Training for Climbing, 2nd: The Definitive Guide to Improving Your Performance (How To Climb Series)

exercises is absolutely necessary as the first step in the rehabilitation process. Gradually introduce Reverse Wrist Curls (page 120) to strengthen the forearm extensor muscles; add weight incrementally over the course of a few weeks. Use a heating pad for a few minutes before stretching—daily use of a heating pad may also speed rate of healing. In mild cases of tendinosis, you may be able to complete the rehabilitation process and begin a slow return to climbing in six to eight weeks. A counterforce brace worn just below the elbow may be beneficial upon beginning a slow return to climbing.
    Remember, recurrence or severe episodes may take six months or longer to overcome—let this knowledge compel you to cease climbing and engage in the rehab protocol described below at the first signs of pain.

Shoulder Injuries
     
    The shoulder joint takes lot of punishment from climbing, especially in those obsessed with V-hard bouldering, steep terrain, and sport-specific training. A variety of injuries can occur, ranging from impingement or tendinitis to a partial dislocation or tear of the rotator cuff. Given the complexity of the shoulder joint, however, a diagnosis can be difficult; expert consultation or an MRI will likely be required to detect small tears of the rotator cuff and other subtle injuries.
IMPINGEMENT SYNDROME, BURSITIS, AND TENDINITIS
     
    These conditions are closely related, and they are a common source of shoulder pain among athletes in sports that demand consistent, forceful overhead arm movements. Pain and inflammation often develop under the acromion, the bony top portion of the shoulder where the shoulder blade and collar-bone meet, as a result of tendinitis and swelling of the bursa (a fluid-filled sac that provides cushion between the bone and surrounding tissues). Onset of pain is gradual over weeks and months, and may eventually lead to pain in the upper arm and difficulty sleeping on the arm or shoulder.
    Diagnosis begins with a physical examination, including movement and strength testing to evaluate pain and weakness throughout the range of motion. X-rays and an MRI may be performed to rule out other causes of shoulder pain, such as arthritis, bone disease, and tears in the rotator cuff. Impingement syndrome may be confirmed if injection of a small amount of anaesthetic under the acromion relieves pain.
    Treatment of these conditions begins with steps to reduce pain and inflammation: icing for twenty minutes, three to six times per day; limited use of NSAIDS (such as ibuprofen and Naprosyn); and cessation of climbing and overhead hand movements. As pain subsides, gentle stretching and strengthening exercises can be introduced gradually—these rehabilitative exercises are essential to lower risk of injury relapse upon returning to climbing (see the “Shoulder Rehab Exercises” box). In minor cases followed up by dedicated rehabilitation, a return to climbing may be possible in one to two months. More serious cases may require six months or more away from climbing, and perhaps even steroid injections or surgery.
SHOULDER INSTABILITY
     
    Shoulder instability is a condition that’s become increasingly common among high-end climbers with a taste for overhanging routes as well as individuals who engage in excessive fingerboard training. The condition develops gradually from long-term, repeated exposure to straight-arm hangs, Gaston moves, and severe lock-offs, as well as from overzealous stretching or climbing on overhanging routes day after day or hard boulder problems without adequate rest and training of the stabilizing antagonist muscles. No matter the mechanism, constant stretching of the ligaments and a growing imbalance of the muscles that surround and stabilize the shoulder joint can lead to instability and risk of injury.
    Dr. Joel Rohrbough has worked with many climbers and believes that a partial dislocation known as subluxation is the most common shoulder injury among climbers. This injury produces instability of the shoulder joint and manifests with pain from deep within or in back of the shoulder (Rohrbough 2001). In most cases the ball portion of the shoulder joint is levered forward during extreme movements with the elbow located behind the plane of the body. Furthermore, the force of the levering motion on the shoulder joint increases when the arm is extended with the elbow pointing outward (and extending behind the plane of the body), as in grabbing a high Gaston hold or