About Tyler Nelson

Tyler Nelson has a lot of qualifications, so I’m going to let his website sum those up for you:

Tyler is a second generation chiropractor whose father was a leader in chiropractic sports medicine for many years. In graduate school he did a dual doctorate and masters degree program in exercise science with an emphasis on tendon loading. He completed his masters degree at BYU and was a physician for the athletics department for 4 years out of school. He currently is the owner of Camp4 Human Performance where he treats clients through his license as a chiropractic physician. He also teaches anatomy and physiology at a local college in Utah and is an instructor for the Performance Climbing Coach seminar series and a certified instructor for gobstrong. When he’s not working he’s climbing or hiking outside with his family.  

You can find Tyler in Salt Lake City at his clinic, Camp 4 Human Performance, where he tests athletes, creates training programs, and treats all kinds of athletes for injuries.

I met Tyler at Steve Bechtel’s first Performance Climbing Coach Seminar in Lander in May of 2017, where we were both instructors. Since then I’ve done 4 more seminars and 4 other podcast episodes with him:

• TBP 084: Injury Rehab and Blood Flow Restriction Training
• TBP 098: Isometric Movements to Prime and Test Your Body
• TBP 108: Bood Flow Restriction for Injury Healing and Performance
• TBP 118: Latest Technology for Finger Training and Performance Testing

He is well-spoken and a wealth of knowledge about how the human body responds to climbing and training.

In my 2nd interview with Tyler, he explained how he uses a crane scale to test people’s power output and maximum strength with all kinds of exercises. It’s all about isometric training and testing (pulling on an inanimate object to either gain strength or test your max strength). He wrote 2 articles for us all about that topic:

• Preparing to Try Hard Part 1: Isometric Testing and P.A.P. for Coaches
• Quantifying Isometrics Part 2: Program Auto-Regulation and Its Implications on Finger Training

This time on the podcast, we’re focusing on how to use heavy isometric loading and other uncommon methodologies to heal tendon injuries in climbers. We discuss the most common tendon injuries we get as climbers and what exercises to use to heal them properly. It turns out that light loading, as in most exercises using PT bands, doesn’t usually produce enough stress on the tendon to actually cause it to heal itself. So we have to use heavier loads but with less range of motion so as not to aggravate the injury.

We talk about shoulder, elbow, finger, and a little bit on wrist injuries in this episode, so I hope this helps some of you who are suffering with an injury right now.

Tyler Nelson Interview Details

• Most common tendon injuries in climbers
• Terms of tendon injuries
• How isometric loading can heal tendons
• Shoulder protocol
• Elbow protocol
• Pulley, tendon injuries protocol
• Flexor tendon info

Climbing Training Seminar with Tyler Nelson

If you’re interested in being a student at one of Steve Bechtel’s upcoming Performance Climbing Coach seminars, there’s one scheduled for October 4-6th, 2019 in Murfreesboro, TN and you can find more info on it here.

Tyler also does his own seminars and classes on all different topics, and you can find info about those on his website: Camp4HumanPerformance.com/courses-1

Tyler Nelson Links

• Personal website: camp4humanperformance.com
• Instagram: @c4hp
• Facebook: @camp4chiropractic
• Other Podcast Episodes with Tyler
  • TBP 084: Injury Rehab and Blood Flow Restriction Training
  • TBP 098: Isometric Movements to Prime and Test Your Body
  • TBP 108: Bood Flow Restriction for Injury Healing and Performance
  • TBP 118: Latest Technology for Finger Training and Performance Testing

Training Programs for You

Do you want a well-laid-out, easy-to-follow training program that will get you stronger quickly? Here’s what we have to offer on TrainingBeta. Something for everyone…

• Personal Training Online:  www.trainingbeta.com/mercedes
• For Boulderers: Bouldering Training Program for boulderers of all abilities
• For Route Climbers: Route Climbing Training Program for route climbers of all abilities
• Finger Strength : www.trainingbeta.com/fingers
• All of our training programs: Training Programs Page

Please Review The Podcast on iTunes

Please give the podcast an honest review on iTunes here to help the show reach more curious climbers around the world.

Transcript

Neely Quinn: Welcome to the TrainingBeta podcast where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and I want to remind you that the TrainingBeta podcast is an offshoot of a site that I created called trainingbeta.com. It’s all about training for climbing. 

Over there we have regular blog posts, we have climbing training programs for all different levels and all types of climbing, we have nutrition coaching with myself – I’m a nutritionist – and we also have online personal training with Matt Pincus. You can go to trainingbeta.com and find out more about all of those services and hopefully one or more of them will make you a better climber.

Thanks for joining me for episode 128 of the podcast. The only thing I want to update you on in my own life is I’ll be in Lander, Wyoming for the International Climbers’ Festival in two weeks. It’s the week after the fourth of July. I’ll be doing a clinic with Matt Pincus. We’ll be doing a climbing clinic about projecting and that’ll be on the 11th. That’s Thursday. I’ll also be part of the training panel that’s on Friday, the 12th. That’ll be with a bunch of other trainers and we’ll be answering questions and maybe doing some fun things in there. I hope to see you there. It’s always fun to meet people in person. If you see me and you recognize me, please come up and say, “Hi.”

Today on the podcast I talked with Tyler Nelson, who’s been on the show several other times. That’s because he’s just so cutting edge in his practice that he’s got interesting new things to talk about that nobody else is talking about, at least not in climbing.

Just a little bit on Tyler: he’s a chiropractor and he also did a dual doctorate and master’s degree in exercise science with an emphasis on tendon loading. I tell you that because today we’re talking about tendons and how to heal them. It’s all about loading them.

He also was a physician for the athletics department for four years right out of school at BYU and he currently is the owner of Camp 4 Human Performance in Salt Lake, or near Salt Lake. You can find that @c4hp on Instagram and Facebook. He does some really good stuff over on his Instagram, especially, where he’s showing you exactly what he’s doing in his practice. 

He also teaches anatomy and physiology at a local college in Utah and he’s an instructor for the Performance Climbing Coach seminar series which I’m a part of as well. I get to teach with him around the country a few times a year. You can join us if you’re interested in that. In October we’re going to Murfreesboro and you can find out more about that at performanceclimbingcoach.com.

So, that’s Tyler. I’m not going to try to talk too much about what he is about to explain to you but I will say that we’re going to be talking about the most common tendon injuries in climbers and how to heal them. I hope you enjoy this and I’ll talk to you on the other side. Here’s Tyler.

Neely Quinn: Welcome back to the show, Tyler. Thanks for joining me again.

Dr. Tyler Nelson: Of course. Thanks for having me. It’s always a good time.

Neely Quinn: We could call this ‘The Neely & Tyler Show.’

Dr. Tyler Nelson: I mean, you don’t want to have me on here too much. There’s a lot of interesting people to talk with.

Neely Quinn: [laughs] It’s nice to have you interspersed throughout these episodes though because there’s always some good research you’re doing and always good scientific information. People really appreciate that so thank you.

Dr. Tyler Nelson: Yeah, you bet. Happy to be here. This is another one of those topics that’s kind of confusing for people and the literature is also not confusing, necessarily, but there’s a lot of unknowns about it too so it will be worth people hearing.

Neely Quinn: Alright, so let’s jump in. What are we talking about?

Dr. Tyler Nelson: We’re just going to talk about tendon injuries. We’re going to talk about tendon rehabilitation. We’re going to talk about specifically tendon loading and just some general ideas and give people some guidance about what they can do when they have pain in one of their tendons.

Neely Quinn: Okay. I think that there are some tendons that people don’t even know are tendons, especially in the shoulder. Why don’t we first talk about the most commonly injured ones among climbers?

Dr. Tyler Nelson: The most commonly injured tendon, probably – it’s hard to say for climbers. People want to think fingers but generally the fingers get injured in the pulleys, which are made of a similar material but they’re not considered tendons proper because they don’t attach muscle to bone. They attach bone to bone or they attach a tendon towards a bone. I would say the most commonly injured tendon in climbers in the upper extremity would be in the shoulder. It would either be the supraspinatus tendon or it would be the proximal biceps long head tendon.

Neely Quinn: And the supraspinatus is one of the rotator cuff tendons, right?

Dr. Tyler Nelson: It’s one of four rotator cuff tendons, right. The one that lives kind of on top of the scapula.

Neely Quinn: And that’s the most commonly injured one in climbers?

Dr. Tyler Nelson: Probably. It’s probably that, at least what I see. Probably that or the proximal biceps tendon and the tricky thing about those two is they live pretty close to each other and so they often present with similar types of symptoms, which would be that anterior tip-of-the-shoulder pain.

Neely Quinn: Can you name the other rotator cuff – oh wait, hold on. You had mentioned the biceps tendon and I was going to say the biceps tendon is in the front of the shoulder and that’s usually what’s involved in impingement, right?

Dr. Tyler Nelson: I don’t really use the term ‘impingement’ a whole lot anymore. That’s kind of a term that’s out of vogue in terms of describing tendon pain in the shoulder but they live in a common location. Now we understand that every time we lift our arm overhead there’s some sort of compression under that bone that lives out there called the AC joint and the tendons, so the term ‘impingement’ happens all the time during a normal loading cycle. We can’t really use that as the cause, so to speak, of someone having anterior shoulder pain.

The other location that I just thought of that I see a lot of, obviously, is the inside and outside of the elbow or on the front of the elbow in climbers, in terms of tendon pathology.

Neely Quinn: What are those tendons?

Dr. Tyler Nelson: On the inside of the elbow is what’s called the common flexor tendon and on the outside of the elbow is the common extensor tendon. Those are also known as golfer’s and tennis elbow. That’s really common in climbers as well.

Neely Quinn: Okay, so it’s the rotator cuff/the front of the shoulder, which is also the biceps tendon which is connected to the labrum, right?

Dr. Tyler Nelson: True.

Neely Quinn: So what is the labrum considered?

Dr. Tyler Nelson: The labrum is just a piece of connective tissue that lives around a little socket in the scapula called the glenoid. It’s designed to create more depth to that socket because the socket is relatively shallow and it’s concave, meaning that it has a concavity inside of it, and then it points outward. The labrum gives quite a bit of depth to that concavity so the head of the arm bone fits tightly inside that joint. The rotator cuff in general is designed to pull the head of the arm bone in toward that cavity and create a negative pressure to create ‘stability’ inside that joint for range of motion movements.

Neely Quinn: Okay, so we’re never talking about the labrum, we’re just talking about the tendons around it, basically.

Dr. Tyler Nelson: Well, it’s very hard to differentiate without advanced imaging and sometimes it’s not necessary to differentiate – any time you have proximal biceps pain it’s very common to have it associated with the labrum. That doesn’t mean there’s always tears of the labrum but it’s very hard to differentiate clinically without advanced imaging but that is in fact something that happens quite frequently and I see that a lot in climbers. However, there are also a lot of climbers that have those pathologies that don’t have pain, either, so it’s a tricky business always blaming things on images for peoples’ symptoms. The symptoms and the actual image don’t always go together very well so it’s confusing.

Neely Quinn: That’s what my surgeon said, too, is that most people who have labral tears don’t have pain. I guess my question is: can you look on an MRI and see that I have a torn supraspinatus tendon and not have pain? Does that happen?

Dr. Tyler Nelson: It happens quite frequently. Most of the time it’s not cost effective to image both sides with an MRI but let’s say you have an MRI scan on one side and then you also scan the other side. It’s very common to have a similar pathology on the other side with no symptoms.

Neely Quinn: That’s crazy.

Dr. Tyler Nelson: I see both. I see labral tears where people don’t hurt and then I also see labral tears where people hurt a lot and they need more advanced interventions. Recently I’ve seen a shoulder labrum injury that was advanced to the point where it was suggested that we just load this shoulder until the biceps tendon became unattached from the labrum and then that individual did not have to have surgery.

Neely Quinn: Woah. That’s what they recommended? How did you load it?

Dr. Tyler Nelson: Just doing high intensity loading, just climbing. It was about a ⅔ thickness detachment of the tendon from the labrum so it was hanging on by some threads more or less. The options are: go in there and do a surgical intervention where they would detach the biceps tendon from the labrum and then they usually pin the labrum to the arm bone. They put it in there and they attach it higher up. They don’t actually attach it to the labrum. They used to but they changed the procedure.

Neely Quinn: That’s what I had done, the tenodesis.

Dr. Tyler Nelson: The other option is to just let it tear and to just let it lower into the arm and then those cells will die and your body will reabsorb it and then that individual will lose maybe 5-7% – I think that’s around the range of the number – of strength in the biceps muscle itself.

Neely Quinn: But this is extreme.

Dr. Tyler Nelson: The good thing about talking about imaging and people’s symptoms is even though people have these symptoms and these MRI findings, rehabilitation is still 90% the way to go in terms of healing tendon pain or helping tendons become more robust and helping tendons be resilient while people work through their symptoms. The whole point of even mentioning that is to promote the idea because I see lots of people who have surgical interventions or I get a surgical consult on a lot of patients and the surgeons will send them back and say, “This is something that we think can be rehabilitated.” I see that way more than I see people wanting to get cut.

People need to understand that, too, because a lot of people get freaked out when they hear, “I’m going to refer you to a surgeon,” and they think that surgeons are these physicians that just like to cut into people and that’s not the case at all. Surgeons want to do as little surgery as they can on people because they care about their patients just like everyone else.

Neely Quinn: This is encouraging. It’s true that some doctors say that you should try to go get it rehabilitated but there are still a lot of doctors out there who are like, ‘Something is torn or partially torn and we need to do surgery.’ Then I get these emails from people who are like, ‘Look at what my doctor told me! I need to have surgery,’ and blah blah blah and they’re all freaked out. It is good, I think, for them to hear that there are other options for them to rehabilitate the tendon.

Dr. Tyler Nelson: Yeah, and if we’re referring to the shoulder in general, there’s lots of papers on double blind studies where they have individuals do rehabilitation and then they have other individuals do nothing and then they have a third group do at-home programs with intensity loading and education. Most of the time over 50% of those people don’t get surgery so there’s lots of benefits of doing a good, long, 5-7 month high intensity rehabilitation program before you get surgery. That’s kind of why I was interested in talking about loading intensity for tendons because a lot of times, clinically, people don’t get enough load on their tendons. By load I’m referring to the intensity of that load, not necessarily how much volume they have but literally the intensity is underestimated a lot of the time.

Neely Quinn: What do you mean?

Dr. Tyler Nelson: Just the intensity. A lot of times I’ll have people come in with injuries to the shoulder or elbow injuries and we’ll test them, have them pull with both arms individually. Most of the time there’s very little difference side-to-side in load tolerance without pain which means when people have injuries they want to really baby the injury and they want to do things that are of such low intensity because they’re scared to load the tendon. In general, for tendon pathology, it limits performance. It doesn’t necessarily limit participation in the sport but it certainly limits an athlete’s performance in that sport. They don’t feel as springy, they don’t feel as resilient, and promoting those ideas into individuals with tendon pain is a really important function of rehab.

Neely Quinn: So I guess just to cover the scope of what we’re going to be talking about, people out there listening to this are probably on a spectrum of injuries, right? Some of them are hoping that they can rehab and some of them are not. Are there any that we should just rule out right now? Like, ‘You can’t rehab this you should just go get surgery.’

Dr. Tyler Nelson: Oh geez, that’s a really hard call. I don’t know that anyone could give a good answer to that question because there’s a large spectrum of injuries that would even be considered surgical consultations. I don’t see a lot of success in people with impingement types of symptoms. With labral impingement in the hip I don’t see good clinical response with rehabilitation in those cases. I don’t see good rehabilitation clinically from people with disc extrusions. Those, I think, respond really good for people that have leg pain and arm pain and those respond good for people who have discectomies. I think those are good surgical procedures but it’s such a big spectrum and it really just depends on your symptoms. 

There are people walking around with some really, really dramatic looking images and they have very little symptoms so those are very difficult questions to give good answers to. I would say to always seek the attention of someone who is a healthcare provider but I also tell people to not just sit around and wait. If it’s something that’s not a big deal, it’s better to know it’s not a big deal and what to do than maybe kind of loading it but not really loading it because as soon as you stop loading your tendons they start losing their capacity so making sure you have a diagnosis very quickly makes a lot of sense as well.

Neely Quinn: So when in doubt, go to a surgeon and get a diagnosis.

Dr. Tyler Nelson: Not even a surgeon. Go to a PT or a chiro or an ATC, someone who understands and that can give you a diagnosis or if need be, they can get you imaging.

Neely Quinn: Right. On that note, I went to PT for months before I had surgery on both of my shoulders, right? It didn’t actually do anything for me. I’m wondering if I had gone to you if it would have been different because I know that your practices are a little bit different. I’m wondering if you can explain how what we’re going to talk about is different than what you might see from a typical conventional physical therapist or something.

Dr. Tyler Nelson: What was your diagnosis, ultimately? Did you have a labral tear?

Neely Quinn: Yeah, a labral tear and a fraying biceps tendon and bone spurs.

Dr. Tyler Nelson: Do you remember the extent of the tendon fraying? Was it ⅓ thickness? A couple millimeters?

Neely Quinn: I think it was just fraying. I don’t even know that they said the millimeters or anything. It was just mostly that I had a bone spur that was causing a lot of pain and then the labral tear was making it unstable.

Dr. Tyler Nelson: The bone spur is a pretty easy solution to fix. A lot of people will go in there and they’ll just shave it down and that’s a much less dramatic intervention than doing a reattachment, a tenodesis of your tendon. What did they do for you in terms of physical therapy?

Neely Quinn: Just some band work and some needling and that’s basically it.

Dr. Tyler Nelson: So therein lies the interesting thing behind the types of loads that people would do on a tendon. It’s really hard to know based on your symptoms now because you have less pain in your shoulder now and it seems like your shoulder surgery was successful. It’s hard to gauge that clinically but in general, when I see those types of clients in my office – and I see fairly frequently – I start right away with taking them through a testing protocol where I would make sure that they have an understanding and I have an understanding of the load tolerance of that shoulder at that given time. 

The one benefit of isolating movements like elbow flexion or shoulder flexion would be to literally try and over stress the biceps tendon, the supraspinatus tendon, and the internal rotators. The internal rotators are a little harder to understand the capacity of because there are some really big muscles that do that movement aside from the one rotator cuff muscle that does it, the subscapularis, but I would individually go through and use the strain gauge to measure each of those muscle’s capacity and then I would make a comparison and an analysis based on the opposite side. Then we would start loading your tendon.

The downside of using something like this and exercise bands is you can’t get the intensity right. It’s very hard to overload someone that’s fit, as you are, like a rock climber with exercise bands. A lot of the interventions that we use for the shoulder are designed to try and strengthen specific tendons but that’s definitely not enough load for an individual. For example, I’m a big fan of using isometrics to start rehabilitation programs with. That’s just a good way to do static types of loading but also increase the intensity very high. For example, a recent shoulder injury similar to yours, proximal biceps tendinosis and some fraying as well. We have this small young female who weighs maybe 115 pounds loading with two arms at the same time on a bar with +90 pounds added to her body doing types of muscle contractions that really cause mechanical strain to the tendon.

Neely Quinn: Wait, actual pull-ups? Not isometric…

Dr. Tyler Nelson: No, she was doing isometrics. She would do two-position isometrics and in general, the science would say the longer the larger joint angle isometrics create more mechanical strain to the tendon – so definitely having her do a bunch of different positions, loading the tendon with really high intensity.

Neely Quinn: That’s really interesting because pull-ups were basically impossible for me for a while, but it was the range of motion. I feel like if I had just done isometrics to strengthen everything, that would have been a completely different story.

Dr. Tyler Nelson: One of the things that we want to look at when we’re doing tendon rehabilitation is trying to stay pain free for a period of time. It kind of makes sense. There’s always a way that you can find to load someone where they don’t have pain. Clinicians can be really creative with how they do that but that’s really important to get people to convince their brain that they can load a body part without it hurting. Every time you load a body part and it hurts you’re essentially creating this big groove in your nervous system and in the cells in your brain that wire this movement to pain. Every time you exercise it’s very likely that you’re going to have pain. Finding a way to load a body part without having pain is a real important priority in the acute stages of loading. Isometrics work really well for that but that’s not the only way you can load tendons at a high tensity that can be pain free, but I’ve had better experience with that than the heavy resistance controlled concentric/eccentric because [unclear] for pain complaints.

The tricky thing for a shoulder, for a labrum or a proximal biceps injury, is that end range flexion position when you’re doing a pull-up. When you’re putting your chin over the bar that tends to be really provocative for shoulder pain on the front side, as does doing a push-up all the way to the floor.

Neely Quinn: Yeah, exactly. Push-ups were impossible, too.

Dr. Tyler Nelson: Those positions tend to hurt.

Neely Quinn: I have a question: when you say you’re using a strain gauge and you’re doing the isometrics – and for anybody who hasn’t listened to your stuff before, you’re basically pulling on something that is not going to move. It’s on a chain and there’s a strain gauge between the foundation of it and the actual bar. You can see how hard you’re pulling.

My question is: would you say to them, “I want you to pull this hard and no harder,” or is it just max pulls?

Dr. Tyler Nelson: I usually have them do something to warm up and I’ll have them do some bodyweight isometrics movement, like hanging on a bar, holding a dumbbell. Depending on the body part we’ll have them warm-up pain free and then I’ll cue them to pull up to their tolerance level, like, “I want you to pull but if it hurts you to pull then don’t pull anymore. I just want you to hit that limit, that threshold.” 

Most of the time, people get really close side-by-side. They’ll maybe have a little bit of difference and you’ll say, “Was that difference because you stopped or because you had too much pain?” Most of the time they’ll say, “It kind of felt like I was apprehensive there so I didn’t pull any harder.” Most of the time it’s within 80-85% of the opposite side which is initially a really good eye-opening, motivating experience for a patient because when people have pain – and anyone that’s had pain understands that – you feel really fragile. Feeling fragile as an athlete is something that’s really hard on your psyche and it’s very depressing. That’s a really, really important component of people’s experience with pain. If we can just address that right out of the gate and say, “Wow. Look how much tolerance you still have,” and be positive and reinforcing with our language, that’s a good place to start doing rehab.

Neely Quinn: Yeah. Question about the mechanics of this: when we think of doing isometrics or any sort of strength training we think of strengthening our muscles but we don’t usually talk about strengthening our tendons. When you’re talking about this I’m assuming the purpose of it is to strengthen the tendons.

Dr. Tyler Nelson: Absolutely. You have to have strong muscles to have strong tendons because you have to have the ability of using a large percentage of your muscles in a specific group to pull on the tendon. The tendons are just extensions of the connective tissue wrapping around each muscle fiber.

Neely Quinn: If a person has an MRI and their tendon is ⅓ or ⅔ torn, how is strengthening it going to make that better? Can you heal the tendon back together?

Dr. Tyler Nelson: There’s some compelling new interesting science that’s come out about loading tendons that show – that’s the whole point of people doing these PRP injections or doing new stem cell injections, to try and promote tendon scarring down. It happens and it’s not very common to have and that’s kind of [unclear] this individual’s case I was talking about. If someone has that much fraying of a tendon, the likelihood that that tendon is going to become robust and thick again is probably not very likely but that’s also not very common. 

When you have pain in your shoulder or your elbow you feel like there’s so much tissue that’s disrupted but most of the time, with long term tendon injuries like in the Achilles or the patellar tendon, when we do ultrasound exams on these or they do MRIs, they still find 85+% healthy tissue there. Most of the time with people’s tendon pathology there’s lots and lots of healthy tissue that we’re trying to address with loading. The more we can continue to load that tendon and treat that tendon as if it’s healthy and create more capacity there, we’re going to have a long athletic career. 85-90% of a healthy tendon is still plenty of tendon to overcome the loads that we apply in sports.

Neely Quinn: So just to clarify, it sounds like what you’re trying to do is make sure that the rest of the tendon that isn’t frayed or severed is really healthy so that it can maybe compensate for the damaged parts. And, there is a possibility to actually heal the tendon back together using PRP, platelet rich – what is is called?

Dr. Tyler Nelson: It’s called platelet rich plasma. It’s interesting science and it’s not really conclusive. Some people get a really good response but other people get no response so there’s a lot of interest in that as well as stem cells and tendon health. I would say right now the research would unequivocally say loading and high intensity loading is just as effective as doing those other types of biologic interventions.

Neely Quinn: Wow. That’s crazy!

Dr. Tyler Nelson: Yeah, the PRP literature is very interesting and it appeals to people and it seems very science-y and it’s really expensive and it’s something that’s not covered by insurance, but I would always suggest people do a good trial of therapy with some high intensity loading before they spend money on that. I think most physicians that actually do that would also suggest that. I have a couple good relationships with orthopedic doctors here locally and whenever I send someone to get an opinion surgically, they’ll always ask about the loading history and whether the loading magnitude has been sufficient enough to actually help the tendon heal as well as for the patient to overcome their fear of moving it.

Neely Quinn: I think you’re working with really good doctors over there because that’s not a question that I’ve ever heard any doctor ask of anybody. 

Dr. Tyler Nelson: I have a pretty good network of some local sports med guys that are young as well that are interested in research papers. Having that communication is really important because a lot of orthopedic surgeons wouldn’t expect someone with my training as a chiropractor to understand all of those types of interventions because that’s not what you learn in chiropractic school. That’s coming from my master’s degree and spending some time working at a couple colleges. Having that open conversation, though, is really important.

Neely Quinn: But honestly, I don’t even know anybody in Boulder who does what you do and this is one of the most progressive health cities that I know of. Who else is doing this kind of thing? Who knows about isometric loading for tendon health?

Dr. Tyler Nelson: I would be surprised if people didn’t know about it and weren’t applying it. I’m not really sure. I don’t know many physicians in Boulder. I talk with Natasha a lot and we always talk about loading and she’s a big proponent of it as well. I’m not really sure of other physicians close by. I do know that one of my clients went to one of the orthopods in that area and he pretty much just said, “You’re screwed. You can’t climb hard anymore,” so we took this individual and did a bunch of other types of interventions. We did lots BFR with him and lots of high intensity loading and for 5-6 months he did no climbing. Just recently, a month ago, he sent his project outside, 5.14 level sport climbing.

Neely Quinn: What was his diagnosis?

Dr. Tyler Nelson: He had tendinosis in his elbow and I forget the exact percentage but he had maybe 40% of the flexor or extensor tendon but it was a pretty significant tear in his tendon and he sought orthopedic consultation and an MRI. The orthopedic physician just said, “This is pretty bad. I don’t think you’re ever going to climb at the level you did before,” so that’s when he reached out to me. We did a bunch of rehab and a couple different programs and he’s so psyched. Maybe you ran into him when we were at the PCC. He specifically drove to Whetstone Climbing just to give me a hug and say hi and to chit chat. He sent his project just recently so it was a really cool story.

Neely Quinn: That’s awesome. 

Dr. Tyler Nelson: It doesn’t always work that great. Individuals all have many other factors that cause things and that’s another really important thing for people to understand: all the psychosocial stress in your life, all the intrinsic stressors in your life that are really hard to understand, they really are significant in terms of the pathology of an injury like a tendon injury and the pain that people experience. Having someone that understands the multi-factorial nature of a pain experience is really important because pain is so much more dramatic than the actual extent of people’s injuries. The door swings both ways. You can have very little injury and lots of pain and you can have dramatic injuries and no pain so pain is really tricky.

He’s a really cool example and there’s a video and a write-up of him on my Instagram account about that. It was really cool.

Neely Quinn: Okay. What’s his name? Or does it say on the write-up? 

Dr. Tyler Nelson: It says his name. His name is Jimmy.

Neely Quinn: I feel like I’ve sort of hijacked this conversation a little bit. There were some things that you wanted to talk about. Are there things that you wanted to cover that we haven’t gotten to yet?

Dr. Tyler Nelson: That’s fine to hijack it. I think maybe you have a non-clinician’s perspective on what people want. The one thing I was going to mention was the descriptors of how people describe tendon pathology, classically. Like the term tendonitis and tendinopathy. Really, they’re referring to similar things but the ‘itis’ of the name implies that there’s lots of inflammation and the research has kind of swung both ways. In the 90s the literature came out and said that there’s no [unclear] this is all a degenerative condition and recently there’s been some science saying that we just have really crappy ways of measuring the tendonitis but there’s still some inflammatory condition. 

In general, the ‘itis’ part of the name, when people use that, refers to passive types of interventions as being the therapeutic effect such as icing it and using [unclear] and ibuprofen and doing other types of soft tissue intervention types of things to help the tendon to heal. We know those things can be helpful for people but the effect and the reason they’re helpful for people is probably not the reason why they think it’s helping. They can be helpful but the real effect is with the loading so we always want to prioritize high magnitude loading of tendons at a high frequency at a really low volume. If clinicians do other types of passive interventions to help people reduce their pain and to provide psychosocial support and contextual challenges, I think that stuff is fine as long as they understand that the real effect is coming from the magnitude of the loading. That’s really important for people to understand.

Neely Quinn: Okay, so do you think this is the kind of thing when people walk away from listening to this podcast they could go and start helping themselves? Or do you think this is something that you definitely need supervision to do?

Dr. Tyler Nelson: For sure, I think there’s lots of self application that I think people can do. I consulted with someone on the phone yesterday about a finger injury. The finger is really sore, acute mechanism that was a month old and then it got really pissed off recently, and yesterday I was like, ‘Go hang on a hangboard and see if you can load your tendons in an open hand position.’ At first people are like, ‘What? You want me to go hang on my injured finger?’ I say, “I want to see the load tolerance of that finger,” because even with acute injuries like that it’s really good to start loading them to tolerance because as soon as we stop loading the tendon, we lose the capacity in that tendon. 

A cool quote that I like to use is, “The capacity of your tendon is right above the load that you put on it.” If you don’t put a lot of load on your tendons, you don’t have very much capacity. If you can load your tendons up to its limit right now or push a little bit more, you slowly increase the capacity of that tendon. People want to always think about that if they have some shoulder injuries. 

People also get very concerned about restricting ranges of motion because there’s this idea that if we don’t exercise something through it’s full range of motion we’re going to somehow become less coordinated or less strong through that range of motion. That makes zero sense but reducing the range of motion during a painful episode makes tons of sense because the brain is wired for that full range of motion. If we change the context by reducing the range of motion and we maintain [unclear], that’s a completely different experience on the brain but it’s still enough high magnitude loading for the tendon.

Neely Quinn: It’s a different experience on the brain meaning it’s a better experience on the brain, in this case?

Dr. Tyler Nelson: Meaning that every time you do a pull-up for the most part your brain has a network of cells that get lit up that create that movement. If we have new pain with that movement and we keep doing pull-ups and we hurt every time that we do them, we’re essentially linking this idea of pain to this movement experience and the cells that do this movement to pain. Every time you do it you expect it to hurt so it’s going to hurt before you even actually do the pull-up whereas if we modify the movement and we still increase the intensity, that’s just contextually a very different experience. There is lots of new science coming out to support that as a very good intervention to do and making sure people understand that’s why we’re doing it is very helpful for people’s pain complaints, in a conservative way. 

Neely Quinn: It’s like a workaround for the brain.

Dr. Tyler Nelson: Yeah, for sure, a great workaround for the brain. It works great for the elbow and it works really good for the shoulder because climbers are so strong in the upper extremity, if you take someone that has a proximal biceps injury – I had one athlete who’s a really high level athlete and he was doing one-pound curls with a dumbbell or something ridiculous and he climbs like V12. I was like, ‘This is a complete waste of our time, let’s start loading you and start adding intensity.’ We had him doing one-arm hangs on a bar, pain free. Making sure that people understand that even if they have pain and the pain feels really dramatic, that doesn’t necessarily mean that it’s a good idea to totally back off all the time and not continue to load your body part.

Neely Quinn: Okay. I think that, for the sake of giving people some useful information, I would like to go through the most common injuries and what people can do for them, starting with the supraspinatus if you’re willing to do that.

Dr. Tyler Nelson: Yeah, we can do supraspinatus and combine anterior proximal long head, too, because they present very similar in terms of pain complaints. The primary method that you would engage the supraspinatus is in the initial stages of abduction. You could do it as simple as taking a dumbbell and starting with a five-pound dumbbell, depending on the individual, and have them lift their arm out to the side and up to the range of motion they have without pain.

Neely Quinn: This is for supraspinatus or for the elbow?

Dr. Tyler Nelson: This would be for supraspinatus. Let’s say they can lift it up 15 or 20° with five pounds without pain. Great. Let’s say they can go all the way to 90° without pain and then we add more load. We give them a 10-pound weight and say they can only go 50° abduction without pain and then it starts to hurt. Okay, great, we’re going to drop it to 45° and we’re going to add another five pounds. Grab a 15-pound dumbbell and they can lift a 15-pound dumbbell out to the side. It feels pretty hard but it’s pain free. Great. That’s a really good starting point for that individual to start loading their tendon.

The concept of micro-dosing tendons is also becoming popular in the literature. Micro-dosing is essentially applying a high frequency load but doing it at a very low volume but doing it a lot during the day. You could take that 15-pound dumbbell to work – let’s say a 10-pound dumbbell because 15 is kind of heavy to do abduction with in that range. So a 10-pound dumbbell and you’re going to do 10 of those movements every couple hours throughout the day. Really what you’re doing is you’re applying a load to the tendon and then you’re setting the weight down and you’re letting the tendon adapt. 

Every time you compress a tendon, you pull a tendon and you put tensile load on a tendon, you push water out of the tendon and then every time you release a contraction you suck water back into the tendon. Creating this hydraulic mechanism is really the only way that your tendons get nutrition and remove waste from themselves. Doing that at a high frequency throughout the day makes a lot of sense. 

Then we educate the person and say, “Great. You were doing it with a 10-pound dumbbell. I want you to increase that load whenever you feel like you can,” so in a couple days they’re going to start using a 15-pound dumbbell. We say, “As soon as you feel like you can move in a bigger range of motion, start moving in a bigger range of motion. Do it with your eyes closed, do it faster, do it slower,” etcetera. There’s all sorts of things you can change about that movement that make people hurt less and it doesn’t really matter, one better than the other, having the options and the variability is really helpful. That’s one exercise you could do for the supraspinatus tendon.

You could also have them do one-arm bar hangs, again because the rotator cuff is designed to create force on the head of the arm bone to pull it close into the socket. Even doing a high intensity load where you’re just hanging from a bar is also a really good exercise to do.

The other exercise that I really enjoy doing with athletes is doing a farmer’s carry but not actually carrying something, just lifted off the squat rack like if you have a barbell down at your side however long your arms are and you’re just lifting the bar up and holding it for a couple seconds as an isometric. That also is a really high load stress to the supraspinatus that works really good for confronting pain.

Neely Quinn: You mean like basically getting into a deadlift position without weight?

Dr. Tyler Nelson: You can do a deadlift. A deadlift would be great, too, but I would not even do a deadlift, they’re just standing vertical with their arms at their side.

Neely Quinn: Oh, with a dumbbell.

Dr. Tyler Nelson: And just bending their knees a little bit, with a dumbbell or a heavy barbell, to lift it off the squat rack. The intensity has got to be pretty high.

Neely Quinn: How many?

Dr. Tyler Nelson: It depends on the athlete. For me, I would probably use whatever they could tolerate without pain, maybe 160 pounds or something, so a lot of weight.

Neely Quinn: A 160-pound dumbbell?

Dr. Tyler Nelson: No, I wouldn’t use a dumbbell in that case. I would use a barbell with plates on it. That’s when loading becomes annoying with dumbbells because load needs to be of high magnitude in line with how strong the individual is. For females I obviously wouldn’t do 160 pounds but I would try and load maybe their bodyweight or 80% of their bodyweight and in that position, have them lift it up. Most people will hesitate. 

That’s one thing that I really enjoy about testing people is because athletes that are injured – I hear this all the time when I test people’s pulling strength. They’re like, ‘Oh, you’re going to be really unimpressed with how weak I am on this side.’ 

I had a 112-pound female the other day and her estimated hang load with two arms on a bar isometrically was like 120 pounds. It was over her body weight so both arms summed together was over her body weight so she had a strength-to-weight ratio of like 2.1. She was like, ‘Oh my gosh. I’m not that strong.’ I was like, ‘Well let’s try it.’ For her, if you’re that strong I’ll have you load one arm because it’s annoying to add that much load to your body physically to do two arms but just to show her she could do it, we did it. We loaded that much weight to her body and she totally hung on that weight and she was like, ‘Wow.’ 

That’s a really eye-opening experience for people, to be like, ‘Wow. I really want to make sure I get the load right. If I don’t get the load right with my tendon I’m really just spinning my wheels. I’m not creating that adaptation.’ Athletes that are trained have a tensile loading history and we’ve got to get them up high. We’ve got to get that load above 80% to really make any change.

Neely Quinn: What you’re describing now is with barbells and dumbbells but it seems like it would be much more convenient to do this with an isometric set up with a chain and a strain gauge.

Dr. Tyler Nelson: The strain gauge can be helpful just for the measurements but most people don’t have those or scales so I say you can do it as simple as grab onto something and pull really hard. If that something is not going to move then that’s okay. You’d better be pulling hard as well. You’d better be trying hard.

That’s one example of lots of different ways that you can stress joints. A lot of people know about the eccentric overload type of protocol and that was very popular in the 90s by a guy by the name of Alfredson, who’s the researcher there. People will take a weight and they’ll lower it under a load and that is also a good way to strain your tendon, but it’s super annoying to do. They’ve created all these crazy apparatus, especially for the supraspinatus. 

I did my master’s thesis on tendon pathology so I’ve actually done this protocol in the lab where you would actually hook a pulley system overhead and you would hook a wristband to your wrist and you would pull with the other arm to get the arm into abduction and then you would release the pulley and you would lower it down to the side to specifically do eccentric lowering. We know that eccentric lowering is a way to stress the tendon but now we have new research that’s come out that says it doesn’t matter if you just do the eccentrics or the eccentrics and the concentrics, the whole point is to make sure that the load is appropriate. If the load is not high enough you’re wasting your time.

People joke with me and say that I talk trash on stretchy bands and rubberbands but that’s not necessarily the case because I think sometimes those things can be helpful for the contextual changes for pain related complaints, post-surgical and whatnot, but usually for athletes that are fit, it’s not enough stress. It’s not enough load to their tissues.

Neely Quinn: Okay, and that was my experience with it too, for sure. 

Dr. Tyler Nelson: There’s tons of different types of interventions on my account, too, that people can look at if people are confused by the description of the exercises.

Neely Quinn: On your Instagram account @c4hp?

Dr. Tyler Nelson: Yeah, there’s quite a few exercises on there.

Neely Quinn: Can we go through elbow stuff?

Dr. Tyler Nelson: Sweet, and nerve shots. Did you see my last nerve shot video?

Neely Quinn: No, but tell me all about it.

Dr. Tyler Nelson: You should watch it. It’s really not that cool but my wife – spouses are so good because they’re so honest with you. I was doing this one shot, this one angle of the camera, in these walk-by shots and my wife eventually was like, ‘I’m so sick of those shots. You need to get over it.’ I was like, ‘Alright, that’s cool. That’s honest. I’ll stop doing it,’ so I made a video of the culmination of those shots. [laughs] It’s pretty funny.

You’d be surprised that the elbow is not that different in terms of loading the shoulder. Things that aggravate the elbow are very similar to things that aggravate the shoulder. Full flexion of the elbow, so your hand all the way to your shoulder, is a pretty provocative position for the elbow. Lots of lock-off training like the top part of a pull-up or holding that position campusing is also pretty provocative for the elbow, both the inside and the outside of the elbow, more so on the inside of the elbow. People with elbow pain, I have them do a very similar protocol or the exact same protocol in some cases where the goal is to load at a really high intensity.

One of the things I would add that I didn’t talk about already would be doing a hammer curl isometric. You would take a heavy dumbbell, probably a 35-pound dumbbell for a male and maybe a 25-pound dumbbell for a female, thumb up, and you would grab it and bend your arm to 90° and you would hold it there for 3-5 seconds. Or, you could do repetitions from extension to 90° to fatigue there. With [unclear] we want to make sure the volume is pretty low. The goal with the tendon loading is to not take muscles to failure or fatigue unless you’re doing something super low intensity like BFR. In general, we want the intensity to be really high and we want the rest to be really good and we want the frequency throughout the day to be relatively high as well.

Neely Quinn: So again, 10 of those and then you just do it every hour or something?

Dr. Tyler Nelson: Yep. You could do it every couple hours or you could do four different exercises. I’m a big fan of doing different positions on a bar like a regular pull-up at 120, regular pull-up at 90°, and then switching the shoulder position to do a neutral grip where the palms are facing each other at 120 and 90°, then doing something with your arms at your side, lifting really heavy, then doing something with the elbow flexed. If people think about the movement, the hammer curl isometric is the exact same thing more or less as the 90° position neutral grip pull-up isometric.

Neely Quinn: Can you say that one more time?

Dr. Tyler Nelson: If you’re hanging on a bar with a neutral grip, so your palms are facing each other, you’re getting the biceps and the brachioradialis tendons pretty good and you’re putting a pretty high load to the shoulder. If you were doing a hammer curl, your hand is in the same position and that pretty much is the same thing. It’s the same movement position. The cool thing about a bar isometric for shoulders and elbows is every gym has a pull-up bar. Most people’s work nowadays has a gym with a pull-up bar and climbers like pulling and holding so that’s a very applicable rehabilitation intervention for shoulders and elbows and even sometimes wrists for rock climbers. 

Neely Quinn: Oh, okay.

Dr. Tyler Nelson: Which works nice.

Neely Quinn: I had a question about pushing. We were talking about how push-ups can be really provocative for pain, for I’m assuming both elbow and shoulder stuff. Would you ever have anybody sit in different angles of a plank position to get at that? 

Dr. Tyler Nelson: A plank would be okay. The downside of a plank is most people that I test that are climbing athletes, push-ups are just too low of an intensity still. We talked about this at the last conference I did at The Front here. The estimated percentage of bodyweight for a push-up is about 60% of someone’s bodyweight so if I’m doing a push-up at 90°, I’m only applying about 60% of my bodyweight to my upper extremity through the pressing motion. Then we calculated my one-repetition max and that percentage. A push-up for me is about 30% of my intensity which is way below the intensity that would be sufficient enough for my tendons to actually adapt at all. 

Most of the time I have athletes do a bench press isometric where they’re really just pushing against the pins of a squat rack or load up the bar to their bodyweight, usually, and lifting the bar off the bench press platform and hold it for a couple seconds.

Neely Quinn: Okay, so they are actually pushing it up so their arms are straight?

Dr. Tyler Nelson: Nope, their arms don’t even go straight. They just try and hold that position and just lift it up. You can do a couple different positions but you could also do the full lockout as well, right? There’s lots of variation. Like a handstand, for example, is no different than an overhead press holding it over your head but most people would be terrified to hold their bodyweight over their head unless they have experience doing it. Essentially, it’s the same thing. The push as well, if you’re doing a bench press, you should be able to bench press your bodyweight. Most people should be able to do their bodyweight and those that haven’t done that probably should work that into their framework because horizontal pressing is a huge movement of strength for rock climbing.

Neely Quinn: Horizontal pressing meaning handstands or push presses/shoulder presses?

Dr. Tyler Nelson: Specifically a bench press, yeah. An overhead press would be a handstand and I think the handstand would probably be a useful function as well but it’s more like a coordinated thing. It requires some skill practice to do a good handstand but being able to horizontally press – because we don’t press overhead that much in climbing but we definitely are squeezing a lot when we’re climbing – that’s essentially a bench press function. For the horizontal press movement, because I think that’s important, too, for shoulder tendon pain I use a bench press. That’s more or less what I’m saying, over a push-up.

Neely Quinn: Okay. I wonder, though, because I’ve had so much success with handstands helping my shoulders after my last surgery and I never really thought about it but it is just an isometric press.

Dr. Tyler Nelson: Yeah, it’s just holding your bodyweight overhead more or less, upside down. The difference is it’s much safer feeling, right? Holding your bodyweight over your head is way scarier than doing a handstand because if you do a handstand and you fail, you just fall over. If you fail holding your bodyweight over your head you’re going to have a barbell that you’re going to have to get out of the way of.

Neely Quinn: Yeah, like a Strong Man competition. No thank you.

Dr. Tyler Nelson: And the difference as well is when you’re doing a handstand you’re essentially just trying to balance. I’m not sure if it’s been evaluated. I’ll have to look because I’m kind of curious now. It makes sense that it’s the same thing but maybe there’s different muscle forces. I’d have to think about it a little more but it seems like it would be the same thing.

Neely Quinn: So that’s shoulders and elbows. Oh, that’s all we were going to do because you don’t really deal with vary many actual tendons in the finger injuries.

Dr. Tyler Nelson: I think with the injuries in the fingers you would apply the same principles, right? [Unclear] tendon injuries but it’s very common to get pulley injuries but one thing that people want to understand is the stress that you put through your tendons in your fingers creates a certain stress on the pulleys. Loading finger injuries up front also to tolerance makes a lot of sense as well. It’s not very often that I totally take athletes off of loading. You’ve got to find some way to add a certain quantity of load to a finger without pain and then have some sort of progression, which is another reason why I’m such a big fan of testing people. Without having some way to quantify, whether you’re using plates or dumbbells or whatever, quantify some sort of tolerance. If we underestimate the load we’re not building capacity and we’re not treating an athlete to be resilient. If we overestimate the load we’re going to get someone injured again. We want to make sure we have an understanding of their tolerance at any given time, whether that’s trying to get stronger or if they have an injury.

Similar principles, if you have a pulley tear or a pulley pop, loading open hand is a much safer loading than at a half crimp or a full crimp.

Neely Quinn: Sorry, can you say that again?

Dr. Tyler Nelson: [Unclear] Most pulley injuries happen because that 90° position at the proximal joint and then you get the tendon pulling away from the corner of the angle and the bone so that’s what stresses the A2 pulleys. If we have a pulley injury, it’s much safer to load in an open hand position than it would be doing a half crimp. A lot of times I’ll have athletes load in an open hand position and a lot of times they can load bodyweight in an open hand position. That’s great without pain.

The one thing as well that I want to make sure that I mention is this idea of the 24-hour cycle of someone’s pain is the best predictor of tendon adaptation or tendons becoming more aggravated. People can have less pain when they’re exercising and they can have less pain when they’re doing rehab but if you have more pain afterwards or if you have more pain in a 24-hour cycle, then your tendon is not very happy. If every 24 hours we do our rehab and we’re having a little bit less pain and the tendon is feeling more stable and secure and less achy then that’s a really good sign. 

Neely Quinn: Okay, that’s really good guidelines.

Dr. Tyler Nelson: It’s easy. People will say, “I go climb when it doesn’t hurt and after it hurts like hell.” That means that what they did was way too much load that their tendon couldn’t tolerate. I usually have people try and get on a program where they load at the same time everyday. If it’s the morning, you load your tendons. If it’s the afternoon then it’s the afternoon and in the evening you load them in the evening. Every morning when they wake up it should be a gauge as to their tendon’s adaptation. 

There’s lots of things you can do to make someone hurt less. All the passive types of things make people hurt less and that’s the point of those things, making them hurt less, but they don’t really have enough physiologic effect on the tendon to actually help the tendon get stronger or better.

Neely Quinn: One last question because Seth, my husband, is dealing with flexor tendon stuff again in his wrist and I know that that’s sort of a common injury in climbers. What would be the exercises to do for that?

Dr. Tyler Nelson: Flexor tendon in the wrist like around the carpal tunnel?

Neely Quinn: Yeah.

Dr. Tyler Nelson: Does he have weird symptoms like tingling and numbness? Or is it just pain, dull pain?

Neely Quinn: It’s just dull pain and sometimes sharp pain.

Dr. Tyler Nelson: The wrist is a really tricky location for pain complaints because there’s nine tendons and a nerve that go through the carpal tunnel and so it’s really hard to pinpoint exactly which one could [unclear]. In general, you want to understand what makes it sore and what makes it hurt and have him try to keep a journal of doing a bunch of different things specifically on any given day and make sure he keeps track of whether those things provoked his symptoms. If they did, those are the things we’re going to cut out for a period of time and find a way to load the tendons of the wrist and the fingers. 

It’s really tricky to assume that if you have non-specific wrist pain, it certainly could be the tendons that go to the fingers because they go through that area but it could also be the muscles of the forearm that attach to the wrist as well. You would do a mix of high intensity neutral positions, so no flexion or extension at the wrist, loading of the tendons, as well as flexion of the fingers because the finger flexors also go through that area and would need to be loaded at a sufficient magnitude.

Neely Quinn: So a mix of hangboarding and resting…

Dr. Tyler Nelson: Sure. You could do high frequency [unclear] and high frequency, high magnitude bar isometric stuff as well, making sure that none of those things cause him any pain and he gets on a habit of checking every 24 hours. If his symptoms are reducing then you continue to add load up to a point and then take a deload week just like normal training and then you would start progressing the load again.

Neely Quinn: Okay.

Dr. Tyler Nelson: But nonspecific wrist pain is tricky. It’s a tricky complaint for individuals to have to rehabilitate because so many things that we do go through the wrist. Understanding the exact cause of that sometimes can be really tricky. I’ve seen some really tricky wrist cases in my clinic.

Neely Quinn: That’s good to know. Maybe that needs some more specific help from a practitioner.

Dr. Tyler Nelson: I’d be happy to chat with him if you want, for sure.

Neely Quinn: Did you want to cover anything else?

Dr. Tyler Nelson: Really, the point here that I wanted to make sure people got was this 24-hour cycle is really important for people to understand symptoms and making sure people have the appropriate loads, and making sure they’re not spending their time doing things that aren’t creating tendon adaptation. Things that are of low magnitude that make people feel like they’re an elderly person, for a tendon injury, will probably have their tendons respond as if they are an elderly person. They’re not of sufficient magnitude to maintain the density or the stress in their tendon that’s needed. We’re probably doing too much volume. 

I see tons of people that come in and say, “I’ve been climbing but I’ve been just climbing on jugs that are really easy. I’ve been climbing a lot still so I’m doing more volume but less load.” That’s the exact opposite of what you want.

Neely Quinn: I appreciate it and I’m sure other people will appreciate it, too, so thank you.

Dr. Tyler Nelson: Absolutely. You’re welcome. Happy to always chat, for sure.

Neely Quinn: Thanks. Talk to you soon.

Dr. Tyler Nelson: Cheers.

Neely Quinn: I hope you enjoyed that interview with Tyler Nelson. There are lots of different ways to learn from Tyler or be treated by him or talk to him. Go to his website at camp4humanperformance.com and you’ll find his seminars on different topics and then, like I said, he teaches at the PCC events. You can go to his clinic and be tested or treated, you can email him, you can call him and do remote sessions with him, so he is available to climbers, thank goodness. He’s a very valuable resource to us which I really appreciate. 

Thanks, Tyler, for another amazing interview. I hope that you guys learned something, especially those of you who are suffering right now with a tendon injury. For me, it gave me hope because I didn’t really realize that you could heal them so well and it was just surprising for me to hear that there’s something other than band work which never really did much of anything for me, to be honest, before my surgeries. I wonder what could’ve happened with me if I had done this before my shoulder surgeries, but alas. That’s Tyler.

Coming up on the show in two weeks, probably, because I’m going to take the fourth of July off, is Josh Larson. I interviewed him last week and he’s awesome. He was a comp climber for awhile – he might still compete but I don’t think so. He’s also put up a lot of FAs around the world, he’s travelled a bunch, so he’s a very well-seasoned climber but also he’s the head coach and he sets at the new USA Climbing facility in Salt Lake City, which its purpose is to help train our American athletes for World Cups and for the Olympics. 

We talk about how those guys train, what this new facility is all about, we talk a lot about the Olympics and he gives us an Olympics 101 rundown so that we understand everything that’s going on and just generally where our team stands in comparison to some of the other teams around the world. I thought it was super interesting. I could have talked to him for a really long time but I didn’t want to bore you guys [laughs] so I cut us off at an hour and 10 minutes, so that’s coming.

I think that’s all I’ve got for you. Remember that we have climbing training programs for you, I see nutrition clients, Matt Pincus sees online training clients, and we might have a new addition to the team sometime very soon. I’ll let you know about that but it will have to do with sports psychology, which I’ve been utilizing myself recently. It’s amazing. It’s an amazing resource so I’ll update you on that soon.

Thanks very much for listening. Follow us @trainingbeta on Instagram and Facebook and I’ll talk to you next time. 

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