Introducing Nina Tappin

I am excited to announce that Nina Tappin has decided to join me at Project Physio. Nina is a physiotherapist hailing from the UK with a wealth of knowledge and experience in treating some of the world's best climbers. Her expertise is second to none.

Together we'll rock your climbing world by bringing you the best available science for your climbing specific recovery, prevention and performance strategies.

Check out her bio below or visit her website at ClimbingPhysiotherapy.com to learn all about her. 


Nina Tappin has been treating sports injuries since she graduated as a physiotherapist from McGill University in Montreal, Canada in 1999.  She has a wealth of experience in treating rock climbers, university athletes and general orthopaedic cases.

Nina is a member of the U.K. ACPSEM (Association of Chartered Physiotherapists in Sport & Exercise Medicine) and has her Silver level of accreditation. She has been mentored by some of the top physiotherapists in sport in the U.K..

Nina has been a dedicated rock climber since 2000, and has been treating rock climbing related injuries ever since.  She has treated some of Britain’s elite rock climbers, such as, Hazel Findlay, Ben West, Neil Gresham, Tim Emmett, and Charlie Woodburn.  Nina has also treated members of the GB lead climbing, and bouldering junior and senior teams.  She treats novice and intermediate level climbers on a regular basis.

Nina writes articles in Rock & Ice, CLIMB magazine and on UKC website.  She also teaches “Common Climbing Injuries & Injury Prevention” Modules to climbers and instructors at various climbing walls, and on Neil Gresham’s Masterclass Academy Coaching Course.

Nina has a special interest in injury prevention amongst children and females in sport.  She is also interested in advising women who are pregnant, and/or recovering from birth on how to exercise, and climb safely.

REHABING A BROKEN PHYSIO

If you've ever wondered how a physio goes about rehabing their injuries, this is your chance. Here’s a glimpse into my recovery process after busting my ankle at the start of the climbing season:

Week 1 (May 17th)

I busted my ankle on Super Dyke. For those of you familiar with the climb, you'll guess exactly where: between the boulder and the tree. My foot blew off the slab quite unexpectedly (I was feeling invincible that night!) and went crashing down onto the tree root below me. My left foot landed flat and my knee proceeded to continue moving forward. For you anatomy buffs, I hyperdorsiflexed my ankle. I did a couple of quick tests which told me I should get an x-ray to rule out a fracture…

 

No fractures!

 

The next day I woke up with a very swollen ankle, unable to put very much weight through my foot. It was clear this wouldn't exactly be a quick recovery.

Swollen ankle

At this point most people would think about RICE. Ever hear of it?

REST.

ICE.

COMPRESS.

ELEVATE.

DID I REST?  

I sure did! I avoided anything that was painful. In fact it's the only thing I could do. That's the beauty of pain and inflammation - it stops you from causing further harm when the system is weak and trying to repair itself.

DID I ICE?

I did NOT. Here's why:

Ice is thought to help slow or even prevent the effects of inflammation. It turns out the inflammatory process plays a very important role in healing. In fact this is exactly what HEALS your injuries, so why would you want to take it away? You shouldn’t take it away. Trust your body to heal itself - it does a great job!

To add insult to injury, when we look at the research, it turns out ice probably doesn’t even penetrate deep enough to have an effect on the inflammatory process. There is no strong evidence to suggest that icing an injury will accelerate your healing time.

Some will say we should use ice to help manage pain. While ice may help reduce your pain, I would argue that pain is very useful and a natural part of the healing process, especially in the acute phase. It tells you to back off! I chose not to use ice for pain management mostly because I could adequately control my pain by resting and protecting my ankle. If you push through the pain and use ice as a management strategy you’re not doing yourself or your injury a favour. In fact pushing through your injury at an early stage may in fact prolong your recovery period.

DID I COMPRESS?

This one isn't as clear cut as icing. Some studies have shown positive results on healing time and pain, while others have shown it to be ineffective. So what did I do? I wore tight ski socks and wrapped it with a tensor for a couple of hours here and there. I could visibly see a decrease in swelling with aggressive wrapping but it's questionable as to whether it had an effect. Just because the swelling is temporarily reduced, doesn't mean this accelerates healing time.

As far as pain goes, I experienced more pain immediately after removing the dressing. This would lead me to think that compression is helpful in controlling pain. What's more likely is that I experienced a temporary increase in pain as the ankle returned to its more natural swollen state. In other words, the ankle wants to be swollen because of damaged blood vessels and permeable cell membranes. The body will repair this over time and swelling will come down naturally with a little help from specific exercises.

DID I ELEVATE?

Surprisingly, this is the least studied of the RICE recommendations. Intuitively, it makes sense to elevate for swelling control, especially if it helps with pain.

Did I elevate it? Yes! I elevated it whenever it was throbbing or aching. Having it high above my heart was the most comfortable position. If it wasn't bothering me, I had it resting on the coffee table or planted on the ground. This is arguably the equivalent of resting my ankle.

What did I do?

If I didn't ice, or do much compressing, and wasn't religious about elevating it, it doesn't sound like I did much, does it? To the contrary, I did quite a bit.

 

Protection and Optimal Loading

I moved my ankle and toes as much as I could through it's available pain free range. I did so in non-weight bearing positions, but also with my foot planted on the ground. I used the help of a belt to move it around, but also did so actively with my ankle and foot muscles. I let pain be my guide. I would avoid anything that brought on an increase in pain, trusting that when I felt pain it was more so a warning sign as opposed to an indication that I was causing more harm (see video below).

I practiced walking as normally as I could using crutches. I also started moving my left knee, hip and back to help avoid the effects of disuse. I used my physio stool to load my left hip, which helped a lot with work! I was even able to get into the pool and tread water lightly. In essence, I tried to be as active as possible without aggravating my ankle.

 

WEEK 2:

 

It turns out my ankle was in fact broken... and I needed surgery.

 


 

To be continued...

 

Pain is a Protector

Project Physio will be running pain education workshops. Skip to the bottom for details! 

Pain is still a mystery to many of us, and misconceptions about what it is, how it works and its purpose is prevalent even amongst healthcare providers. Fortunately, pain science has come a long way and we're much better at explaining what's happening in our body when we experience pain.  

One of the more important concepts to remember is that pain is a protector. It's meant to warn you of a potential danger to your body. It's not, however, a good indicator of whether or not tissue harm has occurred to your body. Check out my latest video for an example! 

For you ice climbers, I'm sure you'll be familiar with the following example. Picture yourself on a WI 4 route, nearing the top and fighting a mad pump. This is the longest ice route you've done so far! You manage to sink your axe over the lip and let out a holler as you pull through and stand up victoriously. You drop your axes and take a deep breath, reflecting on how psyched you are on completing your hardest climb yet - a personal best.

You slowly start to feel an ache build in your hands, and it quickly progresses to a debilitating pain so agonizing you let out another yelp. It progresses to a scream and soon enough you're on your knees yelling at the top of your lungs. It feels like your hands are in a hydraulic press, and the pressure is building excruciatingly slow, squeezing your hands to pulp. There's nothing you can do about it. It continues to build, and build, and build until finally you start to dry heave, then vomit all over the ice you just climbed. That's right, you've just experienced the screaming barfies.

After a few minutes the pain subsides and you have full function of your hands again. Unless you were also frostbitten, there's a slim chance you've caused any lasting harm. That being said, you'll never forget that pain. 

In this example, the pain was a result of blood flow returning to the nerves in your hands and fingers. The nerve endings responsible for transmitting "harm" signals to your brain we're triggered as they were reawakened with fresh blood. Screaming barfies provide a good example of how you can experience significant pain without lasting tissue harm. 

Project Physio will be running Pain Education Workshops aimed at demystifying pain myths and providing you with novel tools for pain management. We've partnered with Kavanagh Danaher, Registered Dietitian, and Danielle Berman, Social Worker, to help make this a comprehensive workshop. It's designed for anyone keen on learning more about pain, whether you have a fresh injury, or are struggling with managing chronic pain. 

Details of the workshop are below. Please RSVP to william.bateman@projectphysio.com or by calling 604.243.1634. Space is limited! 

When: April 29th, 2017 from 9am - 12pm

Where: Ground Up Climbing Gym 

Price: by donation 

On the Docket: 

  • Understanding pain and its neurophysiology
  • Chronic pain and the altered nervous system

  • How our thoughts and emotions affect our pain 

  • Our diet's role in pain and recovery

  • Management strategies

  1. Movement through persistent pain

  2. Pacing and graded exposure

  3. Mindfulness

  4. Visualization

  5. Accessing the virtual body

  6. Assessing and managing diet

   

Wrist and Elbow Training for Climbers: Part 3 - Warm-Up and Projects

If you've learned anything from our prior 2 videos, we hope that it's the importance of training your wrist extensors to help prevent wrist and elbow injuries, and improve performance. We can take this a step further by applying these principles to your warm-up, and if need be, to your projects. Check out the video to find out how! 

Wrist and Elbow Training for Climbers: Part 2 - Hangboarding

If you're lazy like me, you'll want to know how you can train both your climbing muscles and your opposition muscles at the same time. You've come to the right place! We'll show you how to keep your opposition muscles engaged while training your principle gripping muscles on the hangboard. Have a look and share your thoughts!

Wrist and Elbow Training for Climbers - Part 1

In this series, we'll explore how to get our wrists and forearms strong so that we can avoid pesky wrist and elbow injuries, and improve performance on crimps, slopers and pinches. The first video explores wrist positioning in a farmer's carry. The principles we discuss here can be applied anytime you lift a weight off the ground. In our upcoming videos we'll discuss how you can apply this to other typical climbing exercises, like pull-ups and hangboarding. 

Have a look, share your thoughts, and spread the word! 

 

 

Core Stability: Progressing the Posterior Chain

My last video introduced the concept of stability in the posterior chain. We used the bridge exercise as a means of training static stability in the posterior chain. As a refresher, static stability refers to stability around the joints of the body without movement around any other joint. When training core stability, we typically start with static stability and progress to dynamic. We used the push-up and pull-up as a means of training dynamic stability of the anterior chain.

This week we’ll progress the bridge exercise by making it into a dynamic stability exercise.

To help illustrate, allow me to share a few examples of when this muscle group comes into play. The most obvious example is a climber on overhanging terrain using his heel to prevent a barn door. Your posterior chain is doing much of the work anytime you heel hook.

Now picture a climber desperately reaching for a crimp. They first get their middle finger on the crimp, then somehow their index finger, and finally the ring finger. They can now bear down on the crimp, and steady themselves to bring their right foot up to a large foothold. The crux is over. What got them there? Their posterior chain. As the climber reached for the hold, their low back and glutes kept the bulk of their body close to the wall, their hamstring helped drive the pelvis into the wall while also helping the foot maintain tension on the hold. Finally, their calf pushed the heel up, and their mid-back extended their spine so that they could reach the hold.

Now consider the climber reaching for a far off foot hold. The moment the foot lands on the hold she needs the posterior chain to drive the foot into the hold so it doesn’t peel back off the wall. Her calf and hamstring are doing most of that work. If she wants to make her life easier, she’ll drive her pelvis and low back closer to the hold to get more of her weight over the foot. The muscles in her low back are doing much of this work. These are all muscles found in the posterior chain.

In other words, you use your posterior chain just as much as you would any other muscle group. If you want to avoid injury (think low back, knee, hamstring) and generally climb harder, training the posterior chain is key.

 

Core Stability - Introducing the Posterior Chain

In my previous posts, I spent a lot of time talking about how to integrate core stabilizers into exercises many climbers are already doing: the deadhang, the pull-up, and the push-up. Many of the muscles we emphasized work to lift your legs to the next hold or maintain tension in your body if your feet come off the wall. We commonly refer to this group of muscles as the anterior chain.

I would say that most climbers resort to training the anterior chain when they decide to train core stability. The plank, V-sits, sit-ups, push-ups, mountain climbers, russian twist, and crunches are all exercises that emphasize the anterior chain. We tend to forget about the posterior chain, which is a group of muscles on the back side of our body. They start in the back of our neck and run all the way down to the calf, and play a major role in climbing.

To help clarify, think of a climber who is hanging by her hands on overhanging terrain trying to get her feet on the wall. As she reaches for a foothold, her anterior chain will work to bring her foot there. The moment she gets an edge on a foothold is the moment her calf will push into the hold, her hamstring will pull her knee towards the wall, and her glutes and low back will drive her pelvis closer to the wall. All of these muscles work together to keep her foot on the wall. This is her posterior chain working. It is also the major driving force behind heel hooking and rocking over a foot.

Our success on the wall depends a great deal on how strong our posterior chain is. Many of us fail to include it in our training programs, and I frequently treat injuries as a result. Ever hear of the “Squamish knee”, how about a disc bulge?  

Check out the video below to get an idea of how you can start training posterior chain stability with the bridge exercise.

Core Stability Series Part 3: The Push-Up

In my two prior posts, we talked about how to integrate your core stabilizers into exercises used to train for climbing. The first looked at how to integrate your shoulders and anterior trunk muscles into your deadhang - see here. This can be a great tool to help you train static stability.

We then progressed by incorporating stability into our pull-up. The pull-up is a great way of training dynamic core stability (i.e. stability through movement) - see here.

In both of these exercises the feet are doing absolutely nothing. This is contrary to how we usually climb: we want to maintain foot contact as much as possible. We need a way of progressing anterior trunk and shoulder stability with both hand and foot contact. The push-up can help you do this.

Check out the video below to learn how to integrate anterior trunk and shoulder stability in the push-up.  

All of the exercises we’ve discussed have emphasized anterior trunk engagement. These exercises are great at getting your feet high on the wall, or preventing them from pulling you off the wall when they cut. What about maintaining tension when your feet are on the wall, or pulling your hips into the wall? This requires a whole new set of muscles. Check out next week’s article and video to find out more.

This article was first published in Squamish Climbing Magazine on Sept 28th, 2016

Core Stability Series Part 2: Pull-Ups

Last week we discussed how you can start to integrate your core stabilizers with a basic exercise like the deadhang. Check out this article for a quick recap. In integrating your shoulder and anterior trunk muscles within your deadhang you’re training static core stability.

Consider static stability to be any exercise that engages your stabilizers without additional movement generated by your prime movers (the larger muscles in your body responsible for moving your limbs). Another example of a static stability exercise would be the classic plank exercise. You move your body into a neutral posture and hold that position. The stabilizers stay on for as long as you hold that position.

In climbing, you need both static and dynamic stability. Dynamic stability is your ability to control the joints in your body while the prime movers are carrying you up the wall. In other words, stability through movement. Holding a plank or simply training your stabilizers on a hangboard isn’t enough.

Consider last week’s climber who has just thrown for a dyno and their hands have landed on the finishing holds. As their body falls back towards the ground, the prime movers are working to slow the momentum of their body while the stabilizers are working to keep the joints safe. This is an example of dynamic stability. You train dynamic stability by keeping your stabilizers engaged through movement-based exercises.

The pull-up is a great place to start and a good means of progressing the hangboard exercise. Check out the video below to better understand how you can start to train dynamic core stability through pull-ups.

This article was first published in Squamish Climbing Magazine on Sept. 12, 2016.

 

 

Want to learn about Prehab and Climbing? Join me in Colorado at the CWA!

I'm excited to announce that I'll be presenting at the Climbing Wall Association conference this May in Boulder, Colorado. I'll be covering strategies to incorporate prehab and injury prevention into your climbing and training programs . If you're in the area and keen to learn  more, visit the website below. 

http://climbingwallindustry.org/page/2016_CWS_Sessions

Stay tuned for upcoming prehab and injury prevention seminars in Squamish. They'll be coming up soon at Ground Up Climbing

 

 

Warming-Up for Swimmers

Warming-up is an often neglected task despite it's apparent benefits. I had the pleasure of preparing a warm-up schedule for the Squamish Titans this past week. Here's a bit of a summary for those of you who are swimmers, and a refresher for the Titans. 

1. All training should be goal-oriented, whether you're prepping for a triathlon or looking to maintain or improve your fitness. 

2. Goal-oriented training provides a good platform to understand your weak-links. 

3. Weak-links are best understood by doing a baseline test that encompasses all aspects of swimming, including your mobility and stability issues. 

4. An effective warm-up helps prime your system by addressing your mobility and stability issues. It also helps by getting your heart, muscles, joints, and tissues ready for high intensity activity. In essence, it can be a great tool to help you avoid injury. 

5. Work through the exercises bellow to understand your weak links. If one side feels stiffer than the other, focus on that side. If you know you have a hard time breathing to the left, make sure to work on the exercises that help with left rotation. If you know you have poor shoulder blade control, make sure to exercise your stabilizers. 

Mobility: 

1. Neck rotation 



 

2. Mid-back rotation


IMG_20151130_093437.jpg

 

3. Shoulder mobility 

 

 

 

4. Hip mobility 




 

Stability: 

 

1. WTYs




 

2. Swimmers

 

 

 

3. Breathers



 

4. Lunges



 

Sets and reps for each of these exercises will depend on what your body will take. Here are a couple of rules to follow when you're trying to figure out how far you should go: 

1. When you're working on mobility, your breath can really help to get you where you need to be. If you find yourself holding your breath it's your cue to back away - you're no longer getting any benefit.

2. Quality over quantity! If you lose form after 5 reps stop the exercise and take a rest. Try it again once you've recovered and do your very best to stay in good form.

3. The old adage "No pain, no gain!" is completely false. Exercising should NEVER be a painful experience. If you get pain give it up and move on to the next exercise. Seek the help of a professional if you haven't already.

 

These exercises should give you an idea of where to start with your warm-up. They were chosen for their applicability to most swimmers. You may already have exercises that are currently addressing your weak links. For example, you may know to work on hamstring mobility before hopping into the pool. Keep doing it! Find what works for you. 

Once you've completed the basics get into the pool and start warming-up your whole system. The first 10 minutes should be focused on technique! Go slow and focus on your weak links. If you have a hard time reaching in freestyle, focus on your reach. If your breathing is sloppy to the right, focus on breathing to the right. Your warm-up has to be purposeful with a lot of brain power dedicated to the process. Enjoy it and find your rhythm. 

Finally, ease into your session and get ready to enjoy the feeling of your body ready to train! 

 

 

A Question for my Colleagues

Pain is an incredibly complex phenomenon, and as health professionals we often have a limited understanding of why or how people may experience it (believe it or not!). This article is for my colleagues in the health world - are we doing more harm than good? Lorimer Moseley is a leading researcher and physiotherapist on pain science. In his article First, do no Harmhe explores whether the knowledge we impart on clients causes more harm than good. Have a gander and share your thoughts! 

http://www.bodyinmind.org/clinicians-do-no-harm-pain-management/

Acupuncture: Does it Work?

Acupuncture has picked up a fair bit of fanfare in the rehab world. Many health professionals have started using it as a means of managing a client's pain. Is it effective? I'm not so sure. Check out this article by Dr. Colquhoun and Dr. Novella for their take on accupuncture and it's use in managing pain. 

https://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

MRIs: The Gold Standard?

There's been a number of studies looking at whether imaging effectively demonstrates cause and effect for various pain conditions. In other words, can the bulging disk in your MRI effectively explain the pain you're experiencing? In a recent study, researchers have shown that the majority of healthy people (even young adults) show signs of disc bulging. It's a fascinating read! These studies are changing the way we think about pathology and pain. Have a read! 

http://www.ncbi.nlm.nih.gov/pubmed/25584950/

Breathing while Climbing

Has anyone ever told you to BREATH while cruxing out on your project? There's a very good reason for it, and this video helps explain why. A lot goes into answering this question effectively. I've tried to keep it simple and focus on the physiological side of things. Your breathing has a large role to play in your mental game but I'm going to avoid that can of worms for now. Have a listen and share your thoughts. I've highlighted 2 tips you can take away. 

Thanks to the viewer who asked this question. Hope this video sheds some light.


Releasing the Hips

As requested, this one goes out to everyone with tight hips.  Check out these exercises to help release common areas of tightness. Give them a shot and share your thoughts. When rolling out  it's normal to feel tenderness. If you experience significant or lingering pain talk to a professional.

Thanks to Michael Apps for demonstrating the exercises. Check him out at Highland Sport and Spine Physiotherapy for injury prevention tips for skiers.