Tuesday, 30 October 2012

Something reliable

The past few weeks have been a bit tiresome at times. Two separate but related things have been going on with me. The first is obviously my struggle to recover from my recent climbing accident. The second is the thing I’ve been filling a lot of my time with for the past month while I cannot climb properly - working on my injuries book.

I’ve spent weeks and weeks of just reading, wading through scientific papers, medical texts, blogs and case studies. Sports medicine crosses so many specific fields of knowledge. It’s a huge picture. One of the most striking things about the science and art of treating sports injuries is the lack of hard unequivocal evidence in so many corners of sports medicine practice. You could spend your whole life reading the conflicting viewpoints and interpretations of the weak and limited scientific evidence available. The deeper you read into the detail of each field, the less seems reliable.

Of course, a bit of time to step back, digest and put into perspective what you have read makes things clearer. But while reading through the thick of the information, it’s hard not to get disheartened by the lack of hard rules and structure on which to build an approach to staying free of injury and solving existing ones.

One theme that does keep coming up is that humans do seem to be able in a lot of situations to find ways to overcome problems where the available evidence is not much help. When it’s not obvious what to do to either improve performance or recover from an injury, the single most valuable thing we can hold onto is that we have the capacity to literally try everything, to not give up and to work through problems and last the distance until either a resolution or a workaround is reached.

Lack of good scientific evidence to base our decisions is frustrating, but it’s crucial not to let this erode the one thing you can rely on to make progress - strong motivation.


  1. Awesome to hear an injuries book is in the cards. Long overdue!

    A small request, besides the all important forearms and major upper body oppositional groups, please include a bit about lower body injuries and prevention.

    For instance, any info about strengthening knees which can get damaged from severe Drop-knees.

    Ankles would be in terms of strengthening them to prevent ankle sprains from falling. Especially with the popularity of bouldering I feel like it could be useful.

    Cheers, and love your book and website

  2. This struck a chord! I write from the perspective of a physio, and the frequent lack of quality evidence can be frustrating and disheartening. Of course, this also applies in varying extents to wider medicine (and much human endeavour)...

    I would highly recommend 'Bad Science' by Dr Ben Goldacre and 'Irrationality' by Stuart Sutherland for anyone interested in 'good' science (as it were). They've certainly challenged my way of thinking, and if I'm honest, are a little unsettling.

    To Danger: Re: deep drop knees- the mostly likely significant injury is meniscal, and there's nothing much you can do about that, AFAIK. I've certainly never heard of anything that can be done to improve meniscal strength/toughness (although I have never searched in-depth via medical databases, I confess). Just don't do what a friend did, and if your knee hurts/tweaks after a deep drop knee/rock-over, keep repeating ad infinitum...

    Likewise, I'm also unconvinced that one can significantly 'strengthen' healthy ankles, unless there is an obvious weakness. I have heard it said that in recurrent dislocations, there may be ankle joint alignment issues that can be mobilised/reduced, but this is anecdotal. Of course, one could argue that the stronger the musculature and better the proprioception of the ankle/foot, then the less likely an injury is. But again, I'm not aware of good-quality data that confirms this (despite the intuitive appeal of the idea).

  3. Hi Dave,

    First, I would like to sincerely wish you a speedy recover. Congratulations for your positive thinking during this difficult period. I really enjoyed your first book which is really original. I discovered it during my stay in England (I am from Belgium). As a climbing instructor, I frequently suggest it to many of other climbers from all levels.

    As you are talking about injuries and the ability of humans to find solution, I would like to know if you have ever heard about heel's deformity due to climbing shoes. I did not find much information or litterature about this.

    Bumps have appeared on both of my heels. After radiography and echography, it appears that the Achille tendon is not yet affected but the heel pressure of climbing shoes is clearly responsible of this phenomenon and I have to change my habits.

    As you are someone wearing climbing shoes many hours every week, can I ask you if you have any suggestion about this or if you know some specific climbing shoes less aggressive for heels but still performant?

    Thank you very much in advance,


  4. I second Dangers point on ankles. Six months on from an open dislocation after a fall at Dumbie I'm still struggling to get mobility back. Getting lots of ideas for exercises from physios and Pilates teacher, but sometimes contradictory: e.g. one likes me to put weight on a golf ball under my foot to loosen fascia; the other says its to harsh!
    Good luck with the recovery,

  5. Dave, should be a fascinating book but you're spot on....there is very little definitive evidence. Even on the "basics" there is not always agreement.....to take anti-inflammatories or not? Who knows, depends who you read.
    One of the problems we have in all this though is that we stick too rigidly to western medicine's requirement for hard evidence. There is more that we don't understand than we do.
    The power of the mind in injury prevention and in healing cannot be underestimated. Indeed, the power of the mind to project "injury" cannot be discounted. Look up "Lorimer Moseley" and watch some of his lectures on pain...absolutely fascinating and surely must strike a chord with anyone who pushes their body "beyond" its limits.
    Anyway, hope your injury clears up soon, if ever you are after sports massage let me know, just moved into Lochaber.

  6. Hi Richard,

    I couldn't agree more with the comments regarding the power of the mind- the placebo effect is very powerful. (Bad Science covers this fascinating topic very well, and is well-referenced). I don't have a problem using it, per se- if someone gets better and hasn't been put through unnecessary physical pain, or been psychologically or financially exploited, then that's no bad thing! Regression to the mean is quite handy for clinicians/masseurs/etc too...

    So, the fact that "we stick too rigidly to western medicine's requirement for evidence" is not a problem- it's what separates the wheat from the chaff, as it were. I for one would like my treatment and that of my patients to be effective and as economical as possible. Research is utterly critical for this. Humans (in this case those applying a 'treatment') are very good at finding patterns that support their views, science has shown this is not always the case. Alas, as has been pointed out, the evidence base for many treatments is weak to non-existant. This is not limited to sports medicine.

    You'd now be well within your rights to call me out on references for some of the comments I've made- they are covered in the books I mentioned. I'll acknowledge that it's a bit sloppy of me to not go back to the original sources, but I'll be honest, I have plenty of other things going on that have a higher priority! LIke researching someone to fit a wood-burning stove, rock on... ;) They are both very good reads though, and I'll be checking out the Moseley stuff you mentioned.



  7. Tom, I pretty much agree with everything you say and perhaps I didn't phrase it quite correctly. I, too, like to see "evidence" to support treatments and can be very sceptical of new methods until I have seen such.

    However, at the same time, I am in equal measures both disappointed and annoyed when people dismiss "alternative therapies" out of hand when the truth is, if they work for some people, then they are more than worthwhile and, as I said, I believe there is a lot more that we don't know than we do. Who is to say what time and further research might reveal? Certainly, the more recent and relevant research into fascia has very much changed our way of thinking and understanding and there may well be a lot more where that came from.

    On a personal basis, I'm well aware that the hard clinical evidence for the benefits of sports massage is at best sketchy. Yet I, and many others, will attest to the benefits when training hard. Is it a placebo effect? It doesn't matter in the end, it works!

    I guess I am just hoping that Dave is able to do all this justice in his book, although it won't be easy. Good luck!