating right now who had that. 

Another example, I'm treating someone who it hurts just to look up and then we look at his movement is so stiff that even when he brings his arms up you know, he can barely bring his arms up to here. How can you even possibly climb? And it's been sort of gradually building up. It's interesting. He's just noticing how he's more stiff and more stiff. And he tries to do things that stretch it out before he climbs and really open things up more forcefully and it's just, he's so compressed.

He doesn't realize that, you know, the more that he's climbing right now, the more he's making it worse. And he has definitely sort of a lot of weakness in a lot of other areas that are most likely related to the nerves in the neck. So here are we going to tell him reign it in a little bit and let's just give it a week's rest and then we'll get you back climbing in a week. And then we've got to do more of a gradual step approach. And this is quite common, too. I see a lot of people that are like that. 

And then we have another example of another climber who doesn't have any radiating pain. Doesn't have any weakness. It's just stiff and they can keep climbing as normal as well. So two, three treatments and they were good. And got him on an exercise program, building on manual therapy, mobilization techniques to work the joint. Keep them moving and get the muscles that needed to be strengthened and really work on, you know, relaxing and resetting those muscles that are really tight. That way things work more properly. 

Mark: How important is it that the climbers follow the exercise program you give them, in terms of how well they're going to, over the long-term not have this problem recur? 

Wil: It's pretty important. And I think it's funny because you know, we take them through maybe a couple of treatments, and then give them the exercises, they're doing and they feel great. But then I'll see them again in a year or maybe a couple of months, they've increased the training more and ask them well, what's different other than the training.

Oh, I haven't done my exercises that much. And so it's important because the exercises that we give you are individualized to what's going on. So we look at what needs to be targeted and what needs to you know, really be emphasized in terms of even like warm-ups and stuff. And so when those aren't being done and you figure a climber and you're like pushing and increasing the intensity, then it's an obvious recipe for something to happen in the future. If you're going to continue climbing, at an avid level and especially at a competitive level.

Mark: If you're a rock climber in Vancouver with some neck issues, stiffness pain, you want to get it fixed. The guys to see are Insync Physio. You can reach them in Vancouver at 604-566-9716 they're on Cambie and King Edward or in North Burnaby, 604-298-4878 to book. Or of course you can book online at insyncphysio.com. Thanks Wil.

Wil: Thanks Mark. 

Sacro Iliac Joint Injury Rehab Squat Clocks

Start with nice tall posture and engage your core muscles below the belly button by drawing the lower ab muscles inward toward the spine. Then, stand on one leg and hold a stick with the butt end about 2 and a half feet away.

Bend down through the hips to touch the stick to the floor at the 9 O’Clock position like a grid on a clock. Come back up and then bend down to touch the end of the stick at the 10 O’Clock position. Repeat this until you get to the 3 O’Clock position and then reverse coming back to the 9 O’Clock position again to complete the full set.

When doing this exercise keep your knee aligned with your second toe, over your ankle and bring butt back like you are going to sit in a chair. Do 2 full sets 2 times a day on each side.

This is great exercise for developing core stability strength, balance, and control in your Sacro Iliac joint after it’s been injured. 

Neck Injury Rehab Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees. As you place one hand forward bring your opposite foot forward as well.

Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

This is a great progressive core stability muscle strengthening exercise for your neck after sustaining an acute or chronic type of injury. 

Rock Climbing Shoulder Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner chief cook and bottle washer at Insync Physiotherapy in two locations, one in Vancouver, one in North Burnaby. And today we're going to talk about one of his favourite activities, rock climbing, but specifically rock climbing shoulder injuries. How do you hurt your shoulder rock climbing Wil? 

Wil: Yeah. Hey Mark. So one of the most common ways to actually injure your shoulder in rock climbing is basically over-training and overusing your shoulder and movements, not actually recovering enough. And so the shoulder is actually the third, most common part of the body to be injured in rock climbing.

And more specifically with overuse type of injuries related to the shoulder. You can get some other type of injuries that are more traumatic, like from a fall or something like that. But that's like far and few. 

Mark: So is this more of a problem now with the advent of indoor climbing? 

Wil: Yeah, I'm definitely seeing a lot more of it. Also, like I think you know, like we talk about the indoor climbing sort of booming here. Now that rock climbing is a, I mean, it's a professional sport and the 2020 Olympics, I guess it was 2021 in Japan where it made its debut. And so as a result there's a lot of people coming out to the gym and like, Hey, rock climbing, let's check it out. And people who are athletic too, right. They're really gung-ho about it. They may have been working out in the gym, like maybe four or five days a week and they go hard in the gym and then they try rock climbing and then they go hard in the rock climbing gym. Same kind of intensity. 

But when you start off with rock climbing, you've got to be a lot more careful just because you're strong and really physically fit because you go to the gym, doesn't mean you're strong and physically fit for rock climbing. 

Mark: Very different moves. So what kind of symptoms would somebody have from a shoulder problem from overuse rock climbing?

Wil: Yeah. So it'd be like some soreness and achiness, ascribing, a little bit about like, you know, that sort of delayed onset muscle soreness in the elbow earlier in another session. But like, you can also get stuff where it's like moving can be really affected. So it may feel more pinchy. You may feel more limited.

Like you may not actually have any pain in certain realms of movement sort of below or whatnot, or with it sort of a plane of movement, but then as soon as you go beyond that plane, then you start to feel more of a pinching or a sharp pain. And I think when it comes to that you know, most people start to recognize that you need to get looked at. But what I also do see that people start to try to stretch it out and they may have done things from their old athletic days where they've been training. It kind of gets the pain, you know, puts it in check a little bit, but then, and they can keep going, but then it's always there.

And so the problem with that then is then you develop this movement pattern dysfunction. And actually I should correct myself. It's not a developing of the movement pattern dysfunction because the movement pattern dysfunction is already there. Now it's accentuating that even more. And we can talk a little bit more about that as well. 

Mark: Sure. So the cause is basically training too much, not resting enough, maybe bad technique could be part of it. And then when you're diagnosing that, you're mainly using history. How are you climbing? How much you climbing, is that their main function of how you're diagnosing it to start at least.

Wil: Absolutely. So the history gives me an indication of what to look for and then it points me in the right direction. And then we're going to figure out, you know, what part of the shoulder is affected. So that's in the clinical exam when we look at you. So we have a group of rock climbing physiotherapists here. When you come in, we examine and then the other thing that we also do, we notice, and this is like probably 10 out of 10 times, there is a very, very definite movement dysfunction. So what I mean by that is he compared to the other side, that's no problem. And that side that's affected. It's like, what's going on there? How come it's doing that?

And then you try to compensate or facilitate a more normal movement pattern. And then they're like, now they can move again. There's no more pinching pain. So those are very common things that we look for. And we assess those things more thoroughly because we want to get at the root cause.

And part of getting at the root cause is in looking at, Oh, well, you know, what's happening in the neck, because the neck is intimately connected with the shoulder. There's a lot of muscles that connect onto the shoulder to the neck and they work together in synergy. 

Mark: Is it fair to say that the shoulder is the most complex joint in the body?

Wil: I wouldn't say it's the most, but it's definitely very complex. It's very complex with respect that you have a joint that basically is a ball and socket, so that you can imagine, like, you know a golf ball sitting on a golf tee. And then basically the cartilage and the ligaments is what keeps it on more when you're trying to move it around. And the muscles and the rotator cuff. It's very dynamic. And because you have this like 360 degree range of motion, it allows you that freedom. But at the same time, there's a lot of things can sort of go awry. 

Mark: A lot of different little muscles in there and attachments and stuff going on. 

Wil: And they all must work together. 

Mark: And in the right order, of course. So if you've had some pain in there, is this a way to maybe describe it for people that I've injured something, perhaps even underneath under the scapula or the shoulder blade or whatever. And now I just don't reach the same way and I'm kind of twisting myself in order to be able to do things, to avoid the pain. And I don't even notice it anymore. Is that kind of what we're talking about? That movement patterns that are not working properly anymore? 

Wil: Yeah. Like before becomes even symptomatic, you've already developed it. Exactly. So we see this all the time. And it may even start from like a very minor neck thing. Where you might have like, had whiplash from say, I'm just giving you an example. You're a snowboarder as well, and you might have had a bit of a whiplash and then you shake it off, but then you like, you know, you go climbing and then you're pushing it. So there's all these factors that where now you're like, Oh, I'm increasing my intensity. And I'm pushing that. And now your shoulder has to work harder. Because now you don't have like this movement function in your neck, that's optimal. And now you have to compensate with your shoulder. And over time that starts to get more accentuated and then et cetera, et cetera.

Mark: So how difficult is it to diagnose which muscles and ligaments and tendons and pulleys are actually involved in the shoulder issue that someone might have. 

Wil: Well, for us in our team, our rock climbing physio team here, it's fairly easy. As long as you know we get the right information and you're not poor historians, but the movement doesn't lie. You can't fake the way you move your shoulder. So then like, Oh, what's going on there? Like, did you have, you know, was there something in there before, or did you have this for a long time? So it's interesting. Like there's always a history. And like you said earlier, and in terms of like, is the subjected history, one of the biggest ways and best ways to first diagnose. And it's the key.

And you know, it's interesting because we're working the national championships this coming weekend, February 19th, 20th, 20 and 22 here. And there's some climbers, high performance climbers that we've been treating. And it's funny because it was like, Oh, you had an injury there. And they're like, Oh yeah, I forgot. I'm like, that's why it's moving a little bit off. It's really interesting. 

Mark: So what's the typical course of treatment for people? 

Wil: Well it really depends. Like if it's something that's really severe in terms of the movement pattern dysfunction, and it's been going on for a long time and they can't even use their arm. It really takes a lot to try and break those patterns. So we got to do a lot of things to break those patterns with a hands-on approach, you know, whatever modalities that we choose to use that would be most affective for the individual. Plus specific exercise to reinforce the mobility patterns that we want. And the strengthening patterns that we want. And the movement patterns that we want.

So that's the longer game right there. So that's going to take anywhere from, you know, somebody that has something really minor maybe, you know, like several weeks, seven to 10 weeks, maybe, to someone that has more major things going on. It can be several months up to a year.

And especially if you're not consistent with doing your recovery and consistent with your exercises because you know, it's the most important thing to be able to keep retraining that. Some people come in and see us. We reset it with all the things that we do. And we give you things to reinforce it, but you need to keep reinforcing it. It's the training. That's why we give you the exercises that you can retrain it.

Mark: So typical course of treatment could be up to a year. How long until somebody's pain-free? 

Wil: Like I said, it could be even like a couple of treatments. And then we still need to address, you know, that movement dysfunction. And so we do a couple of treatments, reset things, and then they're on their own, really trying to work hard on it.

And if they're really committed to it and most climbers usually are, the ones that are more avid because they basically chase the climbs. And it's kind of a rush thing and you're just kind of addicted. And so part of like staying climbing, and then you want to do the things that are going to help you. So to anywhere like, yeah, it could be like a year or two where you're coming in intermittently here for the same issue.

And it's not uncommon. Like I see someone that's coming in. Yeah, it was good for like six months. And then, you know, I kind of stopped climbing a little bit cause I was working too much. And then I stopped my exercises and it's not a dissimilar story. When it comes to sort of that. But then when it comes to sort of some of the high performance climbers that I've treated, it's a lot easier and there's been some traumatic ones that I've treated that it does take a little longer. But those are far and few. You know, if it's a surgical thing then it could take over a year, a year and a half. 

Mark: And how often is it that you're treating neck, shoulder, elbow, fingers, hands all at the same time, trying to get that whole chain working properly again?

Wil: Quite often. And like I was saying earlier, the neck and the shoulder are so intimately connected that you need to be able to address both. And all of them at the same time. 

Mark: If you want some expert help for your climbing injuries, the guys to see, especially your shoulders, in Vancouver, Insync Physio. You can book online at insyncphysio.com. They're high performance climbers, there's lots of them in there, both the clinics. In Vancouver at (604) 566-9716. If you want to phone and book. Or North Burnaby (604) 298-4878. Get your shoulder looked after. Get pain-free and start doing those high risk climbs that you love to do. Thanks. Wil. 

Wil: You bet. Thanks Mark.

Rock Climbing Elbow Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio and Sports Physiotherapists in Vancouver and North Burnaby. And we're going to talk about rock climbing injuries, specifically elbow injuries. What's the cause of this Wil? 

Wil: Yeah. So first of all, like rock climbing injuries with respect to elbow injuries, it's the second most common type of injuries that you see in rock climbing.

And usually it's an overuse chronic type of injury. So there are some sort of more acute sort of traumatic type of injuries, you know, where you get from like a fall or something like that. Those are far and few versus the chronic type of overuse ones. They can sometimes mimic what people also call it golfer's elbow or tennis elbow.

The other one is I guess it's related to the shoulder, but it can also happen down closer to the elbow, is biceps. So depending on where the injury starts to happen or where you start to get problems and symptoms or whatnot, then you can start to get a biceps overuse injury. And it's the very common thing to happen. 

Mark: So what are the symptoms of an elbow injury from rock climbing? 

Wil: Yeah, it can start off as the soreness that you get from a workout and you think that it's just, oh yeah, I had a hard workout. You know, when you push it in the gym and you feel sort of that delayed onset muscle soreness. And then it continues and it doesn't go away. It can be really sort of a low lying nagging thing too.

And that's the thing that tricks most people. So it starts off as just this little lowing, like ache that's totally tolerable, and you end up like, trying to climb through it and it just doesn't go away. And then like, you know, a few days turns into a week and a week turns into like two weeks and several weeks.

And then quite often I'll see some climbers in here that ended up like, Yeah, it happened like four or five months this has been going on for. And either it's not getting any better or it's getting worse. And so there's a few factors involved with that as well, in terms of, you know, like what contributes to these types of injuries.

And usually one of the biggest ones is just over-training. Over-training, overloading it and not enough rest and recovery. So I'm actually treating a young rock climber right now actually. He's only been climbing for three years, just coming on three years now this summer. And he's basically five days a week in the gym.

That's a lot of training and he's basically all high intensity. Every time he goes out, he givers. And so as a result, he's not really resting. And as a result, he's having such a big overload in his elbow and his forearms that that's why he's getting problems. And actually it's been leading to some hand injuries too. So it kind of trickles down. 

So the other interesting thing about someone like this too, is he's a student. He's first year engineering student and he's on the computer a lot. So now you're compounding all that climb training and all the things that you do on, you know, like already overloading in terms of a physical activity perspective.

And now you look at, okay, you know, so let's say he has a job or another person that has a job that's on the computer. Same thing. Now you've got all got all this repetitive strain happening in the forearm. So that's definitely a huge factor.

Mark: So is just getting the client history, is that your main form of diagnosis of this injury?

Wil: Well, that's a big one, initially for sure. I mean, it automatically points me to direction of what I'm thinking of and looking for. But obviously in the exam I need to rule out other things. I need to rule out like is there any trauma? And what else is going on? Like, you know, if there's other structures involved, like, so if there is like stuff in the hand, for example, is it like a pulley or a tendon or is it a ligament or is it a tendon in the elbow? So it really helps us like kind of focus in on our objective exam, when we take a really thorough history. 

Mark: And once you've diagnosed, what structure in the elbow or leading to the elbow is the problem? What kind of treatments are you, options do you have? 

Wil: Yeah, so usually like with golfer's elbow, it's similar to like on the inside of the elbow where you can get a lot of overused stuff happening around where the points of where that muscle attaches just above the elbow there. And on the outside, which is the tennis elbow. And it can be the exact same area on the upper part of the elbow. And so basically the first important thing decrease the load. Like take the intensity down, take down like the aggravating factors.

You know, if work, in school, you cannot, then obviously you're looking at the loads of like, okay, well, let's look at your training. Your training five days. Let's get you in the gym and what are you doing? You're doing hard every day. Okay. Let's get you in the gym three days a week.

And instead of doing three hard days, let's just do like for the first week, let's just do easy stuff. And then we're only going to do a couple of days that are a lot more moderate and then an easy day. And build it back up. Because ultimately what we want to do if there's any kind of acute chronic type of swelling, where there's sort of like, it's kind of a low lying, but then you climb and you do something and it flares up a little bit, then that's what I mean when I say acute chronic.

That you sort of have this like continual thing happening and it's there, but then now you're aggregate it even more. So you got to settle down that acute stuff. So when it's swollen, you got to sell it down with basically the RICE principle for the first 48, 72 hours. So don't do much, ice, compress, elevate.

So that's important. And then once you got that going, and then you'd move into the, you know, basically trying to get that healing phase. After 72 hours, up to a week is sort of that middle phase of that healing. Where it's laying down, you know, the collagen. Collagen is the basic building blocks of the muscle, tendon and soft tissue.

And then, there's the what's called the final stage, which is called re-modeling, which we want to really work at specific type of exercises. Now that's not possible if you have a lot of other stuff going on where it's not even allowing you to activate that. So this starts to become, oh, well, what caused this?

So we want to really look at, are we addressing the root cause of this first? And so that's how our treatment will be guided because if we can figure out what the root cause of the elbow issue. So maybe there's an issue in the neck. And actually with this individual, he has a neck issue. It doesn't hurt, but he did get in an accident and he had whiplash like when he was younger, but it doesn't give me any problems now, but he's really imbalanced.

It doesn't have any neck complaints per se, other than the fact that it's tight, normal tight. And so that can actually compromise a lot of the, what we call the normal movement patterns of that whole like shoulder, neck, elbow, forearm, our hands and fingers. So then what ends up happening is that that movement pattern is now like totally off.

And so we have to retrain that. And so part of looking at what we needed to retrain that is we've got to also look at what's imbalanced. So things are pulling, you know, and we can get into it a little bit more of that, especially when we look at shoulder. But you get that into the elbow as well. So there's all of these imbalances that happen all the way up. 

Mark: And what sort is the typical treatment timeframe to get that retraining underway so they can get back going five days a week. 

Wil: Yeah. So it depends on how ingrained chronically it is. If it's something that's just started and people come in right away, it will be relatively quicker. And I say this relatively quicker. And so this quotations, like the retraining part will still take a good several weeks, a few months and then ongoing sort of retraining it. And, it's like, if you don't use it, you lose it. And so if it's more ingrained, the dysfunctional movement pattern, then the longer you got to retrain it.

So I'm working with some climbers that have been working for quite a few years now where we've been trying to help them retrain your functional patterns for over a year, year and a half. It gets better, but they climb hard and they forget to do their exercises and the recovery stuff sometimes.

So we had to reset it. And so they come back into the clinic and see us, and then we actually have quite a few rock climbing physiotherapists here that work at the clinics that can help with that too.

Mark: So if you have elbow pain and you're climbing, you need to get it looked after, it's not going to go away by itself, especially if you're climbing hard. Guys to see in Vancouver are Insync Physio, you can book online at insyncphysio.com for both locations. In Vancouver, you can call them and book as well at 604-566-9716 or in North Burnaby, 604-298-4878. Get in there and get some help. Get started on your retraining. Thanks. Will.

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Upper Back Climbing Mobility Crawl Twist

In Rock Climbing part of the Physio / rehab that is really important to do for the spine is improving your upper back or thoracic spine mobility. You need this for large cross over or cross under maneuvers of the hands and sometimes the feet.

To improve your upper back mobility try doing this exercise two times per day and also at the start of every climbing warm up session. Start in 4 point position on your hands and the balls of your feet. Bring your left foot forward and steady yourself on the ball of your foot.

Then cross under all the way with your right hand and arm and then bring it back out and reach up and over. Repeat this for 10 reps on each side doing 3 sets. 

Lateral Elbow Pain Sitting Ball Catches

Start by sitting on a balance ball. Hold a lacrosse ball in your hand with your elbow up and forearm parallel to the ground. Keep your shoulder down. Remember to engage your core stability muscles of your lower back to keep your posture in neutral.

Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand. It’s important to only pivot through the elbow and not the entire arm and shoulder.

Repeat this for 30 seconds doing 3 sets for each side daily.

This is a great exercise to strengthen and functional rehab your lateral elbow pain overuse injuries. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Running Gait Analysis with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum. He's the clinical director of Insync Physio in Burnaby, British Columbia, Canada. And today we're going to talk about running gait analysis. What's this all about Iyad? 

Iyad: Yeah, we see a lot of runners and some who are very into it and some who are just the weekend warriors and some people kind of want to take it to the next level. We have some very keen people who want to know how they're doing, how their form looks. So we would put them on a treadmill and take them through an assessment to see what things they could improve on from a form point of view and running economy point of view. Things like that.

And then you get also the people who are repetitively injured. Despite doing tons and tons of rehab. And they're like, well, what's going on here? And even when you try to manage how much running they're doing and the whole load management piece, they can still kind of keep cropping up with these random injuries. Like shin splint, hip pain, knee pain. And those are people who would also benefit probably from having their gait looked at or their running analyzed I guess. 

Mark: So what would be, what are some of the causes I guess of, before we get into actually talking about how you do this, what are some of the causes of somebody having kind of a not pure running style?

Iyad: I guess it's good to say that nobody, very few people have a very perfect, where we consider perfect running style. And I guess that's really important to normalize it because if you've adapted to your running form, there's really no need to change it. Now it's the people who, for example, the people I've seen mostly, have read something on a magazine, for example, that says you have to switch your running style from a hind foot strike, do a forefoot strike, where you kind of hit more with your toe than with your heel.

And that's a shock to the system, because imagine if you're running, like I think of a marathon training program and they're running between 40 to 50 kilometres a week. That's kind of on average. And then it kind of sometimes can go a bit more closer to competition time. They're trying to run up their volume. So imagine if you suddenly switch your running form. 

Well, that could change the demands on your body quite significantly. It'll change a lot of things. For example, like the length of your stride, which muscles are kind of going to hit the ground first and absorb more. Even stresses on our bones and ligaments. The average kind of like person never thinks about like, oh, I'm loading my bones when I run. And kind of also putting forces through these structures, but they are things that need to also adapt to tension and pressure. And this is kind of where having things done in a graded way is usually the best way to do it.

But then most people who like you're talking about with what happens is it tends to either be people who do too much too soon, and then they start running differently to avoid their pain, or you get the person who thinks they should run a certain way and tries to force their body to do something that maybe it hasn't been used to for 20 years plus of running.

You know, it's like since we're kids, we're just used to running a certain way and those people, if they just continue doing what they're doing, they were probably would have been okay. But now that they've kind of changed this, they got an injury and they can't seem to figure out what's the best way for them to run. So those are the people who would really benefit from kind of having that piece looked at. 

Mark: So this, if I'm to maybe, shortcut and jump through this, like the root, what we're looking at here is really the root cause of how to make your running form more efficient or less stressful and it's going to be possibly, or probably more effective than changing your running shoes or, you know, the stylish shorts you wear.

Iyad: Yeah, absolutely. So like, you know, the people we're talking about, we're not talking that like, the Eliud Kipchoge level, you know, or trying to shave off a millisecond off their marathon time. We're talking about, just you know, like recreational runners or even like serious runners who are not at the elite level.

Yeah like, definitely if you have old shoes, you should probably have that looked at. But most people do that first. Most people assume, oh my knees hurt, the shoes. Or maybe I should change something, maybe my socks are slipping. They literally change all of these things before they start to consider some of the things like, maybe it's just the way they're running.

And we tend to see these things where, it's really interesting, some people were like, well, I've been doing this all my life. How come? Well, things change depending on the stresses we put our bodies. So maybe people used to be more regularly active. And now they're going into periods where they're working all week and then trying to hit it hard on the weekend.

And those are kind of people who might benefit from having their running form maybe addressed better. Because now they're getting all of that training volume in a short period of time, and it's not leaving them with enough time to kind of cope or adjust to that. So for the most part, those are the people who would really benefit from having that looked at. But again, not every imperfect run needs to be changed because if you've adapted to it over time, you're good. 

Mark: Yeah. So before we get into the actual mechanics of what you're analyzing, you're also looking at what kind of volume they're doing? You're investigating what's their typical pattern. What's their history. How are their shoes? All of that is kind of the starting place before you get into, okay here's how the biomechanics are working. Is that right? 

Iyad: Absolutely. It's a great question Mark. The gait analysis is only a piece of this whole thing. So ultimately, even if you have the perfect running form, if I start throwing a hundred kilometres more out of you per week than you're used to, your body's going to react one way or another.

So we'd look at, we would do usually in the clinic, a good history. We'll do a training history. A specific injury history. We'll scan them, let's do a bed type exam. Or if their knees hurt, we'll check that out obviously. We'll check out how they move in like easy planes and movements like front, back and side.

And then we would want to look at them running too. Because you'll have a lot of people who have specific pains at certain distances of running. So even when that happens, we'll get people for example, to come into the clinic after they've run their 10 K and they're starting to feel soreness.

So we get to really see what they look like when they're kind of in that zone of fatigue. Maybe that's where things are starting to go poorly for them. And it really helps us identify deficits. So sometimes it's a purely strength issue. Your muscles are just not coping with with that kind of level of impact or volume. So we would kind of help them shore up up, I guess, wherever they need to strengthen. But yes, it's a total picture. It's never just a standalone piece. It has to be part of a more comprehensive exam. 

Mark: So what's involved in the actual gate analysis. Let's have a look at that. 

Iyad: Yeah, so I'll just do a quick screen share here so we can have a look. This is one of our colleagues here in the clinic when we were kind of playing around with this. So we would just kind of get somebody on the treadmill. We'd get them to run for a few minutes to kind of get used to the feel of the treadmill. And then we'd just look at basic things. 

We don't need to quantify angles and degrees to such an extent that's used in research studies primarily, but it's not going to change our clinical outcome. Because there's so much variation between people. So we look at things like how they're striking, how level they can maintain during a run.

We look at, for example, like if they're crossing over too much we tend to look at it from multiple views. So we'll do a side view. We want to see how far forward are they. For example, relative to their centre of mass. And then what we'll do from there is we will come up with a running program to kind of help supplement that and maybe help them retrain that. Sometimes it's just this small, simple cues of changing their step rate.

Sometimes it's getting their arms swinging more. And sometimes we just look at that and we're like, that looks good. It's just the volume issue. We're going to have to address that because if it ain't broke, don't fix it. 

Mark: On this idea of strengthening, how often is that a component of the analysis or the prescription that you provide?

Iyad: Prescription, almost always. And it tends to be the one area that runners don't like to really focus on. Runners love to run. We know that and they're really good at that. The way we think about this is it helps keep them running versus make them stop. Because that's the last thing I'd ever want to do is to tell them to the rest, for example.

That tends to be a bit of a last resort for us, if there's a serious issue, like a stress fracture or something like that. But yeah, strengthening tends to be a big component of this because it allows us to build capacity in some of these areas that are going to be effected or maybe need to be absorbing more of that force.

So a common example would be for example, the person who just switched their running style. Well they probably should have addressed also that maybe if I switched to my forefoot strike my calfs are going to be loaded more and my achilles tendon might need a bit more. And then their hips and quads might also need to work differently.

So those are kind of things that we want to address too. And it's always important to look at the overall picture. It doesn't need to just look pretty. It also has to be gradual. Because that's a fundamental piece where all of us get into trouble, on the non elite level at least. 

Mark: And the kind of strength training we're talking about, it's not, let's go do some curls. It's more of endurance strength training. How would you describe that? 

Iyad: It would be actually sometimes a mix of that, like where we're just getting them to just go heavy. Because sometimes they just need to get the muscles tolerant. And sometimes we will need to work on like, you know, maybe a smaller, finer movements. But there's no such thing as bad strength training. This is kind of one of the biggest myths that people think we have to do, plyometric only to get running better, actually like barbell training can be very helpful. Dumbbell training could be helpful. 

We use whatever resistance tool we think is going to help them address the deficit. So if the barbell is the best way to do it, we do a barbell. If it's the dumbbells, and it also depends on what they have access to. We get creative sometimes the equipment that they have access to.

If somebody doesn't live near a gym and doesn't want to go, especially nowadays with COVID and all that stuff. We'll try to kind of work within whatever they have at home to allow them to kind of build up that capacity that we need them to be able to run. If that's their goals around run, we kind of work with them with whatever way they have to kind of build up that program for them.

Mark: So the typical course of treatment or length of treatment to get changes so people feel a little bit better about their running. What would that be? 

Iyad: Yeah, that's a good question. So there's lots of research on this and it varies between person to person, but the average is between six to nine training sessions that they'd have to do. We give them some certain cues. Sometimes it's auditory cues. They follow a metronome with the step rate that we find works best for them. And sometimes it's to focus for a few minutes at a time on, for example, swinging their arms a bit more, being chest up a bit more. Some people's knees cave in too much when they run.

So we kind of try to give them some cues to do that. So we'll try to get them to practice that over a while. And this happens in a mix between home treatment and also in clinic treatment because we can't see them every day here. So we're aware of that and we try to give them as much to work with at home.

And yeah, it can take anywhere from six to nine training sessions for people to kind of get used to this new style of running, but it doesn't really affect their efficiency from any point of view, like in the long-term. It's a short-term dip as they get used to this new style, but as they going to work through it, people just kind of pick it up again, and it becomes a new norm for a short period of time sometimes. And yeah, most of the time it's a good way just to kind of keep people running despite the injury. That's also another use for it. So it doesn't have to be, this is going to be your new, permanent thing for life. It could just be a nice tool for us to play with their symptoms and keep them active while they're rehabbing their injuries.

Mark: If you want some expert analysis of your running gait, if you're having issues with your knees. If you're having issues with whatever you want to try something new, get expert analysis at Insync Physio. You can reach them and book at insyncphysio.com on their website. Or you can call them in Vancouver 604-566-9716 or in North Burnaby 604-298-4878. Willingdon and Hastings. Lots of parking, especially in North Burnaby. They will look after you and they're experts in this stuff. Thanks Iyad. 

Iyad: Thanks Mark.