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.