Life of Biceps, #6

Knock on wood, but I’m hoping that this is my last biceps update, and future posts will be about fun things like rock climbing or gangster meals (had to add that link: It ranks as the most awesome thing I’ve found on the interwebs this week).

Potassium is rad.

Okay, back to biceps. Now fifteen weeks out from surgery, my recreational life is beginning to resemble normal. I’ve been climbing and training for four weeks now, which has been quite fun. In the last two weeks, I’ve even been able to try hard on occasion. I don’t say “climb hard,” mostly because I’m still not back to the same level as before my injury and because that isn’t the point. The satisfaction of having a properly working body comes from being able to explore its potential, not just ticking routes that may or may not actually be all that hard.

That said, in terms of climbing performance, I’d put myself somewhere around 80% of my personal best, which means there’s a lot of stuff I can climb (that is, assuming the snow in Boulder ever melts).

Anyone up for some spring ice climbing? Meh. I thought so.

Not to brag, but I’m kind of proud of my recovery. From reading other people’s accounts of their rehab, I think mine has been about 15-20% shorter, and I’ve been able to return to aggressive training more quickly and with fewer complications. I thought I’d share the factors that I speculate have facilitated this great recovery.

1. The best doctor possible. When I knew I needed surgery, I sought out the best doctor I could find and the one who seemed to have the most experience with performing this surgery (and similar ones) on high-level athletes. The whole process was easier because he and his team knew exactly what I needed my arm to do in the future and respected my need to stay active and return to sport-specific training as efficiently as I could.

2. Integrated Manual Therapy. Here in Boulder, I saw Kathleen Eakins, an IMT practitioner, for several sessions in the first six weeks after surgery. She helped reduce inflammation, improve circulation, and heal scar tissue. I would guess that her work helped my healing process by at least a week or two in terms of helping my arm go from the basic healing stage to the strengthening stage.

3. Trigger-point Dry Needling. Dry needling is awesome, if you’re up for it. I’ve had it done many times in the past for other injuries, and I was fairly persistent in finding a PT who would perform this treatment as much as possible. I started getting needled at six weeks (had to get doctor approval), and I’m still going in for weekly sessions. It keeps my muscles firing properly as I increase the training load on my body. You can get dry needled preventatively if you find the right PT; it essentially works similar to deep tissue massage, only it more effectively re-sets the muscle through stabbing a needle into the muscle’s trigger points. It is not like a relaxing massage.

4. Hangboarding. I could start weighting my fingers way before I could climb, so I got a good 4-6 weeks of finger training before I returned to climbing at all. The trick was to load my fingers and not my arm. The thing that worked the best was doing way less than bodyweight (i.e. feet on the ground), but hanging on very small holds and sometimes only one or two fingers at a time. This put huge loads on an individual finger but didn’t require putting lots of weight on my arms.

My home-made hangboard, courtesy of E-Grips and Trango.

5. Getting a climbing/rehab plan from a PT who was himself an elite rock climber. Once I was cleared to climb, I couldn’t just go out and starting climbing hard again. Nico Brown, a PT at Howard Head in Vail, was able to make me a great plan for building back up to full strength climbing and continuing to heal my biceps in the process with very specific guidance on when to push harder and when to be careful with different types of climbing and even individual moves.

6. Cheating. This comes with equal doses of listening to my body, but the idea here is that I always focused on progress. If one workout went well, I would rest a day and then do a slightly harder workout, even if that isn’t totally in line with the protocol. By gradually increasing load in controlled ways, I’ve retrained my arm to deal with the stresses of climbing, and now it is holding up well. At this point, I’m putting fairly high climbing and strength loads on my arm (like bouldering) and then taking plenty of rest afterward to let the tissue recover. Aside from minor noticeable weakness, quicker fatigue, and some soreness, my right arm feels about the same as my left.

Next week, I head to the desert to lead a canyoneering trip, which will be a good break from climbing on my arm. After that, I’ll continue progressing with climbing loads and hopefully transition back to simply going out and trying my hardest with a month.

On Resonated (V9), weeks before I blew my biceps tendon. Photo by Max Kudisch.

Life of Biceps, #5

Usually, when someone tells you they don’t want to see you anymore, it’s a bad sign. But from your orthopedic, it’s a promise of freedom and return to the activities that you love (and that got you into the predicament in the first place, but that’s beside the point).

Yes, a week and a half ago, my doctor cut me loose. “Return to unrestricted activities” is the way he put it. I celebrated by joining my wife and many friends for a Spring Break ruckus in the Moab area, where – you guessed it – we went rock climbing. I’d fantasized about what route I wanted to climb first, what blissful Indian Creek fissure (Incredible Handcrack) or classic tower (Ancient Art) that would mark my return to climbing. In the end, however, it wasn’t either of these or even one of comparable notoriety. Heck, I don’t even remember the name of the route. It was just another 5.10 hand crack on the Cat Wall, fun but nothing remarkable. Really, this was all for the better because, unlike the joyous horse-out-of-the-gate charge up the wall I dreamed of, climbing with my right arm was kind of like trying to do math while drunk: inelegant, inefficient, and mostly underscoring ineptitude.

Thus, I spent my first day lamely top-roping everything, often with hangs and sometimes with a power belay for harder sections. Don’t get me wrong, I’m not saying top-roping is lame. I mean it literally: I was like a lame horse, limping awkwardly up moderate hand cracks. So, being the lame horse that I was, I did what any self-respecting climber would do: I compensated, mainly through banter and alcohol. I also distracted myself with taking photos, climbing obscure (albeit easy) towers, running, and other absurdities.

Psyched after a siege of Ansaid Tower, a 5.7 in Donnelly Canyon. We are actually on the summit, despite the wall behind us. Rad.

Ultimately, I didn’t give a shit that I sucked at rock climbing. Good food and cheap beer were abundant. Someone said, “It’s getting so warm I might have to take off my underpants.” Spring Break!

Alas, Spring Break is as ephemeral as it is rambunctious, and Becca and I drove home two days ago to lick our wounds and return to the world of schedules, assignments, to-do lists, and deadlines. For my recovery from surgery, the freedom of Spring Break evolves into the discipline of Spring Training, which brings with it different but equal excitement. My recovery now is quite similar to a basic training plan for climbing. I have my goal (in this case, a progression back to similar levels of climbing pre-injury), and I work through a grade-pyramid to get there. I start with high volume climbing at a fairly low difficulty and gradually increase the difficulty and decrease volume over the next 6-8 weeks. I’ve started focusing on building stability and functional movement, mainly in my core and my shoulders. I also continue to strengthen my biceps, since he’s still just a little guy.

Another one on the Mountain Blog

So, I’ve been writing a lot recently for the Mountain Blog. The most recent post is on a really cool program Mountain Gear offers called UClimb, a two-day instructional package that covers the basics of outdoor climbing in various climbing destinations around the US. Learn more about it here:

http://www.mountaingear.com/themountainblog/2013/03/who-climbs-uclimb/

Madaleine Sorkin, profile.

Madaleine Sorkin has been a good friend of mine for a long time. We’ve done a lot of climbing together over the years, including some fairly epic trips (see “Our Little Rodeo”). But Madaleine has climbed a few other noteworthy things, too (understatement intentional). So it was a privilege to get to write a little piece about Mad’s accomplishments, drive, and perspective for the Mountain Blog.

http://www.mountaingear.com/themountainblog/2013/03/outdoor-research-athlete-madaleine-sorkin-on-red-rocks/

Life of Biceps, #4

Cool clouds make running way more fun.

I’ve heard a few phrases a lot recently. “That sounds pretty ambitious.” “Do you think you’re ready?” “Be careful.”

While the exact verbiage varies, the sentiment is pretty consistent: Take it easy on your arm.

I’ve heard this from a lot of different folks, medical professionals and lay-people alike. Of course, this is all in response to my enthusiasm about returning to climbing, which is certainly on the horizon at this point.

My arm is feeling pretty darn good. I’ve got full range of motion and can even pick up things heavier than a saltshaker. I’ve started light strengthening, mainly doing huge sets of 5-pound bicep curls, which goes something like this:

The gym is peopled with a fitness class of retirees, a few odd professionals frantically working out on a break, and some high schools boys seeing how much they can bench press. I walk in with a focused look. My shoulders have maintained just enough tone, despite over two months of no climbing, to make me look like I might be a serious weightlifter. Everyone gives me the stare-down. I casually walk over to the weight rack (the one being used by the retirees’ class, not the high school boys) and begin whipping off 5-pound curls until I feel a faint quiver of fatigue, which usually takes between 20 and 40 reps. Then I repeat.

The moral: There’s nothing manly about surgery rehab.

At this stage, I can confidently say that my ego is not the driving force behind my zeal. A Labrador retriever doesn’t chase a ball because of ego. It’s mostly that my arm feels good. I know that a conservative path is the best, and I try my best to heed, even internalize, the guidance I get from the experts. They aren’t in my arm, though; they don’t feel it. They can’t appreciate the electric joy that the contraction of the muscle fibers in my arms give me. Feeling strong feels good, and the promise of strength, which is really what I have at this juncture, is the oasis – or is it mirage? – at the end of a long trek across the desert of lethargy.

So sure, it feels good, so I want to do more. But the Labrador doesn’t just chase the ball because it feels good. The dog chases the ball because that’s what we’ve bred him to do. Likewise, I’ve trained myself to always push harder. (Of course, this drive is partly responsible for my current predicament.) I’m not calling myself some kind of genetically obsessed athlete, but I think most folks who have experienced a high level of commitment and success in a pursuit can relate. If we never push a bit past what we think the limit is, we never know it’s really the limit.

All told, this is not an apologia for why I will ignore all good medical wisdom and jump back on hard rock climbs tomorrow, for I’m not planning on doing that. If anything, it’s an explanation for why, when my physical therapist says I can do x, I do x + 1.

I have had at least two experts tell me that my ambition isn’t all bad. “Those who cheat tend to do better,” I was told. In other words, by breaking the rules, just a little, I might actually have better results overall. I’m not the Labrador who compulsively fetches the ball, even if it looks that way from the outside. I’m just pushing it a little bit.

My final check in with the doctor is March 22. I’m trying to keep an open mind about what the transition back to climbing will look like after that. Until then, I’m continuing to run, lift weights (I’m headed up to 7 pounds later this week!), and ski. In case the medical folks are reading, I can only say that I don’t promise not to hangboard, scramble, lift more weight than I’m supposed to, and any other ill-advised stress. I do promise not to climb – hard.

Divine Stone, Part 2, on the Mountain Blog

A little while back, Mountain Gear published the second installment of the story of our time in Spain. So it seems, that often ourambition comes with inherent risk, especially in our climbing games. We do our best to face them with a little bit of grace. Enjoy.

http://www.mountaingear.com/themountainblog/2013/01/divine-stone-part-ii-shark-attack/#more-579

The Life of Biceps, #3

Earlier today, I went for a long hike with my friend Matt and his 14-month-old son. I fed the young boy some pieces of cereal, and as I watched him grasp at the bits of food with the focus and lack of fine motor function of a child, I reflected on the wonder that is human motion. This has certainly been on my mind recently as I’ve slowly regained motion in my arm after two weeks of virtual immobility.

Most of us probably take movement for granted. We don’t think about it; we simply have an impulse, some vague flutter of a thought about the itch behind our ear, and scratch it. We see an apple on the table, and we grab it. We don’t consciously activate the parts of our brain that control movement; we don’t feel the electrical impulses leap across our synapses. We don’t tell the fibers composing an elaborate harmony of muscle groups to contract. We just move our arm, eat the apple.

To be clear, most of my body is working great, and I have a daily goal to appreciate that good fortunate. But my right arm, on the other hand (an awkward manner of speech, I know), operates a bit more like that of the baby’s: uncoordinated, weak, and often ineffectual. I reach out for the apple and come up 5 inches short.

Almost three weeks out from surgery, the broken wing is starting to mend. The bump just below my elbow is swelling from the incision.

I come up short because I still can’t straighten my arm. The good news is that I went for my two-week follow-up appointment six days ago. Dr. Millett said the surgery was very successful and had only minor concerns about some swelling. Because my tendon is now threaded through a hole in my bone, it is in fact a stronger attachment than the original. The only downside is that my tendon is 2-3 cm shorter than it was, so I’ll have to significantly stretch out my muscle to straighten my arm. Until my follow-up, my arm was in a brace and locked at 90 degrees. At two weeks, we reset my brace at 45 degrees from straight, and I’ve been cleared to begin active range of motion. This is fabulous. I can move my arm around a bit and do minor lightweight tasks, like tying my shoes (a task nearly impossible before). It’s also much more comfortable to go on hikes and generally be active since I don’t have my arm in a sling anymore. I’ve spent a good deal of time hiking in the Flatirons, watching Netflix videos while on the stationary bike, and doing core workouts. I’ve done some minor strengthening on my healthy arm because there is some evidence to suggest that it will improve the strengthening capacity of the injured arm.

This is the face of a champion, sweaty and going nowhere fast.

As promised, here is my rehabilitation plan. But first, I want to qualify a few things. This plan is pretty aggressive and contingent on the quality of the fixation and the level of degeneration of the biceps tendon. I am pretty young for the injury (most patients are men in their fifties to sixties), and I got the operation eight days after the injury so my tendon was still in pretty good shape. In other words, this is the best-case scenario.

Weeks 0-2: This stage focuses on protecting the arm and allowing the basic healing responses (swelling, pain, etc) to run their course. I only performed light passive range of motion (PROM) and scar tissue mobilization work. My arm was locked between full flexion and 90 degrees.

Weeks 2-4 (Jan. 17-31): The stage begins to activate the muscles and initiate arm function. I’ve been continuing with PROM and have added active range of motion (AROM) work, both in arm flexion and in supination and pronation (bending my arm and turning my hand up and down, in layman’s terms). I can now move my arm from full flexion to 45 degrees from full extension.

Weeks 4-6 (Feb. 1-15): I continue with AROM and begin stretching the biceps. I will work toward full range of motion, both in terms of flexing my arm and supination and pronation. At this stage, I also hope to be able to begin strengthening work around my biceps, like fingers/forearms, shoulder, chest, and back.

Weeks 6-12 (Feb. 16-Mar. 29): At this point, I start strengthening my biceps, starting with very light, simple movements and progressing to heavier weight and more complex motions.

Week 12: I begin sport specific training. Yes, that’s right, I can train for climbing (and, accordingly, go rock climbing) again. Yay!

The wall, er, fridge, of rehab.

I’d be lying if I said I didn’t hope to climb sooner, and I don’t think that is totally crazy. At some point in the strengthening progression, I will start climbing in a very controlled way. I also have been scheming about how to maximize my overall fitness so that I return to climbing with the most things working for me possible. That means I have to find ways to strengthen climbing muscles other than my biceps. The obvious options are finger strength, core strength, and cardiovascular fitness.

So far, I’ve been working to build a base in each of these. The core workouts and cardio are fairly obvious. For finger strength maintenance, I’ve used a combination of putty and a bucket of rice. At this point, all I’m really doing is activating the muscles to keep the neurons firing and the fluids moving around (which also helps the inflammation from the surgery).

If all goes well, I should be back to climbing just in time for spring, which is really not so bad. The last time I took more than a few weeks off from climbing was in 2009, so I’m due for a longer sabbatical anyway to let the climbing muscles recover. I’ll check back in soon with my progress.