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.

Sunday 28 October 2012

Doh. Surgery on the cards

Well that was an up and down week. At the start of week 4 of since my accident I attempted some normal steps across a room. I yelped and fell over. My ankle joint, which had seemed relatively unaffected, was immediately extremely painful on the anterior aspect. Pretty much my worst fears then.

In the absence of much ligament damage in that area, pain inside my ankle joint looked likely to mean damage to the articular (cartilage) surface inside the joint. Since cartilage, strictly speaking, doesn’t heal, it wasn’t the best. I was straight back for another x-ray that afternoon, which as expected was inconclusive. At least there wasn’t obvious damage to my talus. There was the faint echo suggesting there might be a bone spur in there, but it was hard to tell, and my doctor felt it would be treated conservatively anyway. I talked to my doctor in detail about what to do next. An MRI scan was really in order, but this and a consultation with an expert ankle orthopedic surgeon would add up into months of wait. Without really knowing what was wrong in my ankle, walking around on potentially damaged cartilage wasn’t really an option given my occupation.

So I decided to find out how much it would be to see the consultant on private time. Even if I just paid for the diagnosis and scanning, I’d be able to jump a lot of the waiting without extreme cost. One week later I was in the MRI machine and the following morning on the consultant’s table. I’m glad I did. The scan showed bruising in my Talus and Tibia but no damage visible on the articular surface. However, I had a large bone spur on the front of my tibia which had broken off. Although I do have the option of leaving it there and seeing if it gives me problems down the line, removing it might be the safer option to protect myself against future problems. There is also the additional benefit of a close inspection of the joint cartilage and any defects can be treated at the same time.

I didn’t feel like I had much option but to get it done, and get it done quickly. Although it’s going to be seriously expensive, it protects my ability to work in the short and long term. So I’m booked for the surgeons table in two weeks time. Depending on exactly what the surgeon finds in there, I’ll either be back to climbing in a few short weeks, or a bit longer. The way it feels, I think it’ll be on the short side. But I’m not thinking about it. All I can do right now is keep training and count down the days until then.

Tuesday 16 October 2012

Foot notes day 21

The strength of my torn plantar fascia (foot arch) is definitely improving rapidly at the moment. I’m imagining it’s still mid way through forming the immature collagen scar, but the earliest new fibres could already be starting to remodel now. Over the weekend I was able to briefly stand on the bad foot alone, though lent on the lateral side and I can stand up on my toes too, but again only if I lean my foot on it’s lateral side, so it doesn't really count.

The medial side is still too weak to walk without pain, and my heel must be well and truly bashed up as it formed fresh swelling and bad pain from yesterday’s weight bearing experiments. Normal walking is still some way off for me. I have to accept that. I still managed to limp across my kitchen though. So making tea continues to get easier.

On the fingerboard, I have also had great progress which I’m sure must start levelling off soon. I got 6 pull-ups on the Beastmaker monos, 3 on the 45 degree slopers (no cheats of course) and back up to 2.5 one-arms on the big hold. My best ever one arm performance was 4 complete pull-ups on a bar, about 6 or 7 years ago. I’m chuffed to get so much strength back so quickly after so many years avoiding pull-ups. My ultimate goal strength levels are still miles off though, so hopefully I can keep having sessions like they are going just now - noticeably stronger every day. It’s just so nice to finally pick up where I left off with a bit of real strength training that was out of the question for so long.

I think my weight has risen by a kilo or 2 which I’m counting as an achievement considering I’ve been sat on my ass or doing isometric hangs. I’m going to try and get myself a bike shortly. I think I might be able to cycle even in another week or so, and I sure as hell want to start burning some calories, getting outside and clawing back some VO2 max as soon as my foot lets me. Even if I only need to do that for a week or two before walking and climbing gradually take over, it’ll still be worth it to get conditioned again, both in terms of VO2 and body composition.

Friday 12 October 2012

Foot-notes day 17

I’m at day 17 post accident and had the expected ups and downs. A lot of folk (including many who are recovering from nasty injuries themselves) from got in touch after my last blog post saying they were heartened to see me sounding so optimistic so soon after my little tumble. Thanks! 

I must admit that the novelty somewhat wore off on Monday morning, waking up after week 2 of recovery and looking forward to week 3… of much the same. On the whole, it’s true what I said that a bit of time uninterrupted by trying to perform would be great to have a proper phase of foundation strength training. That part has been going great. When I go into my wall and start doing my workouts, I sort of forget about the injury for a while and feel normal.

The biggest pain in the ass is not being able to chase my 19 month old wee girl about and generally being a useless lump at home. I’ve only thrown my crutches away in anger once. In the grand scheme of things it’s obviously nothing to moan about. However, trying not to moan doesn't get rid of the feeling underneath. It seems the biggest psychological challenge is not right after the injury, but a few weeks on. What can you do but hang on the the positives of the training that can be done. Since I have a lower limb injury, thats a lot!

My plan to return to climbing with a Gullich upper half and Ondra lower half is working nicely. While my legs are visibly atrophied, my arms get bigger. On the fingerboard, as well as having time to get thorough workouts completed daily, I’ve had time to do all the peripheral stuff too. I have basically avoided basic strength training since 2008 because of golfers elbow. Even last winter, when I got symptom free and could train freely on the bouldering wall again, I still avoided campusing and fingerboard for the time being. Although I’ve been able to manage to keep a decent climbing standard, I could definitely feel my basic power suffering this year.

So with this break I’m determined to get fully back into strength training. So I’ve matched a rather intense program of deadhangs and pull-ups with an intense program of wrist flexor eccentrics for the elbows. It’s definitely working. I was always too scared to really push into elbow pain at VAS 5 just because it felt so wrong. But having bitten the bullet, it’s feeling line the right thing to do. I’ve also started a new method of doing eccentrics to mimic the most aggravating position and so far I think it’s increasing the response.

As expected, walking is still feeling pretty distant. I still cant get near a full weight bear on the bad foot although it can handle sharing the weight for standing now. I had a good meeting with Jaqui at Lochaber Physiotherapy and got a stronger idea of what is going on in my foot. My ankle joint seems to be on good form at the moment. I also still have a foot arch which elicits very localised pain at the attachment to my heel bone. The heel bone and fat pad seems to have been very badly bruised and bashed and will no doubt cause me a world of pain in the weeks to come once I start walking again. I think I’ll have a fine excuse to treat myself to a nice new pair of shoes.

Monday 1 October 2012

End of the line, for a short while

 Oops! Time for a little phase of finger strength training

In my last blog post I mentioned that I had a few wee routes to finish off before I was completely done with Steall. I do like finishing things before moving on, so I was eager to get them done. I’d bolted 5 new routes on the left side of the crag, two on the left arete of the main crag and three on either side of the big slab to it’s left. All needed a good brush since they are a bit slow to dry compared to the other lines, but the rock is great with lovely little pockets and every so often these weird letterbox jugs that are just the most satisfying holds ever!

End of the Line 6b+, first ascent, Steall.

I’d bolted the routes and partially done the hard work of cleaning them on previous visits. With three dry days gone, three of us went up to try and get them cleaned and climbed before they got wet again. All was going well, a new 7b, 6c and 6b+ were in the bag. But then it went a bit pear shaped.

Kev took these pics and had a fine view of my tumble down the bottom bit of the slab into the birch trees

It turned out, the 6b+ slab was quite long and the rope I was using which wasn’t mine was a little short. As I got lowered off, the rope ran out about 6-8 feet above the small ledge at the start of the route proper. Neither of us noticed in time and so I plummeted, clipping the ledge with my foot and somersaulting down the turfy scrambling ground below, eventually coming to a violent stop wrapped around a birch tree on the slope below.

As I was flying head over heels I was wondering what the hell was going on! Normally I always take a long rope to the crag so rope length issues don’t arise and it hit me that the borrowed rope I was using must’ve been too short and the end had gone through the belay device. For a minute or two I thought I might have got away with it but very quickly my right foot started to get bigger and severely object to being weighted.

A rather nauseous hop/clamber/crawl down to the wire bridge followed. The bridge was fine thanks to my practice on the Stac of Handa. After that, the machine that is Kev Shields carried me most of the way back through Steall gorge to the car and a trip to the Belford. A good man to have around when things go wrong! It appears my ankle is not broken but it looks likely I have a grade II tear of my plantar fascia (foot arch) and will be on crutches for a few weeks. It’s still early days to get a close idea of exactly what’s been mashed and bashed inside my foot.

On the bright side, I was about to start the yearly retreat to the fingerboard to avoid the autumn deluge and begin my foundation of strength training for the season anyway. So now I’ll have a even more focused start to that. I might even finish writing my book too. A few weeks out of immediate performance goals to really build a base of finger strength is something I should have been doing much more of in previous years. It will be really interesting to see if it yields a positive effect. I know where I’d place my bets!

I took day 1 post-injury off since I felt pretty damn sore all over and sorry for myself. But yesterday (day 2) I started gently with an hour and a half session of deadhangs, pull ups, antagonist work and flexibility training. My neck still felt a bit sore from the somersaulting down a crag, so I felt pretty weak and tentative. But that will give me good motivation to climb out from the hole.

I feel awful I’ve had to cancel a coaching trip I was due to go on next week, and a trip right afterwards to the trad area of Bohuslan in Sweden that I was greatly looking forward to. But both can be done when I’m stronger, healthier and have the book finished. 

So no there is no time to waste! I’ll be back on the cliffs in 4-6 weeks and have a lot of deadhangs and writing to fit in before then. Best get stuck in!

[UPDATE] I wrote the above on day 3 post accident. It’s now day 6 and I’ve already made a bit of progress. I started early mobilisation on day 4 and have got 80% ankle range of movement back from about 20% on day 1. I can rest the weight of my leg on the ground now and even get 10kgs of force through my forefoot pain free. Looking good!

Dam That River 7b, first ascent, Steall