Physical Therapy has taught me the importance of training certain muscle groups that might otherwise be neglected if I just climbed all of the time. For instance, no matter how strong I think my rotator cuff is, it went from being strong to pretty weak really fast. At least, that was my impression. The reality is that I don’t do rotator cuff exercises everyday of every year. And, when I do them, I do them in a pre-conditioned way with similar weights/resistance and only at certain times of the year. Now that I am experiencing a shoulder problem and I am trying to treat it with the least invasive prescription I can find, I am learning a lot about shoulders. As a climber, this is an area to pay attention to since I rely heavily on them to get me up the wall!
For starters, I didn’t know that medical understanding of the labrum is relatively new. With the advancement of lab techniques and the ability to get better images with ever advancing imaging technology, it has become possible to study this structure. One of my Dr consultations warned me that people are quick to assert a Labral tear. Partly because active people can get injured and when it’s something non obvious (xray or MRI are unclear), it seems like the likely choice. And, partly because as we age, apparently this tissue structure gets more and more fragile, again, making it a likely option.
There is too much information on the web and opinions vary including amongs doctors. While doing my research, I learned that recent studies are frowning on taking surgical action on a possbile labral tear. There are findings that reducing the labral tissue (called debridement) or removing it can lead to degenerative or osteoarthritis. Therefore, the two options left to consider are either to repair the labrum or rehabilitate through physical therapy. In short, not all tears need surgical resolution.
But, how do I know if mine does?
The body is a complex structure and the shoulder has many parts to it that may or may not be contributing to the injury. Further, one person’s injury and rehabilitation is not the same for another. As much as I might be guessing what is wrong, my doctor might be ‘guessing’ as well. From one Orthopedic evaluation, I was told that the pain and ache would ease up over time as scar tissue developed. And, as long as I wasn’t re-injuring the tissue, I should feel normal again. However, with the restriction that I have in the shoulder, I needed Physical Therapy to help stretch things out and regain mobility. Well, as you can imagine, I can’t fathom not climbing and any downtime would be a hinderance to my goals. Therefore, I took the risk to keep climbing (conservatively) and do regular Physical Therapy to help with mobility. If conditions worsened, I’d have to rethink my choice.
The shoulder is not 100%, yet, and my climbing performance is still inconsistent, but I’m doing it…slowly…and my performance is coming back! Further, Physical Therapy has shown me that no matter how strong I think an area of my body is (like the rotator cuff), it can always be stronger. To counter all of the pulling I do in climbing, I am doing a series of opposition training like the following: rotation exercises, strengthening the lower trapezious, serratus anterior, triceps, deltoids, and lengthening the pectorals and subscapularis regions. This is allowing me to continue to train, climb and prevent further injury.
My recommendation to other climbers, if you aren’t already opposition training, start and start like me. And, if you do this type of training from time to time, you might want to rethink how often or at what resistance you are really training. It might be time to mix things up.
Disclaimer: I’m not a physical therapist or doctor, these are my findings through my own injury and recovery process.