I give my runners, ultimate frisbee players, and people recovering from ankle sprains a goal of how many neutral heel raises they should be able to do, given the demands of their sport. A good base line is 4 sets of 20 single leg heel raises with good alignment.  If you aren’t able to properly do a single leg heel raise, you may need to start in sitting or standing with 2 legs to get the right neuromuscular patterning.

So far, I have been talking about the ankle. Let’s look at the foot! One important job of the foot is to absorb shock. If you jump on one leg, you should be able to land quietly, without a loud thud. It’s common for people who have lower leg or knee issues to land with a thud.  Check out the video below to show the difference between quiet landings and loud (thud) landings.

Some home care I give my clients to help soften the arch of the foot so they can absorb shock better, is to roll with a La Crosse ball on the bottom of their foot and to stretch the calf with a bent knee. Here’s how to roll your foot and your shin (if you have high arches). A mistake a lot of people make is not using enough body weight to get into the deep muscles of the arch. When you are rolling, there should be enough pressure from the ball to elicit a 3 or a 4 on the pain scale.

Also building up the small muscles in the foot is really helpful for absorbing shock and correcting fallen arches. My favourite youtube video for strengthening your feet is here.

And for those of you suffering with calf problems or knee problems, this is what Geoff, a client of mine, had to say about the work we did. “Just wanted to let you know I ran the 8K in the GoodLife Marathon race yesterday.  I felt great – no problems with calf muscles or knees. As a matter of fact, I ended up #15 in my age group.  It was all due to your help – I want to thank you again!”

In this post I will go over a few basic activation exercises I found helpful when dealing with my own neck and shoulder pain. The focus of these movements is to unload the neck while moving the shoulder and arm.

From a pain science perspective, the brain needs to know that it’s ok to move your various sore parts without aggravating your symptoms. Pain usually increases if the nervous system is heightened (i.e., when you are feeling stressed or in a sympathetic nervous system response). Here is a video that Gabriel Shaw, a kinesiologist and Tai Chi instructor in Victoria, has put together. He has been helpful in correcting some of my movement mechanics. I highly recommend him. I find his video helpful for loosening up without overstretching while also calming the nervous system.ere

The scapula (shoulder blade) needs to move with your arm. The three muscles that rotate your scapula upwards are your Upper Trapezius, Serratus Anterior, and Lower Trapezius (called Traps for short). For some people, their Upper Traps do too much work, especially when neck pain is a problem. For others, they need more Upper Trap activation which we will look at in a future post For the first two exercises shown in the video below, the goal is to recruit your Serratus and Lower Trap to help with moving the scapula, not just relying on your Upper Trap to do everything. Here is a video of two exercises: Prone Ws and Prone Ys.

In the next video, we look at standing Ws, Supraspinatus strengthening, and a shoulder stretch. Gabriel surprised me in the middle of filming with the last two exercises.

Another good exercise to get you thinking about moving the arm and shoulder blade together is rolling a ball under your hand or doing a basic push up plus against a wall while focusing on moving the whole arm and shoulder blade together (the motion of the scapula in this exercise is protraction/retraction combined with a bit of downward and upward tilt).

With all these basic movements, I encourage quality and mindful reps instead of quantity. If you feel you can only do 4 or 5 reps and stay connected to your Serratus and Lower Trap, that’s alright. As you practice, you will get better at engaging your shoulder stabilizers. You can work up to 3 sets of 10 reps in all the exercises listed above once you can produce quality reps. Then you will be ready for some more challenging exercises in Shoulder Rehab 2.

Contact Gabriel Shaw, BSc, Kinesiologist, through his website if you would like some help with your mechanics.

Do you ever get tingling or numbness in your hands and wonder why? There are a myriad of things that can cause your hands to go numb or tingle, but I’ll let you go down the Dr. Google rabbit hole if you want a comprehensive list. Sometimes it can be due to neural tension What is neural tension you ask? Let’s be realistic, you probably didn’t ask, but for the keeners reading this, I’ll explain. Think of all the nerves in your body as a spider web. If you pull on a single strand, it will pull on the rest of the spider web. Neural or nerve tension is the result of nerves, like the web strand, being pulled on from somewhere in the body. It’s my job to figure out where those pulls come from, which leads to nerve tension tests.

I have been experimenting with nerve tension tests (median, ulnar, and radial) and finger injuries in climbers as of late. I have found that for people who have positive nerve tension tests and finger injuries, if you decrease nerve tension in session, there is a strong correlation to improved grip strength (measured with a dynamometer before and after a treatment). Improvements range from 5% to as high as 45% in one session, which is exciting! When neural tension is involved, finger injuries will often heal more quickly once the neural tension tests are less positive (centralizing) or are completely negative.

Nerve glides or nerve tension tests are a helpful way to determine if there is neurological involvement for a person’s pain or weakness. It is common for me to give nerve glides to people who have forearm, wrist, elbow, shoulder, or neck pain along with nerve sensation in their arms or hands. Here is my disclaimer: I would highly recommend seeing a professional to rule out conditions that nerve glides might irritate or make worse, such as disc herniation or a facet irritation in the neck.

I compare nerves to a brake line on your car — pulling out all the analogies in this post. You have the brake cable, (which is like a sheath for the nerve), your brake fluid, and the brake line (aka the nerve). When you try out nerve glides, the intent behind the movement is a pumping or gliding motion. A lot of people think that nerve glides are a stretch, but stretching can irritate an already taught nerve and make your symptoms worse. If you try these nerve glides, you want to keep the back and forth motion smooth and avoid stopping and stretching at the end range. You also only want to go to the point where you begin to slightly feel the nerve sensation. Less is more with nerves and the nervous system. I usually recommend five to ten reps a few times a day. And if you ever feel more irritated after doing them, follow up with a professional; don’t overextend while performing nerve glides.

There are two types of nerve glides: tensioners and sliders. Check out the video below for an example of a median, ulnar, and radial nerve glide, also called tensioners.

If a person finds that tensioners elicit too much sensation, sliders are a much more gentle way to encourage the nerve to slide through its sheath to reduce neural tension. Here is the video for nerve sliders.

If you find that you have a hard time keeping your fingers pointed to the ground on median nerve tensioners, try them against the wall as shown here.

The purpose of this blog is to help you build shoulder strength. I talked about this in the last blog, but it’s really important, so I’m going to get back on my soapbox. Everyone is different regarding what position feels the best for them when training their shoulders. Some people like a chest open cue when climbing. Others prefer to focus on keeping their shoulders out of internal rotation (this happens when you chicken wing). Others envision an extended T-spine. Some people think about moving their shoulder blades as they move their arms. It doesn’t matter which cue works for you. What does matter is that the cueing helps take stress off your neck, shoulders, or fingers or that it diminishes your symptoms. Some of the consistency of knowing an activated position comes from training in this position while you lift as well as incorporating this into your climbing.

Shoulder Stabilizers

I like doing Ts and Ys on the rings or TRX. Using both face up and face down positions will get both your back and chest working. A neutral grip (thumbs up) will also help keep your chest open. I performed push ups on the rings, but if you have access to a bench press bar, that will demand more force production. Which, in turn, gives you a stronger training stimulus.

Upper Trap Activation

Upper Traps sometimes get a bad rap for doing too much; however, we do need strong Upper Traps for climbing. Handstands are a good exercise to do while on the road. Here are a few other exercises that are good for overall shoulder stability and that target Upper Traps using weights.

Single Arm Hangs

Single arm hangs have been really helpful for me to train all 17 muscles that move my shoulder. When you hang off of one straight arm, you want to keep some space between your arm and your ear. You can also hold lock offs around 90 degrees of elbow flexion. Avoid training lock offs at 45 degrees or less; they can irritate the common flexor tendon due to compression of the tendon against the bone. Lots of high-level climbers talk about trying really hard while holding one arm hangs. I like to take a page out of David MacLeod’s book and hold isometric one arm hangs for 5 to 8 seconds with a 20 second break before doing the other arm. Then rest for at least a minute before you begin your next set. I find 4 or 5 of these per arm is really challenging when performing them at max effort. You can take a bit of weight off by holding onto something with your other hand, or by setting up a pulley system so you can complete the hang for 5 to 8 seconds. If you are a crusher and eight seconds is easy for you to hold, you can grab a weight to make yourself heavier or hold a smaller hold.

Push Up to Side Plank

The last exercise incorporates dumbells with a push up. If I only have a minute to do a shoulder exercise, this one gets my shoulders pumped and engages my stabilizers while challenging my core. Enjoy.

For more inspiration, check out climber David MacLeod’s vlog here.

Once you have gone through the Neck/Shoulder Rehab 1 exercises and you are able to move your shoulder and connect with your stabilizers a bit more, you are ready to increase the load. I have found it important to strengthen my shoulders in a similar position that I want to stabilize my shoulders while climbing. The cueing can vary from person to person. The most common cue that I give, and that I use myself, is to open the chest or extend your T-spine. This corrects internal rotation of your shoulders and, based on assessments at the clinic, improves many climbers’ function in their shoulder exercises (i.e., feels more stable and strong with less pinching).

It’s common for climbers to complain about issues with their rotator cuff, especially Infraspinatus, which does external rotation and stabilizes the shoulder joint while reaching, and Supraspinatus (see Shoulder/Neck Rehab 1 for a related exercise). Here is a progression of external rotation exercises starting with the easiest and progressing to a challenging functional movement we do while climbing. All of these should be pain free.

For the last exercise, people who are climbing 12+ or above on a rope or bouldering V7 or above should be able to perform this exercise with around 3 sets of 10 at 8 to 10 lbs (this number is based on a small sample size, so consider this just a guide). If you can’t, you need to build more shoulder strength to perform the “shouldery” moves you are required to do at those grades.

This next group of exercises that we just saw incorporates upward scapular stabilizers with arm movement. It’s hard to completely isolate muscles that act on the shoulder, but in the last three exercises in the video, you want to feel your Serratus Anterior (on the side of your rib cage) and Lower Traps, not just your Upper Traps. The three exercises are Wide arm raises with a band, Wall Walkers (thanks Tony Gentilcore for this one), and the block against the wall (harder than it looks for those who lack mobility in your shoulder). Some people find that one exercise works better than another. You don’t have to do all three; just pick your favourite.

The next two exercises look at Tricep strengthening. Some climbers with elbow pain find these helpful. Feel free to read over the Finger Rehab 1 and Finger Rehab 2 posts to go over other exercises that help with elbow pain. The two exercises I like based on EMG patterns (from a small sample size) are Skull Crushers (also train Upper Traps isometrically) and supinated (palm-up) Tricep kick backs. Training Triceps in supination has been very helpful for me in balancing out Pronator Teres, which is often tight on climbers and can aggravate elbow pain. If you find this mimics your elbow pain in a dull, achy kind of way, this is a great exercise to help rehab your elbow. A lot of people think of Triceps as an antagonist muscle, which it is to some extent, but as you progress in the grades you need to be able to lock off and then push from the locked off position, which uses your Triceps. Check out these two exercises:

With all of these exercises, you can play around with reps and sets. If you are doing band work, make sure your last rep is challenging. If you do your band exercises and your last rep feels as easy as your first rep, you need more resistance. Without enough stimulus, the muscles won’t need to adapt (get stronger) since the load isn’t challenging enough. As your shoulders get stronger and can tolerate more load with a combination of band work and free weights, you will be able to start working toward complex movement patterns and heavier lifting for your shoulders. Those exercises are coming up in Shoulder Rehab 3.

Photo: Tosh Sherkat on “Just Go Climb” V10. Credit Kim and Graham McGrenere.