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Shoulders and Rock Climbing

 


Shoulder Biomechanics

 
Our  shoulders have greater mobility than any other joint in our body due to  their complex anatomic structure. The shoulder girdle is made up of  three bones including the proximal humerus, scapula and clavicle. There  are four articular surfaces including the glenohumeral, sternoclavicular 


 The  main articulation happens at the glenohumeral joint which is housed  within a capsule and surrounded by muscles and ligaments. One key to the  shoulder’s incredible mobility is the glenoid’s shallow depth. There is  limited contact between the humeral head and glenoid or socket. Only  about 25% of the humeral head makes any contact. For climbers this is a  double edge sword. We are rewarded with amazing mobility at the cost of  compromised structure. 


 Stability  is supplemented by the fibrocartilaginous ring called the labrum which  is attached to the outer rim of the glenoid. The shoulder joint relies  on extrinsic or outside support from a handful of muscles and ligaments.  Supporting ligaments include the superior, middle, and inferior  glenohumeral ligaments. For dynamic activity the shoulder relies on  support from the rotator cuff which is composed of four muscles  including the supraspinatus, infraspinatus, teres minor, and  subscapularis. 


 The  rotator cuffs main function is to hold the humeral head within the  glenoid. Most of us are familiar with the rotator cuff as shoulder  discomfort is usually a result of acute or chronic injury to it. Often  the supraspinatus (muscle or tendon) is damaged. The supraspinatus is  susceptible because it passes through a narrow space between the humeral  head and acromion process and when the shoulder is abducted impingement  can occur. Furthermore repeated abduction with impingement can cause  repetitive use injury to the muscle or tendon and even eventual ischemia  (or lack of blood flow) to structures. Many of the motions required to  rock climb put our shoulders at risk of acute and chronic shoulder  injury. 

 

Common Shoulder Injuries
 

Common  Shoulder Injuries: Although the supraspinatus is vulnerable there are  many other common sources of shoulder pain and discomfort. This is a  limited list of some of the more common shoulder ailments. It is by no  means comprehensive.

Rotator Cuff Tears (RCT):  In general individuals with RCTs will report trouble with overhead  activity, be unable to hold the affected extremity in an elevated  position and may report pain that awakes them from sleep. In other folks  the tear (lesion) may be asymptomatic. As we learned above 4 muscles  make up the rotator cuff. The supraspinatus is the most common damaged  and torn. RCTs are not a good injury to sit on as progression of the  tear can cause atrophy of the rotator cuff and make repair extremely  difficult. In young healthy athletes an orthopedist should evaluate a  full tear as soon as possible for the best chances of a favorable  outcome, (i.e. eventual return to climbing). With RCTs your provider  should also rule out subacromial spurring and calcified tendinopathy.

Multidirectional Instability of the Shoulder (MDI): Arises from shoulder joint laxity, sometimes congenital or developed  slowly over time. Often individuals have a history of overhead sports  that repetitively strain and stretch the glenohumeral joint. Extreme  motion leads to ligaments being stretched, micro tears of the labrum and  rotator cuff and potentially dislocation or subluxation.

Glenohumeral Osteoarthritis:  Results from damage to the cartilage that covers the bones of the  glenohumeral joint. Bone on bone contact leads to bone spurs of  (Osteophytes) and compromises smooth articulation and leads to eventual  reduced motion.

Impingement Syndrome:  Tendons of the rotator cuff and subacromial bursa are pinched in the  narrow space beneath the acromion leading to inflammation and swelling.  Symptoms are worse with the affected arm raised. As we get older  arthritis, bone spurs and calcifications can make the impingement worse.

Labral Tears:  Abnormal movement of the humerus (fall, blow, and crash), repetitive  trauma of the greater tuberosity, rotator cuff on the posterior labrum  can cause soft tissue pinching or impingement as a result of repetitive  overhead activity. One common labral injury is called a Superior Labral  Anterior to Posterior Tear or SLAP tear. As the name suggest it’s a  labral tear on the top of the labrum compromising the attachment of the  biceps tendon to the glenoid and can even lead to biceps rupture.

Shoulder Bursitis:  Most joints have fluid filled pads that help “cushion” the joint. The  pads or bursae can become inflamed. Acromioclavicular Joint Injuries:  Usually associated with sport injuries, direct trauma and occur often in  young adults. Typically the result of a fall with an upper extremity in  the adducted position which pushes the acromion medially and inferiorly  from the clavicle. Can have accompanying neurovascular injury,  sternoclavicular dislocation and brachial plexus injury.

Clavicle Fractures: Usually results from a fall onto the top of the shoulder. Clavicle  protects the great vessels, brachial plexus and lungs so can have  serious complications. Be sure to assess neurovascular status of the  affected limb.

Glenohumeral Dislocation:  Associated with high impact trauma. Usually the individual will hold  the affected arm in the contra lateral hand, will have pain with motion,  and a palpable humeral head in the axilla or a dimple inferior to the  acromion laterally. Most dislocations are anterior (90%) from abduction,  extension and external rotations forces. Posterior dislocations often  happen as a result of a fall from a seizure or electric shock. In both  cases be sure to assess for nerve injury.

Proximal Humerus Fractures: Often seen in the elderly with low energy falls. When seen in younger  individuals usually the result of a motor vehicle crash or sports  injury.
Frozen Shoulder (adhesive Capsulitis): Most folks will  complain of stiffness and pain. Can have a gradual onset and spontaneous  resolution. Treatment usually includes range of motion exercise and  sometimes corticosteroid joint injections. Arthroscopy is rarely used.


 Shoulders and Rock Climbing


I  always thought we were built for climbing. Our close animal ancestors  the great apes, (chimpanzees) were well adapted tree climbers and in my  mind this meant humans must be meant to climb as well.
 

It  turns out the shoulder design of our tree dwelling ancestors and homo  sapiens are a little different. While chimpanzees were hanging in trees  our hominoid kin walking the earth needed a shoulder layout that would  allow them to hunt, throw spears and use tools. I am not sure that  natural selection had sport climbing or bouldering in mind as our  shoulders evolved. Especially with modern climber’s obsessions with  increasing steep climbs and boulder problems our shoulders are under  tremendous and repetitive workloads. Sport climbing specifically is  harsh on the shoulders as we often attempt to hang on, pivoting our body  around a locked off shoulder. Often for a little longer then we should,  putting the fatigued joint at risk of injury as our form dwindles and  stabilizing structures get tired. Along with the typical climber hunch  back posture and compromised shoulder mechanics that follow climbers are  primed for shoulder injury as instability insidiously develops from  endless lock off, gastons and hang dogging on our favorite rock climbs.


 


Climbing Hard and Keeping Your Shoulders Healthy

 

Don’t  always climb overhangs, vary things up. Sometimes throwing in a day of  slab climbing of crack climbing in to give your shoulders a little rest.   

Stabilize antagonist muscles. A big back and underdeveloped  chest muscles is a recipe for disaster. Throw in some “push” type  exercise.

Give your shoulders some rest, along with the rest of your body from time to time.

Don’t always climb to full fatigue especially when climbing at your limit. In many sports as intensity increases so do injuries.

Focus  on smooth movement in everything you do. Have light weight days at the  gym where you focus on form. Precision of movement is everything on a  hard climb. If you train sloppy you will climb sloppy and expose your  shoulder to injurious forces.

Spend some time with a movement  specialist, or guru of form. Poor movement over and over will lead to  injury. Abolish old unhealthy movement patterns that lead to injury.

Diversify your training. Take the dog for a Nordic ski, chop wood, go for a skate ski or to a kick boxing class.

Train smart. Obsessive training has diminishing returns and will lead to injury. Find a mentor or coach.

Climbing  hard more than a few days a week will eventually lead to injury. Devote  a day to active rest and mental training. Work on your positive  self-talk.

Avoid obsessive stretching. Stretching is important but don’t go nuts.

Commit  to technique. Keep your feet on the wall. Professional athletes letting  their feet rip may look good in a picture but will only get you hurt.

Using large muscles puts less strain on the small ones. Train to push through your legs, not just pull with your arms.

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Recommended Shoulder Exercises

 

Most  of us do a good job training our Deltoids in the gym but many of us  lack specific training for the all-important rotator cuff. Deltoid  training without rotator cuff exercise, specifically external rotations  movements, can still leave our shoulders vulnerable to injury while  climbing.  

All trainers and exercise efficienatos have their  favorite external shoulder rotations exercise. Below is a list just to  get you started on the path to more stable shoulders. Remember these  exercises need to be done with light weight and more of a focus on form  then repetition.

I sprinkle rotator cuff exercises into my work out every couple days. Again light weight. Perfect from!

Standing or Lying Dumbbell External Rotation
Rubber Band External Rotation
Scapular Plan Elevation
Cuban press
Face Pull
External Rotation at 90 Degrees Abduction
Front Lateral Raise/Cross Body raise/Y
Scapular Wall Slides
Plank Plus
Lat pull down without bending elbows.

Standing Dumbbell External Roation

Standing Dumbbell External Rotation

Scapular Plan Elevation

Cuban Press

Face Pull

External Rotation at 90 Degrees Abduction

Front Lateral Raise/Cross Body raise/Cable cross body Y raise

Scapular Wall Slides

Plank Plus for Scapular Stability

Lat pull down without bending elbows

References

 

References

Chang CY, Torriani M, Huang AJ. (2016). Rock  climbing injuries: acute and chronic repetitive trauma. Curr Probl in  Diagn Radiol. 45(3)205-14.
Modarresi S, Motamedi D, Jude CM. (2011).  Superior labral anteroposterior lesions of the shoulder: part 1, anatomy  and anatomic variants. Am J Roentgen. 197(3):596–603.
Kibler WB. (2006). Scapular involvement in impingement: signs and symptoms. Instr Course Lect. 55:35–43.
Roach  NT, Venkadesan M, Rainbow MJ, Lieberman DE. (2013). Elastic energy  storage in the shoulder and the evolution of high-speed throwing in  Homo. Nature. 498(7455):483-6.
Quillen DM, Wuchner M, Hatch RL. (2004). Acute shoulder injuries. Am Fam Physician. 70(10).
Reinold  MM, Escamilla RF, Wilk KE. (2009). Current concepts in the scientific  and clinical rationale behind exercises for glenohumeral and  scapulothoracic musculature. J Orthop Sports Phys Ther, 39:105.
Martinoli C, Bianchi S, Prato N, et al. (2003). US of the shoulder: non-rotator cuff disorders. Radiographics, 23:381.