T4/5 Laminectomy Climbing rehab

I was a keen rock climber but pretty much gave it up a couple of years ago due to a variety of sciatica like symptoms. Recently this was diagnosed as a benign tumour on my spinal cord which was removed via a T4/5 laminectomy two months ago. Despite coughs and colds I have recovered well but want to start rock climbing again. The specialist has forbidden me form climbing until 12 months post op, but I'd like to hit the ground running in November.
I have had experience of ligament and tendon damage and know that these strengthen more slowly than muscle can. The last thing I want to do is cause some damage and have a big setback just after starting again.

Although the surgeon tells me I need no physiotherapy, I would really like some advice on any stretches and exercises I could do so that my shoulders and arms are relatively strong prior to starting climbing.
I currently have access to free weights, a finger board (pullup board for climbing specific exercises) and have a gym local for CV exercise and other machines.
I am told that pain is no indicator of damage, but I'm not keen to test this too much without some advice!

Any suggestions gratefully accepted.
--
Mark.

Hi Mark

I presume that the surgeon has banned you from climbing - not so much because of the strenuousness of the activity (though that could be a reason) but because of the potentially disastrous result a fall might have on the vulnerable healing laminectomy site.

As far as need for rehab goes I think he is being a bit dismissive about not having physio. Sports people are going to subject their bodies to greater than usual stresses in the courses of their obsessions! It seems wholly sensible for you to be in the best condition you need to be for recommencing your sport.

I would not be happy giving you advice at a distance on exercise for a laminectomy. Two reasons:

1. Yes your surgeon did a laminectomy but I don't really know what he/she did and if I was your physio I would want to before putting you through your paces
2. A thoracic laminiectomy is a less common site (usuallyat the neck of low back) and the procedure is a bit different. Therefore again I wouuld not want to be in the dark about the procedure

You have had serious heavy duty surgery to one of your most valuable body parts - the part that protects your nervous system. you are entitled to get the best treatment you can. I would advise you to pursue getting some physio with a rehab type bent - in the gym with progressive resistance training, stretching, aerobic fitness, stability and balance training, specific exercises for the involved site - the whole works. But be under safe guidance. Your physio must communicate with your surgeon to ensure the best outcome for you.

I tend to agree with gcoe. That said I would ask your surgeon if it might be OK to do some bouldering around the local climbing wall. Here in London we have some excellent indoor walls for bouldering and basically working on body movement whilst only a leg up off the ground. Perhaps you have access to the same in your country? Where exactly is that?

Hi, I live in Cheshire, UK. I have access to excellent climbing walls with very good bouldering facilities. Although I appreciate the risks of a fall, being a trad climber at heart, I am generally keen not to fall. My greatest worry is pulling muscles, damaging ligaments/tendons and damaging the scar tissue / attachment points. To be honest, currently I know it is way too early to start any form of climbing, but I am keen to know what I should and shouldn't be doing. When to push and when to hold back.

I have a clinic appointment (of some sort) next week at the hospital, if I get the opportunity, what questions should I be asking?

A second question is: I know a good sports physio locally, but is this the correct profession to help me? A sports injury clinic has been suggested, but what is the difference between this and a physio?
Many thanks for the help so far.

Hi Physiobob,
As you seem to know about climbing I'll say a little more...
When I start climbing again in November, my plan is to start with the basics again, traverses around the bouldering area and easier slab climbs on top rope. If this feels OK, then would look to shorter vertical top rope routes and again if nothing hurts give easier vertical indoor lead climbing routes a go. If something starts to pull or strain then I plan to end the session. I dislike falling and try to avoid it!

I feel, maybe incorrectly, that my surgeon does not fully appreciate the 'unique' forces at work on your shoulders when climbing. I am keen to progress sensibly at the wall and get myself into as good a shape as possible prior to getting to the wall.

I tend to agree with your approach. The issue is that in order to perform a laminectomy some of the muscles need to be reflected off the thoracic vertebrae in the region and neighbouring spinal region. Your rhomboids are attaching in this area and they therefore won't have a great potential to cling on to their attachments in the beginning. That is why I suggest bouldering first before you have to hang to much off the shoulders. A peg board might just be to much load on that muscle attachment at this time.

Think of it as that relationship of the muscles attaching the scapulae to the spine and you should work so as not to put to much load on them for the first 3 months. That said a gentle contraction along the normal direction of the fibers is a good thing. Only the surgeon knows how much work he did in there so only he/she can really say how long they want you to be super careful. My opinion is that your best rehab is in the climbing wall but with advice from the local sports physio who can guide you in acceptable exercises to maintain and retrain the rotation elements of the spine in that area. We don't want tough scar tissue inhibiting movement that might tear on the first 'dangle' by the finger tips :)

So I think if you have a premise for deciding what is an OK exercise and what is not then you will be able to work forward on that basis. Discuss that with the surgeon in light of what is and is not stable at this time and what will become stable and what will be lacking in the future.

As an update, I have just started physiotherapy to strengthen the muscles and tissues supporting my shoulders.
From the way the exercises feel, they are targeting weaknesses which obviously need strengthening, but not explicitly (yet) the muscles which were interfered with during the operation.

My physio seems unaware of the unique stresses caused by climbing, and I have been asked to document my plans for when I start climbing again (as detailed earlier in the thread. She would like to plan for tailoring the therapy to these actions, but I am a bit lost for words.....
"I need to be able to pull, or push with my arm in any position" seems to be an accurate if perfectly useless description of what I aspire to doing again!
If I was rowing a boat, or doing archery, it would be reasonably easy to describe the actions as they seem reasonably simple and reproducible, but for rock climbing the arm and shoulder actions seem to be more complex and non-routine.

Could anyone help me put climbing in physio speak.....
Any specific muscle groups need particular attention?
Any specific risks as a result of the laminectomy which physio could mitigate?
Is there any physio / medical terminology which describes how I am using my shoulders?

Having worked professionally with a number of different professions, I appreciate that different groups have different 'languages' and if I can explain my needs to a non-climbing physio in 'physio-speak' I feel it will help us both get the treatment right.

Many thanks for reading so far, and all help gratefully appreciated.

Hi markaut

It is up to the physio to analyse the task you are proposing from a biomechanical and anatomical viewpoint - not you. In my opinion getting you to do the analysis is a cop out. The physio should get off her chuff and do a task analysis. This should be based on actual observation (one site visit is all it takes) + a quick look at the biomechanics of rock climbing is all it takes. This should then be matched against your current capacity - particularly strength and postures you adopt for the sport.

There are a number of reasons I am so adamant about this. Here are the two main reasons:

It is the physios responsibility to advise you on what is safe, what is borderline and what is genuinely unsafe. She should be basing this on her own objectively derived information and not on your perception - let's say you are wrong and give her an underestimation of what is required and you then injure yourself - then where does the buck stop? the physio! If you failed to follow the advice given and then injured yourself that would be entirely different. But it the first case it is the physio's responsibility to give you advice based on sound knowledge and observation.

Just because the physio hasn't struck this sport before doesn't mean the physio should be avoiding finding out what is actually involved in an objective manner. This is part of on going learning that members of the profession are expected to partake in

Finally I don't think you should be relying on hypothetical analyses of rock climbing tasks such as you might get from this website. The therapist needs to see what YOU actually DO.