Jared Vagy is a doctor of physical therapy who specializes in treating climbing injuries. In addition to his doctoral degree, he has completed a one-year residency in orthopedics and a one-year fellowship in movement science, totaling nine years of concentrated study. He is the author of the Amazon #1 best-seller “Climb Injury-Free,” has published numerous articles on injury prevention and lectures on the topic internationally. Dr. Vagy is an assistant professor at the University of Southern California, one of the top doctor of physical therapy programs in the United States. He is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist. He is passionate about climbing and enjoys working with climbers of all ability levels, ranging from novice climbers to the top professional climbers in the world.
The Injury
Although Jonathan Siegrist is a world class rock climber, he injured his shoulder while mountain biking. Jonathan says “I came down hard on my mountain bike, I kept both hands on the handlebar…rolled and landed on my left shoulder and hit the side of my head. I could immediately tell that something was wrong. I was concussed badly, and I instinctually tried to raise my arm overhead and it felt awful. Thankfully I was only a 5-minute drive from the hospital…they saw me pretty rapidly. I was probably getting x-rayed within an hour form the crash…the image showed that my clavicle, where it normally connects to the scapula, basically was separated - and the clavicle was pointing straight up...everyone knew it was an AC joint separation right away.”
The Diagnosis
A shoulder separation, also known as an AC joint sprain, is a relatively common shoulder injury among athletes. The AC joint is made of ligaments that hold the collar bone (clavicle) to the shoulder blade (acromion – the tip of the shoulder blade). It is commonly caused by a fall directly on the shoulder or a direct blow to the shoulder. It is graded typically from I to VI. Recovery can last from 1 to 12 weeks depending the grade of injury.
X-Ray showing Jonathan’s Grade 3 AC Joint Sprain
The Rock Rehab Pyramid
After Jonathan was diagnosed with a Grade 3 AC joint sprain, he was referred to physical therapy and began a rehabilitation program. He unloaded his shoulder, improved mobility, increased strength and returned to climbing movement.
During the interview, The Climbing Doctor walks through Jonathan’s rehabilitation program and organizes it into a structured framework known as the Rock Rehab Pyramid. This framework was developed by Dr. Jared Vagy and is illustrated in his book Climb Injury-Free (although an AC Sprain injury is not included in the book). The framework of the rock rehab pyramid can be used to rehabilitate any rock climbing injury. It allows climbers to self-gauge their injuries and determine to progress to the next stage of recovery starting with the unloading phase moving to mobility, followed by strength and lastly the movement phase.
Jonathan’s Recovery
Outlined below are written descriptions and interview excerpts outlining Jonathan’s experiences rehabilitating his AC joint sprain. It is important to note that since the severity of this injury can vary greatly, all AC joint sprains should be treated on a case-by-case basis. Rehabilitation is not one size fit all and always consult a physician and medical professional before starting any rehabilitation program.
A sling can be used for up to 2 weeks to support the shoulder and the AC joint. However, the goal of this phase is to immobilize the joint while allowing motion of the shoulder. Being in a sling for several weeks can help stabilize the AC joint, however if does not allow for shoulder motion. So, Jonathan’s goal early on was to slowly progress into taping the joint directly for stability rather than relying on the sling. He used Leukotape and Cover-Role to directly stabilize the AC joint. Leukotape lacks breathability and is more expensive than white athletic tape but it is much stronger. Leukotape maintains over 70% of its tension during athletic activities. Leukotape should never be applied directly to the skin. When applying the Leukotape, you must first apply a tape under-wrap called cover-role. This under-wrap protects your skin from the strong adhesive in Leukotape.
Jonathan says “The way that we were taping it was that I would go straight over the clavicle…and it would be basically pushing down on the clavicle. And then one more (strip of tape) up the arm (to secure it down). For anyone that experienced something similar, I cannot tell you enough how important this taping was…It made me feel like in a number of a few days I didn’t have to use the sling anymore.”
It is important to maintain range of motion after an AC sprain. But there Is a fine line between maintaining range of motion and aggravating the injury. Active range of motion exercises can be performed by simply raising your arm to shoulder height. Active assisted exercises can also be performed by using your opposite arm to gently lift the injured arm into greater ranges of motion.
Jonathan says “I was trying to move (my shoulder) a few times per day. I wasn’t complete putting in a sling and having it by my side. If it felt feasible, I would grab a mug with the hand…Definitely for the first week any overhead motion was out of the question. I was just simply moving it (up and down) as much as I could, and maybe simply picking up a book, but it wasn’t at the point where I could lift anything heavy...I could pretty actively move it up until shoulder height but anything above shoulder height I would take with my other arm and explore.”
It is often difficult (and painful) to perform finger strength training exercises with an injured shoulder on a hangboard because of the shoulder position. Jonathan was able to solve this problem by training with a portable hangboard (such as a tension block) with his arms down by his side. He supplemented the workout by using occlusive cuffs to create blood flow restriction. Blood flow restriction is a training method that uses tourniquet system around the upper arm to partially restrict arterial inflow and fully restricting venous outflow in working musculature during exercise. Click here to learn more about this training method.
“I had heard and read a little about blood flow restriction training and I had never done it in the past since I hadn’t seen an application for it. But after a week of complete rest, I started to experiment with blood flow restriction…I would put the couplings on both arms and do really simple range of motion (exercises) with my fingers.” I would take a 10-pound weight with a tension block and I would get outrageously pumped. It was like a pump like you’ve never felt in your life. What I did that I liked the most is that I would have a tension block (or a portable hangboard) that would allow me to do the finger curls and on the other side I would have a griper, like a gripmaster. I would do 20 reps on each side and then I would switch…trade back and forth 2-3 times and rest for 30 seconds…and what I was aiming for was to do as many times as I could between 10-15 minutes with the cuffs on the whole time. It’s…hard!”
At this stage Jonathan began progressing his range of motion both passively and actively. He began to explore his range of motion further and incorporated gentle stretching into his rehabilitation routines. He also started becoming more aggressive with using the foam roll and lacrosse ball to reduce muscle tension.
Jonathan wanted to return to sport specific training such as hangboarding but hanging with his arms overhead was not comfortable. So, he was able to modify his hanging by bending his elbows to 90 degrees and hanging on a fingerboard with his elbows at shoulder height. It was scary to try at first, but it opened up new possibilities for his climbing specific training.
“Hanging felt completely out of the question...but the reality is that hanging at 90 degrees, you are using so many of these big muscles that were undamaged…Even as I was handing on the bar and preparing to brin my feet of the ground I was like, this is never going to work. And then, it was like, it’s working!...That was an enormous revelation…I could (now) start doing some isometric hangs and hangboard. That was a huge turning point for me.”
It is important to note that during phase 2 that several strength exercises should still be avoided such as pullovers, pushups, bench press, shoulder press and dips.
Jonathan says “It was around 3 weeks that I started doing a little bit of climbing. It was well below my limit and it felt like I had pretty good strength with the left arm from (shoulder to waist height) and there were certain boulder problems where I might do a long move and a (smaller move) with my left arm.”
“Some of the main things that were difficult at first were handing with my arms fully overhead…so I started to do (modified) hangs and pull-ups. At first pull-ups felt pretty hard. And then I started experimenting on a Yoga matt in a plank position and moving…I spent a lot of time experimenting. Using elastic bands to remove weight…simple exercises in the weight room…and every day pushing it a little bit more.”
Jonathan says “For me, what was a really great formula was a combination of seeing the physical therapist, weight exercises, and actually trying to climb. Ultimately the goal was trying to climb. I would climb super easy to start like 5.8 slabs and then gradually went to vertical 5.9/5.10 (routes) and by the end of week 3 early week 5, I was climbing 5.12 in the gym…the beautiful thing about climbing is it brings you through such a diverse skills set and range of motion…I would take my experiences from climbing go to my physical therapist and say “this feels fine and this does not. He would (then give me examples) of how to work on (each difficult move).
It is important to incorporate higher level strength training into this final phase of recovery to prepare for a full return to prior level of activity. There are many ways to perform higher level exercises, but the goal should be to have them closely resemble or mimic movements that are specific to your sport.
Jonathan started progressing his strength with single arm hangs. “One of my favorite training exercises arm simple one arm hangs…on a small edge for 5-6 seconds and resting for 20 seconds. I started doing one arm hangs with my left (injured) arm and removing weight with elastic bands…then I got to a point where I could hang one arm on a ring, then I slowly worked from that to actual climbing holds (until I was) close to the edge size I would normally use while hanging before the injury.”
He then began to incorporate dynamic exercises such as bouncing a tennis ball on a tennis racquet to improve the ability of his muscles to stabilize his shoulder.
After completing the first four phases of rehabilitation, it is important to return back to your previous level of sport participation. For Jonathan, that was learning how to integrate more dynamic climbing movement. As Jonathan became more comfortable with climbing, he started to challenge himself with harder routes and more challenging moves.
Jonathan started challenging himself with dynamic movement on the rock wall. “I started to feel like I was getting good at statically climbing and I want to be able to climb dynamically…so I started introducing dynamic movement on the wall as controlled as I could by doing the easiest dynamic problems that I would find while focusing on keeping my shoulder engaged.”
Jonathan was able to take the same discipline that he puts into to climbing and apply it to rehabilitating his AC joint sprain. Getting hurt is never fun, but it is inspiring to see how quickly Jonathan was able to bounce back when he focused his efforts on a step-by-step recovery process. He has gotten stronger each day and is now back on track to achieve his climbing goals.
Climb on!
Jared Vagy is a doctor of physical therapy who specializes in treating climbing injuries. In addition to his doctoral degree, he has completed a one-year residency in orthopedics and a one-year fellowship in movement science, totaling nine years of concentrated study. He is the author of the Amazon #1 best-seller “Climb Injury-Free,” has published numerous articles on injury prevention and lectures on the topic internationally. Dr. Vagy is an assistant professor at the University of Southern California, one of the top doctor of physical therapy programs in the United States. He is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist. He is passionate about climbing and enjoys working with climbers of all ability levels, ranging from novice climbers to the top professional climbers in the world.
Jonathan is a passionate professional climber and global traveler. He spends his years primarily on the road and overseas, constantly on a mission to develop new areas and pursue the challenge and beauty in hard rock climbing. Since he began his journey with climbing at age 18 he has step by step experimented and refined his methods of training for a variety of goals. His list of career highlights include 196 5.14 ascents, 5.14 traditional routes, many 5.14 flashes including one at 5.14b, dozens of first ascents, several big walls up to 5.13+, several ascents of 5.15a and the third ascent of Jumbo Love 5.15b.
