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If you and your climbing buddies compare injuries, you almost always compare painful wrists, hands/fingers, shoulders or elbows. That's because climbing places massive loads on the arms and can truly stress tendons. In fact, nearly half of all chronic climbing injuries involve the fingers, and over 80% are in the upper limbs.
Having tendinopathy and fixing it is all about load management: if you add too high a load or force to a tendon, it reacts by becoming sensitive to those big loads. That's why tendinopathies are common among climbers - as we said before, climbing involves putting huge forces through your arms over and over again. So how do we manage the load?
Tendons have a different physiology and therefore need different treatment than other tissues. To learn more about how to heal tendons, check last month's newsletter. In this newsletter we describe how a poor sequence of muscle engagement, i.e., the "kinetic chain" used in climbing can cause injuries on the tendons of the fingers, wrists and shoulders. Keep reading for tips to correct the kinetic chain.
Quick Physics Lesson
Remember in high school physics class when we learned Force = Mass X Acceleration (F=ma)? The maximum force or stress we can put on a tendon is to have a heavy weight moving quickly through a big motion - think jumping to a hold, grabbing it, falling slightly to stretch the tendon, and pulling yourself back up.
Scapula is too high - so there is less space between shoulder and ear on the right
Anterior Tilt - bottom corner of shoulder blade sticks out.
The faulty position of the right scapula is due to weak scapular stabilizers. This will decrease space for rotator cuff and therefore increases strain on the tendons.
If you move your elbow away from the wall you increase the torque needed to resist gravity. This often occurs when there is an imbalance in the muscles of the scapula (shoulder blade) and it overloads the tendon(s).
Elbow away from wall - increases work load on the fingers. Puts rotator cuff at a mechanical disadvantage.
VS.
Elbow under hand - shoulder more neutral.
This "chicken winging" may also occur when the forearm muscles are too fatigued, but moving the elbow away from the wall will only exacerbate the "pump" felt within the muscles.
There are a few "easy" things you can change, but it will take a significant cognitive effort to modify your movement pattern:
Quick Tip #1
Move slowly to decrease the acceleration (and therefore force) on a tendon.
This may require weight training to build strength of the muscle (and ultimately the tendon).
Quick Tip #2
Climb with your elbow directly under your hand.
Though not always possible, but if you have the option, angle those elbows underneath your hands. This allows you to stabilize your scapula and shoulder joint more effectively.
Quick Tip #3
Isometrics/the hang board is your friend.
Tendons are trainable, and complete rest doesn't help. Tendon load tolerance can improve, and hang boarding for long durations may help decrease sensitivity.
Kinetic Chains of Climbing
As climbers we are constantly pulling ourselves upwards, and to do that we have powerful lats (latissimus dorsi muscle). Lats connect your upper arm to your lower spine, they have a powerful advantage over other shoulder muscles to directly influence core position. All the other muscles work to stabilize the scapula so the lat can work efficiently to pull us up.
If I was a brain, I would rather contract that one lat muscle than all the other muscles in between. And that is just what many brains try to do, but then you're hosed! The stability provided by the other muscles in the kinetic chain is critical. Without that stability, things start to move funny down the chain: the elbow gets kicked out to the side, away from the wall; the wrist extends, stressing the elbow; and the finger tendons are placed on stretch, increasing the amount of work the tendons and pulleys have to do.
The Rehab Process
Our main focus initially is to improve stability and position of the scapula to unload the supporting structures. In the picture above we would want to target the mid and lower trapezius to stabilize the scapula lower and more towards midline. Long duration holds improve the activation of scapular stabilizers.
You might have to start with only a short hold and increase the time as you can, while still maintaining form. Once muscles are stronger, the trick is then using them to climb. This takes a lot of repetition and patience for it to become automatic and you might need your PT to watch you at your climbing gym as you are becoming accustomed to new ways of moving.
No one exercise is a fix all for everyone - some shoulder blades live too low due to shortened lats, and some shoulder blades "wing" or move freely away from the rib cage due to weak serratus anterior muscles.
So the most important quick tip of all:
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