PT for climbers article

[NYC007]

this is from a PT monthly magazine, advance: note steve house's ex in it..:

 

Vol. 18 •Issue 4 • Page 12

Aiming High

PTs who climb the top peaks discuss treating mountaineering injuries

 

By Beth Puliti

 

It's hard to understand why anyone would climb a mountain—until you climb one yourself.

 

Some people find it spiritual, others crave the satisfaction of reaching the summit and many climb to escape today's high-paced and high-tech society.

 

"Climbing is special and difficult to explain. It is easiest to explain while on the trail or at the summit," said Jorge Paz, a mountaineer who started climbing seriously 11 years ago.

 

Paz has been to the summit of Mt. Washington more than 75 times and has climbed numerous other mountains in the U.S., such as Mount Ranier, Mount Hood, Mount Adams and Mount St. Helens, as well as peaks in Argentina, the Spanish Pyrenees and Chile.

 

"Today's [society] sometimes measures accomplishments by the material possessions one can afford. The outdoors reminds you how insignificant material possessions are for achieving happiness and tranquility in life," he said.

 

Whether it's due to wider media coverage, growth of outdoor retailers or adopting a healthier way of life, mountaineering and outdoor sports in general are increasing in popularity and influencing the lifestyles of millions of Americans.

 

Physical therapists, if willing to expand their knowledge and clientele, are in the prime position to treat this population.

 

 

Catering to 'The Mountain Crowd'

 

Bruk Ballenger, PT, CSCS, USA Triathlon Level I Coach, co-owns Real Rehab Physical Therapy in Seattle, WA. His clinic—which uses "Reach Your Peak" as its slogan—is tailored to cater toward the care and management of endurance and mountain athletes. Even the artwork on the walls (photos of the staff on climbing trips) inspires and encourages their climbing clients to reach their own goals, both in and out of rehab.

 

"Like many enthusiasts, mountaineers like to work with a PT that understands their activity, so we see more than our share in our clinic," he said.

 

Ballenger, a mountaineer himself, has been on climbing trips and expeditions throughout the Pacific Northwest, Canada, Alaska, Ecuador and Bolivia.

 

"In a crazy, chaotic, 'civilized' world, those experiences generated some of my most spiritual moments," he said.

 

Though some find climbing mountains to be peaceful, it's certainly not easy. To understand how physically demanding a mountaineering experience can be, last June Ballenger raced in an Ironman Triathlon and found it to be fairly easier than some of his climbing trips.

 

Ballenger's clinic makes a point to cater to the mountaineering population in several ways. They have invested in equipment such as a treadmill with a steep incline, a variety of balance devices to simulate the varied terrain a mountaineer might entail and climbing handholds that are used for a wide variety of pulling exercises (in lieu of regular handles for pulley weights).

 

In the past, Real Rehab has advertised in a local mountaineering publication as well.

 

"Some of our advertising is directed toward the mountain crowd, with images that identify us with climbers," said Ballenger. His clinic has also offered discounts on some of their specialty services at a local climbing gym.

 

"Mountaineers are most definitely endurance athletes, and should train and be treated as such. Their goals should be identified and incorporated into their plan of care," he said.

 

 

Treating Mountaineers

 

In order for PTs to treat the overuse injuries a mountaineer might experience, they must first get a clear picture of the kind of mountaineering demands the patient will be returning to, and then train and rehab to meet those demands, said Ballenger.

 

Injuries that occur from mountaineering are most often due to either acute trauma or repetitive stress/strain. Mountaineers can experience lumbar strains from a prolonged and loaded lumbar flexion position from a backpack, knee pain typically from the impact of downhill hiking with a backpack and tendonitis issues with the Achilles or the tibialis anterior and posterior from fatigue and repetitive impact on uneven terrain.

 

The most common climbing/mountaineering injuries Ballenger has treated in his clinic are sprains and strains. However, he's also treated several traumatic injuries from severe falls.

 

"Emphasizing cross-training and a logical return to activity is important. Be aware of hiking routes with elevation gain, as uphill is very fatiguing, and the downhill return creates high ground reaction forces," he explained.

 

He has his patients prove their activity tolerance first with distance, then by adding elevation gain/loss of no more than about 1,000 vertical feet per workout. For example, he'll have them hike six miles with no gain the first week, and add 1,000 feet each week thereafter.

 

A mountaineer's pack weight should also be minimized until tolerance to distance and elevation is proven.

 

If a patient is unable to train outdoors, PTs can work inside on rehab exercises and training that simulate mountaineering tasks.

 

Patients can train on a treadmill at increased inclines (Ballenger sought out a treadmill for his clinic that had a steeper than normal incline of 22 degrees for this purpose). The mountaineer should walk in aerobic range only, simulating steeper and slower movement.

 

"Add mountaineering boots, add 45-degree sidestepping intervals, add up to five pound hand weights in one or both hands to simulate carrying an ice axe or a bight of rope," Ballenger suggested.

 

 

Common Injuries

 

As a child, Ruth Mahre, MPT, OCS, was introduced to mountaineering by her father, who took her on overnight camping trips and led her up the standard route of Mt. Rainier at the age of 15.

 

In 1998, Mahre became an assistant guide for Rainier Mountaineering, Inc. during the months she had off from PT school. There, she was able to climb with some of the best mountaineers in the world.

 

Now a physical therapist at Biosports Physical Therapy in Wenatchee, WA, Mahre said common acute mountaineering injuries are shoulder dislocation, spinal injuries, fractures, concussion, hypothermia, frost-bite/nip, high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE), and retina irritation.

 

She noted that chronic injuries are typically postural dysfunction (cervicothoracic), tendonitis (knee, Achilles, plantar fascia) and low back pain (disc or strain).

 

Mountaineers can prevent overuse injuries by participating in "proper preparation/conditioning, maintaining/improving flexibility, correct gear fit, possible orthotic management and adequate recovery periods," said Mahre.

 

Anne Keller, PTA, emergency medical technician and mountain guide, agreed. "There are a lot of people who are really high-mileage athletes who are pushing their bodies and have never been counseled into any orthotic or arch support," she said.

 

Keller works at Winthrop Physical Therapy in Winthrop, WA and climbed Mt. Rainer for the first time when she was 17.

 

She tributes her physical therapy knowledge and experiences to Peter Dickinson, Winthrop's owner. His clinic has a range of services available for the active population in the surrounding community, including biomechanical assessment, advanced exercise prescription and proper footwear education/fitting.

 

Keller believes PTs could potentially become educated to work with and fit equipment to outdoor clientele—including mountaineers. Specifically, she thinks PTs could make a huge impact in the sport and outdoor community by addressing proper footwear, proper arch support and proper alignment.

 

"Something that I see a lot with my friends who are high-end mountaineers are alignment issues. I think that is something that PTs could really be more involved with in this community," said Keller.

 

She feels that any type of orthotic or alignment intervention would make a big difference in this population because mountaineers and other endurance athletes are enthusiastic people who want to continue their sport after the injury.

 

 

Patient Education

 

"As a patient population, [mountaineers] are more driven and more likely to experience overuse injuries, so they need to be counseled in proper strategies and exercise progression," Keller stated.

 

Mahre noted that it is important for mountaineers to educate themselves in self-care because medical care is often not available while on a climb or when out of the country.

 

"Individuals can also take courses and become certified in 'Winter Emergency Care' (WEC) and 'Outdoor Emergency Care' (OEC), which provides terrific information and skills for mountaineers," she explained.

 

WEC and OEC courses provide material for acute management of traumatic injuries in the field.

 

Certain home exercises, such as strengthening, flexibility, core and cardio, can also be taught to mountaineers that could help them prepare for their next trip, suggested Mahre.

 

Brent Okita, a climbing guide and ski patroller, is preparing to climb Mt. Everest in April or May of 2007. Currently, he is following exercises to treat patellar tendonitis.

 

He is using ice and naproxen sodium, as well as minimal use of his legs for the first month of rehab. After that, ultrasound and general knee exercises are recommended.

 

Okita summited Mt. Everest in 1991 and doesn't believe his current injury will impact his planned trip to Everest this spring.

 

When asked what it will be like to stand on top of the tallest mountain in the world, Okita admitted that it will be a very proud accomplishment.

 

"At the time, I'm a little more pragmatic about things, such as thinking about getting down. But certainly after the fact, I love the whole process of the expedition.

 

"Mountains are an integral part of my life, and as such, climbing the tallest mountain in the world holds a special place in my soul."

 

 

Beth Puliti is assistant editor at ADVANCE. She can be reached at epuliti@merion.com

 

http://physical-therapy.advanceweb.com/common/EditorialSearch/printerfriendly.aspx?AN=PT_07jan29_ptp12.html&AD=01-29-2007

 

Edited February 9, 2007 by NYC007

[layton]

Bruk's clinic seems like an excellent place for climbers to rehab or improve their fitness.

[brukb]

Hey how 'bout that, two of the Physical Therapists in the article are from right here in the great state of Washington!

I've been waiting to see that article come out in hardcopy, funny how it airs on CC.com first, I shouldn't be surprised. This article is one of the few that I've seen in the healthcare field, especially in Physical Therapy, that identifies climbers as a unique group.

[NYC007]

yeah its a mag that you can suscribe to on their website. I got it in the mail then posted it from the sire. Thought some people might enjoy it and learn a good rehab location.