No Pain, No Gain…No, Really.
Again, I’ve made the mistake of ignoring the nagging feeling in the back of my mind, that feeling that something is just not right with my body. The first time was when I ended up getting diagnosed with Celiac Disease. Not sure why I didn’t learn my lesson the first time…
I was in physical therapy before leaving on this road trip for recurring shoulder pain. I made some minimal changes, but overall I didn’t trust my physical therapist. I thought she was full of it. Ok, just partially full of it. She assigned a few back exercises and stretches and sternly told me that I needed to climb less frequently for a while. Whenever I asked for an explanation, she gave me a half-ass response. Whenever I asked a follow-up question, she dismissed me. She was scatterbrained and always in a rush and I didn’t like that about her mode of therapy.
So I only half listened to her. I was so busy with work and leaving my life in SF (renting out my apartment, packing up, etc.) that I barely had time to climb anyway – I was focused on getting out of the Bay Area and on the road. I changed up my daily habits a bit, things that were obvious to me, such as not holding the phone between my shoulder and head while typing and carrying an ergonomic backpack during my daily walks to/form the BART station. My shoulder pain went away without me doing any of the exercises that she has prescribed. 8 months later, I realize that she and I had both missed the big picture. I’ll get back to that a little bit later…
At the end of February, we finally left for the trip. With everything else going on (getting used to being on the road, building up the blog, and trying to shoot/edit video), I was focused on climbing as much as possible and easily ignored the intermittent shoulder pain that had come back. Since it was also summer, we weren’t trying that hard on anything…our main goal was just to stay as cool and dry as possible until we got to Colorado. It’s difficult to motivate when the rock is as greasy as a Big Mac.
Fast forward to Colorado. We had been on the road for 4 months when we arrived in Fort Collins. I had definitely seen strength gains, but not as great as I would have liked. I was climbing in the gym a couple times per week (at most) in the Bay Area, now I was climbing ALL THE TIME, in the gym and outside. Still, I wasn’t really sending. And it wasn’t even the non-sending that was bothering me, but the fact that I didn’t feel stronger. I felt like something was holding me back. Maybe it was too much climbing and not enough training?
As I previously mentioned, we currently have a gym a stone’s throw away in Brad’s garage. When we moved in at the beginning of August, we began training on our rest days. I began to actually enjoy training, but my shoulder kept acting up. An action as simple as opening the truck door would set it off and then I was unable to do even a push-up without pain. That, combined with the gut feeling that the hunch in my back and excessive winging in my shoulder blades was not normal, sealed the deal. Something was wrong. I knew it and it was time to stop ignoring it.
Enter Jeff Giddings of Adams & Giddings Physical Therapy. I was tipped off to his therapeutic ways by a couple long-term climbers – Paul Nadler, who had seen him for recurring shoulder issue, and then Tim Rose, who went to see him for a lat issue while he was staying with Brad, Spenser, and I in Fort Collins. What instantly attracted me to this particular physical therapist was both Paul and Tim said that Giddings himself was a climber and that he did not prescribe eliminating climbing. SCORE!
Damn…this guy’s a busy! I guess that’s a good sign? Made an appointment. Had to wait 2 weeks, but finally got in! Jeff Giddings is a soft-spoken man, who is not afraid to tell it how it is. He even brought out his spine and shoulder models to teach me about the muscle imbalances happening in my body. I know, what a concept. I could immediately tell from the worry in his eyes that what is going on with me is serious. Thankfully, it’s not too serious yet. No surgery, no MRI, no tear, nothing permanent. Operative word: YET.
My hunching, excessive winging, and shoulder pain are all related. Like many climbers, I have overdeveloped lats. No surprise there. But, for whatever reason, when I began climbing I didn’t use my back muscles (specifically the ones between the shoulder blades) and overused my lats and teres major. Now, these muscles don’t want to let go. Here’s what I learned: the lat (aka latisimus dorsi) actually wraps all the way up the front of your shoulder. My lat has a firm hold on my shoulder and is pulling it forward, causing it to twist. Twisting is bad, unless you’re doing ab exercises. Jeff made is clear that if I didn’t fix the issues, things were going to get worse, fast. I was on the road to surgery.
Other issues include incredibly weak upper back muscles (those ones I don’t use while climbing) and curving of my thoracic spine (mid-back), but we needed to deal with the tightness first – my lats had to be forced to let go. So, the mobilizing and needling began. That first office visit, Jeff focused on my left side, since that is where the pain occurs. He needled my lat and teres major, those were the main pressure points. I know that he is not full of it because when he found those trigger points, man, did they hurt – even causing inadvertent twitching of one leg or the other! Pressure points, indeed.
For those of you who are saying, needling…WTF? Needling is short for Trigger Point Dry Needling, or TDN. A very fine acupuncture needle is used to relax, or shut down, painful or knotted areas in your muscles. Most of are walking around with knots, that hard ball that won’t go away, in certain muscles. If you don’t address these knots with massage therapy, they can harden further and be extremely difficult to release. Most of the time, you can still choose to do aggressive massage therapy over needling, needling is just a faster solution. If you have never heard of needling, you either have never needed it or likely live in one of the 4 states that prohibit physical therapists from practicing it…California included.
I was nervous and weirdly excited. Tim had been needled while he was in town because his lat injury forced him to almost give up the climbing during his climbing trip to Colorado. After one session with Jeff, he was back to crushing. Since they use acupuncture needles, they do not hurt entering the skin. Then, the fun begins. As Jeff hit my trigger points, the muscle went crazy in spasm. It’s an incredibly strange feeling, but painful is not a term I would use to describe it. Your legs twitch, your eyes tear up, and then it’s all over in a flash. Deep breaths help.
Starting the first week, I was supposed to stretch out on a foam roller twice PER DAY. My exercises included laying on the foam roller length-wise and putting my arms out to the side while holding a 1-pound weight in each hand. Hold for a minute, or until my arms have lost feeling, rest and repeat for 4 reps total (shown in the picture above). Then, still laying lengthwise with the 1-pound weights, I needed to do 10-20 reps of bringing opposite arms up and down and 10 reps of flys, making sure my hands touch the ground each time. Lastly, we needed to start to deal with the curvature in my thoracic spine AKA hunching. This involves laying with the foam roller cross-wise right at the bottom of my scapula (shoulder blades) with my hips on the ground and forcing, yes, forcing, my thoracic spine back for at least minute. To deal with the winging, I needed to do modified plange push-ups (shown below) – 20 reps, 3 sets, 3 times per week. I am currently not allowed to do a full push-up, so my modification for the plange is to start on my knees in a push-up position and then push my chest in towards my spine and hunch my back, as shown below, then come back down to the start of a push-up for each rep.
I took my tasks seriously and did the exercises religiously. When I came in for my next appointment, Jeff was psyched at the improvement. This, in turn, made me psyched. Now my right side was more tight than my left…funny that. Apparently, both sides were almost equally imbalanced. According to Jeff, it was pretty much a crap-shoot for which shoulder started experiencing pain first. Alright, more mobilization of the shoulder cap and more needling. This time, more extensive needling on both sides, including both my lats, teres major, muscles over each scapula and upper traps. I could barely drive home I was so sore. The soreness was rough for the rest of the day, but felt much better by the evening and even better the next morning.
Since I was succeeding in stretching myself out in the right direction, it was time to add a few back strengthening exercises to balance out my over-developed lats. Ys, Ts, and Ws (you can see an example of how to do each of these in this cheesy 2008 video). Back extensions on an exercise ball and seated rows with a green Theraband (videos of how to do them here and here, respectively). 3 sets of 10 reps for each of these. Do these as much as possible, basically any day that I am not climbing outside, in addition to the foam roller exercises I still need do to twice per day.
I will say, there is one sucky side effect…I felt weaker than ever climbing. Jeff explanation made sense: my previously tight back muscles were now becoming more slack, which means that they had less power. Hopefully in a few weeks they will adjust and, in theory, I’ll be climbing harder than ever. AND using the correct muscles to climb. What a concept!
Last Tuesday, I went back to see Jeff again. More improvement, more needling and we added one more exercise. The rotator cuff muscles need to become stronger in order to help pull my shoulders back, so I am now doing side lying rotator cuff external rotations with a 2-pound weight (I also place a towel roll under the working arm). 2 sets of 10-15 reps on each side. I was so much less sore from the needling therapy this time, I was even able to do my back exercises that evening!
I won’t see Jeff for another 2 weeks, now it’s up to me to take my exercises seriously. We’ve also extended our stay in Colorado…again. It’s hard to leave and it also doesn’t make sense to leave until we’re ready. My back/shoulders are not ready yet, so it looks like we’re staying around Fort Collins until the middle of October. Spenser just came home with the Joe’s Valley Bouldering guidebook, we’ll be happily making our tick-lists and finishing the lastest RV Project episode in the meantime.
Anyone else out there having shoulder or back issues from climbing? Anyone else as imbalanced as I am? I would love to hear what other people have done to rid themselves of any sort of chronic pain. Misery loves company.
I am actually a little giddy to see Jeff in 2 weeks. I’m incredibly thankful to have finally found someone who is knowledgable and not scared to explain why each exercise is important. I know I’ll be keeping up with my exercises, no matter how mind-numbingly mundane they are. Remembering to keep things in perspective and look at the big picture: I understand this is a long-term therapy and I also understand that I have to do this if I want to be climbing long-term. I want to stay as far away from surgery as possible and right now, I’m too close for comfort. Jeff and I are looking to have me “crushing” (words from his own mouth) by the time The RV Project pulls into The Pit for another Bishop Thanksgiving. I cannot be more excited.