Monday, June 22, 2015

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 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. (Signed copies from Dave's shop)

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