Mirror Neurons: How we learn by watching

You here it all the time, don't you....

Watch better climbers and you'll learn to climb better

And it seems to work, we see someone shift there body position slightly, maybe twist into the wall a bit more, and can then reach that elusive hold. Then we can recreate it.

But how does it actually work?  

Well, I went to a very interesting lecture last week on mirror neurons, with the thoughts that there are a certain set of neurons within your brain that fire whilst you are doing a task, and whilst watching someone do the task, for instance, you reach for an object, XY and Z neurons fire. You watch someone else reach for the object, XY and Z neurons fire again.

This is a new concept, as previously it was thought that when learning (or relearning) a new task, the brain observes, analyses, breaks down step-by-step, then recreates the new task. 
But it's much more of an instinct as that.

With one provision:

There must be a goal, a purpose to the task

 If there is no goal, say, just a hand making a fist shape, then the mirror neurons get bored, and therefore don't fire. The task has to be purposeful, like reaching for food or an object (or climbing a route!)

The brain sees the initiation of the movement, understands the task in hand, and almost figures out the "filler" bit in the middle of how to achieve it. 

This helps us understand lots about how we learn new tasks, and can be used in a context of a child's learning, or in the re-learning of tasks, for instance, after an acute brain injury.

It also helps explain how we feel empathy, as when we watch someone fall off a problem, miss a hold, miss a penalty, whatever the analogy, then it's like we are the person doing it, the same neurons in the brain are firing.

The lecture I went into went into a lot more detail, however, I'm going to leave you here, further reading is available below, or some TED talks that are always worth a watch! 

Any questions, comment below!

References

Harriss JP 2014 Mirror Neurons. Presented at Annual Brain Lecture

http://www.pbs.org/wgbh/nova/body/mirror-neurons.html

http://blogs.scientificamerican.com/guest-blog/2012/11/06/whats-so-special-about-mirror-neurons/

Papers

Franceschini M 2010 Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med.

Rizzolatti G 2008 Mirror neurons and their clinical relevance. Nature Clinical Practice Neurology


Further watching:

Ramachandran 2009 The Neurons that shaped civilization. TED Talks

And a heart warming story to end, to show that it does work:

R D'Angelo, F Fedeli 2013 In Our Baby's Illness: A Life Lesson. TED Talks

Helmet or not to helmet?

So, the idea of this blog is to discuss injuries and injury prevention, so I thought I'd share some discussion on helmet wearing within rock climbing, as that clever piece of brain matter is quite vital!

The author climbing "Looning the Tube" E1 5b in the Dinorwic slate quarries, helmet in situ.

Now, there are plenty of sports that wear helmets, horse riding and cycling are the immediate sports that spring to mind.

Yet, out on the crags, we see climbers choosing not to wear helmets, yet a lot of them will wear helmets when they are involved in other sports such as cycling.
I understand that there are no rules and regulations that require climbers to wear helmets, that it is a personal choice (unlike, for instance, horse riding competitions), so I just thought I'd share ideas about wearing helmets.

Below is the BMC video from last year that canvassed opinions from climbers out on the Eastern Grit about helmet wearing.

Some people do have the opinion that a helmet limits visibility, impairing balance and cause overheating, however, modern helmets nowadays reduce this, and from a personal point of view, my helmet does not limit my climbing!
Sometimes, I think it's vanity, but luckily this is starting to change, with rock climbing magazines and guidebooks proudly displaying pictures of hard climbing/climbers wearing helmets! Helmets now also fit better and look slightly more aesthetically pleasing.

Also, some people only think that helmets protect you from falling objects, so some that will choose to only wear a helmet at crags that are classed as "unstable", such as quarries such as Horseshoe Quarry, however, most head injuries I've seen have been from falls have been where the climber has inverted by catching their leg behind the rope (such happened to a friend at Pen Trywn - luckily, he only had minor concussion and was right as rain after a few days), or from swinging underneath an overhang or round awkward corners (seen this a few times on the grit, fortunately no serious injuries).

In contrast to this, in Paul Pritchard's recovery from his head injury from a rock fall in Tansania , on the Totem Pole, which resulted in his hemiplegia, the doctors who initially assessed the extent of his injury reported that if he had been wearing a helmet, the angle at which the rock hit his head could have resulted in him being killed outright instead of resulting in a recoverable (albeit long!) head injury.

And statistically speaking, head injuries account for 12.2% of accidents in the US (similar figure acquired by UK Mountain Rescue Teams), and the majority of these being lacerations rather than serious injuries. There is a higher likelihood of a fracture or overuse injury. But it's still 12.2%!

From a personal point of view, I don't wear my helmet when bouldering or indoor climbing, although some will argue that there is a place for helmets in these environments. From my point of view, it's a calculated risk, as I'm generally not high balling routes when bouldering, and most indoor routes are straight lines and well thought out for clipping etc. When soloing, I don't wear a helmet, as it's not going to be much use if I fall off!
When I'm out trad or sport climbing, the helmet is always in the bag, and the decision is made on arrival at the crag to wear it or not, dependant on the crag and route. I generally wear a helmet sport climbing in the Peak, on the limestone, do to the nature of the rock, whereas trad on the grit is normally a route-by-route decision. 
I took my helmet out to Kalymnos, and rarely wore it, and at times wish I did, due to some routes still being loose and friable (especially on Telendos), but when you come back without incident, it gives you time to reflect and ensure you do so next time.

So there you have it, take from it what you will, but do remember, recovery from a head injury such as a bleed or hemiplegia is much longer than from a finger injury, and much more serious (if anybody knows someone who's had a stroke will know it can be a long road to recovery).

Paul Pritchard's craniotomy in 2012
Copyright Paul Pritchard

So next time you go to the crag, will your helmet be packed? Personally, I know mine will. 


References/Further Reading

Paul Pritchard 1999 Totem Pole

BMC articles: 
Head Case 
Keeping a head; a head injury case study 
Tech skills; why wear a helmet 

Personal experience!

Feet and rock climbing

So you're out climbing, and you pull your climbing shoes out the bag. What size are they? One size smaller than your normal shoes? Maybe two? Well, this post is to discuss the links between feet, footwear and climbing, and other foot injuries/problems.

Do remember, however, that we aren't the only sport or hobby to do this to our feet.....

In a study of 104 rock climbers, Killian et al (1998) found that 81% suffered from an acute or chronic pain or pathology in the foot and/or ankle during or after rock climbing. They suggest that this is in relation to the biomechanics of wearing small rock shoes.

First, as always, I will discuss the anatomy of the foot.

Ligaments

Muscles

Tibialis anterior is also the main dorsiflexor of the ankle.
The gastrocnemius, soleus and plantaris are the plantarflexors of the ankle (there are more muscles involved with platarflexion due to needing to lift the entire body weight, whereas dorsiflexion only consists of lifting the foot.)

Movements of the foot

Feet position within climbing shoes

Arches of the foot

Forces through feet when climbing

Robert Bradshaw-Hilditch and Gary Gibson (yes, THAT Gary Gibson) are both podiatrists who have been conducting some brilliant studies in collaboration with Staffordshire University regarding the forces that are exerted through climbing shoes, and where. 

Their research has found that the forces when front pointing on the hallux (big toe) during climbing causes more force through the metatarsal head, and puts the plantar fascia under tension.

During edging, the forces through the hallux again puts most of the force through the hallux metatarsal head, and stresses the plantar fascia, but also places the foot in a supinated position.

This is just the tip of the iceberg for this research, and Rob and Gary are looking at expanding this much further, as this was only looking at the plantar aspect of the foot in an indoor climbing situation.

But what does it mean?

This means that the feet are more prone to ankle injuries due to the supinated position (see below), and this increase in pressure on the plantar fascia could cause plantar fasciitis (see below as well). The forces being placed through the metatarsal head will change the biomechanics of the foot through the strength of certain muscles, and could cause problems with the arch of the foot (see below) and these problems will surpass what happens on the rock alone. 

So what can be done? 

Read on...

Problems with the feet

Hallux-Abducto Valgus (commonly known as bunions)

Hallux valgus is defined as a 20 degree difference between the axis of the first metatarsal and the axis of the proximal phalanx of the toe, and was noted in both feet in 53% and in one foot in 20% of climbers participating in the sport for more than 5 years and climbing UIAA degree IX. (Peters 2001)

Bunions are not actually caused by wearing tight shoes, but climbing shoes can worsen the deformity. Bunions are most often caused by an inherited faulty mechanical structure of the foot. 

Treatments include wearing bunion pads, orthotics or different footwear and pain killers, or there is the surgical route if the pain is severe. There is no physiotherapy intervention that can help here, therefore prevention is the best cure, by avoiding wearing tight shoes and decreasing the effect of escalating the problem. 

Vessel Compression

65% of sport climbers have found to have tingling and/or pins and needles in their feet, thought to be caused by medial to lateral compression of blood vessels and nerves of foot by smaller climbing shoes. This usually dissapates quite quickly once the shoes are removed. If it doesn't, I'd get it checked out by a professional fairly quickly.

Arch Disorders

Rock climbing has been found to have a beneficial impact on longitudinal arch of the foot (due to strengthening), but does cause an increase in frequency in transverse arch disorders such as tansversal platypodia (flat foot),and an increased frequency of abnormal toe-to-surface adhesion.

Both these problems affect the frontal areas of foot, caused by climbing footwear - changes in the biomechanics of the foot, can cause weakness in muscles controlling 1st metatarsal head extension.

Ankle sprains

Ankle sprains are an injury that don't just affect rock climbers, as you may well realise. They are much more likely to affect other sports persons such as fell runners, however, with climbing, due to the already supinated/inverted (turned inwards) position of the foot means that there is an increased risk of an ankle sprain, normally due to jumping/falling off (this has happened to a few friends, one bouldering in Font, the other trad climbing at Stanage – and both those walks out seemed to take forever!) Hochholzer & Schöffl (2006) found that 24% of climbers have suffered from an ankle sprain.

Ankle sprains are normally caused because the muscles around the ankle don't act quick enough to stop the ankle surpassing it's normal range of movement and the ligaments have to take the brunt of the force.It is normally when the ankle is inverted.

Therefore, the preventative measures you can do to improve the acting of your muscles around the ankle would be to improve the proprioception of the ankle (knowledge of where your body is in space).

To do this, you can use the use of a wobble board or wobble cushion. Stand on the board/cushion on one leg until you can do it for 1 minute. Then close your eyes and try to reach one minute. This can also be used as late stage rehab for an ankle sprain.

 

 Early stage treatment for an ankle sprain would be to follow the management of acute injuries, along with maintaining range of movement in a non-weight bearing manner.

Taping can also be used to support the ankle if injured, such as the technique below, to prevent further inversion:

To read more about ankle sprain and preventative measures, check out Global Therapies recent blog.

Plantar Fasciitis

Plantar fasciitis is heel pain that is caused from an inflammatory process of the connective tissue, the plantar fascia. 
It is commonly caused by long periods of weight bearing and flat feet, as well as poor footwear, poor biomechanics, high arches, and/or running/walking long distance on hard surfaces.
The treatment is normally rest, ice, reduce inflammation and swelling, calf stretches, and finally, correcting what caused the problem in the first place, be that poor footwear, muscular imbalances etc.

Achilles Tendinopathy

This has already been covered by a separate post here.

Ankle fractures

So, an ankle fracture, as you'd have guessed, is when a bone involved in the foot or ankle gets broken. There is no real preventative measure for this, and will normally occur from a fall. Therefore, the approach for a fracture is surgical intervention, or conservative treatment (which normally involves just casting the foot and ankle in plaster and waiting it to heal).
The time frame and approach is entirely dependant on where the fracture etc is, and what other structures are involved.
Post op/plaster, you should be referred to physiotherapy for rehab anyway.
So I'm just going to leave you with a tasty X-ray of an ankle fracture and repair!

Other problems

There are also other non-musculoskeletal problems hat can occur with the foot, such as corns, cuts, toe infections etc which just needs you to look after your feet!

Prevention

Just a few tips to try and prevent foot and ankle problems:

As previously mentioned, use of the wobble board or cushion can help prevent some ankle injuries.

Ensuring you have appropriate sized climbing shoes, or if not possible, remove them at all opportunities, or alternate your shoes for different routes

Parallel training to strengthen the muscles around the foot and ankle

Appropriate sized normal footwear

Foot hygiene

If you are a diabetic, please please please avoid tight shoes!! This is because of change in the sensation in the feet (neuropathy) that can be caused by diabetes, and can cause much more serious foot problems!

To avoid some ankle injuries, have some (decent!) spotters when bouldering, and try to have dynamic belay techniques when roped climbing, to avoid clattering into the rock and giving you time to slow down the motion with your upper legs rather than at the ankle!

However, the main take home message is that with footwear, pain is insane! here possible, make your climbing shoes fit properly, feel comfortable, and look after your feet!

Kids feet and climbing shoes

This will be covered in the next post, just to break up the amount of information I'm giving you! 

References

Peters P 2001 Orthopedic problems in sport climbing. Wilderness and Environmental Medicine, 12; 100-110

Morrison A 2009 Climbing shoes: is pain insane? BMC

Killian RB, Nishimoto GS, Page JC 1998 Foot and ankle injuries related to rock climbing. The role of footwear. J Am Podiatr Med Assoc. 88(8):365-74.

Morrison AB, Schoffl VR 2007. Physiological responses to rock climbing in young climbers. Br J Sports Med 41;852-861.

Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn). Lochner Verlag: Ebenhausen.
Killian RB, et al. 1998. Foot and ankle injuries related to rock climbing. The role of footwear. JAPMA 88(8);265-74.

DrJulian Saunders 2009 Ankles Away

E. Demczuk-Włodarczyk, E. Bieć, T. Sipko, E. Boerner, R. Jasiński 2008
ASSESSMENT OF MORPHOLOGICAL ARCHITECTURE OF FEET IN ROCK-CLIMBERS
Biology of Sport 25(1)

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

Stretching

Ok, so in response to this article about stretching from the New York Times blog on reasons not to stretch that is making the rounds at present, I want to explain a little about stretching.

The blog post basically says static stretching during a warm up makes you weaker pre-sporting activity.

Well, of course it does! The idea of stretching is to lengthen muscles. Muscles work optimally in their mid range, so the longer the muscle, the less optimally the muscle is going to work!

This is easily demonstrated when looking at the structure of sarcomeres, the muscle fibres.

If the "H-zone", the area between the muscle fibres, is longer, then there is less overlap of the muscle fibres to connect to.
This means the muscle is not going to contract as strongly as it would, therefore be weaker.

The idea of stretching is to make muscles longer post activity. These muscles are not going to stretch very well cold, therefore they need to be warmed up first. This is why it is best to stretch as part of your cool down routine, to prevent DOMS (delayed onset of muscle soreness) and speed up recovery.

Rant over! :P

Kinesio Taping: A Sceptic's View

So I'm beginning this post as a sceptic towards the use of kinesio tape. I aim to look at the research behind kinesio taping, review some of the papers, and we'll see if my stance changes.
Even as I begin to type this, I'm getting reports of success stories from the use of kinesio taping, however, there seems to be a lack of understanding of how kinesio taping works anatomically, and of robust studies testing it's use.

Firstly, let me explain about kinesio taping. Kinesio tape has many brand names (such as Rock Tape, KT Tape etc) and is different from the traditional use of taping.
Traditional taping is using zinc oxide tape and is what is commonly used with climbers to tape fingers etc, and is generally used to prevent a certain movement, for stabilization and support.
Kinesio taping, according the the Kinesio Taping Website, "is applied over muscles to reduce pain and inflammation, relax overused or tired muscles, and support muscles in movement on a 24-hour-a-day basis. The taping is non-restrictive and allows for full range of motion"

The tape is basically an elasticated therapeautic tape.

More information on Kinesio taping and how it is supposed to "lift the skin microscopically" is widely available on the web, but I'm going to now look more at the evidence published.
I will stick to kinesio tape applied to the shoulders, as I feel this is an area appropriate to climbers, rather than the lower limbs. I have also tried to look at the most recent papers I have access to, and a variety of outcome measures tested.

First paper I will look at compares kinesio taping to a programme of physiotherapy modalities for the treatment of shoulder impingement. This study compared 30 patients in the kinesio taping (KT) group to 25 patients in the physiotherapy (PT) group (5 dropped out in the PT group and were not included in the final data analysis) between the ages of 18-70 years old. 
Both groups had a home exercise programme. The PT group had daily intervention of TENS, exercise, ultrasound and hot pack. The KT group had just the home exercise programme and the taping, for a 2 week period.
There were no significant differences between groups at baseline. 
DASH scores (Disability of Arm, Shoulder and Hand) and pain scores decreased significantly in both groups compared to baseline. 
The pain scores for the KT group were significantly lower than the PT group at 1 week, but no significant differences were found at 2 weeks.
Therefore, this study found that kinesio taping is comparable to physiotherapy treatment for the treatment of shoulder impingement, but has a more immediate affect on pain scores. 
From a cost implication point of view, the kinesio taping was only applied 3 times in the 2 week period, compared to daily treatment of the PT group, therefore the kinesio taping could be seen as a more cost effective method to reach the same end-point. 
   

The second study I have read consists of 42 18-24 year olds complaining of shoulder pain. This study compared kinesio taping to a sham application of kinesio tape over a 6 day period with 2 applications of the tape.
This study was more robust that the previous study, with the participants randomly assigned to the groups and the study procedure being double-blinded.
They found that there was only a slight increase in shoulder abduction range of movement on initial application of the tape, but no significant differences were found after 6 days for range of movement, pain intensity or disability score compared to sham tape.
There was also no control group for comparison, and it must be noted that it has been widely published that taping has a high placebo affect (in the case of taping for patellofemoral pain).

The third study looked at kinesio tape vs placebo taping again, in 17 baseball players with subacromial impingement. There were randomly assigned to the kinesio tape or placebo group first, and performed both interventions. 
Outcome measures consisted of muscle activation, strength and scapula range of movement. 
The study found that kinesio tape increased lower trapezius muscle activation and strength but it is unclear whether this was significant change, and whether this is a beneficial change to the participant. 

Finally, I also read a meta-analysis on kinesio taping in treatment and prevention of sports injuries, and they found similar results to me (regarding slight increase in range of movement), just in a much more scientific manner!


So, in conclusion, I still think that the evidence is weak for kinesio taping, but it has been shown to have a short term effect on range of movement of the shoulder abduction.
This doesn't mean I don't think it works, but it is difficult to measure the effect placebo taping has. 
Please feel free to share any anecdotal stories of success with kinesio taping. 

For further reading on how Kinesio tape works, see the following links:
How Stuff Works.com
Kinesio website

Paper's Reviewed:

1.  Kaya E, Zinnuroglu M, Tugcu I 2011 Kinesio taping compared to physical modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology 30:201-207
2.  Thelen M, Dauber JA, Stoneman PD 2008 The clinical efficacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. Journal of Orthopaedic and Sports Physical Therapy 38(7):389-395 (9 /10)
3.  Hsu YH, Chen WY, Lin HC, Wang WTJ, Shih YF 2008 The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. Journal of Electromyography and Kinesiology 19: 1092-1099 (4 /10)
4. Williams S, Whatman C, Hume PA, Sheerin K 2012 Kinesio taping in treatment and prevention of sports injuries: A meta-analysis of the evidence for its effectiveness. Sports Medicine 42(2): 154-164 (Level of evidence not applicable due to being a meta-analysis)
   
   (The number in brackets equates to how high the level of evidence scores)