I might write with a confident style but please don’t let that confuse you; Whilst I am a qualified Instructor and Coach, I'm not a professional climber or mountaineer so please don't take the blog post below as an authoritative guide. It’s a means of sharing my experiences and thoughts as I progress on my journey in the climbing and outdoor world and I hope they might be of help to you.

10-second summary:

• It's your body and it's got to go with you on your journey. Understand as much as you can about it and any injuries that you might sustain

• If you aren’t a medical professional, seek one out early to understand the full extent of your injury and what you need to do.

• Rehab often does the lion's share of the healing process. Be prepared for this and commit to it. It can be a long journey.

• Managing your own expectations about what you need to do, the likely quality of recovery and how long it will takes, is vital to ensuring that you can manage the injury throughout its rehabilitation.

• Keeping injury free allows you to make incremental gains which in turn help to prevent avoidable injury. Pay attention to your body and give it it the support it needs, push hard but give it the time it needs to adapt. Eat really well.

Intro

As I start to write this I'm reflecting that it's been a rough 2 years. 6 weeks ago whilst working, a trip and fall due to a descent path collapse led to a terrible triad injury to my elbow. Rehab has been tough, fighting off boredom, pain, and being disciplined about rehab and taking the small gains. Just over a year ago I took a bad fall whilst trad leading and shattered my right pelvic wing, fractured my sacrum through to the spinal column somehow not damaging the spinal nerve (well cauda equina) itself. I managed to do this just 3 weeks after taking an unlucky fall that everted my ankle, a subsequent x-ray revealing I’d broken a couple of bones six weeks before… so it feels topical to write this but not because this is the first time, I’m fairly familiar with injuries having 2 ACL tears, ripped my thumb off, dislocated my arm and had a tooth turned to rubble and thats just the musculoskeletal stuff. So of all the blogs I’ve written it feels like I really do have (unfortunately) quite a bit of experience in this area!

Understand your injuries

It's your body and it's got to go with you for your journey understand as much as you can about it and any injuries that you might sustain.

It's often said, but not really understood, but it is your responsibility to understand your body and everything that happens to it, so it's key that you do your research and understand your injuries and what you need to do. This is a really important point as it creates ownership and empowers you to take control over managing your injury which gives you the greatest chance of a successful recovery. It's really easy to become down and depressed about an injury and its implications and if you don't feel like you're able to do something about this it can make things even worse.

It's also important to understand that this is not a fixed but an evolving understanding especially in relation to your injury from the immediate treatment through to seeking appropriate medical attention, surgery if necessary, and crucially through rehabilitation to full recovery.

The important caveat here is in an age where you can get information from pretty much any source is to make sure your sources are good! Relevant, deep, qualified and more than one is best.

See a professional

If you aren’t a medical professional, seek one out early to understand the full extent of your injury.

I’ve got weak ankles, I mean really weak - if I do a mountain day without a painful roll then it's the exception rather than the norm. As a result, when I’ve injured it I just get on with my usual 'healing' process; “it's not that bad”, “I can sort this at home”... taken too far this can lead to a bad place. 

I recently rolled my ankle outwards badly, then again, a week later. I adopted my usual ‘no big deal approach’. About a month later I rolled it again but to the inside and it blew up by a balloon, finally, I thought I better get checked out. Turned out the second roll had broken several bones. Not good. There is an important lesson here which is we all have different pain tolerances and just because it's not painful doesn't mean the damage isn't significant it's always better to see a medical professional to understand your injury and be told it's not serious than not seek an assessment and find out later that it is serious. Some injuries need quick attention, especially those relating to ligaments and tendons and deferring seeing a medical professional in these cases can reduce the quality of your outcome. Each injury is different and whilst it's good to understand your body unless you've got a qualification in that body part, seek out someone who does and get their expert assessment. You'll be glad you did and they'll be glad you did, and the taxpayer probably will be too! Several years on that ankle still hurts…

Be prepared to work for it

Rehab often does the lion's share of the healing process. Be prepared for this and commit to it.

Regardless of whether your injury requires surgery, or if it is something less significant you'll likely need some form of rehabilitation. Injuries are typically traumatic events that throw out your ligaments, tendons, muscles and also your motor control and proprioception. Rehabilitation is vital to make sure that the injury doesn't have long-term implications and that everything returns to the way it was before or adapts to your new circumstances. 

When I first had my ACL reconstructed I met a number of people who'd had the same surgery as me and weren't fully recovered years after the operation. A consistent theme in my research into rehabilitating an ACL post-surgery was that 80% of the success of recovery was down to the quality of the rehab and the one thing that all of those people I spoke to had in common was that they hadn't committed to the rehab program. This was really sad to hear as it had a considerable impact on their life afterwards, not just physically but also with damaged confidence. But it was something that was within their gift, both post-surgery and in the present, for them to fix. It's not easy to accept that when you’re wounded and you'll be fighting feelings of negativity but you've just got to get on and do it. 

The thing is rehab is tough and often pretty boring and monotonous and can be painful at times. But what you're doing is providing stimulus to your body to regrow, strengthen and rebuild muscle and the mind-body connection. It's really important that you stick with it, I've half done my rehab before and it's just meant it's taken longer and I've had to work harder. Find some good music, an audiobook, a TV programme, whatever it is, get a routine and stick to it. Be disciplined. What goes into your routine will make the gains you need to get back to whatever activities you enjoy. Begin with the end in mind and visualise on that end-goal. This is especially true in the early stages of rehab where your injury may not have moved for a while and the ligaments have shortened, this can result in pain and difficulty to get the joint moving again but you just have to get through it. Mental strength is key to rebuilding your physical strength. 

The flip side to this is don't go too hard too fast. As the title of the book at the end of this article neatly sums up stimulating muscle growth is make or break; too much, too soon and you may incur reinjury. (Yep I’ve done that too…)

Having a goal can also really help: returning to sport, pushing onto a higher level than before, being able to keep up with loved ones on walks, or some form of challenge that isn't just about rehab can also help. When rehabbing my ACL I wanted to complete a Tough Mudder and for my second ACL I decided that wasn't enough and took on the 20 mile, 100-obstacle epic that is Rat Race. Having goals like these meant that I wasn't just rehabilitating the injury, I was getting fit to take on challenges worthy of a person without injury - the person I wanted to be again.

Again seek professional support here, it's unlikely the person you see at the point where you sustain the initial injury is going to be the person supporting you to get back to normal. This will normally be physio or other practitioners, in many cases, especially with surgery, it's the rehab that is the most important part of seeing you return to activity.

Be realistic about the time it takes to recover

Managing your own expectations about what you need to do, the likely quality of recovery and how long it will takes is vital to ensuring that you can manage the injury throughout its rehabilitation.

The body is an impressive thing and given enough time it can overcome really severe injuries. I'm still amazed that, within a period of just over 3 months, my body somehow took a pelvis that looked like a smashed dinner plate and has drawn all the pieces back together into a working bone that can bear the strain of the attached ligaments and muscles and all is working properly. But it takes time and there's no way of shortcutting that process. I had excellent medical treatment at the point of injury and superb NHS and private physio but it was taking the time to rest and do the rehab that helped the body heal effectively.

Bear in mind wider stress, also known as allo stress, plays a big factor in your speed of recovery. If you're placing lots of different stresses on your body as well as asking it to heal a major injury it will interrupt the process and slow it down. 

Much like building new muscle and exercising, you need to consider nutrition and sleep/rest. Unlike exercise, your body won't necessarily need a stimulus to heal in the way that it needs a stimulus to adapt, but it still requires the same building blocks as normal exercise; good quality nutrition and effective rest to allow the body time to heal.

Also, air on the cautious side of things, injury healing time scales and research often provides a range for example 8-12 weeks. What is often harder to find out is the 8 weeks is the minimum timescale where the injury is still very vulnerable and 12 weeks is where the quality of the healing will be much better and corresponds to much lower reinjury rates. With my first ACL repair, the advised healing period was 9 to 12 months before a full return to sport. I worked really hard and felt like I was in a good place and around 6 months. I returned to MMA and Brazilian jiu-jitsu. Big mistake. Less than 18 months later I had to repeat the surgery. Whilst it was healed and rehabbed to a high functional level, the healing process whereby the body integrates the surgical change and strengthens around it hadn't been completed as I had not given it the time for this to happen. It was only after tearing the graft that I did further research and found out that the reinjury rate at 12 months rather than 9 months was 80% lower!

How not to get injured again… or don’t get injured in the first place!

Keeping injury free allows you to make incremental gains which in turn help to prevent avoidable injury. Pay attention to your body and give it the support it needs, push hard but give it the time it needs to adapt.

In many respects, the biggest goal of any training activity is to not get injured in the first place. Getting injured almost invariably halts or more often sets back your progress. So as the old adage goes, prevention is better than cure. Not all injuries can be prevented especially those that arise through accidents, but plenty of injuries are avoidable through proper preparation, staying fit, assessment of risk, education, appropriate nutrition and rest and stress management.

The first way to prevent injury is through an effective warm-up. As climbers, we are notoriously bad at warming up. It's really rare that you see climbers warming up and if they do it generally consists of one or two easy climbs before jumping into harder grades. Climbing by its nature puts some pretty extreme and unusual stresses on the body. Unlike a lot of other sports, we place significant strain on the extremities of our bodies namely our toes and our fingers. By their nature as extremities, these areas are some of the last to be warmed up and they receive their warmth from the blood that travels outward from your core. Warm-ups don't have to be long but they should consist of some form of pulse raiser to raise the heart rate, mobilisation of the core and larger muscles of the body and finally climbing specific exercises such as those warming up the fingers. At this point, you can proceed onto easier routes for the purposeful practice of movement and technique as well as dialling the mind into the movements of climbing. This should ensure that when you jump on your hard routes for the session your body and mind are fully warmed up and ready for the challenge ahead.

Similarly staying fit and active will also have a preventative quality to it. It's far more effective to maintain a constant level of fitness through small inputs when you can't get to the wall rather than doing nothing. These are reminders to the body that it means needs to maintain fitness rather than adapting away from it now that the stimulus is no longer present. It also helps to view fitness as a marathon, not a sprint you want to make small and continuous gains.

Assessment of risk is a pretty broad term in climbing but as it pertains to injury it's largely about assessing the risk of a specific movement for creating an injury. Movements that might cause injury are those that involve moving your body into the extremes of its range of motion or placing a lot of strain on an isolated joint such as pockets. These can be effectively limited by warming up but also understanding the bounds of some of your current climbing abilities. This doesn't mean you shouldn't try hard movements but try and recognise where they may be risk and how you can deal with it. With regards to falls causing injuries this may be on hard lead climbs where there is a risk of falling when close to the ground. If this is a factor try red pointing or projecting the climb. You could try on top rope first to assess the moves or pre-clip to a certain height to reduce the risk. When you're outdoors this may include things like being aware of ledges and other natural obstacles which may prevent an injury risk.

Education as always plays a vital role here and a bit of time spent understanding the physiology involved with climbing can also help to prevent injuries. Understanding how you should structure a session is also useful. A good example of this is you should try your hardest climbs or training earlier on during a session (after a thorough warm-up!). Hard climbs but especially things like fingerboarding or campus put huge stress on the body. Again this is something that we can be bad at, especially novices who will happily jump on a fingerboard at the end of a session without really knowing what they're doing. They are great training tools but also a quick route to injury if you don't understand how to use them properly.

Finally, stress management relates to how much stress, both mental and physical, your body can take and still make effective adaptations. If you lead a very busy life with lots of things going on; work, kids, many hobbies, etc. Adding additional requirements on the body can have limited effects and at worst can be counterproductive. Try to get the most out of your sessions you need to allow the time and space for the body to recover effectively. Simply piling in training sessions whenever you can get them as frequently as you can do them might not be the best route to results. Stress, and the capacity to manage it, is highly individual, so paying attention to yourself and how you feel is an important way of gauging this.

It's taken me a long time to realise this but constantly pushing hard, exceeding your limits and feeling like you always need to be on the go isn't always the optimal approach. When I was younger I tried to pack in as much as possible and I often found myself picking up small injuries or just being ill. In retrospect, I realise this was because I was packing more stress in than I could handle.

Reading/viewing ideas

Make or Break - deserves a special mention as it's a rare example of a book focused specifically on climbing injuries and how to rehab them. Written and expertly researched by the legendary Scottish climber Dave MacLeod. I’ve found it an invaluable reference for both rehabbing, but also supporting physical training.

One move too many - Climbing is full of repetitious movement which lead to stress and strain and finally injury. This book focuses on developing an understanding of the patterns of injury and how to prevent them.