Knee Injuries Rock Climbing with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto, he's the principal at Insync Physio, physiotherapists in Vancouver, BC, Canada. We're gonna talk about knee injuries from rock climbing. How you doing Wil? 

Wil: Hey, I'm doing great. Thanks, Mark. Yeah, rock climbing injuries related to the knee. It's a good topic.

Mark: So what's typically causing this? 

Wil: Well, there's one really main one, like in terms of rock climbing. It doesn't matter if you're looking at what kind of rock climbing that you're doing, cause there's different styles or types, I guess, categories. Like there's what's called bouldering, or you're not using a harness or a rope. And you're essentially climbing a boulders. And in the advent of gym's popping up with bouldering gyms you know, you you have a lot more of these sort of knee injuries related to the rock climbing.

And then also in sport climbing where you're climbing up with your rope and you're doing certain maneuvers that are more technical that can cause strains into the ligaments, especially in the knee or into sort of like that cushiony area that sits between the two bones and knee and the knee joint called the meniscus.

So yeah, I wanna talk a little bit about that today because that's something that I think is really important to really understand and also look at how that can be preventable. 

Mark: So what symptoms is someone gonna exhibit other than their knee hurts?

Wil: Sometimes they may actually swell up and so you might see some inflammation into there. And so there might be what we call the sharp, you know, principle where you have an injury. Sharp is an acronym. S stands for swelling. H stands for, there's heat, it feels hot. A is the altered function. R is for redness. So it's like discolouration in red from the swelling. And then the P is basically the pain. 

And so that's usually sort of a good little acronym to go by. And then, typically it will also hurt and feel like you don't really want to use that leg and that knee for specific maneuvers when you're climbing. And there's two real common ways of injuring it actually in technical aspects of climbing, where you're looking at what's called the heel hook, where you're basically using your heel and your foot like a lever. Kind of keep yourself up and it takes the weight off of your hands and arms a little bit more. And it also just helps with your body position. Sometimes body position and balance with a heel hook can really help you through the next move. So there's that part of it. 

And then the other part that can really contribute to an injury, is really just looking at when you're climbing that is, is when you're rotating excessively and you're dropping your knee to the point where it goes beyond the range and it can injure the meniscus. 

Mark: So when you're diagnosing it, does it make much difference, what the course of treatment is based on what you diagnose? 

Wil: Yeah, absolutely. So if it's an instance of you know, like a ligament strain or tear, then it's a typical four to six week timeframe, kind of thing, in terms of being a more of a mild to moderate injury. Where you're looking at it being from a full healing, full recovery, and fully rehabbed.

And so being fully rehabbed that final stage means that now you have the right things that you're doing to make it strong and feel like you can climb 100% and feel like you know what you're doing and then you're not gonna re-injure it.

And that's gonna be a process too, as you go through that recovery, the healing recovery and rehab phase. And for a mild injury it would take like four to six weeks and then get more moderate into more severe. So that would be definitely going beyond that timeframe a little bit more. And that's important to recognize.

Mark: What if it's a meniscus tear or some other thing like that, as opposed to a ligament?

Wil: Those can be a little trickier. And the reason why is because you're meniscus, it doesn't have the same blood supply or the nerve supply. So sometimes you might even hurt as much, but it's just locked. Sometimes the symptoms are a bit different, so they can really alter your function. So going back to that whole sharp acronym. So your altered movement and function is going to be more noticeable. 

So one of the other aspects I didn't actually talk about with bouldering is the falling part where you're falling right on the knee, you're not falling properly. So you wanna like do kind of like a fall and roll and really not fall on like extended knee and that's where you injure ligaments potentially, and then have more impact on the meniscus.

So that meniscus injury can be more complex. And then if it doesn't retain more normal functioning of the knee joint that's been injured, then we wanna look at more of a diagnostic next step. Because that way that'll help guide us towards management and then ultimately the rehab.

Mark: And how often does a knee injury require maybe surgical intervention? 

Wil: That all depends. I guess from my experience, it can be like, I would say outta the knee injuries like maybe 25% of the time. Depending like from even more serious major ligament ruptures into some more of the major ligaments that don't happen as often in rock climbing.

But I have seen it like the ACL which is one of the major ligaments of the knee to like meniscal injuries and very rarely do you get surgery done on like your collateral ligaments in the knee. So those are the side ligaments. And so the reason why it really depends is you wanna avoid going under and having it surgically operated if you can.

And so really the goal is to retain that function. Say you even have a meniscal tear, you want to just retain that function and get it rehabbed properly. Because the more that you can preserve that meniscus without having to snip it away and get into the knee and really surgically operate it, then the better it's gonna be in the long run. So that's key. Because if you're rehabbing and you're trying to really push through this and it's just not getting any better and you can't even walk, then getting in there and doing something about it, if we've had the proper diagnosis and have followed the proper channel of the medical path and looking at, you know, what's going on. That's when we wanna maybe look at more that surgical intervention that can help. 

Mark: How often is overtraining a component of knee pain in rock climbing? 

Wil: I think that with overtraining, it has a factor. More in the aspect where like if you're not using your core and you're doing like what's called a lazy type of heel hook and you're doing a lazy knee drop where you're over rotating and you're not engaging the core and you're not fully connected with that lower part of your body, with being on the wall or on the rock, then that can lead you to really cause your range to be over extended.

Or to get into that position of the knee where then it's more compromised. And then ultimately you add that with then you go to torque for some more difficult maneuver or move or using more power force. Or you have a fall on a rope or on the boulder and then you land, then that's a combination of it's been overused and you're not strong enough, and then you have the trauma on top of that.

So, it's kind of a tricky question because it's like sometimes people like say, yeah, it didn't start hurting until I had the fall. But then they've been doing things like they've been noticing that's been feeling tight doing that specific heal hook maneuver. Or that knee dropping maneuver. And so these are things that you need to look for, even just for those little things. And they should not last for more than like, you know, five or six days. Those little kind of things that you notice in your body and your knee, especially. 

Mark: How much is working someone through that so that they don't overtrain, they use their body properly, is incorporated into the rehab process?

Wil: Oh, it's super important because if it's not incorporated and it's not part of your rehab routine, then it can very well happen again. And then you can also get something worse happening or you can have something else happening.

A really good example, we had a client that came in that had this happen and rehabbed the knee properly. But then stopped doing the routine and the exercise of keeping it strong and then started to have back problems because they weren't engaging in the core. So it's kinda like you go in to see your dentist and you have cavities, and then now he's like, do you brush your teeth every day? No, I try to do it once a day. And then your dentist says, well, maybe it'd be good if you do it twice a day. I think that'd be really good. And then it's gonna help your cavity prevention even better. So you do that for the first little while, but then you stop that. It's the same thing. 

Mark: If you're having some knee pain from your rock climbing, if you've had a fall, if you've got some kind of trauma that you wanna get looked after, the guys to see in Vancouver are Insync Physio. You can reach them on their website. You can book for either location in North Burnaby or in Vancouver at insyncphysio.com. Or you can call the Vancouver office, (604) 566-9716. You have to call and book ahead. They're always busy. And they'll get you moving right and better. Better than ever. Thanks Wil. 

Wil: Yeah, you're welcome. Thank you, Mark.