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TBP 014 :: Physical Therapist Jared Vagy on Injury Prevention and Treatment 2017-09-26T11:37:56+00:00

Project Description

About Dr. Jared Vagy

I am so excited to put this podcast out! Holy crap. This is some MUCH NEEDED info for climbers of all types and ability levels, and I really hope you listen to the whole thing.

Jared Vagy is a PhD physical therapist who also happens to be a rock climber who’s had a lot of injuries. He works with athletes of all kinds and does phone/skype and in-person sessions with climbers all over the world.

He’s written a book just for us on how to prevent and treat common climber injuries, and he’s got a lot more info for us up his sleeve. He’s super passionate about educating us, and I’m so happy I found him!

He’s dissected our contorted movements and figured out how we can prevent finger, elbow, and shoulder injuries.

What We Talked About

  • Finger injuries
  • Elbow injuries
  • Shoulder injuries (my favorite!)
  • What we’re doing wrong on the wall and in daily life to cause these injuries
  • How to properly warm up before climbing

Related Links

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  • Please give the podcast an honest review on iTunes here to help the show reach more curious climbers around the world 😉

Music

Intro and outro song: Yesterday by Build Buildings 

Transcript

Neely Quinn: Welcome to the TrainingBeta podcast where I talk to climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and we’re on episode 14 today, which I can’t believe we’re on episode 14.

Today we’re talking with Doctor Jared Vagy of www.theclimbingdoctor.com. He is a PhD physical therapist and he pretty much specializes in climbers because he is a climber himself and he’s gone through a gamut of injuries.

In our interview we talked a lot about the different kinds of injuries that we commonly get as climbers, so finger injuries, elbow injuries, shoulder injuries, and how to prevent them, which movements we’re doing wrong that are causing these things, and then how to treat them once we have them. You’ll hear about all of that and listen to my interview in just a second. I have a couple announcements before we do that.

The first one is that we are doing our first giveaway on the site right now, which is pretty exciting for us. One winner will get a fingerboard – one of the Rock Prodigy Training Centers from Trango, which the Anderson brothers put together with them – and then a year membership to our bouldering strength and power program which we just released. The total value is $270 and one big winner will get those two things sent to them. You can enter the drawing by just clicking on the link on this page. If you’re on iTunes you’re going to have to go back to this page on TrainingBeta, under the ‘Podcasts’ tab and find that link.

Anyway, tell your friends. If you do spread it to your friends, every time somebody signs up through your link you will get two extra entries so anyway, it’s a big deal for us and we hope that you like it.

Secondly, I have to mention our training programs because those are how this is made possible, how my time is available for this. We have our power endurance program, we have our endurance program, we have our nutrition program, strength program – well, a strength guide from Steve Bechtel – and then our new bouldering strength and power program from Kris Peters that we just put out. It’s a subscription program. You can check it out on www.trainingbeta.com under the ‘Training Programs’ tab.

So now, we will get on to the interview. I really hope you will enjoy it.

 

Neely Quinn: Alright, I would like to welcome Jared Vagy to the show. Thanks so much for being with me today.

 

Dr. Jared Vagy: Absolutely, absolutely.

 

Neely Quinn: Tell us a little bit about you. You’re a very important person that a lot of us climbers don’t know about.

 

Dr. Jared Vagy: Well, a little bit of background on me and, I guess, how I got into climbing and how I got into doing what I do now is way back in high school I was one of the top runners in the state. My sport was track and field. That sport meant everything to me and I had a chance at a college scholarship and I actually got injured and it kept me from competing my second year in college.

I needed something while I was in college to get my mind off of my injuries and there was an indoor rock wall on campus. Like many people that climb or that start climbing, the second I touched the wall I was completely hooked. I wanted to do every single problem that was on the wall and eventually I was like, ‘There must be things outside of this wall, outside of this gym,’ and I started going outside. I started doing single pitch climbs then multi-pitch climbs and started trad climbing, then I started doing big walls and then big walls solo, then I said, “There’s even more climbing outside the US,” so I started traveling internationally doing big mountains, doing alpine. Basically, everything that I could get my hands on that was climbing related, I was addicted to.

In this process I started having some tension in my fingers and I started having some irritation in my shoulder but I just kept climbing through it. Like most climbers, you feel a pain or some discomfort in a part of your body and you decide, ‘Well, climbing is more important. I’m going to put my time into that rather than find a way to stop this pain.’ So, what I ended up doing is I ended up not listening to my body and I popped a pulley tendon in my finger – or a pulley ligament in my finger – and then I tore my rotator cuff.

It was at the same time that I was actually finishing up my doctorate degree in physical therapy at USC, the University of Southern California, that I started realizing that there are ways that you can start to prevent these injuries from happening in the first place. I started mapping out the different movement patterns that climbers put themselves in and from a biomechanics perspective, started to analyze: how can you change your movements and how can you do specific exercises to take stress off these areas so you don’t get hurt?

What I ended up doing is I talked to Matt and Mikey over at Deadpoint Magazine and they were pretty excited about the new content and we started a column over there on preventing injuries. I got in touch with the local rock gym and started doing seminars on this topic, and then things just really picked up. People – this was something that was very new for a lot of people and they had never heard of a lot of these things I had been discussing, so I started getting a lot of invitations to go out to different festivals – The Red Rock Rendezvous, the International Climbers’ Festival, Yosemite Facelift – to do lectures and seminars. People started hearing about some of the treatments that I do and started doing remote consultations on the internet with people in different countries and just focusing a lot of my time on trying to help climbers.

That’s kind of where we’re at today.

 

Neely Quinn: It’s a great story. Where can we find you online?

 

Dr. Jared Vagy: That’s a good question. You can go to www.theclimbingdoctor.com. On there, you can find a lot of content about how you can prevent injuries from occurring. You can get any magazine articles I put out. They’re all-access. I have a book out and you can download a sample copy of the book if you just want to get some free content or if you want to purchase the book you can also get it there as well. It’s www.theclimbingdoctor.com and there’s some awesome content up there.

 

Neely Quinn: Yeah, you’re super generous with your content and I’m sure a lot of climbers will appreciate it. Today we’re going to be talking a lot about – selfishly, I want to talk about shoulder stuff.

 

Dr. Jared Vagy: [laughs]

 

Neely Quinn: And of course, all of the other common climber injuries. I just want to comment that I think it’s pretty funny that even as a PhD physical therapy student you still just completely ignored your body and wrecked it.

 

Dr. Jared Vagy: Oh my god. We were sitting in class learning about, ‘This is the rotator cuff and this is the position that puts stress on it,’ and then the next day I was out at the crag just cranking on my shoulders. You know, you never really put two-and-two together until you actually have that injury.

 

Neely Quinn: Right, so it’s kind of cool, in a way, that you did have these injuries so that you could relate more with climbers.

 

Dr. Jared Vagy: Yeah, absolutely. I climb myself, too. It’s a huge part of my life and once I started identifying these poor movements or these positions that put you at risk, then I stopped having my injuries. You’ve got to drink your own Kool-Aid, I guess.

 

Neely Quinn: So did you heal those injuries that you got? Like the rotator cuff tear. Did you tear it, did you say?

 

Dr. Jared Vagy: Absolutely. The tear repair and I strengthened the muscles surrounding it and now, when I do those same movements that would have caused pain back when I had the injury, I don’t have any pain so it’s definitely – the biggest thing I can kind of put out there for climbers or for anybody is: it’s too late before we realize we have an injury and we do something about it. Just doing a couple minutes of some simple, simple band work or exercises each day can really help.

 

Neely Quinn: I wish that I would have been doing those things. You said that you did have a tear and you didn’t have surgery for your rotator cuff. You just healed it on your own?

 

Dr. Jared Vagy: Exactly, yeah. Over time I allowed the inflammation in that area to kind of calm and settle down. You have four rotator cuff muscles. Three of my other ones are working quite nicely and I have a whole series of scapular thoracic, or shoulder blade muscles, that have gotten quite strong so there’s not very much stress that’s put on the area while I climb.

 

Neely Quinn: Cool. That’s really awesome and super encouraging.

 

Dr. Jared Vagy: Yeah, definitely.

 

Neely Quinn: So, where should we begin? I want to go over finger injuries, elbow injuries, and shoulder. Am I missing anything big with climbers?

 

Dr. Jared Vagy: No, I think that’s good. We’ll see where that goes. I always have some questions, too, about wrist injuries but those are related oftentimes to the same type of patterns as elbow injuries.

 

Neely Quinn: Okay, so let’s start with fingers and we’ll save the best for last with the shoulders.

 

Dr. Jared Vagy: Alright.

 

Neely Quinn: Tell me the most common reasons that people get finger injuries and what those finger injuries are.

 

Dr. Jared Vagy: I guess first, the most common finger injury is, you’ll hear all the time, ‘I popped a pulley.’ Some people know what that is and means and some people don’t, but just to give a background you have pulleys, which are basically ligaments that go over, across, and to the sides of your finger and they keep the tendons that run through your finger from bowstringing out.

I believe it was Mark and Mike Anderson that have this analogy in their book but you can almost imagine a fishing pole and the fishing line is kind of held in by those little circles that go all along the pole. Those are your pulleys and it keeps the fishing line along the pole. If one of them were to pop, you can imagine that that line would bow out and often times, climbers will have this injury. It’s a pulley strain or a pulley tear.

There’s different grades of it and normally, there’s three grades, but what we normally feel is right across your finger you feel a tenderness. A tenderness to touch and it’s often sometimes red and swollen. People feel this and sometimes there’s a pop that occurs when you’re crimping or on a hold and sometimes there’s not. That’s likely the most common finger injury that you’re going to have as a climber.

 

Neely Quinn: Okay, so how do you get that and what do you do about it?

 

Dr. Jared Vagy: A lot of climbers, they get finger injuries. You have to look at two things: one is, look at the hand. If you’re doing boulder problems or climbing outside or indoors or whatever you’re climbing, and there’s a lot of crimpers, it’s the position of your joint that actually puts a lot of stress on that pulley.

If you look at your hand and – it’s right in front of you. Everyone take a look at your hand. See that last aspect of your finger that kind of flexes? That’s called your phalanx and imagine if you’re on a crimper, it actually flexes backwards, so it almost extends or hyperextends. That’s the position, when we’re gripping really hard on crimpers, that our fingers usually take. It’s the most passive position, it’s the way that we can generate the most power. That position is called a ‘closed crimped grip.’ You know it’s a closed crimp grip when the last aspect of each of your digits are, instead of flexing forward, they’re kind of extending backwards. That puts the most amount of stress on our pulleys and that’s often times how climbers injure it, is they’re overusing that type of grip.

 

Neely Quinn: Okay, so what do you do? How do you not do that? I mean, that’s kind of what we climbers do to get the most out of our fingers, right?

 

Dr. Jared Vagy: Exactly. You know, I get that question so much but if you think about it, think about you’re doing a problem or you’re on a route and you’re crimping. Not every single hold on that route is going to be a crux move. Not every single hold you need to be doing this crazy, high stress crimp position. I’ll look at people that have these constant pulley injuries. They’ll be climbing and I’ll be analyzing them. We’ll do a little bit of video as well for their analysis and regardless of the hold, whether it’s a very simple hold or a crux hold for them, they’re always using a closed crimp grip.

What I recommend for people is if you have to, it’s a crux move, you can do what’s called a ‘thumb lock’ where you actually take your thumb and you wrap it on top of that last aspect of your digit that’s extending. If you can kind of imagine it looks like an OK sign. That’s protecting that digit and the pulley in that area and it’s making it a little bit stronger grip. Or, the most preferred way is if you open your grip up a little bit more and it’s called an ‘open grip.’ Actually, if you extend your fingers and grip with a little bit more of an open palm, then that can take some of the stress off the pulleys as well.

 

Neely Quinn: Okay, and that makes sense. It seems like that’s something that you would have to train to get really good at, like the open hand crimp gripping. It seems really good that when you’re training on the fingerboard it’s always suggested that you do have an open hand grip. I think training on the fingerboard might even help reduce injuries. Am I wrong there?

 

Dr. Jared Vagy: Yeah, if you’re thinking about using the right patterns, it’s absolutely all about reinforcing these movement patterns throughout time. When you’re at a crux move or you’re at a difficult part of the problem that you’re working on, the last thing you’re thinking about is, ‘Oh, is my finger and wrist in the right position?’

If you train it and you get used to it, you do it on the fingerboards or you do it – I’m sorry, on the hangboards – you change your finger positions. Or, during your climbing warm-up you focus on crimpers but you do easier crimpers and focus on form, that’s when the pattern really sticks. It’s really interesting because I’ll look at a lot of people climbing that have these pulley injuries and I’m not just looking at their hands. Where else do you think I would look?

 

Neely Quinn: Like, their elbows or wrists or something?

 

Dr. Jared Vagy: Possibly, but kind of think in the bigger picture. What’s outside of that?

 

Neely Quinn: Their feet?

 

Dr. Jared Vagy: Exactly. Really? We have to use our feet when we climb? It’s a completely foreign concept but what you’ll notice is over 44% of the injuries happen in climbers in their fingers and their wrists. The majority of them actually happen because they’re using poor footwork and poor body positions. If you can imagine if you are in a dangerous crimping position, if you squat down a little bit more, take your center of mass a little bit lower, and put more weight into your feet and into your legs, that takes a significant amount of pressure off of your hand.

 

Neely Quinn: Then is there anything we can do with our wrists or our elbows? Or is that more of the upper body stuff?

 

Dr. Jared Vagy: Yeah, there’s definitely – if you engage some of your helper muscles – a lot of climbers have, and we can talk about this more in depth when we talk about the shoulder, but you’ll notice that they climb with their arms and the rotator cuffs and they don’t really climb with their shoulder blades engaged. What you can also do is you can engage your shoulder blades by almost gently squeezing them together. It’s very, very subtle or small movement, but what that does is that’s going to stabilize your shoulder, which is going to make your wrists and your fingers able to work better from a more solid foundation.

 

Neely Quinn: Got it. It’s probably taking some of the pressure off of the fingers.

 

Dr. Jared Vagy: Definitely, definitely. It’s really a combination of how you move and position your body that can help reduce or prevent some of these injuries. I’m all for when people actually do get an injury, to rehab it specifically and do all the different things that you can do if you want to reduce inflammation, improve range of motion, and increase the strength but if you just stop it from happening in the first place by climbing properly, then that’s way more powerful.

 

Neely Quinn: Yeah, you know, I’ve actually had a lot of finger injuries. I guess that’s what comes with climbing for – how long has it been – a long time now. Part of what has made those things happen is that I was climbing too much or I wasn’t warmed-up enough, so what do you have to say about that?

 

Dr. Jared Vagy: Well, I mean the warm-up is one of the most important parts of preventing injuries while climbing. There’s really three types of warming up. One is statically stretching, the other is ballistically stretching, and then the third one is dynamically stretching. If you take a look around at people that do warm up, which is a small percentage, what type of stretching do you think you normally see?

 

Neely Quinn: Um, I mean what I see people do is maybe put their hand on the wall and extend their shoulder forward so they’re kind of stretching out their shoulders but I don’t really see people do anything else besides that.

 

Dr. Jared Vagy: Yeah, and I don’t see that many either but when people are stretching they’re doing exactly what you said. They’re almost fixing one part of their body and then they’re turning and rotating on it, then they’re holding it. Usually they’ll hold it for about 30 seconds and so what static stretching is, and I’m going to kind of explain and while I’m talking about these, I guess the listeners and you and kind of everybody think about which one is the only one that you should be doing before you climb and which two are actually dangerous.

Static stretching, what it is, is you take a joint or a limb and you put it into a stretch position and it normally lasts about 30 seconds. That would be the example of you’re stretching your wrists. You’re putting your hand behind your fingers, your elbows in front of you, and you’re kind of pulling back and holding. That’s probably the worst thing that you can do before getting on the rock wall.

 

Neely Quinn: Okay

 

Dr. Jared Vagy: Research for the past 10-15 years, there’s so much of it that says, “Do not static stretch before activity.” It can be dangerous, it can actually increase injury rates, and it can decrease your power or your ability to actually perform on the rock wall, so my biggest pet peeve, and I’m a huge dork with this stuff, is I’ll walk around the crag and I’ll see a couple people kind of stretching back their hands and their wrists and I almost want to – it’s in my head – go up to them and say, “Do you know what the research has said for the past 10-15 years?”

 

Neely Quinn: That’s like me in the grocery store, watching other people’s carts.

 

Dr. Jared Vagy: I’ve never even thought of that, actually. That’s kind of – what do you do with people’s carts?

 

Neely Quinn: No, I mean as a nutritionist I’m like, ‘Do you know what’s in that food that you’re eating?’

 

Dr. Jared Vagy: Now, do you ever go up to them and say, “You know, you should substitute this for this?”

 

Neely Quinn: No, but I think it would be more appropriate for you to do that than for me to do that, but go on. Keep going.

 

Dr. Jared Vagy: I still don’t do it. It’s really just in my head unless I really want to say something. What it is, that’s one of the worst things that you can do before you climb and the second worst thing is ballistic stretching. What this is, is imagine you’re stretching your hamstring, like, the muscle in the back of your leg, and you kick it up on a bench and then you’re leaning forward and bouncing on it repeatedly.

If you think about how this is damaging to the muscle, what it does is it activates a stretch reflex and the muscle actually fights back against you and you’re not able to truly stretch it and you actually create microtears within the muscle. That’s kind of the second most dangerous type of stretching you can do before you climb.

 

Neely Quinn: Okay, so what do you do?

 

Dr. Jared Vagy: Alright, so dynamic stretching. This is really the key in a climbing-specific dynamic stretch, the best thing you can do on the rock wall, and there is loads and loads of research that supports this. If anyone wants the studies, shoot me an email. I’ll be happy to send them out to you, but what this is, is you’re taking your limb or your joint through a range of motion very smoothly that mirrors exactly what you would be doing on the rock wall. It usually lasts about three seconds, going in and out of each position.

 

Neely Quinn: Okay, so I’ll admit. I’ll just tell people. We did this interview before and it failed, so we actually talked about these things once before so we know each other really well now. You had said that so I went to the climbing gym when I was climbing 5.6s on my broken shoulder and tried doing what you had described, but I don’t think I got it. I want a really clear explanation of what you’re saying. What are the movements that you would have us do?

 

Dr. Jared Vagy: Got it. First of all, if anyone wants to see the movements, go ahead on my webpage and go to ‘Published Work’ and it’ll say ‘Climbing-specific Warm-up’ and there’s a photo of each of the movements. We’re actually working on putting together a video, which is going to be a huge help for everyone to kind of see.

What it really is, and some of this was built upon Neil Gresham’s work on his identifying different kind of Tai Chi climbing positions, but what it is, is you think about what you’ve got to do climbing on the wall so you break down the different movement patterns. For example, if you have to do a reverse outside flag on the wall, then you go on the ground and you’re mirroring that exact same position as a reverse outside flag. If you’re going to be doing a drop knee, you would do the exact same rotate, drop a leg, one arm crimps down, the other arm reaches up over your head. The same drop knee position you would be doing on the wall.

Another example, if you’re doing a high knee or you’re doing a high step, like there’s some high steps in the problem, on the ground you’re going to be balancing on one leg, flexing your hip and grabbing your knee, holding for about 2-3 seconds and releasing, to mirror that kind of high step position.

 

Neely Quinn: Okay. Just so you know, I’m doing all of these motions as you say them. [laughs]

 

Dr. Jared Vagy: I’ll join along with you.

 

Neely Quinn: No, that makes sense, though. Like, I put my foot up on something. I could do it on a rock or something and make the drop knee and pretend that I’m holding something and it stretches your body out the right way.

 

Dr. Jared Vagy: Exactly. People all the time will say, “Well, I’ll just go and climb instead and that will be my warm-up.” Yeah, you’ve got to do that as part of your warm-up too, but if you’re thinking about preheating the oven, you’re going to kind of gradually build up. The second part of your warm-up is actually on the wall, kind of slowly progressing into different climbing positions and movements.

Part of the climbing warm-up I developed not only has those full-body-on-the-wall type exercises but also it has other components you need. There’s a section where you rotate each part of your body. There’s a part where you stretch your upper body. You stretch your agonist muscles, which are the ones that normally work, and your antagonist muscles, which are the ones that oppose it. You kind of stretch them equally at the same time. Then, there’s a section for the fingers/wrists as well. Guess how long all of this takes. It probably took me longer to talk about the warm-up that it actually does to do it.

 

Neely Quinn: [laughs]

 

Dr. Jared Vagy: But guess how long the warm-up takes.

 

Neely Quinn: Like, five minutes?

 

Dr. Jared Vagy: You got it! Yeah, it takes five minutes to do this. Sometimes even less. It’s just getting that pattern and that program.

Every time before I climb, I do the warm-up and people come over and they’re like, ‘What are you doing?’ and I’m like, ‘I’m doing a climbing warm-up,’ and they get excited about it and they do it as well. They obviously look a little goofier because they haven’t been practicing it – no, I’m just kidding – but anyway, it’s something that if you even take a couple components of it and spend just two or three minutes warming up, it’s better off than probably doing what most climbers do before they climb anyway.

 

Neely Quinn: Yeah, that’s really cool and different. So you’re saying that warming up properly is going to allow us to not get injured as often. That’s the number one thing? Or the number two thing in your mind?

 

Dr. Jared Vagy: It also depends on what types of injuries we’re talking about. Warming up properly is going to help you prevent a strain or possibly a sprain but it’s not going to likely prevent, as much, some type of overuse injury.

There’s really two categories: the overuse injuries, you’ve got to change your movement while you’re climbing and you’ve got to strengthen your opposing muscles from the ones that are injured and stretch out the ones that are short and stiff. Then, the warm-up just really allows all the blood flow to circulate and for you to avoid strains and sprains.

 

Neely Quinn: Okay, so you would do this five minute stretching routine and then you would get on the wall and you would warm-up further, so we got that. We’ll all do that from now on.

 

Dr. Jared Vagy: We shall see. We shall see.

 

Neely Quinn: But then going back to the finger injuries, I think we have a couple other things to talk about with that. We got into a really good tangent but let’s go back.

So, we had the pulley injury. What other injuries are common and how do you know if you have them? I mean, vaguely.

 

Dr. Jared Vagy: Another common climbing injury, I guess we’ll work up the chain, is going to be elbow injury. We can talk about, first, the outside of the elbow. This is, often times, people would call it ‘tennis elbow.’ The medical term currently is lateral epicondylalgia. Some climbers call it ‘climber’s elbow’ but I usually just refer to is as simply ‘outside elbow pain.’ People can easily identify the area that they’re having pain.

How do you think this is often caused? It may be a little bit different than many people think.

 

Neely Quinn: I have no idea. Climbing wrong somehow? [laughs]

 

Dr. Jared Vagy: Good. Yeah, you’re catching on. Poor climbing movements but if you look at it – so, everyone take their arm and put it right in front of you, extended straight, and have your palm down. Trace from your fingertips all the way over towards your elbow, a little bit on the outside of it. You’ll notice that there’s a little bit of a tendon and then a bone right in that area. What you’ll notice is, if you extend your wrist backwards and you follow that muscle, that muscle actually attaches into the outside of your elbow. So, it’s attaching from your wrist and your fingers to the outside of your elbow.

 

Neely Quinn: Through the top of your forearm.

 

Dr. Jared Vagy: You got it. Many people that have outside of elbow pain, I pay particular attention to what’s going on at the wrist. What you’ll see and what you’ll notice is, what the research shows is, when your wrist is cocked back 35° that is when our grip is the absolute strongest. You’ll notice a lot of climbers are going to be climbing with their wrist cocked back on almost every single crimper hold that have this injury, because they’re so used to over-activating these muscles. You’ll notice the same thing I talked about with the fingers, is yeah, you’ve got to get a really strong grip if you’re on a crux move and you can cock that wrist back 35° and crimp really hard, but on the 90% of other moves in your problem or on your project, you want to keep a more neutral wrist position.

 

Neely Quinn: With an open hand grip.

 

Dr. Jared Vagy: Exactly. [laughs] There you go, building upon it. Yeah, with an open hand grip and then now you’re killing two birds with one stone. You’re preventing that lateral or outside elbow pain and then you’re potentially reducing your chance of getting a pulley injury as well.

 

Neely Quinn: Okay, so that should help prevent the climber’s elbow, the outside of the elbow injuries?

 

Dr. Jared Vagy: Yes.

 

Neely Quinn: What about the inside of the elbow, because that’s what my husband is struggling with right now. It’s like it connects to the biceps tendon, I think, or to the biceps muscle?

 

Dr. Jared Vagy: So, there’s two parts of the inside elbow and the one that’s more common in climbers is usually the lower part of your inside elbow. That is where, let’s do that exercise again where you have your hand right in front of you and you now have your palm up in the air and you trace from your finger all the way down to the inside of your elbow, and then you flex your wrist up in the air. What you’ll notice is you’ll kind of notice a little bit of a bulge kind of stick out. That inserts into the tendon on the inside of your elbow. Those are our wrist flexors. They’re on the opposite side that we had just talked about.

 

Neely Quinn: Okay, so what is that? You’re pulling your fingers towards your face, basically, so when are we doing that in climbing?

 

Dr. Jared Vagy: Okay, good question. The positions or the holds that mostly mirror that are going to be if you’re going to use a sloper. You can imagine, you almost have to flip your fingers around, but that same position would be if you’re slapping onto a sloper or if you’re doing an undercling. Those are the two most common positions that are going to overly stress the inside of the elbow.

 

Neely Quinn: Got it.

 

Dr. Jared Vagy: So when people have that pain and that discomfort, what do you think I usually tell them to strengthen?

 

Neely Quinn: I don’t know. I’m really bad at this quiz. [laughs]

 

Dr. Jared Vagy: Think on the opposite side.

 

Neely Quinn: Oh, the top of their forearm?

 

Dr. Jared Vagy: Exactly. The answer to this question is, almost all the time, strengthen what’s on the opposite side of what’s injured and weak. Then, you have to look at the bigger picture but what I normally have them do is they’re going to strengthen those wrist extensors or the muscles that kind of cock their wrist back in the opposite direction.

 

Neely Quinn: Oh, with like that roller thing with the weight at the bottom and the string in the middle?

 

Dr. Jared Vagy: Exactly, and if people don’t want to buy a weight and a string, I actually have an article up on the webpage where, if you’re a trad climber or a sport climber or whatever, you use your rack and you can use an anchor. You can actually make that out of a Swiffer Sweeper or a dowel or something and your rack and your anchor, so there’s really no excuses for frugality for doing this exercise.

 

Neely Quinn: What about sport climbers?

 

Dr. Jared Vagy: No, no, exactly. For sport climbers you can take your quickdraw rack and you can put your climbing shoes on it as well, clip your helmet and put your water bottle, and now you’ve got yourself a nice mix.

 

Neely Quinn: Good. I hope you have pictures of this somewhere.

 

Dr. Jared Vagy: [laughs] Yeah.

 

Neely Quinn: So you said that, for the underneath the bottom of the elbow, you strengthen the top of your forearm. Did you say what you’d strengthen for the back of your elbow?

 

Dr. Jared Vagy: Yeah, that’s a good question. What I usually direct people for this is I say most of the time we’re going to strengthen our antagonists, the muscles on the opposite side. The thing is, the muscle on the opposite side on the back of your elbow are your forearm muscles and, as climbers, those are probably the strongest part of our arm so they’re overdeveloped and over-strengthened.

What the exercise is, this is also on my webpage, it’s in the book, too, if people want to take a look at that, but what you can do is you can take a Flex Bar and these are from Theraband. They’re basically a way to, it’s called ‘eccentrically strengthen’ these muscles. The eccentric strength is, if you imagine with your biceps you’re doing a biceps curl and when you come up that’s concentric strength. When you lower the weight down and the muscle’s elongating and kind of resisting the speed, that’s eccentric strength.

What the research has shown is eccentric strength actually builds and strengthens the tendon. So, in these exercises, the one for outside elbow pain, the one that I recommend based on research is an exercise that’s going to strengthen that tendon that’s likely weak and overused.

 

Neely Quinn: What’s that exercise? Is it explainable?

 

Dr. Jared Vagy: Yeah, it’s a little bit explainable. I would recommend people, for this one, go to the website. There’s five different pictures that show it and it’s a little bit easier to get from the web page.

 

Neely Quinn: Which web page is it on?

 

Dr. Jared Vagy: www.theclimbingdoctor.com and you go to ‘Published Work’ and under ‘Published Work’ it’s going to be under ‘Climber’s Elbow.’ There will be a diagram and pictures of how to do it. I’d recommend just do that, because this is a little more tricky to explain, but do know if you don’t want to go out and buy this Theraband Flex Bar, just use a towel and roll it up nice and tight. It’ll take a little bit more setup and prep time but you can get a similar type exercise, or you can take a weight or a Theraband and you can do eccentric exercises for the back of your forearm. All you would do is you would help support it and lift it back, and then you would allow it to slowly curl forward.

 

Neely Quinn: So, now we have the resources about what exercises to use, what injuries there are, but I’m assuming with a lot of these injuries rest is really important or do you think that climbing and training, or at least doing these exercises through pain, is a good idea?

 

Dr. Jared Vagy: Well, it’s really determined by what you mean by rest. A lot of people think of rest as, ‘Well, I’m injured. I’m not going to climb. I’m going to take one week, two weeks, three weeks off and it’s going to mess with my psych. I’m going to be, you know, pretty upset I’m not going to be able to climb but then I’ll be able to go back to the wall and not have this injury.’ That’s where a lot of climbers that get injured go wrong. There’s a big difference between rest and active rest.

Neely Quinn: Okay. Tell us more.

 

Dr. Jared Vagy: Okay, so what active rest is, really, is if you have an injury you’ve got to be moving. Whether it’s cross training, whether you’re doing something that mirrors climbing a little bit, or you’re still on the wall but you’re completely dialed down and you’re doing very simple problems. Technique problems, footwork problems, things like that to train your climbing technique. With injuries, you’ve still got to be on the rock wall because what do you think happens if you don’t climb for, let’s say five weeks?

 

Neely Quinn: I know exactly what happens when you don’t climb for five weeks.

 

Dr. Jared Vagy: Well, what happened to you? What happens?

 

Neely Quinn: All of my muscles are gone and that’s about it, and I’m upset almost everyday.

 

Dr. Jared Vagy: Yeah, there you go. All your muscles atrophy and then that actually affects your mental – basically, how you feel each morning. Neither of that is good for climbing. The hardest part about having an injury, and I’ve been through almost every injury you can imagine myself before I learned how to prevent them, is going to, let’s say the rock wall, and not being able to climb that 5.12, 5.10, whatever your ceiling level is, or that problem that you were working on. Not being able to climb that.

You go there and you see all your friends are crushing and doing really well and you are doing, like, a 5.6 because you’re injured. You’re like, ‘Nah, you know, maybe I’ll try a 5.10,’ or whatever your level is. ‘Maybe I’ll step it up a little bit,’ and then that’s usually when you get hurt again. It’s this crazy, vicious cycle.

 

Neely Quinn: Yeah.

 

Dr. Jared Vagy: You’ve got to have some self control if you’re injured and go to the rock wall and climb several levels below your grade then take these techniques, the position of your wrist, fingers, arms, and actually that’s your focus instead of focusing on trying to get to the next grade.

 

Neely Quinn: Oh, so retraining yourself how to climb, basically.

 

Dr. Jared Vagy: Exactly. That’s going to create a way better foundation and then by the time the tissues that have been injured finally heal, then you’ll be in a better shape. Your body won’t be as atrophied, you won’t lose as much muscle, and you will have better movement patterns that you’re less likely to get this injury again.

 

Neely Quinn: So there’s no merit to taking time completely off?

 

Dr. Jared Vagy: That’s a good question. If you have an injury, let’s say a pulley injury, there’s three grades. Grade one is a slight tear, grade two is a little bit more, and grade three is a complete rupture, meaning that little circle on that fishing line that’s keeping it in place just pops off. That is the case where, in general, the medical community recommends up to two weeks of rest or they’ll sometimes even splint you for a much, much longer time and immobilize that area to allow the ligament to heal down.

A lot of research these days, and there’s two different groups/two different schools of thought on this, but a lot of research is starting to point to immobilizing something and not letting it move is not the best idea. Eventually, you start to stiffen up and you never really regain that full range that you had.

 

Neely Quinn: Yeah, so in which of those cases – you’re saying in none of those cases would not climbing at all be a good thing.

 

Dr. Jared Vagy: I think that in a grade three, so if you fully pop a pulley, obviously with all this stuff you’ve got to consult your medical professional and you’ve got to get them in the loop as well and read up on the most recent research, but I think in those cases when it’s a severe injury, take up to two weeks off. Allow time for the tissue to fully – I wouldn’t say fully heal but for the tissue to start to heal. Then, begin to do some gentle exercises to progress you along the path.

It’s a very tricky question because there’s way different schools of thought on every end of when you should start to move/mobilize – and mobilization is another word for movement – and a lot of medical doctors or physicians are still in the old school mindset that, for example, if you sprain an ankle that you’ve got to put someone in a boot for 4-6 weeks.

 

Neely Quinn: Right.

 

Dr. Jared Vagy: If you read all the literature, all the research, I think for the past 20 years it’s said that the most important thing after you sprain an ankle is to get your motion back. It doesn’t mean go ahead and start running on it the next day. It means do some gentle stretches and start to build back progressively into your exercise, so I think for all this stuff you can boil it down to: let pain be your guide. There’s really no steadfast rule but if you’re climbing and even doing simple things and it’s very painful, then first you’ve got to find a way to handle and manage that pain and let the tissue heal.

 

Neely Quinn: I’m assuming you don’t mean take ibuprofen, and lots of it, to manage the pain.

 

Dr. Jared Vagy: No, there is other ways. That’s another debate, too, the ibuprofen debate. That’s heavily supported and researched on two different sides of the fence on what people believe.

 

Neely Quinn: What do you believe?

 

Dr. Jared Vagy: Well, I mean what the research shows on that is, in the short term, let’s say taking ibuprofen or icing, it’s going to help get you returning to activity quicker. It’s going to reduce your pain and reduce inflammation and swelling and allow you to get back to what you’re doing at a quicker speed but, in the long term, what swelling actually is, is our body’s response to try and heal a tissue. Your body is sending all these leukocytes and all these different cells to this area to try and regenerate and heal it and by icing and taking anti-inflammatories, you’re actually reducing your body’s capability to heal in the long run. By doing those things, in the long term, it may not be as effective and you may actually be worse off.

I normally just tell people, ‘If you have something you really want to work on in your training, if it’s your training phase, or if you’re at a section where you have your project coming up or if there’s a really big trip coming up in the near future, you can ice and you can ice frequently, but just know there may be some long term consequences with it.’

 

Neely Quinn: I think you’re the least-conservative health professional I’ve ever talked to.

 

Dr. Jared Vagy: Yeah.

 

Neely Quinn: You’re like, ‘If you really want to send, you can. It’s okay if you’re in lots of pain.

 

Dr. Jared Vagy: It’s funny because I get so many climbers that come to me. You know, a portion of my practice is made up exclusively of climbers and a lot of them I consult with internationally, through Skype, just because they can’t be in this area. A lot of the climbers, high level, low level, wherever they’re at, they want to climb and they’ll go to a standard healthcare professional or a typical physician and they’ll say, “Oh, I have this injury,” and they’ll say, “Rest six months.”

If you’re a climber, like all of us are that are listening to this, if someone says, “Rest six months and don’t climb,” how does that make you feel? To even know that they’re saying this possibly with no supporting literature or research, it’s just what they’ve been saying for the past 15-20 years from when they were in medical school, I think anytime someone gives you a recommendation, always say, “Hey, do you have an article that can support that?” If they don’t have some type of proof or support I would start to look elsewhere.

 

Neely Quinn: That is quite a rule of thumb about health practitioners. I think that most of us would be looking elsewhere for help if we actually asked that question.

Okay, I have a couple more.

 

Dr. Jared Vagy: I hope everyone asks [unclear] and see what you get.

 

Neely Quinn: Yeah, it’s a good question. I would like my health practitioners to know what is going on currently.

I wanted to go back to the finger injuries for a second because we talked about the exercises for the elbows but are there exercises for finger injuries? Did we go over that and I wasn’t listening?

 

Dr. Jared Vagy: We did not go over it and there are exercises. You know, we talked about the positions that you can put your body in that can prevent finger injuries but we didn’t talk about how to prevent them, what types of exercises.

Most people that do finger exercises – Neely, what do you see them doing?

 

Neely Quinn: Well, my husband has a rice bucket so he’ll put his hand into the rice and extend his fingers.

 

Dr. Jared Vagy: Good, good.

 

Neely Quinn: But that’s all I’ve ever seen people do, or maybe take your other hand and pull your fingers back?

 

Dr. Jared Vagy: So maybe stretch your fingers with your other hand?

 

Neely Quinn: Yeah.

 

Dr. Jared Vagy: Well, first of all, good for him extending his fingers in the rice bucket because that’s not as common for people that train their fingers to do. Most people are going to take a squeezing ball or a grip strength trainer and always squeeze, squeeze, squeeze things. What they rarely do is they rarely focus on extending their fingers back and activating the muscles on the opposite side of their hand.

If you think about it, when we’re climbing we’re always gripping, gripping, gripping. The same rule that we talked about is: what’s on the opposite side of your fingers that may potentially get injured? It’s the outside of your hand. Putting your hand in a rice bucket and extending your fingers back, you can also – Theraband makes a hand x-trainer that you can use. I think Metolius makes one as well, where you put your fingers in and you can extend them back against some resistance. Another thing you can do is you can take a rubber band or a hair clip and you can loop that on each of your fingers and extend them back as well. That’s kind of a cost-effective way to train the outside of your hand. That’s going to prevent pulley injuries.

If people want to see some pictures of that, that’s also up on the site. I did a whole article on preventing finger pulley injuries.

 

Neely Quinn: That’s awesome.

I would like to talk about shoulders for the rest of the time and into the night. [laughs] I think that, I mean, I have a torn labrum in my left shoulder and I haven’t climbed in six months. It took me about three months to actually go to a health practitioner. I was going to massage therapists and rolfers and acupuncturists and dry needlers and you name it. It wasn’t getting much better and finally I was like, ‘Well, I guess I’ll go to the doctors who I don’t really trust.’ Then they diagnosed me.

Now, I have surgery scheduled for three weeks from yesterday and every person, just about every person, I talk to has either had a shoulder surgery or they know somebody very close to them whose had shoulder surgery. Obviously, we’re doing something wrong. I just want to say real quick is that what I realized what I was doing wrong, which my husband has been making fun of me for for nine years now, is my posture. In general, it’s horrendous. I have total climber posture and I think that contributed to it but I will shut up now. Tell me everything you know about shoulders.

 

Dr. Jared Vagy: Alright, well where do you want to start?

 

Neely Quinn: What are the most common injuries for shoulders?

 

Dr. Jared Vagy: The most common injuries, there’s normally two common injuries with climbers for their shoulders. Obviously, there’s a whole list of others that may occur but often times, climbers are going to get a rotator cuff tear or strain, or they’re going to get impingement. Then, labral injuries is kind of the third category that you mentioned. Those are kind of the third, more serious, type of injury that usually, you’re going to have one of the first two that I mentioned first and then eventually your shoulder is going to develop into having some kind of labral injury.

 

Neely Quinn: Oh, that’s why when a lot of people go in for labral tears their surgeon will find a torn rotator cuff, too?

 

Dr. Jared Vagy: Exactly. When they’re going in there – and for everyone that doesn’t know surgery, usually they go now arthroscopically, when they go in there with little cameras. They’ll notice with the labrum that, if you imagine and I’ll kind of break down the anatomy. Hopefully I don’t bore too many people.

Imagine your shoulder is a golf tee and there’s a tennis ball sitting on it. This is a slight exaggeration but you can imagine that is a really small kind of surface with this giant ball. What that allows is that allows you a lot of mobility or a lot of motion, but it’s not a very stable area. What the labrum is, is on the golf tee, just imagine that there is a suction cup that’s made out of a very soft, gooey surface that keeps that golf ball kind of secured on that tee. That’s what your labrum is.

 

Neely Quinn: I still don’t understand. The labrum is cartilage, right?

 

Dr. Jared Vagy: Yes, it’s a type of cartilage.

 

Neely Quinn: So it’s cartilage and it just tears because it’s being stretched in a way that it shouldn’t be stretched?

 

Dr. Jared Vagy: The way it normally tears, and it can either tear from a traumatic incident like you fall off your dirt bike or you deck on the first couple feet of a problem and you fall on your arm. It can tear traumatically is one way, but the most common thing that we see with climbers is it tears from overuse and repetition over time.

If you imagine the analogy of that golf ball, I’m going to add another – I may lose people on this analogy – thing. Imagine there’s now a piece of string that is attached to that little tee and that labrum, kind of pulling as well. That piece of string is your biceps tendon. Imagine if your shoulder is not very stable and that golf ball is always kind of rubbing, rubbing, rubbing on that tee and that string, that biceps tendon, is always pulling, pulling, pulling on that area, eventually that gooey, cushiony surface is going to give a little bit and it may potentially tear. That is what we see how most climbers end up tearing a labrum.

 

Neely Quinn: Okay, so my surgeon said that when they do studies on baseball players and volleyball players who do not have shoulder pain, that 70% of them have torn labrums. ‘This isn’t a big deal. You don’t need surgery. You can recoup this on your own.’

Is that true? Or was he just fully lying to me?

 

Dr. Jared Vagy: No, and this kind of opens a can of worms as well because we’re talking about something that’s very complex which is called ‘pain.’ Pain is so complex. You can imagine, let’s say a soccer or a futbal player. They just kicked the scoring goal and they go and they slide on the field and 20 different athletes are cheering and they jump on them and they kind of mush them down and they feel great. That whole day they feel like a million bucks and they’re not injured at all.

Imagine someone else that they’re walking and they just run into a door and now they have pain for four years and they have chronic pain, right? They’re slight exaggerations here but this is very common.

Pain is interpreted in our brain and it’s a very complex pattern and so just because – this is very important for people that are thinking about getting surgery – just because there is an area that is torn doesn’t mean that that area is a pain generator.

They have these studies in the low back as well. People have bulging discs coming out of every low area in their back and over 60% of them have zero pain. That’s why you’ll notice that not every surgery is successful. People that have labral tears/labral injuries and get surgeries, some do amazing, some do great. They are 100% or 90% afterwards and some it almost doesn’t change it at all. It could be yeah, you’re repairing a structure that a large percentage of the population they already have a tear and the reason they’re generating pain may be coming from something else.

 

Neely Quinn: Okay, so what I heard from that whole thing is that you think I’m a baby.

 

Dr. Jared Vagy: [laughs] No, not at all.

 

Neely Quinn: I’m just kidding. I understand that we’re all different and we all have different pain thresholds and our bodies give us different messages depending on if we’re a crazy futbol player or not.

The other thing I want to note here is this wasn’t a traumatic event. I know that a lot of climbers injure their shoulders where they’re dynoing – or, not dynoing – or going up one hand, dynamically, to a hold and they snatch it and their feet cut or something. Like, that’s pretty common, right, for rotator cuff and probably labrums?

 

Dr. Jared Vagy: Yeah, absolutely.

 

Neely Quinn: What happened with me was it was pretty exciting. I was sitting on my couch for three weeks with my laptop on my lap, working pretty much straight through that time. Then, I went back outside to climb at the Cathedral, where we were living, and it hurt a lot. I mean, before I sat down at my computer I was climbing on .13c’s, not having any pain, so I was trying pretty hard.

It was just really weird and I guess one thing I just want to say that for is I just want you guys to know that it can happen in any situation. It seems like any sort of overuse situation is bad for climbers.

 

Dr. Jared Vagy: Yeah, and you bring up a huge point which is posture. Often times, climbers will think it’s all about what they do on the wall but, even if you climb everyday or five days a week, what percentage of the time of your day are you actually climbing? What percentage are you either sleeping or sitting at the computer or doing something else? Throughout the day you have to be very cognizant of the position that your shoulders are in if you have shoulder pain.

 

Neely Quinn: Yeah, and one thing that I just did recently – this is kind of funny. My husband’s mom found this shoulder girdle thing in the Sky Mall.

 

Dr. Jared Vagy: Oh yeah. Is it the one that pulls back your shoulders as you sit?

 

Neely Quinn: It’s just this one continuous piece of fabric with a clip in the middle of it and it makes this sling and pulls back both of your shoulders. I’m wearing it right now. I have to stand up straight. The day I got it I had this terrible neck and shoulder pain and it went away in, like, four minutes, so now I’m kind of obsessed with this thing.

 

Dr. Jared Vagy: Yeah, they have all different kinds of those things. They actually have a kind of t-shirt that is wound so tight in certain areas that it pulls you back into a proper posture position. They have all different kinds of gadgets for people that need an extra boost for their posture.

 

Neely Quinn: What do you say to people that have either rotator cuff injuries or labral tears? Like, what kinds of exercises would you have me do?

 

Dr. Jared Vagy: As far as how to prevent them? Or if you already have them, what to do?

 

Neely Quinn: Let’s actually start with preventing them.

 

Dr. Jared Vagy: To prevent them, a lot of climbers that have these injuries, first of all, their shoulders are generally a bit unstable meaning they have a lot of flexibility but they’re not as secure. This is great, meaning that people with unstable shoulders can put their arms in some crazy positions that I could never imagine my arm going into, but the one downfall is those positions are very stressful on the area. Often times, there’s not as much support in the shoulder so you have to rely a lot on your muscles to support your shoulder.

The most common patterns we’ll see for rotator cuff tear is climbers climbing with bent arms. What do you think happens to your shoulder when you bend your arms and start climbing?

 

Neely Quinn: Oh god. Another question. Probably bad things to your shoulders?

 

Dr. Jared Vagy: Yeah, exactly. You’re getting good at these answers. Bad things to your shoulders happen so what you do is imagine the opposite scenario. If you’re on a rock wall, maybe it’s a little overhang, and you extend your elbows and instead of bending your elbows and pulling with your shoulders and your biceps, you actually squeeze your shoulder blades gently together. What this does is this activates – they’re called ‘scapulothoracic muscles’ – but it activates your shoulder blade muscles. This adds another layer of support to your shoulder.

In this position, you can start to pivot your hips and rotate more to gain leverage rather than to keep your hips square to the wall and always pulling with your shoulders and your biceps. That’s usually the best way to climb in a safe manner to protect your shoulder.

 

Neely Quinn: Okay, so if you’re going to bend your elbows you do so while you’re sort of pinching your shoulder blades together on your back.

 

Dr. Jared Vagy: Yeah, if you can. That’s something you kind of have to train while you’re doing it. If you’re on a crux move and it’s a very static move and you know it’s going to be extremely stressful, yeah, you’ve definitely got to be gently squeezing your shoulder blades together to add some additional support to your shoulder structure.

 

Neely Quinn: I’ve seen this in action. Right before I injured my shoulder I was with my friend Shanna and she said that she had struggled with shoulder injuries and didn’t climb for a long time. Then, somebody was like, ‘No, you’ve just got to learn how to stand up straight and make your posture better when you’re climbing.’ Basically, she explained just what you explained and she’s like, ‘Now I don’t have problems at all.’ You could tell when she climbed that her movement was different, definitely, than mine. It’s pretty cool.

 

Dr. Jared Vagy: And it’s really interesting if you’re watching people who are really strong climbers but have injuries and certain types of injuries on a certain problem, and watching people who are strong climbers and don’t have injuries on the same exact problem. It’s interesting how their movement patterns change. Often times, what you’ll see is someone who has the repetitive shoulder injury is likely to climb probably the same grade but they’re likely going to be pulling more and bending their arms. Someone that doesn’t have shoulder injuries is going to be engaging those muscles a little bit more.

It’s kind of a fun exercise for people to go out to the crag and check out their friends and ask them.

 

Neely Quinn: Isn’t that what we always do?

 

Dr. Jared Vagy: Yeah. Am I the only one that does this, really?

 

Neely Quinn: In the weight room, when I first did this, my husband was like, ‘Okay. These are the exercises you need to do with weights to strengthen your back muscles and your scapula – whatever they’re called – in order to be able to engage them more when you’re climbing.’ Do you suggest those?

 

Dr. Jared Vagy: Yes, definitely, but I caution people to really think about what it looks like when you climb and make sure your strength exercises are starting to look more like that. For example, a common way to strengthen, let’s say the rotator cuff, is you stand. Actually, I wrote an article on how I think this is ridiculous, but you stand with your elbow bent at 90° and you’re pulling a band kind of out to the side with some resistance.

You’re thinking about when you climb. First of all, when are you ever in that position with your arm? Maybe you’re pulling in really close on a overhanging lip or something like that but generally, when we climb, our arms are above our shoulder level. They’re rarely, rarely, below our knees or below our chest. What you would do instead to activate and strengthen the same muscles is you actually straighten your elbows out, bring your arms right in front of you, and then pull that band out to the side, almost like you’re making a letter T, then bring them back in. Now that’s looking a little bit more like what you would do when you climb.

I always caution people that you’re going to get way quicker results and more effective results if what you’re doing in the weight room in your rehab actually looks like climbing.

 

Neely Quinn: I mean, it’s so hard to really – you’re obviously creative because I went to physical therapy for months and she was having me do the one where your elbow is down and at a 90° angle and you’re pulling the band out to the side or toward you, into your stomach. It didn’t do anything for me, first of all, and…

 

Dr. Jared Vagy: That doesn’t surprise me.

 

Neely Quinn: I mean, I continue to do them now because I’m like, ‘I don’t know. This is what I was told to do,’ but that makes a lot more sense. I actually intuitively started doing what you just described and I’m glad that you just confirmed that I wasn’t totally wrong about that.

 

Dr. Jared Vagy: In my book I basically distill it down into one exercise for each injury. It just takes all the guesswork out of it. It’s kind of like you have a certain injury or you want to prevent one, all the research boils down to: just do this one thing. That’s kind of the hope, is to almost oversimplify a very complex topic. There will be less confusion out there and people will start to understand actually what to do and to know what to look for in an exercise.

 

Neely Quinn: Can I ask you about a few other exercises and what you think about them?

 

Dr. Jared Vagy: Yeah, go ahead.

 

Neely Quinn: What about shoulder presses? With weights, obviously.

 

Dr. Jared Vagy: You’re explaining where you’re standing and your arms are basically flexed 90° and you’re pushing the weight overhead?

 

Neely Quinn: Yes.

 

Dr. Jared Vagy: Alright, so with a lot of these things you can get picky but this is what I would say. First of all, when we’re climbing, how often are our legs fully extending and straight?

 

Neely Quinn: Not very often, I guess.

 

Dr. Jared Vagy: Unless you’re climbing with terrible technique because the second that you bend your knees and put weight into your legs, then you start to activate those muscles and the pressure goes away from your arms, wrists, and fingers. If you’re doing a shoulder press, that’s fine. Those are some muscles that – your deltoids and your shoulder muscles – need to be strong for climbing but go ahead and get into a semi-squat position, as if you would be doing while you’re climbing, and go through that same exact motion.

 

Neely Quinn: Cool. I’ve been doing that. Jonathan Siegrist told me to do that. Thanks, J-Star.

 

Dr. Jared Vagy: Nice. It’s a great exercise but can you tweak it to make it look a little bit more like what the whole body does when we climb?

 

Neely Quinn: Do biceps curls do anything for shoulder stuff?

 

Dr. Jared Vagy: That’s a really interesting question because when we talk about the labrum, remember when I had that analogy with the golf tee and the tennis ball?

 

Neely Quinn: Yeah.

 

Dr. Jared Vagy: There was a string and that string was kind of constantly pulling on that area.

 

Neely Quinn: Yeah.

 

Dr. Jared Vagy: Possibly remember?

 

Neely Quinn: Yes.

 

Dr. Jared Vagy: That string is actually the biceps tendon and a lot of climbers that I see with labral injuries actually over activate their biceps. The analogy that you would be thinking is that string is kind of constantly, constantly pulling on that labrum. I tend not to, unless you’re having a project where you have a lot of underclings and you really need that strength to secure and hold on, I tend to caution climbers with labral injuries from doing bicep curls. If they do them, just do them in a very safe position.

You can do them with your elbows down from your side and that’s going to be a little bit safer than doing, let’s say a bicep curl with your elbows elevated to your shoulder level.

 

Neely Quinn: Okay. Then tell me one more exercise with weights, with a dumbbell or whatever, for all shoulder injuries.

 

Dr. Jared Vagy: Okay, so we’re trying to find the one shoulder exercise with weights that can kind of capture everything?

 

Neely Quinn: Sure, or just a good one for a particular thing.

 

Dr. Jared Vagy: What I would recommend – I’m kind of on the spot, here – I would say what you would do is you would get into a little bit of a crouch stance and you would hinge forward at your hips, so your torso is about 45° and this is kind of mirroring a little bit how you would look if you were on an overhang. Then you take some weights and you extend your arms down, so they’re almost touching close to the floor, and you bring the weights out so you make the letter T with your thumbs up in the air, then you bring them back down.

What that’s going to do is that’s going to strengthen your rotator cuff, it’s going to strengthen your middle trapezius muscles so the ones that kind of squeeze your shoulder blades in, it’s going to put you in a climbing position where you can activate your leg muscles to kind of help support, and it’s going to be pretty safe on your shoulder.

 

Neely Quinn: Okay. That’s great.

 

Dr. Jared Vagy: That’s one weight exercise that would probably be the one I would recommend.

 

Neely Quinn: And the weight, I’m assuming, shouldn’t be super heavy. Like, this isn’t a power lift sort of position. This is pretty tenuous, right?

 

Dr. Jared Vagy: No, you want to choose a light weight. It’s a much more challenging position than you can imagine because you have what’s called a really long lever arm so your weight is a very far distance from your shoulder and shoulder blades. In general, I recommend with that exercise, start with a low weight until you can become comfortable with it.

 

Neely Quinn: Right. I’m assuming you don’t want to be jerking your arms up to be able to lift the weight.

 

Dr. Jared Vagy: No, no, no. Slow and controlled. Nice and smooth.

 

Neely Quinn: Like 10 reps or something? To be able to do 10 reps with the weight?

 

Dr. Jared Vagy: It depends on your goals. If your goal is – typically, if you’re a boulderer you’re going to want a little bit more strength and power so you’re going to go slightly quicker with the exercise but less reps. Let’s say if you’re a traditional climber, you’re definitely going for endurance. You’re on problems for longer than 30 seconds to a minute so I tell people that are traditional climbers to go ahead and you want to do something like 15+ reps because that’s going to mirror how long you’re going to spend on the route a little bit more.

 

Neely Quinn: Look at you. You’re so smart and practical.

 

Dr. Jared Vagy: Yeah, that practicality. [laughs]

 

Neely Quinn: Okay, first, any last words for me with my injury? A very selfish note.

 

Dr. Jared Vagy: I mean, I think the hardest thing, because I’ve been through so many injuries myself, is the mental aspect. Especially if you have a surgical date coming up and you’re going to go through surgery. Trust your surgeon, trust the physical therapist you’re going to be working with, and just go through the stages in the process. Know that you’re going to be bummed out for certain aspects of time when you’re going through the rehab process but there’s a light at the end of the tunnel.

At 12 weeks, generally, that’s when you start to initiate with these labral surgeries a return to your sport activity. It doesn’t mean that you’re climbing hard but that’s when you can start to, if you’ve reached your proper milestones, get back on the wall. I normally tell people that you can get a calendar and mark off the days or whatever you want to do in your mind but know there’s some light at the end of the tunnel.

 

Neely Quinn: Get a few bottles of tequila. [laughs]

 

Dr. Jared Vagy: Exactly. Drink away…

 

Neely Quinn: Mark off your shots.

 

Dr. Jared Vagy: Yeah.

 

Neely Quinn: Actually, that reminded me of one other question I wanted to ask you, which was: I said that I had waited three months to actually get medical attention. What’s your recommendation about how long you should be in pain before you should go to a doctor?

 

Dr. Jared Vagy: Good question. It depends, first, on what state you’re in and who you have access to because often times, I’m a little bit biased, but I would recommend when you first get pain, go first to a doctor of physical therapy and they’re going to be able to recommend and prescribe you exercises and kind of rehab modalities. Now, you can also, if you choose, go to a physician which is great and that’s often times a good step as well, but know that, in their toolbox, they’ll generally recommend medications or splinting or something to that effect.

Physical therapy is generally a more active approach and there’s other healthcare providers – chiropractors, acupuncturists, different healers. If you trust someone and know their credentials in your circle, that’s definitely another way that you can access someone in the healthcare field early on.

I’d recommend – this is always a tricky question – if you have pain for more than two weeks, you should probably do something about it. You should take that first step, whatever that step you choose would be.

 

Neely Quinn: My first step was to go to an orthopedic doctor. She was actually a PA and she gave me an x-ray and found some abnormalities and then we did the MRI, which I’m assuming is a very common sequence of events. Your suggestion is to go to a physical therapist first. Would they also say, “Yeah, let’s do an x-ray and an MRI,” or would they probably send you out to an orthopedic?

 

Dr. Jared Vagy: It depends on who they are and their experience, but often times what they would do or what I would do is take a look at the condition. I would say, “Is this something that we can rehab or is this something we need to refer out and get some images?” At least right now, you are beginning the rehab process.

What often times happens is, first of all, people wait until it’s too late so they wait a year or whatnot until they have the injury and then they go into a physician and get the x-ray. After the x-ray they go get an MRI and three weeks later, they haven’t really started an active approach to the therapy. Then they’re referred to therapy to do conservative care to see if it’s going to work before surgery.

 

Neely Quinn: That’s totally what happened to me.

 

Dr. Jared Vagy: If you want to jumpstart the process, which I’m pretty sure most people do, and it depends on your state, obviously, with what the legal rules are with your state – I know this is true with California. Go see the physical therapist first and what I almost always do is if I feel as though it’s something that may be more advanced than I can help them with in that short period of time, I refer them back to the physician but at least they’re already started on a program and at least they’re already in the door, doing something.

 

Neely Quinn: That’s great advice. I wish I would have done that.

Okay, we’re way over an hour at this point but you have a really great knowledge base and I appreciate it. I think a lot of people are going to be psyched on this. I would love to have you back on the show, if that’s okay.

 

Dr. Jared Vagy: Yeah, absolutely.

 

Neely Quinn: In the meantime, please go see Jared’s stuff at www.theclimbingdoctor.com and buy his book because it has a lot of the information that we just talked about. Any last words from you?

 

Dr. Jared Vagy: I say just get educated. Take this information. There’s a lot of content out there that I’ve developed and you just spread it to people that you know because it’s through climbers that we start to, in our small communities, develop these habits and patterns.

 

Neely Quinn: Alright. Thank you and I will talk to you soon, hopefully.

 

Dr. Jared Vagy: Thank you.

 

Neely Quinn: Alright, that was Doctor Jared Vagy of www.theclimbingdoctor.com. I hope that you learned as much as I learned because what he said – and I had to do the interview twice, like I said. I learned even more in the second round. That guy knows a lot and I’m actually talking to him about doing a webinar series with us about injury prevention and treatment and all that, so that we can get better at not injuring ourselves.

If you have any feedback about that, like, what topics you would want to hear about from him in a webinar series, please email me at neely@trainingbeta.com or info@trainingbeta.com. In general, if you want us to do webinars with other people on different topics, definitely let me know that, too. We’re kind of exploring the whole webinar thing.

I hope you enjoyed that interview. Lastly, I’m just going to remind you one more time about the giveaway. It ends on Wednesday, this Wednesday night. You can sign-up. I’m going to put the link on this podcast page so just go check it out on TrainingBeta.

Other than that, happy training. I’ll talk to you next time.

 

[music]

 

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3 Comments

  1. Carrie-Ann B November 5, 2014 at 8:22 am - Reply

    I enjoy all the podcasts but this one was great, especially because you talked about the competing perspectives and research on injuries and healing them. It put all the confusing mixed messages that I hear about into a cohesive context that helps me choose what will be right for my own personal situation. Thanks!

  2. ed November 4, 2014 at 3:33 pm - Reply

    It’s very disappointing to listen to what is otherwise a great podcast about injuries that tries to rely on science instead of woo, only to end it with a recommendation to go to acupuncturist or a chiropractor.

    • Neely Quinn November 7, 2014 at 11:08 am - Reply

      ed – Sorry that’s all you chose to take away from this podcast! I think there’s some absolutely awesome information in this episode on all levels. And I don’t see anything wrong with acupuncture and chiropractic, along with PT. They can all work very synergistically.

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