[laughs] Yes, so I am a sports-specific chiropractor. My specialty is, I’m kind of on the edge of all the different realms. I blend together physiotherapy, soft tissue care, massage, acupuncture, and just really creating a stable, firm basis in the athlete’s mind of where they need to go with their home care, delving through what has and what hasn’t worked, and really working out a functional plan. Almost like a trainer would do for you in a gym, as to figure out these problems and kind of solve them from the ground up.

 

Neely Quinn: What do you mean, ‘Kind of like a trainer would do for you in a gym?’ Like, what kinds of programs would you set up for people?

 

Dr. Lisa Erikson: For the basic athlete we would delve into, instead of strengthening tissue, we would first go into mobility of that tissue and ensuring that the inflammation’s under control and then from there, progressing into working on regions that need stability, and then building the framework for that athlete to return to sport without injury ever creeping back in.

 

Neely Quinn: Okay. So I want to get into details about this but I wanted to ask you about your book because you have an upcoming book. Can you tell us about that?

 

Dr. Lisa Erikson: Yeah, so my upcoming book is Climbing Injuries Solved. I’m super excited for it because the Kickstarter for it actually ends in an hour from now. I know this is going to come out way afterwards but I’m just so excited that we actually went over our goal and have raised an extra $600 or so for the ASCA.

The book is focused on teaching climbers about their anatomy and about common injuries that they will see out climbing, from the finger all the way up to the shoulder. It’s very in depth on those regions, as for really spending the time to go into: what is tendonitis? What is a pulley injury? How can we untangle these from being an issue and prevent them with stability drills and mobility drills from coming back?

 

Neely Quinn: Wow. Does it focus mostly on fingers or does it go into other injuries, climbing injuries?

 

Dr. Lisa Erikson: Yeah, it primarily focuses on the common ones which are of the finger, the hand, and the forearm. It delves a little bit into the shoulder and AC issues and rotator cuff/labral issues, but a lot of it is focused right down where climbers tend to have the most issues which are in the hand, the tendon, those different tissues.

 

Neely Quinn: I’ve had finger injuries over the years and forearm issues. I didn’t go to you for these things and maybe I should have, but I never really got much relief from acupuncture or massage or anything. What do you do differently for people with finger injuries?

 

Dr. Lisa Erikson: Well, that’s an excellent question. The biggest thing I’m trying to instill in the climbing community is this whole paradigm shift. It needs to happen in medicine, too, from focusing on where the pain is and where our injury is, per se, and kind of looking at the big picture of where that injury comes from. We can do a lot of acupuncture and a lot of physiotherapy on your tendonitis or your sprain or you repeated swelling knuckle but if we don’t address the stability of the hand and weakness into the elbow and shoulder, or even into the core – into the front of the abs and the back that is causing that issue – it could keep coming back.

That’s a big paradigm shift that I’m trying to help with and also to teach people how to work on mobility. I know all these years we’ve been focusing on teaching people that if it hurts to start strengthening it, and instead we need to work on loosening up the tissues around that injury so that it’s not heavily loaded and that region can heal faster and not just be this – Kelly Starrett says it the best: ‘It’s a tight hinge that starts to have a lot of friction and a lot of inflammation and that’s where your symptoms come from, but they could very well be coming from – and most likely coming from – the larger picture of how all the muscles and the tissues interplay around that injury.’

 

Neely Quinn: So you have to have a lot of knowledge about how the body interplays with/how each part interplays with other parts. I’ve had a lot of experience with that, with rolfers and some massage therapists but it seems to be sort of a specialty to think that holistically.

 

Dr. Lisa Erikson: It doesn’t have to be anything that is really mind-bending. It’s just that if you have a bicep tendon that’s painful, we need to go up into the muscle that’s tugging on that tendon and unweight it and make it loose and flexible and soft. Instead of going straight into weight training for that area, instead we need to go into inflammation control with icing and compressing and loosening up that muscle and making it flexible and then yes – we can do weight training and stability work but it should not be on the muscle related to that tendon. It should be on all the areas around it to unweight that muscle or region so that it can heal faster.

 

Neely Quinn: Okay, so let’s go through a sample person. A patient comes in and they have a pulley strain. What exactly do you do for them, and what do you send them home telling them to do for themselves?

 

Dr. Lisa Erikson: Research is now showing us that we don’t need to do surgery on any of these pulleys unless we have ruptured or completely torn 100% of, or 1+ of, two or more pulleys. For the average pulley that walks into my office, we can support it and try to get the swelling out of that area. We go straight to immersion baths and kinesio tape or compressing that pulley, and then spending a bunch of our time working upstream, through the hand and into the wrist and into the forearm, which is where all of the flexor tendons and all the muscles that flex the finger are. If we can get those nice and loose, and flexible and relaxed, the softest tone that that muscle can be, then it won’t be rubbing underneath the pulley.

Those poor pulleys actually have this friction happening underneath them, day in and day out, while you’re at your desk, while you’re sleeping, while you’re driving your car, so while we’re waiting for them to heal if we can unweight them by doing all this muscle work and by working upstream, so up into the forearm, that pulley will heal faster.

 

Neely Quinn: By ‘muscle work’ you’re meaning massage and needling, or what?

 

Dr. Lisa Erikson: Yeah, it can be as simple as buying a can of soup and working into the forearm, so a small roller. Lots of athletes know about the big foam roller for working on their legs and their hamstrings and their butt muscles, but we can take the same principle and apply it to a small area with, say, a can of soup or a customized foam roller. The Armaid does an excellent job of working on these areas.

Acupuncture works fantastically, so does massage, but not all athletes have access in the areas that they’re at to getting these treatments. With that said, I try to teach each athlete to go in and do self-care on themselves. My biggest role model out there is Kelly Starritt. He works with Crossfit and his book, I believe it’s called Becoming a Supple Leopard, really delves into seeing if you can do particular motions with your body such as a squat. If you are not flexible enough to get into that position then he goes through all these mobility drills with PVC pipe and tennis balls and foam rollers to mobilize your body, almost like Play-doh that’s been left outside and it has dried. It has misformed and we warm that Play-doh back up again and turn it into something that can be beneficial for us.

With the forearm and the shoulder and all the muscles that we use to climb, learning how to work on those with our self-care tools, a minimum of a couple of minutes a day, just kind of rotating through the body, is one of the best things to keep a climber healthy.

 

Neely Quinn: I think that’s one of the biggest problems, is climbers get injured and then we start doing stuff like this self-care, but we don’t ever do it before then so would you recommend that all climbers do self-care like this everyday?

 

Dr. Lisa Erikson: I would. They recommend, coming from Kelly again, he recommends four minutes of mobility for every 30 minutes that you sit everyday. That’s focused on the front of your hip and your thigh, so if you’re a climber and you’re working your forearms all day long and then you sit and you type all day long, you might have to do four minutes of mobility per forearm, per shoulder, every day. If you’re really working hard or you have a job that is really aggressively using these areas, so it just depends on where you come from.

Some people are more flexible, some people are more stiff, but it just comes down to how risky are these factors for your body and what is your body’s response? Some people can climb through these tightnesses without getting injured and others, sadly, have a collection of injuries that they’ve just had over the years and taking time off is not really helping the contracture, so when they come back to climbing after these four-five-six months off, their injury comes right back. Those are the athletes that I really want to reach out to, that can learn how to do this care and can start climbing with health again.

 

Neely Quinn: This is speaking to me. I have all these nagging injuries, and so many of us do.

 

Dr. Lisa Erikson: We do, and it’s just making the time. We spend all this time caring about our boss and caring about our families and our tax deadlines and what our spouse wants for dinner and we don’t spend time thinking about what our body needs to be healthy in the future. Most of us think about now and right here, and can I climb today on this finger and is it going to scream at me, and we’re not really focusing on six months down the road or our trip to Hueco or four years from now, if our fingers will be healthy enough to keep climbing on at the level and the volume that we’re doing now with what currently is going on underneath the surface.

 

Neely Quinn: Yeah, and speaking of time, if we’re looking at what you just suggested – four minutes per hour of typing and climbing – if we’re working eight hours a day and then maybe we go climbing for a couple hours a few times a week, that’s 10 hours a day sometimes, which is 40 minutes, right?

 

Dr. Lisa Erikson: That’s a lot of self-care and that’s why some athletes do so well with doing an hour class of yoga once a day or a couple times a week, or getting in and doing focused stretching or focused mobility work, maybe 20-30 minutes a day. It’s just kind of focusing on your weaknesses and looking around and keeping tabs on things.

I really try to push people to do a running log to where we’re not only checking in on the injury that we’re facing the most right now but we’re also checking in on that shoulder you just had surgery on a little while back and that big toe that was bothering you a couple months ago that had an issue. Just kind of checking in and keeping tabs and ensuring that, even though all these injuries and all these what I like to call ‘watch regions’ are improving. We’re making sure they’re not getting worse, but we also want to make sure that each of them on their specific path are improving or staying at optimum.

 

Neely Quinn: I want to back up a second. You said a while back “immersion baths.” I’m assuming that means water with ice in it?

 

Dr. Lisa Erikson: Yes, yeah, it’s a little trick that Dave Graham taught me in my office. We were going through all different types of options for pulley injuries and for pain and we tried – traditional sports medicine, we love ice cube massage, so if you have a knee we’ll go in there with a Dixie cup full of water. We’ll freeze it in the fridge, pull it out, and we’ll slowly unwrap the edge of that Dixie cup and massage the knee. For a finger, a Dixie cup is just a little bit too big so then we started getting in there with ice cubes and doing ice cube massage on that, and that really seemed to help, however, he felt like the blood flow was disappearing for him in the tips of his fingers. He wasn’t thoroughly getting the healing that he felt that should benefit that area.

Then, instead of icing, we swapped to immersion baths which are actually – it seems counterintuitive but they’re actually the opposite of icing. You stick your hands in a bowl of lukewarm – I would say like cold tap water – with maybe just a few ice cubes in it. It does the exact same thing as going out and climbing on cold rock does. You go out there, your hands get freezing cold, you get off the wall, they immediately warm back up and then they are hot for the rest of the time you’re climbing. They’re nice and prepped for it.

Immersion baths work the exact same way. You freeze them up in the water but it’s not that cold of water and it is something you leave them in there for a period of time, so instead of ice cubing it for two minutes or compressing it with ice for a couple minutes, instead we’re going to immerse it in just a barely cold water. We’re going to leave it in there for 15, 20 minutes and when we pull it out our body’s going to send all kinds of warm blood to that area. By sending warm blood to the area it’s going to bring in more nutrients, it’s going to bring in fresh blood flow, it’s going to bring in more oxygen, and it’s going to flush out all the waste and all the used toxins from that area to give it a new shot at healing.

For someone that has a really inflamed, puffy finger, that’s probably the wrong treatment strategy but for someone that has a chronic, long term tendon issue or a joint that just is chronically bothering them, these immersion baths are really successful.

 

Neely Quinn: Yeah, it is counter-intuitive. I’ve always thought of immersion baths as trying to freeze the crap out of your limb.

 

Dr. Lisa Erikson: [laughs] That could very well be like an iced Whirlpool. There are those, too. I ran in college. I did a run/ski and they made us get in these ice cold Whirlpools and we had to put Saran wrap over our toes so we wouldn’t get frostbite, and we would stand in them all the way up past our waist with hats on and scarves, and I had a big fuzzy blanket I wrapped up in. You would just stand there, shivering, for as long as you could bear it until the whole extremity went numb, and then you would get out.

That is extreme icing. It’s extreme inflammation control and for us, we were all running on fractures and injuries so the coaches wanted to get their money’s worth out of us so they just wanted to numb us up. It wasn’t really in prevention of injury, in my opinion, it was just injury management to where we had so little inflammation from all the icing that we didn’t feel our injuries so that they could get their money’s worth out of us – in my opinion.

The immersion baths that I have my climbers doing are not nearly as cold and the goal of it is just very lightly cold water with a couple ice cubes so it’s the same as going out in cold weather, on a 40० day where it’s lightly raining. Your hands are cold on the rock and then they warm up, and that additional blood flow afterwards is what’s actually doing all of its good for us.

 

Neely Quinn: Okay. What about a person who does have an inflamed, puffy finger? What do they do? Ice, obviously.

 

Dr. Lisa Erikson: The issue with the inflamed, puffy finger – right after an injury we don’t want to do any aggressive icing on it. If you’ve just jammed your finger, we’re now deciding that the first 2-3 hours of it, we want to leave it alone and give your body time to get all the healing factors, all the nutrients, all the little cells out there to heal up that injury. We want to give it time to do that.

Then there comes a point in the healing that this poor finger is swelling too much. The poor athlete that has a ring on that’s afraid they’re going to lose blood flow to it or the joint that is just totally misshapen or enlarged, those patients we want to compress that joint. We can use some gentle stretchy tape on it or we can get into some basic climber’s tape or athletic tape.

My favorite tape is the stretchy tape but we don’t want to tape it so tightly that we lose our blood flow or have a tingling, numb, blue finger. There is this whole ‘controlling swelling but not overdoing it’ gradient and it is different for every athlete, so that’s where I usually say, “Gently tape it, tape it very lightly, and see how your finger responds to it.”

The goal behind the stretchy tape is as it is compressing that poor digit, that poor finger, it’s not giving any space for fluid to collect so as it’s compressing it’s creating this pressure gradient and it’s squeezing that finger and pushing all of the fluid and the swelling and the inflammatory products that come along with swelling, out of the finger. By doing that, we decrease pain.

 

Neely Quinn: Then after a while should they ice? Or what do you think about icing?

 

Dr. Lisa Erikson: Icing definitely has its place. It depends on the patient’s – if your hands are always cold it means you have very little blood flow to the tips of your fingers so icing that may not prove as much a benefit as not icing it and just keeping it gently taped/gently compressed. Icing definitely does have its place so with every athlete I say, “Try it out and see how your body responds to it.’ An unhappy, puffy ankle or knee I would happily slap some ice onto it and compress it with an Ace wrap and that would make such a benefit, but way out on our finger it is so far away from our heart that it’s very hard to get blood flow to it so unless you have a very major injury, I would rather just have people compress it than actually get in there with ice.

 

Neely Quinn: Okay, so what about people with chronic finger injuries? What do you suggest to them about climbing? Should they be climbing? At what point should they be climbing?

 

Dr. Lisa Erikson: Lots and lots of climbers are taking time off when they don’t need to. Now, with that said, climbing on an injury can make it worse. If you’re able to climb and your injury does not talk to you and it doesn’t hurt while you’re climbing and it doesn’t hurt after you’re climbing, and the next day it doesn’t hurt either, you’re totally fine to climb on it. We can modify our climbing for some injuries and be able to climb even though that injury exists.

For, let’s see here – what was the second part of that question?

 

Neely Quinn: Just at what point should they be climbing on injured fingers?

 

Dr. Lisa Erikson: Oh yes, so with an injury that persists or an injury that’s new, we really need to unweight that poor area so it can heal. If you want – like, I have a nodule on my pulley tendon on my left hand. I always check the route before I climb up it and I’ll look and see, as there are very specific hand holds that, little devils, I will not touch them because they’ll puff that thing up for a month or two. I will look up the route and if I see one of those suckers, I’m not touching it. I’m climbing around it. I don’t care.

Looking at the route and seeing what lays before you and testing things out and seeing what your body can and cannot handle. The realm of what you can climb before you were injured changes every week as you’re doing your self-care so you might go out and try to climb some easy slab next week and your body might be just fine and then you might try to add in one vertical route and it tells you, ‘That is too much.’ It is very important to get a ceiling for what your body will allow you to do and then back off just a little bit and then you know kind of where your safe zone is. We can start adding volume and climbing more routes, climbing more days, on that and ensuring that we have a nice, beautiful base while you’re doing your rehab, while you’re doing your self-care, using your foam roller, doing some tissue mobility and all the different things that you need to do at home. We can most definitely climb while we’re doing that.

 

Neely Quinn: Are there any general recommendations for things to look out for when you’re climbing? Should there ever be – if you have a finger injury, should there ever be sharp pain while you’re climbing? If you have sharp pain, should you stop right away? Can you/should you climb through pain at all?

 

Dr. Lisa Erikson: That is an excellent question. Sharp pains are usually no-no’s. If you have sharp pains – a paper cut will give me sharp pains while climbing, so kind of looking and seeing what are we talking about? If you have a flapper and you’re pushing it into something really jagged, it’s going to give you a sharp pain.

Skin pain is totally acceptable, in my opinion, to have sharp pain on and keep climbing but if you’re having sharp pain on a tendon or sharp pain in a joint or sharp pain in a muscle, that’s your body telling you that we need to stop and do some care and some work. You might just hop off the wall, do some stretching on that muscle that’s talking to you, do some mobility work on the joints near it, and just really try to work the flexibility and then hop back on the wall and see. Does it get better? Does it get worse? If the pain is not going away, that’s something that we need to listen to because we can hurt our bodies and we can make them worse.

I tell athletes that when you’re starting to climb again after taking time off and after doing all your rehab, you might have your body talking to you on a little bit of your climb and that is a protective spasm. That region that was bothering you might talk to you for just a brief moment. It might be a twinge or it might be a quick little twitch of that muscle or a little spasm. If it’s something small like that and it’s not prolonged, it’s pretty quick, and it is gone, I wouldn’t worry about it. If you’re climbing on something and it hurts and it hurts all through climbing, and it’s more than just a brief, momentary pain, that’s your body trying to tell you something. Or, for the poor climbers that climb the whole time that they’re fine and immediately afterwards their poor fingers start puffing up, then they have hand pain all night long or the next day, that’s a sign that we need to work on stability.

With climbing, we have these horrible muscular imbalances, very much so on the back of the forearm, into the back of the fingers. They’re very much weaker than they should be in order to stabilize your finger because your distal finger flexors, the crimp and the sloper muscles, are so strong. Research is showing that they are 40% stronger than a nonclimber but the back of the wrist/back of the hand is 20% weaker than the average Joe just standing on a corner. We are set up for major injuries and all the puffy joints that I see, quite a few of them that come into my office, they lack the stability or the strength of the forearm and the wrist to hold those joints in a safe, stable position. Instead, while they’re climbing, those joints are collapsing and they’re twisting and that’s where their pain is truly coming from as they are wearing and tearing them with every motion that they do. Things to think about.

 

Neely Quinn: So what do you do? How do you strengthen the back of your forearm? It seems like that’s the problem spot.

 

Dr. Lisa Erikson: Yeah. There are some pretty easy tools out there. One of them is my favorite. It’s called The Flexbar. It’s from Theraband and it’s this big rubber bar and you can work the bar by – let’s see. You have straight arms and you’re just kind of twisting the bar and it’s all wrist exercises, so by wrapping your fingers around the bar, you’re not allowed to use your strong muscles or your distal finger flexors. Those are our climbing muscles so if you can’t use those, as you’re twisting the bar, doing u-shapes and all kinds of twisty motions, it’s all coming from the wrist. That is one option.

Another option is – we’ve talked about, a lot of people know the rubber band around the finger. You can go get those in the produce aisle, like around asparagus or broccoli, and you can pick up a couple of them. Put them around the very tips of your fingers and just opening and closing the fingers nice and slowly, and trying to build up for two or three minutes there and if that’s easy, put another rubber band around and another rubber band around, so building up the difficulty level based upon your body.

 

Neely Quinn: How often should people be doing these? What would be a good program for me?

 

Dr. Lisa Erikson: [laughs] I would say just like spring training, where we’re getting back to really getting going, 3-4 times a week is getting the job done and I’d say take a day off once or twice a week to let things heal. After a couple of weeks of working them every other day, if not daily, you’re going to have a whole different set of muscles to help you climb.

 

Neely Quinn: So, 3-4 times a week for how long and how many reps and sets?

 

Dr. Lisa Erikson: Excellent. I’ll usually tell patients to go for a minute or a minute and a half at each exercise. If an athlete starts pumping out early because that muscle’s fatigued, they can just take a break and then come back to it.

I’ve had some high school climbers that pump out at 20 seconds of using the Flexbar. They’re V9 climbers and they’re pumping out at 20 seconds, which is pretty sad. An athlete that has all this finger joint swelling, might I add, so two weeks later he came back with his Flexbar and he said, “I can do it for 20 minutes, no problem. Piece of cake now.” So I bumped him up to the next level of bar, which is the green one, a little more difficult, and then he was back to square one. He was pumping out quick again.

Just listen to your body and the biggest thing is to just keep it playful and keep it fun. Don’t treat it like a job you have to do. Treat it like, ‘Hey. We’re working on our weaknesses. I’m going to be a better climber for this,’ and instead of focusing on our strengths, which is the finger board, we’ll be focusing on everything else to help support those muscles so that our fingers and our wrists and our elbows are safe.

 

Neely Quinn: Even though we’re not necessarily using those muscles very much during climbing, you’re saying that it will make us better climbers.

 

Dr. Lisa Erikson: Most definitely. It will hold your joints in a stable position.

 

Neely Quinn: So it will make us less injured climbers.

 

Dr. Lisa Erikson: Most definitely, yeah. You may not hold on better on a crimp but you’re definitely not going to pump out as quickly, you’re going to have longer endurance, especially if you’re doing more routes per day. You’re definitely going to have more strength overall because the strength of the finger is transmitted through this stuff called fascia. It’s a thick, fibrous membrane that goes over the top of the muscle. They say that a muscle can transfer its force to a totally separate region. It can transfer 40% of its force through the fascia, which is pretty fascinating.

As we start to strengthen up all these stabilizers, even though they might be muscles for the wrist or muscles that just hold the wrist straight while you’re using other muscles, they’re very, very important for the overall strength and stability while we’re climbing.

 

Neely Quinn: With that high school kid you were just talking about, what ended up happening with him? Or are you still in the midst of his recovery? Is he getting better?

 

Dr. Lisa Erikson: Yeah. It originally began with – kind of the kicker on it was that it wasn’t just one or two joints, it was four or five joints. This was an athlete that, like all of us do, gets a little excited about climbing and all of a sudden it’s all we want to do. He went from a couple of days a week to every day a week to two and a half hours every day a week to only trying really difficult stuff. He had not built up the structures to support him so his tendons were very thin still. The muscles that he had strengthened up – he does a lot of fingerboard stuff and a lot of campusing and the different power wall? I’m losing my words today.

 

Neely Quinn: System wall?

 

Dr. Lisa Erikson: Thank you. System wall. Yeah, a lot of that stuff so he was really working his grip strength and his distal finger but everything else was weak so with him, once we started strengthening it up, we started noticing the joints were just one or two, and then they were only the joints that had the most force on them. Then, all of a sudden it was once a week to once every two weeks till it was under control and then he’d go climb really hard and then one finger would bother him instead of all of them. We really got it down under control to where once he started adding the strengthening, and then definitely I had him taping those joints with the kinesio tape, the stretchy tape, just to provide some additional stability.

That kinesio tape acts almost like another muscle and it definitely will compress that joint and provide a little bit more torsional stability than climbing without it.

 

Neely Quinn: I’m just going to interrupt here for a moment and tell you guys, the audience, that Doctor Lisa has been featured several times in Climbing Magazine, whether it’s her writing her own article or her being cited as an expert in somebody else’s article. I think that that just speaks to the quality of the magazine itself. They’re always trying to give us training information, trying to keep us as healthy and safe as possible, and try to get us to climb our hardest, and giving us beautiful photos along the way.

I love Climbing Magazine and I always have and I’m really excited to tell you that they’re offering you the magazine for a year for $10. Normally it’s about $60 so it’s kind of a big deal. If you want to get it delivered to your door for a year, you can go to www.climbing.com/save and find articles by Lisa. I’ve actually written for it before and other awesome experts.

If you want to do that just go to www.climbing/com/save (link no longer available) and you’ll get it for 10 bucks. Alright, back to Lisa.

 

Neely Quinn: In your book do you talk about how to put on kinesiology tape? I don’t know how to say that.

 

Dr. Lisa Erikson: I do. It has all these different names. You can call it k-tape, kinesio tape, there’s different brands: Rock Tape and Cramer Tape so yes – I have a bunch of different YouTube videos that are very poorly done because I’m still learning. I do them myself so if anyone has pointers on it, please shoot them my way. Some of them are quite comical but I try to involve the audience as much as possible and answer any questions.

I just did one on taping the A2 pulley on climbing tape versus kinesio tape. That is on YouTube under my title, which is The Climbing Doc. I think it’s episode 13 and then I definitely have photos and step-by-step ways of instructions of how to tape your pulleys, how to tape your joints, and just make sure that you hit all the bases for self-care.

 

Neely Quinn: Also, in your book do you talk about the Flexbar and rubber bands and how to do that?

 

Dr. Lisa Erikson: I do. You know, it took me a long time to write the book and then it took me a very long time to get all the layout and editing done so of course, I’m always coming up with new ideas after the book has come out. For the Flexbar, there’s a little bit on it in the book and then the rest of it that I’ve kind of discovered as I’ve been using it for myself, I’ve put onto the Youtube videos and I think a little bit of it is on Vimeo as well.

 

Neely Quinn: When will your book be available, actually?

 

Dr. Lisa Erikson: Today is the very last day of my Kickstarter and by the time this podcast comes out, it will be available on my website, www.climbinginjuriessolved.com and then I also have it on eBay and Amazon, but I have to pay them $7.20 per book for them to sell it so if people are more likely to go to my website, that would be better, but it is going to be out by the time this podcast is out and I’ve had really kind reception for it, thank goodness. Planet Granite is going to have it, as will all the EarthTreks so it will definitely be out and around.

 

Neely Quinn: Cool. Is it only in hardcover or whatever? As an actual book? Is it also going to be an eBook?

 

Dr. Lisa Erikson: It is definitely also an eBook and we’re still currently working on the eBook. My editors were Julie Ellison from Climbing Magazine and then Alton Richardson, who has worked for them and then also for California Climber, so this is something new for us, to put out a book. It’s definitely been a learning curve. An eBook especially is difficult. You have an eBook too, don’t you?

 

Neely Quinn: We have a few on the site, yeah.

 

Dr. Lisa Erikson: Did you try to put them onto iTunes yet?

 

Neely Quinn: No.

 

Dr. Lisa Erikson: Yeah, iTunes is ridiculous. I had Alton make me an eBook and it’s in a two-page format. However, patients that want to read it on a viewing device, you only want to see one page. You don’t want to see two so I’m having Alton redo it for that and then also, iTunes has a special format. It will definitely be on iTunes soon but it’s going to take a lot of work to make it perfect to be able to put it on iTunes.

 

Neely Quinn: Yes, I have dealt with that. It is a pain in the butt.

 

Dr. Lisa Erikson: It will be worth it but it’s just one of those games. I find it very interesting that they all get 30% of stuff when you put it on there but it also makes it widely available to the world, so it’s a much needed evil. [laughs]

 

Neely Quinn: Yes, it is. I want to back up for a second. Why do you specialize in climbers? I know that you see people who are not climbers as well, but why are you focusing on us?

 

Dr. Lisa Erikson: I think it kind of captured my interest. It started out, I just had some climbers come in and I treated them but they were like any other athlete. My background – I have an endurance background of crazy running and crazy biking and crazy skiing and coming into climbing, I didn’t understand, particularly the forces and the loads that were placed on the joints, because it is not the average sport. We’re loading a joint with a torque so we’re flexing it but we’re also bending it, so that’s the distal finger and that’s also with the knee, like drop knee moves.

I started helping out with some of the climbing events and seeing what you guys are doing to your bodies just freaked me out. I couldn’t understand it on an anatomical level so I started delving into the research and I still couldn’t get it so then I decided, ‘Well, screw this. I’m going to go do it myself and see what it is.’ I went to te the gym and had a good buddy from Crested Butte start teaching me how to climb and it is obviously, as everyone’s listening, extremely addictive and really fun and extremely challenging. Then, you jerks gave me the bug and I got really, really into it. It all kind of stemmed from trying to understand it and then, in trying to understand it I really fell in love with it, if that makes any sense.

All of a sudden, something that came from just trying to understand it, it kind of became my passion in doing so, which is beautiful. I’ve kind of grown bored of the other sports and of working in those realms and it’s really something that is beautiful and challenging and it changes as the years go on. That’s kind of, in a nutshell, that’s kind of how I got so addicted to it. It’s something we even talk about at home. We’ve got all the books and on the weekend we decide where we’re going to go. Are we going to go climb a tower? Are we going to go to a crag? Are we going to go do a multi-pitch? We pull out all of the books and we hop on Mountain Project and that’s kind of what our dreams are built on.

Now, climbing allows me not only to go run around the mountains I love but I can run around them and see something cool on there and go conquer it. There’s something so awesome about sitting on top of a tower and looking off into the world and enjoying life. It’s just beautiful.

 

Neely Quinn: Wow. Yeah, you got really psyched on climbing.

 

Dr. Lisa Erikson: [laughs] Well, we all do.

 

Neely Quinn: Yes. Well, here I am, running a climbing podcast so obviously I can relate. So, you focus on climbers and you’ve worked on quite a few of us, it seems like. Do you find that you’ve had a bit of success?

 

Dr. Lisa Erikson: Yeah, well it’s been really fun yet challenging. Of the principles that I’ve brought from working on my other athletes and from the things I’ve learned from massage therapists and just from the different realms of sports medicine, climbers haven’t really seem to have heard before. It’s really fun to tell them something that I thought was pretty mainstream and have them look at me like I had funky antennas on my head.

It really has been successful because it seems to me a lot of climbers that have had these long term injuries, all the options I have for them for treating them are things they have never tried or have never heard of before, which for me, it’s really – coming out of school it was extremely scary for me to be in the office and have a high-end athlete come in and say, “Well, I’ve been to everyone. I’ve tried everything. I’ve done every test. No one can help me. What can you do?” It’s really scary to do that so I have to start from scratch, and sitting down and saying, “What exactly was your homework? What exactly do you understand about your injury and what have you been doing on your own to help heal this injury?”

I notice all these familiar things missing from a lot of self-care routines and also, their poor doctors, what they’re trying to relay in the small amount of time that we actually have with you in our office, it’s almost impossible to relay all of the information that we want to give you. I just had a Skype session with a patient online. He was actually in Brazil and it was just supposed to be an hour talk with him. A new patient exam, so we look over his MRI and we talk and we discuss and we point at injuries and we figure out how to fix them. I had him on Skype for two hours and I had to cut him off because we were about to start and it’s just that there’s so much to discuss and so much you can do to work on. It’s not the end of the world and there are numerous opportunities and options to help heal these things. Just because you’re seen all these conventional doctors, you know, there’s a lot that they may not have considered or had the time to discuss with you for fixing it.

That’s where the book comes in. I can really sit down and spend seven hours talking tendonitis with you and people might beat their heads against the wall and think it’s boring or others might say that absolutely makes sense and now I get it. I guess I wrote it in hopes that I might fill in those tiny little windows that might be missing in some athlete’s care or gigantic mountains that are missing in some athletes, in the realm of what they’re doing for themselves. We can really start to piece together your health and get you going again.

 

Neely Quinn: Speaking of talking to this guy from Brazil online, do you see clients online often? Could people just call you up from a different state and start seeing you?

 

Dr. Lisa Erikson: Yeah. It kind of started by accident. I had someone who couldn’t make it down to see me who was on a barge somewhere and then before I knew it, I started seeing people remotely. I check in with them on Skype and I do the exam but it’s through the computer so I have you point to where it hurts, have you tell me what it feels like, I have you copy me doing all these motions and then if you have any imaging – X-rays or MRI’s or CT scans – we look at them, then we kind of discuss who to send you out to. Maybe work with your doctor in town or give you a bunch of homework to do and check in in a couple of weeks and see how it’s going.

 

Neely Quinn: So, my next question is about the docs that you just mentioned. What is the difference between you and, say, an orthopedic doctor?

 

Dr. Lisa Erikson: Each provider is going to have a specific knowledge base and a specific go to for how to treat things. Each athlete needs to be aware of this. When you go into your basic MD or your family practitioner, he opens up a window for who you get to see unless you want to go straight to your physiotherapist or physical therapist. They can also do that for you.

You go in and you see your MD and he says, “Uh, I need to send you off to the orthopedic doc to have a talk.” Then he books that appointment because that is a specialist and then he sends you off to the orthopedic doc, who is a surgeon. That doctor looks at your joint and tells you whether or not he can do surgery on it and/or whether he recommends physiotherapy or chiropractic or acupuncture or massage or whatever realm – rolfing – that he might recommend for you.

Going to the basic MD first is what most climbers are going to do and most of them are given either an inflammatory drug, so something to treat the swelling and the pain, and/or a muscle relaxer. It’s kind of all they’re offered. Some of them are offered corticosteroid injections which I usually tell people to try to stay away from and now they’re doing platelet cell therapy injections, PCT, which is where they inject your own blood. They take your blood out, they spin it down, and then they inject these platelets into your injury and what it does is it forms this thick, fibrous callus. You have to keep that joint immobile for a period of time and the hope is that if it’s a joint that is all bone spurs or if it is an area that has a gigantic tear that they cannot fix, that they will inject it and heal it up.

That is kind of where it starts out as for the docs and who to see and that type of thing. PT is also an excellent one to go to and the average PT will start you off with a bunch of home care exercises and a lot of the work is done in office. My care is a little different because I get very bored doing exercises with patients. I prefer if – most of my patients are so driven because they’ve been injured for so long that I can trust that I can send them home and do their homework and then I give them the scare factor, that, ‘If you don’t do this then I will be able to tell.’ They will usually do their homework.

The average chiropractor is mostly for joint mobility, so if your joint is stuck and not moving, or if you’re having muscle weakness because there is an imbalance in the muscular structure related to the muscles or the tendons or the joints, that’s where they come in.

A DO and a chiropractor are almost identical except for DO’s are now in hospitals. DO is pretty synonymous with an MD as for, ‘Do you want drugs? Do you want painkillers?’ There’s a variety of providers to go to and many of which have different education levels or different interests. Try to pick one who is a sports medicine doctor because they have a lot more information and knowledge about soft tissue therapies and exercises and that type of thing.

 

Neely Quinn: Okay. So it sounds like you’re pretty open-minded and you think that each doctor has their own place and that there is a place for each of them.

 

Dr. Lisa Erikson: Oh, most definitely. It’s just when you go see your doctor and he tells you, “You have to go see the surgeon,” or the surgeon says, “I want to cut on this,” that is their training. Your orthopedic surgeon knows nothing about massage, he knows nothing about physiotherapy. That’s not what he focused on in school. His job is: can I do surgery on this? Can I improve it with surgery and if so, what are your outcomes? What’s the research on that? That’s where his focus is. A neurologist, their focus is: are the nerves working perfectly? Is there anything that I need to do spinally or to move that nerve or to uncompress it so it works?

Each of these providers definitely have their place in medicine. We just have to understand, with their recommendations, what that means. All we know is what they’re saying is, nerve-wise or bone-wise or surgery-wise, their opinion goes. They are the knowers on that but definitely for massage and physiotherapy, I’d definitely head off to one of those and have them check you out because we’re all specialists in our own realm. I only know a tiny little bit about the body and how it works but that tiny little bit that I know, I know a lot about it but it’s very specialized. I don’t know anything about doing surgeries. Well, I do, but nothing like the surgeons do so we’re all very different and we work well together. We just have to be given the option.

In your area you may have a doctor that is not familiar with climbing injuries so that’s why I wrote this book that you can show them: here’s all of these options, what do you think about it? Or: here’s what it says I need, what’s your opinion of that? Your doctor is immersed in our culture as well as us being immersed in his so that we can work together as a team instead of wondering what exactly is going on from both ends.

 

Neely Quinn: When I had my surgery, it was kind of like it wasn’t this sure thing. I think this happens to a lot of climbers. They get injured, their shoulders or their elbows, and there is the option to do surgery. It’s kind of hard to decide sometimes whether or not you should. Do you have any advice on when you should?

 

Dr. Lisa Erikson: Yeah, most definitely. Things that most definitely need surgery are things, as pertaining to your shoulder, would be rotator cuff. If you have torn the tendon beyond 50% and they want to resew it back together or if you have tugged it off of the labrum or there’s something that is definitely broken or torn in there, you probably need surgery on that. A labral tear is something different entirely because if you have – the labrum is pretty much like a, how would I explain it? I would explain it like…

 

Neely Quinn: A golf tee?

 

Dr. Lisa Erikson: Yeah, it’s kind of curved at the edges and it’s almost like a rubber grommet that holds the bone in the socket. Well, it guides the bone into the socket. So your rotator cuff and the muscles of your shoulder attach onto this rubber grommet and when they yank, they create this little sharp edge in it. People can have a labral tear and not feel it. It just matters if that little sharp bit comes into contact with anything.

For patients that have a labral tear – I have one in my shoulder that I tore hiking downhill in the rain. I slipped and fell and did something funky to my shoulder. I knew immediately because I couldn’t let it hang, I had to put it in a brace and it was horrible. I have rehabbed it back up and it’s totally fine. Every now and then I get a twinge and it bothers me but it’s not worth surgery.

For some patients, if they’re feeling a sharp pain deep within their shoulder and they have gone through all the massage and things are nice and loose and they have done a bunch of rehab and they still have this long, lingering issue, then yes – I would go in and I would talk with more than one doctor about it. I would discuss with two or three different orthopedic surgeons. You might call your doc and say, “Who is the shoulder guy in town?” or “Who is the go to for my particular injury?” You can see someone who does the surgery all the time and when you meet with him, start asking him statistics. How many times does this need to be redone, this surgery, or is there a risk of failure with it and if so, what is it? Or, if I have the surgery what is the risk that the pain stays there? All of these types of questions are totally fine for you to ask your doctor and he would rather have you ask than after the surgery and you still have shoulder pain and he says, “Oh, well I did the surgery so that joint was in perfect harmony but it’s not designed to fix your pain.”

These are all things we need to discuss with our doctor. It can very well be with a lot of my patients, they don’t need surgery. They just need that joint stabilized so someone that has impingement syndrome of their shoulder or they have rotator cuff tendonitis or they have a pain on the front of their shoulder because that shoulder keeps slumping forward and that bone of their humerus is grinding underneath their deltoid muscle. These are all non-surgical things and if you were to have surgery on them, the chance of them coming back is really, really high because it is a stability issue and it is a muscle control issue and that’s where going and working with a personal trainer or a physiotherapist or someone in town who can help organize that.

Even at Crossfit gyms they have an ‘Intro to Crossfit’ where they show you proper loading patterns, they show you how to hold your shoulder. That is some of the best training that we don’t get and I don’t know why we don’t reinforce these in gym class and in health class because it’s really important.

 

Neely Quinn: Yeah, yeah it is.

 

Dr. Lisa Erikson: So there’s very few things that are definitely surgical. A lot of things if you’re worried about it, I would say unless it’s a major tear or you’ve actually tugged a tendon off the bone, I would say do all your rehab as you’re supposed to and see how it comes along. Go into your PT, do all of your PT – start to finish – don’t just do the first two weeks and leave it alone, and then see how your shoulder is or your finger or your knee. It might be that it’s completely gone. I’ve seen things that have gone through PT and not have gotten better and then I send them off for four or five visits of massage and it’s gone and it never comes back.

There’s a lot to be said for muscle work because if the muscles are tight around your shoulder, they’re just grinding that poor joint and all the friction, all the inflammation, is going to make someone with no shoulder injury feel like they need their shoulder replaced. Over time, it might just be that it wears down if we let those muscles continue to be tight when we could use a tennis ball in the car, kind of leaning on it, or use a foam roller on the floor. There’s all these options for fixing our bodies on our own.

 

Neely Quinn: Yeah. Those are good guidelines and actually, if you have any time guidelines like, for me with my shoulder, I injured it in May and I had surgery in November. I did everything I knew between, in those months, and I had six of the requisite physical therapy and finally I was just like: massage, acupuncture, dry needling, and rolfing are not working, and chiropractic, so do you have a timeline for people?

 

Dr. Lisa Erikson: Yeah. Part of it comes down to inflammation because I’ve had athletes – I had a triathlete come to me with a knee issue and she had a race that next week. She said, “I’ve been to see everyone and my knee’s not better. Would you work on it today?” So I worked on her knee and then it was even more – it came in looking kind of puffy and I told her, “We need to ice, we should probably not do any muscle work on it. It looks like it’s had too much already,” and little did I know, she had already been to four PTs that day. Every PT grinded, did their muscle work on it, and it was just too much.

We really need to watch the inflammation and the mobility of that joint and focus on that first before we start doing our muscle work and our exercises. It’s much more body dependent and not as much time frame dependent but if it feels like it’s going the right way, then I’m happy but if it feels like it’s getting more aggravated or going the wrong way, then we need to check in with our doc and have a serious talk with him – or our therapist – have a serious talk and ask that we’re not strengthening it too soon because that is the most common mistake that I see. Taking an injured tissue and trying to strengthen it when it needs inflammation control and it needs just to be untangled and loosened up and unbound, first, and then strengthened. Maybe just checking in and making sure that’s happening first and then after all yoru six weeks of PT, if that thing’s not coming around then yeah – most definitely have that discussion.

Some of my athletes, it takes three or four months to get that fixed and if we’re talking a major shoulder surgery on someone in their 50s or 60s that has bone spurs, there’s an awful lot we could do in the office for that poor athlete before we put them under the knife and I’d rather try to do my very best before they go under that surgery because things are never the same after you do surgery. Some of them are – like labral tear fixes, they just go in and do a little trim – totally different so definitely discuss with your doctor the gravity of what type of a surgery they’re doing and how much they’re actually doing. If it’s just a little modification in there or to remove debris, not a big deal, but if they want to go in and chop the edges of the bone down to make more space, I would definitely avoid that and definitely try all these different techniques way before then. Some of them are really extreme and it really just depends on the doctor.

 

Neely Quinn: Yeah. You talked about inflammation. Do you use ibuprofen in your practice or what would you recommend? It’s so common for climbers to get injured, take ibuprofen, and then go climbing. What do you think about that?

 

Dr. Lisa Erikson: Ibuprofen is excellent for inflammation control. I try to remind patients that the ‘i’ of ibuprofen is like the ‘i’ of ice, so taking ibuprofen gets the swelling down in that region, however, it is also hard on the body. A third of it goes straight into your fat stores and is slowly released over 2-3 months and another third of it, your poor kidneys are trying to clean out of your urine so if you have any issues with your kidneys – I damaged my kidneys trying to take. I ran a 50-mile race and it was snowing and it was blowing horrible wind and it was really, really cold and I was an idiot. I took too much caffeine, too much ibuprofen, and it was cold and I fried my kidneys and they were fried for months.

For athletes that are going to take ibuprofen, I try to make sure that they don’t have any pre-existing kidney issues and that they’re not using it out in the cold because when it’s cold, the blood flow to your kidneys shrinks so the stress on your kidneys is much higher and for patients that worry about that, Tylenol is actually broken down by the liver so it may seem – oh, don’t mind that beeping. I don’t know if you can hear it – but it may seem like the Tylenol doesn’t work as well but it’s actually broken down by a different organ so if that’s a risk factor, think about that. Definitely, for patients that want to take the ibuprofen, it’s something we can take up to 12 of the small, tiny pills a day with your doctor’s approval, of course, but we can’t do that for long periods of time. It’s two weeks maximum and that is a huge amount of load on the body. Just a little bit every day doesn’t do as much as really building it up in the bloodstream over a period of time and that will have a pretty major effect.

There are also some really excellent natural anti-inflammatory tools on the market such as curcumin, or turmeric is anti-inflammatory. It’s nontoxic, it’s safe for pregnancy, you can’t overdose, and then really avoiding the inflammatory foods like tomatoes, red and green bell peppers, all the plants in the nightshade family, peanuts are very inflammatory so kind of going through the foods you’re already eating and ensuring that you’re not eating any of those because those are just building blocks for inflammation. If your body thinks it’s trying to heal itself, those foods can make it worse.

Then, there’s a bunch of foods that are anti-inflammatory so adding them to your diet would be very beneficial and those foods are the onion family – onion, garlic, leek – the Christmas spice family – cinnamon, ginger, nutmeg, cardamom – so these are all – curry spices as well. I’ve been making lots of Indian food and I’m noticing it all has anti-inflammatory properties to it as well. There are so many different options for trying the natural way as well, if people are worried about the side effects of ibuprofen.

 

Neely Quinn: With turmeric it seems like – as a nutritionist, I’ve worked with this quite a bit and it seems like you have to take quite a lot of it in order to really get the effects. Do you have any thoughts on that?

 

Dr. Lisa Erikson: I saw a new study out there. I don’t think it was on turmeric, I think it was on circumin. Isn’t circumin the active ingredient of turmeric? They said that even just sprinkling a little bit on your food in tiny doses had quite a nice effect but I went through that quickly online. It was on www.pubmed.com and I don’t exactly remember what study it was but it seemed to show that it worked pretty well. I just have to go through and look again.

Research is always changing so we always have to go through. I like to tell people, “If you’re going to a major university, go use the different databases. If you go into PubMed you can type in ‘turmeric’ and you can try typing ‘summary’ and the year and it will give you all the research.” Someone so nicely will go in and compile all the research and go through and tell you what it says.

 

Neely Quinn: Yep, it’s nice like that. We are pretty much up with our time. It’s been an hour. It’s been a quick hour. Where can people find you online?

 

Dr. Lisa Erikson: Let’s see. I work here in Boulder. They can find me on my website at www.climbinginjuriessolved.com if they’re looking to book an appointment then www.climbinginjuriessolved.genbook.com but there’s a booking button my website. Then, I am on Facebook as Climbing Injuries Solved and I am on YouTube and Vimeo as The Climbing Doc.

I did not know about Doctor Vagy over in Oregon who has written a wonderful, wonderful book. I know you’re probably familiar with it. He is The Climbing Doctor and I am in no way trying to take over his space. We both just happen to be climbing docs but another excellent resource for people to go to is him as well.

 

Neely Quinn: Yeah, you guys do have – I’ve interviewed Jared on the podcast and we actually distribute his eBook.

 

Dr. Lisa Erikson: Yeah, it’s a great book. I bought it and for all those wishing to work on their forearms and their full body stability, his eBook – I have it and it’s fantastic.

 

Neely Quinn: Then your book – what is it called again?

 

Dr. Lisa Erikson: It’s called Climbing Injuries Solved.

 

Neely Quinn: And once again, where can we find it?

 

Dr. Lisa Erikson: It’s on my website, www.climbinginjuriessolved.com or it’s on eBay or Amazon.

 

Neely Quinn: Okay, cool. Alright, well I think that’s it. You answered quite a bit of questions. I was planning on asking you more details of how to deal with elbow injuries but I think we did some good talking about finger injuries and what to do to prevent and treat those and we got a lot of good information in there.

 

Dr. Lisa Erikson: I’m honored you had me on the podcast today, Neely.

 

Neely Quinn: Yeah, thanks so much. Good luck with the book sales. I hope that all climbers find out about it because we all need to know a lot more about this stuff.

 

Dr. Lisa Erikson: Thank you so much. Just working on that paradigm shift and I’m pretty sure it’s going to happen, so as people start passing the word and showing each other their tools and sharing, as a community, what we’ve learned I think that’s really going to make a difference.

 

Neely Quinn: Yeah, I do too. Well, thanks again, Lisa.

 

Dr. Lisa Erikson: Anytime. Bye, Neely.

 

Neely Quinn: Bye.

Thanks so much for listening to that episode with Lisa Erikson. That was episode 26 and I, as always, am your host Neely Quinn. I got a lot out of that. I mean, I didn’t understand icing very well and it made me think more about doing even more self-care than I have been doing.

I mean, it’s like you think about the Tour de France and other big races for bicyclists. They have massage therapists following them around and chiropractors and whatever else they need because their bodies are being thrashed. We kind of do the same things to ourselves but we don’t have the massage therapists following us around so we’re kind of just thrashed all the time. We could be taking care of ourselves for free with things like the Armaid and other tools. That’s just a good reminder.

Let’s see, what else? Next week – well, I’m trying to get an interview with Nathaniel Coleman and Alex Megos. If you know them give them a little nudge to get back to me. I really want to get in an interview with them. Hopefully those will be coming up soon.

As always, if you guys ever have any suggestions for me just email me at neely@trainingbeta.com. I really take them to heart and I almost always follow up on them and ask people for interviews.

Other than that, I just want to remind you guys that we have training programs for you in case you are struggling to get stronger or struggling to get past the plateau. We have things for route climbers and boulder climbers. ‘Boulder climbers’ – is that really a thing? Boulderers [laughs], and people who want more power endurance, endurance, and people who want more information on nutrition, too, and injury prevention. Definitely check those out at www.trainingbeta.com and they’re up at the ‘Training Programs’ tab at the top.

I think that’s all I’ve got for you guys. It’s July fourth tomorrow and here I am, sitting here doing a podcast but I hope you guys are out doing something fun and that you crush it this weekend. I’ll talk to you soon. Thanks for listening.

 

[music]