Rehabilitation after a climbing injury

Rehabilitation will have a significant effect on how long it takes to get back to exercise. Rehabilitation starts at the time of the injury (or awareness of) with some self-help, to consulting a professional and then on-going rehabilitation - including exercises, massage, cross-training and psychology.

Immediate steps

The action you take when you first realise you have an injury will, to a degree, determine the speed or completeness of recovery.

• Stop climbing straight away
• Cool the injury as quickly as possible (use a tap or stream for cold running water, or call into a pub for some ice)
• Do not test it to see if it is 'better'
• As soon as you get home follow the R.I.C.E. procedure (see below)
• Make a call to a sports injury specialist for an appointment

Next steps  

This needs to be followed by a diagnosis from a practitioner to clarify exactly what the injury is, together with an explanation of the main contributory factors. From this point, your practitioner should be able to determine what processes of rehabilitation need to be completed and provide you with some indication of timescales.

As far as the local tissue is concerned, your practitioner will probably focussing on:

• Settle acute inflammation
• Encourage correct healing of tissue in terms of fibre alignment
• Restore elasticity and flexibility to the healing tissue
• Restore inherent strength of the healing tissue
• Restore the functional strength of the tissue
• Progress towards 'normal' training
• Progress towards return to competition

Your practitioner will work on the causative or maintaining factors of the injury such as:

• Joint stiffness
• Reduced flexibility
• Muscle imbalance

Other causative or maintaining factors for you to look at (and the steps to take) include:

• Training errors (Discussion with coach/expert)
• Faulty equipment (Check your shoes etc)  

Other general practical steps you can take to assist are to:

• Maintain adequate sleep
• Maximise optimum nutrition to assist the healing process
• Work on other areas of 'weakness' in a performance enhancement or preventative manner without stressing the injury site
• Maintain positive motivation towards recovery.
• Find a local sports injury clinic, physiotherapist or rehabilitation expert 

Stretching, strengthening and stabilising exercises  

Exercises can vary at different stages of the rehabilitation process so seek advice on them from an appropriately qualified practitioner. For example:

• Stretching performed in the earlier phases to encourage correct fibre alignment is quite different to stretching done during the stage of return to normal training.
• Strengthening exercises done at the beginning of restoring strength of the healing tissue are quite different to those exercises performed in the later stages of recovery.
• Stabilising exercises would be done throughout your rehab to restore efficiency of movement and to help prevent muscles from either overpull or underpull increasing the risk of re injury.

Self help measures  

R.I.C.E. Theory and Cold Treatment  

As a generalisation it is appropriate to cool or ice the injured area (remember to protect the skin) as part of the early rehabilitation process following injury. Most people follow the R.I.C.E. acronym:

• Rest
• Ice
• Compression
• Elevation

If practical, one would cool or ice the local area under light compression (e.g. an elastic bandage) in a comfortably supported and elevated position. In ideal circumstances this would be performed for 20 - 30 minutes every two hours during the first 24 - 48 hours. Make sure you follow your practitioner's advice about rest.

As the acute inflammation settles, the frequency, length of application and method may all change.

In an acute injury (e.g. an ankle sprain) the speed of icing or cooling is the most important. i.e. the sooner the application of ice to the injury, the better!
At other stages of the rehabilitation process cooling or ice may be appropriate to dampen an inflammatory potential after exercises or training of some kind, and would perhaps only be applied at that time. This approach may have to continue for some time even when the pain from the injury site has gone.

Heat  

Warmth or heat encourages elasticity, pliability, relaxation and increased blood flow within the body. Once the acute inflammation has settled there may be a place for heat in your rehabilitation programme.

Heat can be applied in the following ways:

• Applying proprietary 'hot packs' which can be heated in a microwave
• Use of a hot water bottle
• Hot towels
• Immersion in hot water
• Taking a bath
• Directing a shower jet onto the area  

Depending on which method is practical, and under the guidance of a sports injury specialist, heat could be applied for 30-40 minutes and up to a maximum of 4 times a day.

Massage

This can have effects similar to heating (and many more) and can be very valuable at many stages of the rehabilitation process.
Ideally, an experienced sports massage therapist should determine the site, depth and choice of technique.
Be a little wary of deep massage techniques during the acute inflammatory stage or if an injury has just occurred. Sometimes it may feel helpful at the time but can actually traumatise the tissues further.

Cross Training  

The concept of cross training during rehabilitation to maintain or improve fitness, work on weaker aspects of fitness, maintain your sanity or avoid potential overload due to too much of the same thing, is generally a good one. However, make sure that you are clear about the specific aims of your cross training and that your selected methods satisfy these aims.

Make sure you are not 'accidentally' irritating the injury site indirectly and thus slowing down the recovery process.
Be aware that to suddenly do a lot of a different form of exercise could carry with it the risk of another injury potential.

Maintaining positive motivation  

It is much easier to maintain a positive approach throughout your rehabilitation if you understand exactly what the injury is, what processes need to occur, what complementary things need to be done and the timescales of the whole process.
Put the same time and effort into your rehabilitation that you would put into your normal training.
Some climbers throw themselves into other activities. Some use the time to analyse, learn from their mistakes and re-plan where appropriate. Some spend more time with family and friends or just do things they would not normally do and enjoy the change.

In simple terms, try to avoid being dragged down by the injury. Use it as an opportunity to re-think, plan and ultimately gain. By having a clear rehabilitation plan it can be exciting to be completing the different stages of the rehabilitation process with the end goal getting closer every day.

Rehabilitation Myths and Mistakes

• 'I will be able to climb it off.' Many injuries initially feel as if they can be 'climbed though' but then suddenly get worse and no longer disappear when climbing. Climbing will aggravate, and therefore prolong, most injuries.
• 'It will be alright tomorrow.' If something is painful today it is unlikely to be recovered by tomorrow. Even minor inflammation will take 2-3 days to settle.
• 'It was painful earlier but it feels better now, so it must be okay.' Many inflammatory conditions feel 'easier' once you 'get them going'. However working them often maintains the inflammatory process and therefore aggravates the problem.
• 'It goes away while climbing. It must be okay.' There are a number of conditions that will ease off during climbing. This process is usually a downward spiral over time taking longer to disappear during the climb or not quite going. Again this is a route to serious and prolonged injury.
• 'Give it a good rub and it will be okay.' 'Rubbing' injuries may help injuries but it can also aggravate them. Be cautious with the firmness of the rub and if things do not improve over a few days then visit a sports injury specialist.
• 'I cannot feel the injury when I take anti-inflammatories.' Anti-inflammatory drugs often also contain painkillers. This can easily disguise the severity of the injury, so be very careful, you may be doing damage without feeling it.
• 'It is a waste of time going to see the doctor.' GPs generally are much more interested and knowledgeable about sports injuries these days. Give them a chance to help you.
• 'I will keep going until the end of the season and then get it sorted out.' This hardly ever works. Sadly, it often contributes to the development of a chronic, or even a degenerative, injury which can be very troublesome, often taking a long time to recover.  

Conclusion
  
If there is ever any doubt about what to do during the rehabilitation period following injury, then do less rather than more. It may save a lot of time and heartache in the future if you wait a little longer before you move on to the next stage, and have a little more time to truly assess the feel of the tissue and its responses.

Remember that injuries are not necessarily 'cured' at the point at which they have just stopped hurting. You may need to carry on with rehabilitation exercises or treatment for some time after this point.
Find a local sports injury clinic, physiotherapist or rehabilitation expert.