Make or Break by Dave Macleod: A Review

Rating: 5 stars

Summary: Must have book for anyone seriously involved in high-end sport climbing or bouldering, extremely useful for any climber who wants to understand the physiology of climbing injuries

In the recent Bouldering World Cup at Vail, there were four injuries serious enough for competitors to have to pull out of finals, perhaps the most spectacular being Alex Puccio's knee getting hurt in iso. There's a short story on this on 8a.nu. All these climbers were experienced, very strong and as far as I know were professionally coached. Yet they fell prey to the specter of injury. It's unlikely that you have not already suffered something similar or know someone who has within the last year.

Climbing injuries, as in any sport, are a simple fact of life. Rarely do serious climbers go for too long without something turning up and given the increasingly extreme body positions, dynamic movement, and of course ever smaller holds, this tendency is not likely to go away any time soon. Climbing at a high level imply demands a great deal from body parts not intended for that level of stress. So the question is, "How can I manage the risk of injury while still training and working on harder climbs?" And the answer to this is not simple. There are no shortcuts or easy solutions, no wonder salves or miracle devices that will remedy climbing injuries.

Dave coming off surgery for his ankle

The master of writing about things in climbing that have no easy solutions is, in my opinion, Dave MacLeod. There is no better writer in English on the subject of getting better in climbing, and I cannot think of any with a better track record on hard routes of every type, including hard bouldering. In his book, 9 Out of 10 Climbers Make the Same Mistakes, he delivered a clear message that if you want to get better you need to take a clear, objective look at what you are doing wrong. This could mean some fairly harsh self-appraisal in the process.

In his new book Make or Break: Don't Let Climbing Injuries Dictate Your Success, he takes a similar tack, encouraging climbers to look at all the dimensions of injury, especially climbing and training practices and attitudes that increase the chances of injury. He writes, "Even though injuries often seem to be an accidental misfortune it is likely that the causes are are things under your control. You just didn't know it."

Finding the balance between healthy productive training and climbing and injury-provoking unproductive training and climbing has long been the holy grail of serious climbers. The internet and social media has complicated this quest by dumping dozens of possible approaches, many of them without context or explanation and often in the form of "training" videos that showcase the abilities of marquee climbers to do one-arm campus boarding or one-finger front levers or whatever. Training for climbing however is a much more complicated process than imitating the achievements of the famous. A World Cup champion told me recently that the things he did in one of these videos were the result of years of careful training and preparation and certainly not to be imitated without a similar period of training.

Climbing in particular is, as MacLeod puts it, at an "embryonic stage" when it comes to understanding its biomechanical principles. Only recently, for example, have researchers begun to understand the physiology of tendon overuse injuries. Figuring out the best ways to productively stress body tissue and perhaps more importantly, productively recover from these stresses is still in an incipient state. The media reports breathlessly about the latest greatest sends and sponsors are eager to tout their athletes' strength and achievements. Sometimes it seems like all we have to do is go "a muerte" and miracles will happen. MacLeod reminds us that more likely than not, the bill will come due sooner or later, regardless of age or skill level, unless we correctly manage the stresses of training and climbing.

For MacLeod, the key elements for injury prevention are self-knowledge combined with a constant vigilance for bad technique and an awareness of the most likely scenarios for injury. Managing expectations for training and climbing is a critical component for navigating the path between productive and injurious stress. Awareness of good body, limb, and hand positions as opposed to mechanically disadvantageous ones is critical to learning the most efficient movement pathways. Often overlooked are tactical strategies. Shoe fit, chalk, impromptu competitions, climbing when tired, all can play a role in setting up the conditions for a serious injury. Finally adequate attention needs to be paid to posture and resting. As Macleod writes, "Amateurs are essentially trying to lead a double life, one with family and work commitments and another of training." Multiple non-athletic stresses can add up to poor physical and psychological recovery, chief among which is lack of sleep. Lack of mental clarity and focus can cause significant issues while training and climbing.

But what if you do get injured? What then? How can you recover effectively and as quickly as possible. Again Macleod's advice is realistic, accurate and well founded in personal experience, not mention a copious amount of reading in scientific and medical journals. Climbers are notorious for seeking out quick fixes for injuries and MacLeod discusses many of the more popular modes of therapy but with the cautionary note that "there is a gross lack of hard scientific research evidence for their effectiveness in achieveing long term recovery from soft tissue injuries." A similarly skeptical and conservative approach to drugs and surgery is expressed which is certainly to a climber's benefit owing to uncertain (except in obvious cases) benefit and problematic side effects. It's clear that the only effective approach to treatment is serious research and conversation with peers and medical professionals, the latter an especially dismal task in America given our haphazard and expensive medical "system."

A couple of effective and short chapters on the psychological dimension of injuries and special issue relating to youth climbers follows. The latter is an increasingly important aspect of climbing training, not least because relatively few youth coaches have any serious background in sport science at this point. I recommend this chapter especially to youth coaches and would be surprised if a proper text on youth climbing coaching doesn't appear soon. There is a real need for it.

The remainder of the book focuses on specific physical aspects of climbing injuries looking at typical problem spots such as elbows, shoulders, fingers and lower body areas, the latter being of particular interest to boulderers. Injuries to ankles and knees from impact upon landing are a serious problem. These chapters are invaluable reference points for climbers having to deal with the classic issues of elbow pain and finger pulley tears. Again MacLeod is not preenting magic cures or secret tricks, just thorough complete discussion of what we know and can do about these injuries.

I would unhesitatingly recommend this book both to climbers and health care workers interested in treating climbers. It is the best single authoritative resource in English on the subject from a climber with extensive personal experiences with injury (recounted in the back of the book) and experience at the top of the sport across multiple disciplines. It's not an inexpensive book but if it saves you the expense in terms of time, effort and hard cash that an injury can involve, it is well worth it.

http://davemacleod.com/shop/makeorbreak.html (Signed copies from Dave's shop)

http://www.amazon.com/Make-Break-Climbing-Injuries-Dictate/dp/0956428134

Bouldering and its Physical Impacts: What Should We Know?

Climbing has reached new heights of visibility so to speak with the widespread media coverage of the Dawn Wall ascent earlier this year, an ascent where the strengths and skills developed through high-level bouldering played a major part (to be discussed in another post). In this country at least bouldering as a competition discipline appears to be much more popular than roped climbing and clearly a favorite for youth team training. In other words the future trajectory for bouldering participation appears to be on an upward trend (haha), which is a good thing.

Along with this popularity, however, there is going to have be a serious discussion of how gyms, youth coaches and the industry in general will mitigate the physical impact of bouldering going forward. This is a topic that is gaining increasing traction in youth football right now and there is considerable concern that parents will be reluctant to allow their children to play football for fear that irreversible brain damage could be a result of hard hits on the playing field. It has been suggested by Dave MacLeod in his new book Make or Break, that repeated impacts on young climbers could affect vulnerable growth plates, just as with finger overuse injuries, stunting the growth of the lower limbs.

It has long been noted that in bouldering, "Every fall is a ground fall" and the (under-reported) fact is that a fair number of old-school boulderers  are paying a significant price for the harder falls of the pre-pad generation. John Sherman, author of the "other" book on bouldering,  was taken to the hospital by myself and a friend after popping off a lowball traverse and bouncing his head on a slab at the base. This was one of several concussions he sustained. He has also had two hip transplants. I had a similar experience a couple of years ago in RMNP, ironically bouncing off a pad and winding up with six staples in my scalp.

It is a concern of mine that we are not anticipating carefully enough the long-term consequences of bouldering falls, not merely hard impacts as mentioned above but also the less-obvious impacts of repeated "safe" falls, especially in the gym. While I don't think they present the kind of threat posed by the collisions of tackle football, I also am not seeing any clear effort made by the climbing industry to fund scientific research on landing materials, landing configuration, wall construction, route setting and of course fall training as it relates to indoor climbing. This is critical because although outdoor falls present the apparently more dangerous outcomes, most falls occur in the confines of a gym where the convenience and apparent safety of a wall allow multiple repeated falls in a short span of time.

As a long-time boulderer myself, I have become increasingly aware of problematic trends in bouldering wall design that have the potential side-effects of promoting long-term chronic injury for their users. The first and foremost of these is height. Despite the glamorization of so-called highball bouldering in climbing media, there are certain basic laws of physics at work that cannot be ignored regarding mass acceleration and the impact forces that result. In a nutshell, the longer the fall the more intense the forces that must be absorbed upon impact.

These forces multiply very rapidly so that a fall of two meters has half the impact of a four meter fall, basically a doubling of impact force created by a negligible amount of additional vertical rise in climbing terms. You can check this out thanks to the Splat Calculator, a page posted by a climber. What this implies for a boulderer is that a common gym design, that is a steep lower wall followed by an upper more slabby portion, is tacking on vertical gain in such a way as to make that upper portion much  more dangerous in the event of a fall. This danger can be augmented even further by a problem set with a crux move near or at the end, raising the chances for a fall and even worse an out-of-control fall.

It's my view that bouldering gyms are now making walls that are much too high. Tall walls look better in photos and create an initial perception of adding value to the visitor's experience but for regular users may have the opposite effect, raising the chances for catastrophic acute injury and inevitably, and unnecessarily adding to the cumulative impacts of repeat falls and deliberate dismounts from the wall (as when a climber is forced to drop from the top). Ironically tall walls inhibit effective training for this reason as the climber pays a real physical cost for repeated impact in exchange for uncertain training benefit, especially with movement that is all too often affected by awareness of the wall height and the potential impact of a fall.

I hear from route setters and others that actually these walls aren't that high, remarks that are often tinged with a hint of young male bravado, implying that my concerns are a byproduct of timidity or cowardice. However, I have seen too many young climbers quit the sport for various reasons, especially injury, and have heard from too many older climbers who are intimidated precisely by the potential real-life consequences of an injurious fall to take these responses seriously. Regardless of one's reserves of courage, the laws of physics are strictly enforced in the event of a fall and it seems incumbent on gyms to maximize the well-being of their customers over the ego of the setters and wall designers.

Another issue is the landing surface and its configuration. While there are commonalities with gymnastics there are also significant differences as well, especially regarding the height and irregularity of the falls, not to mention the skill level of the athlete and lack of spotting. Basically bouldering gym flooring is in a state of infancy regarding its materials and how it is set up. Gyms want a surface that is safe and durable, two qualities that do not always coincide.

So what is to be done? Obviously the first option is the status quo which so far is building high walls and hoping for the best. In my view to do this is missing a great opportunity to seriously study the costs and benefits of different bouldering setups to find the one that best maximizes climbing potential and minimizes risk of injury, whether acute or chronic. The industry is currently on a binge of wall construction which provides a great laboratory for next generation walls and landings to build upon.

If you are a frequent boulderer and want to stay healthy, focus your training time on low-impact high difficulty problems that won't cause repeated high-impact falls. If you are motivated to work a particularly high problem, a good tactic to use inside is climbing up on big holds to establish on a high crux in a less tired state, so you learn the move quicker and are less likely to take repeated falls. Avoid gratuitously dangerous high moves such as big sideways dynos as they have a tendency to wreck shoulders and pitch climbers upside down. Outside, if feasible, working a highball on toprope is a really good idea to spare your ankles, knees, hips and back the repeated stress of landing. It goes without saying to pad things as well as possible. Lastly, inside or out, learn how to fall correctly, dissipating impact forces by rolling away from the landing whenever possible. Always analyse in advance the most likely places to fall and anticipate your possible body position in flight and at impact. A competent spotter can be a big help in limiting these forces as well. Good luck and safe bouldering!