Knee Injuries Rock Climbing wi Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physiotherapy in Vancouver. They're on Cambie Street and we're going to talk about knee injuries from rock climbing. How you doing Wil? 

Wil: I'm doing good. Thanks. 

Mark: So knee injuries, rock climbing. That doesn't make sense. How do you hurt your knees rock climbing? 

Wil: Yeah. So typically we injure our knees through like running sports mostly, and sports like Ultimate Frisbee, things that involve cutting. And quite commonly, you know, it's either a ligament or more specifically in what's called your meniscus. And so in rock climbing, the most common way to injure your knee and the structure that gets injured is the meniscus. And I'll explain to you what that is in a second. 

And so there are three ways of injuring it, really. Three main ways. So you're doing these maneuvers and essentially it's like now, when you look at the evolution of rock climbing, you have these moves that you make that are so much more dynamic, so much more involving the whole body.

And we're still used to training mostly just with our upper body. When you think of rock climbing, you think of just mostly upper body strength. And so when we don't have a strong, lower body and we're not tensioning through the lower extremity and through the knee in that way, then this is how we can injure the meniscus.

And so when we do things like what's called a heel hook where you bring you heel up high, and you're trying to use that as a lever to offload your upper extremities. Then basically what happens is that then you know, that can really injure meniscus and cause damage to there. 

Another maneuver is basically doing what's called a drop knee. And a drop me is basically when you're rotating, like you're, you're basically pivoting off of your toe, and you're internally rotating your hip in such a way where that rotation gets magnified in the knee. And if you don't have like a tension in that knee to hold it in, then it's a lot more wonky and wobbly, and then you tend to torsion it right at that meniscus. So if you can imagine that. 

And the third way is basically, as you imagine, when you're climbing, you're doing this maneuver called a high step. And so with high stepping, it's like bringing your, it's just basically exactly what it sounds. You're trying to bring your foot up high and then you're trying to reach and climb and you got your foot up high.

And at the same time, you're trying to push off that knee and balance yourself. But if you don't have the proper tension, once again, that that knee can get a little wobbly and cause some torsion on the outer edges of that meniscus. 

So what is a meniscus? So the meniscus is basically that spongy part that fits between the two bones between what's called your femur, your thighbone, and then your tibia, which is your lower leg bone. And it's provides protection in terms of a shock absorber. And it also provides stability in your knee. It's not like a cushion cushion, flat cushion per se, where it's like, you know, you absorb all the impact right in the middle. It's kind of more C shaped. So, what that means is that the outer edges and that's where it tends to get torsioned. So because of that sort of makeup of that meniscus, and when you don't have tension strength the knee holding it, then that's where you can really start to have that torsional strain on it.

Mark: So what kind of symptoms would someone have? What would lead them to, other than just it hurts? Are they going to have swelling? What's it going to look like?

Wil: Definitely. So swelling and obviously pain, but the loss of mobility, and one of the biggest ones would be like clicking and popping. Especially if you tear the meniscus and it gets caught in there. So the next step then is really looking, well, what do you do for it? So you always want to look at, you know, three main things really. Like you want to look at, okay, how do you regain your mobility? So there's things that you do for that. 

You know, and then strength, maybe number two. Okay. And then third thing is basically your functional movement. Now obviously proceeding all that, depending on how bad it is, if it's really swollen, the first thing that you do, you want to control that swelling. So there's things that you can do for that. 

But obviously you want to start to get the knee moving and that mobility is super, super important. And in terms of figuring out, okay, well, is this a meniscal injury or is this something else? Or is it like, you know, maybe like something else that that's not as sinister, like maybe just like an overuse sort of imbalanced thing.

So there's certain tests that we can actually perform on the knee. And usually you want to do a battery of them. So you don't want to just do one, you want to do a few of them to really test out whether or not it's a meniscal injury or even like, is it a really bad one, or if it's a minor. So you can sort of do that with some of these tests. 

Mark: So diagnosis, I imagine the history of how this happened becomes really important as a diagnosis tool to tell you okay, as an indicator of how bad it might be?

Wil: Yeah, usually, and it can sometimes present like a little worse and you don't really know until you go through that rehab process and doing the right things to work on those three things that I was talking about. Well, I guess four, if you add decreasing the swelling, and then mobility, and then strength, and then the functional movement. 

So typically that should take about six weeks, four to six weeks. If there is very, very little progress. In that four to six weeks, then I'd be wondering, Hmm, maybe we need to actually look at this a little bit further. And I would recommend a referral for you know, see your doctor and get some scans done. And especially if you're wanting to get back climbing and it's just not getting any better, you know, and it's hampering your lifestyle.

Mark: Yeah, swollen, hurt knee is going to limit a lot of things. Couldn't I just stop doing what I do, how I hurt myself, let the swelling go down and have it heal up. Isn't that going to make it better? 

Wil: You do want to actually have a period of time where you don't climb or do any activity, but then after you know, it settles down. It could be a couple days or maybe a week or something like that. And then you do want to get it moving though. So there is a process. There is a process to this rehab where you want initiate, where we'll help it get better. So you do want to start to get it moving in that way and that way you know, you're working towards that recovery. Working towards that rehab process.

Mark: And what about, you mentioned movement retraining. Is that basically okay. This is, if you have to do heel hooks, knee drops, high stepping, et cetera for your climbing. Here's how to do it properly. So you don't hurt yourself again, or at least lessen the chance that you're going to hurt yourself in the future. Is that part of the training that you're going to provide? 

Wil: Yeah, for sure. And I think the other important thing to add to this too, is that there is definitely some research that's showing that when your knee stronger or when you have more strength and conditioning in the lower extremity, then you don't tend to actually have as many injuries. And they've looked at a sample of a bunch of climbers where, I think like climbers who weren't in very good shape, or weren't very strong in their lower body, tend to have these kind of injuries more in their knees. 

And so I'm alluding to more competition climbers. Competition climbers tend to have more strength in their lower extremity in their conditioning. And because of that, you know, they use tension strength, tension forces appropriately, to protect their knee versus, climbers that are not as strong and don't have the same strength in their knee and their lower body. And then as a result, it doesn't stabilize the knee. And then that's where the injuries tend to happen a lot more. So that's, that's another huge part of it too. 

Mark: And what would be an example of the kind of strength training that someone would do? Just maybe just one exercise as an example. I don't imagine it's just going to the gym and doing squats. It's probably a little more complicated than that given how your body is being used while you're climbing. 

Wil: Yeah, for sure. So if you're rehabbing it from an acute injury. Then it's really getting certain things activated and then progressing through that sort of activation muscle pattern, of say your hamstrings with your glutes and that core.

So doing two-legged bridges or, or one-legged bridges, as a very simple, basic exercise. To progressing to doing things like a bridge on a ball with a hamstring curl. Those are just some examples kind to you know, throw right off the bat here. But then there's some other complicated things that you can start doing.

And the other aspect of it is what do you do in your warmup? So when you're climbing and you're about to get on a climb, whether it's like a roped climb, a lead climb or a bouldering climb, how are you warming up, like even your hamstrings properly? How are you warming up like your knee? How are you warming up your hip? And how are you engaging things in your core? Because those are all important things because we quite often forget that we think, oh, you know, this is mostly upper body warmup stuff, finger warmup stuff. 

Mark: If you've had a climbing injury, the guys to see are Insync Physio. You can reach them on their website to book at either location in Vancouver or in North Burnaby at insyncphysio.com. Or you can call. The Cambie location is at (604) 566-9716 to book. Or North Burnaby, (604) 298-4878. Get expert climbing help from expert climbers who can help you be back out there and climbing well. Thanks Wil.

Wil: Thanks Mark.