Hot Stuff! Warming Up

So, I've been asked a couple of times to write some more posts about injury prevention. So, what better way to prevent injuries than a proper warm up, which I know many climbers often omit from their climbing routine. 

 

The professionals do it, why don't we?!

A warm up is brilliant, both to prepare your body, muscles and joints physically for the effort you are about to exert, but also for your brain to be mentally prepared too, to help it remember to “do that climbing thing again!” (rehearsal effect).

Unfortunately, there is no prescribed warm up, everyone has their own routine and way of doing things. It's about finding your “groove” and the best way you warm up. Because of this, however, there is little scientific evidence for warm up routines, due to their variety.

Passive Warming

Passive warming up (an external source warming you, e.g. a warm shower, dryer, sun etc) have some short term benefits on an active warm up (you warming yourself), especially if the active warm up is too intense or lacks recovery time, however, an active warm up definitely has better intermediate and long term performance benefits. Passive warming is useful though to maintain temperature. (Bishop 2003)

I will therefore talk about the principles of warming up, and what you should achieve from it.

Rest between exercises is important, and should usually be kept to a minimum. Alternating exercises that focus on different body parts (i.e. an arm exercise followed by a leg exercise) will help to stimulate blood flow and increase body temperature.

The benefits of warming up are:

• increasing blood flow to muscles
• increasing oxygen delivery
• decreasing vascular resistance
• increased release of oxygen from myoglobin
• enhanced cell metabolism
• reduced muscular viscosity meaning smoother muscle contraction and efficiancy
• increased sensitivity to nerve receptors
• increased speed of nerve impulses
• decreased stiffness of connective tissues
• increase synovial fluid (which acts as joint "shock absorbers")
• increased relaxation and concentration
• all leading to..........decreased likelihood of injuries!

(See blog post on "physiological effect of hot and cold for more info)

(Brukner & Khan 2012)

First part of a warm up should be raising your heart rate.

 

You can do this in any way you wish: running, cycling, skipping etc. Start slow, and build up the intensity. The goal is to be breaking into a sweat after 5-10mins.

This could even be the walk-in to the crag (unless it's somewhere like Pen Trywn or Burbage North, which is literally roadside!), or cycling to your local wall.

Second part is flexibility. 

This is static stretching -
NOT this type of stretching!

This is NOT static/ballistic stretching which are designed to “stretch a muscle or muscle group beyond their normal range of motion”, (as a study published in the Canadian Journal of Applied Physiology (vol. 26 (3) 2001) showed that static stretching prior to activity showed force production loses of decreased Maximal Voluntary Contractions by 12% and increased muscle inactivation by 20.2% which is not what you want prior to beginning your sporting activity). More on static stretching here.

This is dynamic stretching, which “systematically loosens the participant to their current full range of motion”.

With dynamic stretching, you should first off begin with shallow movements and build up the the full range in stages. This means that, for instance, you are warming up the shoulders with some “windmills”, you don't start off and swing your arms round as fast and as far as you can, but build up with smaller circles.

Not these type of windmills!

These are the windmills I was referring to!
Build up the circles gradually until full range is achieved.

This is key for all the warm up – start slow, and build it up gradually – jump in too fast, too hot, and you'll hurt yourself and it will defeat the point of the warm up in the first place!

Don't forget to warm up those fingers and keep them moving too! Click for handy warm up exercises!

Final part of the warm up is sport specific activity. 

This is usually in the form of easy bouldering (bouldering is normally best as you don't have to bother with ropes, harnesses, belaying etc)

Then build up through the grades (i.e. if your max is 6c, don't jump straight on a 6b+, start on a 5 or 6a and work up to it).

 

Remember, between routes/problems etc, it is important to stay warm, or you'll have to go through the process all over again. So it may look nice and warm out there, but just a t-shirt isn't necessarily going to keep you warm between boulders at Stanage when that wind starts blowing! Remember a jumper/belay jacket to throw on between routes to maintain your core body temperature (an example of passive warming, as mentioned above)!

Now your body is prepared for your competition/project/high end route!

Sample Warm Ups

Here is the Fifa recommended warm up for footballers

Climbing specific warm ups:

Moonclimbing's warm up, by Rich Simpson

Robbie Phillip's warm up, as shown on UKC

References

GreskaE, Ryan S, Dynamic Warm Up 

Hochholzer T, Schoffl VR 2006 One Move Too Many. Lochner-Verlag, Germany

Brukner P, Khan K (eds) 2012 Clinical sports medicine 4th ed. Sydney: McGraw Hill pg 116

BMC 2007 Warming up for climbing

FIFA 11+ website 

Bishop D 2003 Warm Up II: Performance Changes Following Active Warm Up and How to Structure the Warm Up. Sports Medicine 33(7): 483-498

Moonclimbing's warm up, by Rich Simpson

Robbie Phillip's warm up, as shown on UKC

Preventing Rotator Cuff Injuries: Advice and Exercises (Updated)

I've now updated this post, based on some training I attended last week:

Today's post is based on the rotator cuff, and ways to, hopefully, prevent injuries via regular exercises and advice.

First off, as always, I will discuss the anatomy involved.

The space between the acromion and humeral head is where the rotator cuff tendons get impinged, especially when performing overhead activities.


What does the rotator cuff do?

The rotator cuff muscles internally and externally rotates the humeral head. These muscles help support and secure the head of the humerus into the glenoid fossa.
This means that the rotator cuff muscles are key to stabilizing the shoulder joint.

Preventative Exercises

Often, rotator cuff strengthening exercises are given as shown below, with internal and external rotation being strengthened in standing or in lying.

 

 

These exercises do strengthen the rotator cuff, but not in a functional way applicable to climbing, as the predominant movements involved in climbing are above head actions, therefore the rotator cuff should be strengthened in a similar manner.

It is the same movements as described, but with the arms above the head as shown. 

 

These movements can be performed in either standing, as above, or in lying, as below. They can be done using resistance bands, or free weights. The movements should be performed in a slow, controlled manner, ensuring the 90 degree angle at the elbow is maintained throughout.

Other exercises that can be performed to work the rotator cuff in a similar, over-head manner are displayed below. Again, these exercises should be performed in a slow, controlled manner, paying particular attention to the positioning of your scapula.

Important note: When performing any of these exercises, it is imperative that the shoulder complex as a whole is in the correct posture....

...as most climbers adopt the thoracic kyphosis posture, due to overtraining of the forward flexors. 
This also applies to when performing the exercises, if the shoulder blades don't stay pulled back and become rounded and forward while performing these exercises, with the head of the humerus becoming more anteriorly located (moves forward), either drop the weight, or perform the exercises without the arms above the head, as described at the start of this post.

Advice

So other preventative measures for looking after your rotator cuff muscles and shoulder joint in general, are such methods:

• climbing technique - remember to use your feet, don't stretch too far for the next hold, rather work your way up to it, to reduce the load on the upper limbs
• flexibility - there may be a lack of spinal flexibility, especially around the thoracic area, as this can cause lack of movement around the scapula; tight posterior shoulder capsule or posterior rotator cuff muscles may also do the same (see below for stretch that can be performed on the posterior shoulder capsule)

 

  

• posture - this relates to flexibility, as well as the movement relationship between the scapula and humerus, known as the scapulohumeral rhythm, that is a key component in rotator cuff impingement. Also, musculature imbalance is related to posture, which is especially prominent in climbers! In some instances, it may be necessary to retrain the scapula and perform scapula setting exercises.

I hope these exercises and advice can prevent an injury. These exercises need to be performed often, and with low weight, high reps, as they are stabilizing muscles.

Any feedback or queries, give me a shout!


Further Reading

Roseborrough A, Lebec M 2007 Differences in Static Scapular Position Between Rock Climbers and a Non-Rock Climber Population. North American Journal of Sports Physical Therapy 2(1): 44-50

References

JE Budoff 2005 The Etiology of Rotator Cuff Disease and Treatment of Partial-Thickness Pathology. Journal of the American Society for Surgery of the Hand 5(3): 139-152

McCall C Presentation on shoulder conditions in rock climbing. BMC Climbing Injuries Symposium 2012

The Risks of Ibuprofen

So, you have some swelling, after an injury, or maybe it's a chronic condition? So you pop some ibuprofen or two?

After a while, you realise the ibuprofen is no longer having the same effect, so you take some more to reach the same level of pain relief?

Before you know it, you've been taking it for weeks/months/years.

Sound familiar?

I hope not.

Non-steriodal anti-inflammatories drugs (NSAIDs for short) have there place and can be relevant when taking appropriately. However, I wanted just to discuss some recent evidence that was brought to my attention about the dangers of NSAIDs (not to scare anyone, but just to inform you).

It has been widely documented that NSAIDs can cause kidney damage (Murray & Brater 1997) due to all NSAIDs reduce blood flow to the kidneys. As a result 2 things can occur: elevation of blood pressure; and, more dangerous, the risk of acute renal failure/acute tubular necrossis.

But other studies have now shown the they may also cause damage to the intestines, and to bone healing.

Bone Healing:

A recent systematic analysis of studies looking at affects on bone healing caused by NSAID's by Pountos et al (2012), and found that, although there is an absence of robust clinical trials, that due to the scientific knowledge of the interference at a cellular level caused by NSAIDs, that they should be viewed as a risk factor to bone healing.

The idea is, due to the anti-inflammatory effect of NSAIDs, that it reduces the amount of certain chemicals in the cells that aid healing, as they are induced by the inflammation process.

These chemicals are thought to enlist osteoblasts which are responsible for bone formation.

Osteoblasts via microscope

Intestinal damage:

It has already been tested that you get some marginal intestinal damage when exercising (due to functions such as digestion become a luxury when exercising, as the blood that normally supplies the small intestine is instead diverted to the muscles. Due to this lack of blood to the intestines, some of the cells lining the intestines are traumatized and start to leak.)

However, it has been shown in a recent study by Van Wijck et al (2012) that NSAIDs, specifically ibuprofen, can aggravate this phenomena. To what extent, I'm not too sure, but the result was a significant one.

It is worth noting that this was performed on healthy males performing an aerobic exercise (cycling), and only 9 subjects were used, and is only a short term effect. The long term effects and consequences are not yet clear.

So, there you have it. I'm no pharmacist or chemist, but I thought I'd share with you what I'd read. Draw whatever conclusions you wish to from this, but it's worth bearing in mind.

References

Murray MD, Brater DC 1997 Effects of NSAIDs on the kidney. Prog Drug Res. 49:155-71.

ReynoldsG 2012 For Athletes, Risks From Ibuprofen Use. New York Times Blog

VanWijck K, Lenaerts K, Van Bijnen AA, Boonen B, Van Loon LJ, Dejong CH,Buurman WA 2012 Aggravation of exercise-induced intestinal injury byIbuprofen in athletes. Med Sci Sports Exerc 44(12): 2257-2262

PountosI,GeorgouliT, Calori GM, Giannoudis PV 2102 Do Nonsteroidal Anti-InflammatoryDrugs Affect Bone Healing? A Critical Analysis. Scientific WorldJournal 606404