Tibial Plateau Fracture!!!

I’ve been trying more outdoor sport climbing this year and finally plucked up the courage to try some lead climbing in the UK.

A couple of weeks ago I packed my tent and climbing gear, jumped in the car and found a mountain guide to show us the best spots to lead climb in North Wales. The weather was great and I was surprised by how many bolted sport climbing routes there are around the old quarries. It also surprised me how attractive some of the old quarries are.

We were climbing some really fun routes and generally enjoying the day but just before lunch time disaster struck. As my partner was lead climbing she fell backwards from the rock, her foot got caught behind the rope and so she was flipped upside down. Although it looked awkward there was no obvious collision with the wall and it didn’t look too serious. Her pain levels weren’t that high when we lowered her off the rock face, so it initially appeared like she may have sprained a ligament in the knee or possibly damaged the meniscus.

The pain didn’t ease off and is appeared slightly swollen and was made much worse by weight bearing so we decided to go to the nearest A+E in Bangor.

An X-ray in A+E showed a potential fracture at the top of the tibia which seemed strange as she hadn’t banged into the rocks, but a follow up CT (3D X-ray) showed a big dent in the top of the tibial plateau (the top of the shin bone where it forms the knee joint). It’s quite a rare injury but basically involves the femur (thigh bone)smashing hard into the tibia (shin bone) with such force that it makes a large crater at the point of impact (in this case the lateral side of the tibial plateau). If left untreated this would effect the way the knee joint moves, and more than likely lead to early onset arthritis in the knee.

Based on the research and advice of knee surgeons we know it seemed to be a no brainer and so a couple of days after the accident she went under general anaesthetic and had surgery to rebuild the tibial plateau (basically using screws and plates to push the bone up and level off the surface of the tibia). The suregery seemed to go well and the bone seems to be healing well. Now it’s just 6 months of rehab before we’re back out climbing again.

Incidents like this are tough and make you question everything, but it’s never possible to eliminate all risks. Cycling to work, running in the hills, indoor climbing, swimming in a reservoir all have the potential to cause serious injury or even death, all we can do is accept the risks and take them seriously.

Ultimately the most serious risk to our long term health is inactivity. So, painful as this episode has been I think it’s important to remember that not exercising is the biggest risk to a host of health conditions from heart disease to arthritis. There will always be risk in any form of activity but it’s important not to let that stop us doing the things we love.

Should I push through the pain

A question I get asked a lot in clinic, especially by athletes, is whether it's OK to keep going if you feel pain.

Conventional wisdom stated that you should rest at the first sign of any pain/injury although research over the last few years has demonstrated consistently that that’s rarely the best course of action. By continuing to use muscles/joints/tendons you are stimulating blood flow and allowing the bodies own healing mechanisms to operate effectively. Of course there’s a limit to this and pushing a damaged tendon too hard may well lead to further damage and longer recovery time.

A classic example is tennis elbow (or lateral epicondylitis), the tendon is damaged and it can be really irritated when you engage the muscle by gripping, I see it a lot in climbers. The temptation is to completely rest the wrist and forearm but in my clinical experience even if it causes short term pain, people who carry on using the muscles tend to heal quicker in the long run. A degree of common sense is helpful and it’s best to use lighter weights than normal until it’s completely recovered.

When I get minor running injuries my rule of thumb is that I will carry on running as long as the pain doesn’t get significantly worse while I run, the pain doesn’t effect the way that I run (eg landing on the outside of the foot as the inside hurts to land on) and I don’t need to take painkillers to keep going (honestly, you’d be surprised ;)

There are always exceptions, such as stress fractures where it’s vital to take pressure off the bone to allow it to heal. But even in this instance it’s important to keep some pressure on the effecteted area.

So in conclusion, rest is very rarely best but it’s a fine line between stimulating repair and doing too much.

Climbing as a competitive sport?

As someone who’s dabbled in climbing over the last few years (initially to complement running but more recently because I’ve come to really enjoy sport climbing) I thought it was great to see climbing at the Paris Olympics last year. Initially I was surprised such a primal sport has only recently been accepted into the Olympics. I’m not a massive fan of watching sport on TV but I thought it worked quite well as a spectator sport, even if it was unrecognisable from the climbing I see when running through the Peak District on a Sunday.

However, when I mentioned it to a much more experienced friend, who identifies as a ‘proper climber’ they dismissed it as ‘grabbing bits of plastic’ which has more in common with gymnastics* than the pure climbing which originated from mountaineering and is more a way of life than a spectator sport.

I’ve since chatted to lots of climbers (especially trad and/or mountaineers) who agree with this. I’ve also chatted to a lot who think that the Olympic version of climbing is fantastic as it makes climbing seem less daunting and so opens its up to a whole new generation of people who may be more inclined to try indoor sport climbing, bouldering or top roping.

On balance, I think that anything that encourages people to climb is a good thing. The health benefits are too many to list here and it compliments running incredibly well. It may be an oversimplification to say that running compresses the joints of the lower half of the body whilst climbing stretches the upper half, but we all like simple so I’ll say it anyway.

After hearing all the opinions I’m inclined to agree that indoor climbing (the Olympic variety) has little to do with the outdoor mountaineering lifestyle which spawned climbing, but that doesn’t stop me enjoying indoor climbing, doesn’t make it any less watchable and doesn’t stop it being a great way of staying fit and healthy.

*nothing wrong with gymnastics

London Maranoia??

It’s London Marathon season and everyone’s getting excited (except for me, I’m getting FOMO as I forgot to enter). There’s nothing quite like the magic of the London Marathon (magical around the cutty sark, miserable by canary wharf). But are you read for race day?

For a lot of runners that excitement can morph into anxiety about whether their training has been good enough, how they’ll react to energy gels on race day, if they have the right shoes, even if the weather on race day will suit them….and for lots of people this can be about wondering if they have a serious injury that’s going to ruin the big day.

Lots of people are turning up in clinics with what was traditionally termed ‘Maranoia’. I’m not a massive fan of the term because ultimately people do get injured training for the marathon (some of them seriously). It’s important to take all pain seriously at any stage of marathon training but also be aware that during these final few weeks of training, emotional anxiety levels will be high, this can increase your awareness of pain, making relatively minor niggles feel like serious injuries that might put your marathon dreams in jeopardy. If in doubt get it checked out…