In this episode, we have a conversation with, registered physiotherapist and climber, Quinn Turner. We found Quinn’s Instagram account @alpine.physio and was truly inspired by his content. Quinn resides in North Vancouver BC where he works out of Body Works Sports Physiotherapy and Kinematics Sports Medicine & Rehab. He began his studies at the University of Calgary obtaining a BSc in kinesiology and later receiving his Masters from the University of Alberta. Quinn specializes in concussion and vestibular rehabilitation but treats a wide range of ailments found in the life of a climber. Like all of us, Quinn has a strong passion for the mountains. He is an experienced Nordic skier, hiker, and climber. In our conversation, we cover topics such as the accidents that inspired him to become a physio, concussions, their severity, symptoms, and the healing process, the physics of helmets and their effectiveness in climbing, we discuss evidence-based rehabilitation and outdated medical practices that are still being prescribed today, and finally, we dive deep into the mysterious pulley injury and its relation to crimping and dynamic movement.
In this episode, we have a conversation with, registered physiotherapist and climber, Quinn Turner. We found Quinn’s Instagram account @alpine.physio and was truly inspired by his content. Quinn resides in North Vancouver BC where he works out of Body Works Sports Physiotherapy and Kinematics Sports Medicine & Rehab. He began his studies at the University of Calgary obtaining a BSc in kinesiology and later receiving his Masters from the University of Alberta. Quinn specializes in concussion and vestibular rehabilitation but treats a wide range of ailments found in the life of a climber. Like all of us, Quinn has a strong passion for the mountains. He is an experienced Nordic skier, hiker, and climber. In our conversation, we cover topics such as the accidents that inspired him to become a physio, concussions, their severity, symptoms, and the healing process, the physics of helmets and their effectiveness in climbing, we discuss evidence-based rehabilitation and outdated medical practices that are still being prescribed today, and finally, we dive deep into the mysterious pulley injury and its relation to crimping and dynamic movement.
00:00:01:00 - 00:00:25:21
Speaker 1
Hi, everyone. Max here. Climbing majority. Thanks for tuning in today and being a part of our growing community of climbers around the world. This podcast was created for climbers by climbers and it means so much to us to have you here. In this episode, we have a conversation with registered physiotherapist and climber Quinn Turner. I found Quinn's Instagram account at Alpine Physio and was truly inspired by his content.
00:00:26:08 - 00:00:50:03
Speaker 1
Quinn resides in North Vancouver, B.C., where he works out of body work, sports, physiotherapy and kinematics, sports medicine and rehab. He began his studies at the University of Calgary, obtaining his Bachelor of Science in Kinesiology and later receiving his masters from the University of Alberta. Quinn specializes in concussion and vestibular rehabilitation, but treats a wide range of ailments found in the life of a climber.
00:00:50:14 - 00:01:17:07
Speaker 1
Like all of us, Quinn has a strong passion for the mountains. He's an experienced Nordic skier, hiker and climber. In our conversation, we cover topics such as the accidents that inspired him to become a physio. Concussions, their severities. Symptoms, and the healing processes. The physics of helmets. And their effectiveness climbing. We discuss evidence based rehabilitation and outdated medical practices that are still being prescribed today.
00:01:17:20 - 00:01:42:09
Speaker 1
And finally, we dove deep into the mysterious Polley injuries and its relations to crimping and dynamic movement of a wicked man. How's. How's it going?
00:01:42:18 - 00:01:44:08
Speaker 2
Oh, it's going well, fellas. Are you guys.
00:01:44:22 - 00:01:45:18
Speaker 1
Yeah, that's good.
00:01:46:12 - 00:01:47:12
Speaker 2
Stuff, to be honest with you.
00:01:47:22 - 00:01:49:14
Speaker 1
Sweet. Yeah. No. On.
00:01:49:23 - 00:01:53:04
Speaker 3
Yeah. Max, how did you. Have you guys know each other? If you do at all.
00:01:54:11 - 00:01:55:06
Speaker 1
Instagram in.
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Speaker 3
The lovely.
00:01:56:08 - 00:01:56:14
Speaker 2
New.
00:01:56:14 - 00:02:03:12
Speaker 1
Digital age of social media and I found Alpine Physio, which I was like, Oh, that's super interesting and incredibly relevant.
00:02:03:12 - 00:02:07:06
Speaker 4
So that's that's how that happened. Yeah. Yeah.
00:02:07:23 - 00:02:08:23
Speaker 3
Quinn, are you a climber?
00:02:09:20 - 00:02:10:23
Speaker 2
I am a climber. Yeah.
00:02:11:08 - 00:02:12:01
Speaker 3
Cool. Awesome.
00:02:12:14 - 00:02:14:22
Speaker 2
Yeah, I'm a.
00:02:14:22 - 00:02:15:15
Speaker 4
I guess, physio.
00:02:15:15 - 00:02:34:15
Speaker 2
First climber second or vice versa. But I kind of got into climbing about ten years ago and, you know, similar as everyone, it seems to consume you, right? It's kind of starts as hiking, then gets into scrambling and suddenly you find yourself in a in a van in Squamish for four months on an island, right.
00:02:35:10 - 00:02:35:18
Speaker 4
Yeah.
00:02:37:08 - 00:02:57:21
Speaker 2
But no, I'm a physiotherapist. I work in North Vancouver, I grew up in Calgary basically lived in Calgary my entire life. I did my undergrad at the University of Calgary, got a Bachelor of Science there in Kinesiology. And then I moved up to Edmonton for a couple of years to my Masters of Physiotherapy there. And then recently I actually met myself and my partner.
00:02:57:21 - 00:03:03:01
Speaker 2
We moved to North Vancouver. So now we're, we're stationed here and I'm working both on the North Shore as well as downtown.
00:03:03:19 - 00:03:05:11
Speaker 1
What, what sparked the move for you?
00:03:06:09 - 00:03:29:14
Speaker 2
Yeah. So it would it would basically come as a climbing trip. So we came out here, we loved it. It it felt very homey, right? And so eventually we kind of just made the decision that it was time to move in and get away from from the cold and the blistering temperatures there and decide to make our moving Squamish where it's a little bit more cruisy.
00:03:29:14 - 00:03:31:08
Speaker 2
And we can we can spend some more time on rock.
00:03:32:09 - 00:03:37:14
Speaker 1
Yeah, makes sense. Fair enough. You do? Do you like ice time at all?
00:03:38:02 - 00:03:59:22
Speaker 2
I used to, yeah. Yeah, it's, you know, and I think the the risk management is caught up to me on that forefront where I'm not willing to take the same level of risks that I used to. And ice climbing really is, and it's at its core, a lot of heavy risk. Right. So that's kind of as I as I got a little bit softer, I guess with age, I'm kind of with that.
00:04:00:02 - 00:04:11:21
Speaker 2
But I used to be quite, quite an ice climber that that's kind of how I got into climbing. That's how I spent my winters for for a number of years there, about seven years I spent ice climbing, but I don't think I'm into it anymore.
00:04:11:21 - 00:04:18:07
Speaker 1
Yeah, fair enough, man. Yeah. I was going to say, though, if you're still into it a whole bunch, you know, moving on the West Coast compared to Alberta.
00:04:19:00 - 00:04:20:15
Speaker 4
That's going to be a big a big difference.
00:04:20:15 - 00:04:22:15
Speaker 3
But it sounds like you're going to be doing just fine.
00:04:22:16 - 00:04:23:00
Speaker 4
Yeah.
00:04:23:07 - 00:04:24:11
Speaker 2
It's an easier. Right.
00:04:25:11 - 00:04:29:02
Speaker 3
It sounds like there's a story attached to that. Did you have a close call or anything?
00:04:29:21 - 00:04:52:00
Speaker 2
You know what? I didn't have any particular close calls, except I think ice climbing itself is just a series of small, close calls. Right. There's. Yeah, there really is. Enough. Enough. The Times where I've looked back and been like, oh, yeah, you know, it's enough when loading up there that something could have happened or, you know, detached flake or whatever else where, you know, it's the stoke is definitely reaching for that.
00:04:52:00 - 00:05:00:17
Speaker 2
That's that pursuit. And now I'm just into the skiing and the and the rock climbing seems to be my, my source of fun.
00:05:00:17 - 00:05:01:04
Speaker 4
Cool.
00:05:01:20 - 00:05:20:23
Speaker 3
Yeah, it's definitely an interesting story. It's the the I guess it might be the Canadian way where like, oh, I got into climbing by starting ice climbing, you know. Yeah, I never heard that before until I met Max. And now, you know, this is another story. So definitely cool. I've really an interesting way to get into the sport is just straight into ice climbing.
00:05:21:00 - 00:05:25:13
Speaker 3
It seems so foreign to me because out here it's like just a mystic sport almost.
00:05:26:21 - 00:05:32:06
Speaker 1
I think. I think you also got to look at climate a little bit because like, what's the climbing season in Alberta.
00:05:32:09 - 00:05:32:16
Speaker 4
When.
00:05:33:20 - 00:05:36:02
Speaker 2
It's like a month and a half maybe? Wow.
00:05:36:09 - 00:05:37:15
Speaker 4
Yeah, yeah, yeah.
00:05:38:14 - 00:05:50:00
Speaker 1
Yeah. So in Alberta, it's like the climbing season runs. It's absurd. Like you can climb ice into April higher in the Alpine and stuff and then you guys get like, what, a couple of months of rock? And then it's like, boom, right.
00:05:50:04 - 00:05:51:20
Speaker 2
Back in October.
00:05:51:21 - 00:06:08:01
Speaker 1
You ice climbing all again, you know? So yeah. And and the ice there, it's just like so good. It's mega. It's just on a different scale, right? So it's so common for everybody there. It makes sense. I mean. Yeah, yeah. Climbing climate ice is pretty natural extension there for sure.
00:06:08:12 - 00:06:09:22
Speaker 2
Oh, for sure.
00:06:09:22 - 00:06:20:01
Speaker 3
When you got into climbing itself, did you have like a mentor or did you just go after it? You want to kind of talk about maybe just very briefly, those those beginning stages of of the first four years.
00:06:20:01 - 00:06:37:20
Speaker 2
Yeah. So it seems to run in my family a little bit. My uncle's a guide and he lives in Penticton now and he actually runs Schoolhouse Rock Climbing Adventures. So he's kind of been a, you know, he lived the big life there for the better part of 45 years. So he's kind of been around the world and done it all sort of thing.
00:06:37:20 - 00:06:55:20
Speaker 2
And that was a bit of a mentorship. The kind of brought me into it to start or are just a source of Stoke, I would say maybe. But then even going for it, really, it was it was more about reaching out to, to potential mentors and almost going through a little bit of a weaning process of kind of who's a good fit and who's safe and who's not.
00:06:55:20 - 00:07:06:09
Speaker 2
And and, you know, looking back, I don't know if I had the best judgment of character of who I was being mentored by. But, you know, I survived and we're here now. So we know a little bit better as we've kind of gone through the stages.
00:07:07:09 - 00:07:31:13
Speaker 1
Yeah, I think that's an interesting one that like a finding a mentor is such like a particular thing and getting a partnership where you both have like similar temperaments and goals and stuff like that could be really tricky and difficult, you know? So I think that's like that's an interesting fine line to walk and it can be really tricky to do, you know, but like so, so crucial.
00:07:31:13 - 00:07:34:04
Speaker 1
Yeah, that's, that's something we've touched on a lot for sure.
00:07:34:11 - 00:07:51:09
Speaker 2
And the thing is to like you kind of look back on it and you realize you did some Gumby stuff, right? So, you know, if I was to do it all again, I'd definitely start with my courses. And I wouldn't I would start with a couple of years of ice climbing before you kind of get into rope rescue and all that sort of management.
00:07:51:20 - 00:07:52:20
Speaker 4
But yeah.
00:07:53:05 - 00:07:55:23
Speaker 2
You can you can only hindsight. 2020, right?
00:07:56:14 - 00:08:15:14
Speaker 3
It's just a super common thread. I think even with professionals we've talked to a few guides and they even them, they have their stories of like, yeah, like I had so many close calls in my first year of tried climbing, I was completely in over my head. I had no idea what I was doing, but I was completely full of stoke and excitement and that's what carried me through.
00:08:15:14 - 00:08:21:19
Speaker 3
And a lot of them consider themselves lucky to be on the other side. And I think that a lot of people can can relate to that exact experience.
00:08:22:07 - 00:08:54:23
Speaker 1
Totally such a such a commonality in this sport. And, and, and, and even like reading, climbing like autobiographies of lots of famous climbers, like they all have the same thing, you know? And I feel like there's sometimes, like, people think that's like some kind of like, you know, singular, like, thing that they don't want to share. Like, Oh, man, like my kind of like horror stories of the mistakes I made or the really stupid things I did, like starting out, but the reality is, like, so many people start out like that, like, I wish I had heard exactly what you just said.
00:08:54:23 - 00:09:11:17
Speaker 1
You know, I totally wish I'd just, like, jumped into a course and, like, found a guide and, like, a mentor and, like, gone through that avenue at the beginning, you know, rather than, like, finding out a little later into into climbing, you know, I think I think it'd be a lot better if that was the norm for people.
00:09:13:00 - 00:09:13:15
Speaker 2
No kidding.
00:09:14:02 - 00:09:39:05
Speaker 1
I was just climbing at the gym and there's these two really funny, like old timers, you know, like pretty darn old timers. Those guys are like late sixties, seventies, like with guys just having so much fun in the gym and laughing it up and still climbing pretty hard. But they were saying, you know, like they're out of your park the other day and he's like, he's like there's like three different parties throughout the day when they were climbing where like he was like, you know, we had to stop to tell them, like, if, if you're if you're going to be continuing.
00:09:39:05 - 00:09:39:23
Speaker 4
Doing that, like.
00:09:39:23 - 00:10:08:16
Speaker 1
You're not going to be climbing much longer because like something terrible is going to happen to you. You know what I mean? It's yeah, yeah, it's it is it is an interesting thread that we've touched on before where it's just like there's climbing is exploding in popularity and exploding as a sport. And you get so many people going from a gym who are like quite physically strong, but then that like actual technical competency or the skills or, you know, descending, those are just things that people just overlook in so many different ways.
00:10:08:16 - 00:10:19:12
Speaker 1
And I think that we're so hyper focused on like, I need to get stronger, I need to get fitter, I need to get lighter, I need to climb harder. But like, it's so easy to overlook all those other important skills right.
00:10:19:18 - 00:10:20:10
Speaker 2
Now, for sure.
00:10:20:20 - 00:10:39:19
Speaker 3
It's not as glorified the risk management side of it. And it's it's not a focus in any sort of I mean, it's there, but it's almost like, all right, let me do the bare minimum so I can get outside and start and start sending. So yeah. So where, where are you at kind of right now in terms of your climbing, do you have any sort of objectives?
00:10:40:03 - 00:10:46:21
Speaker 3
Where are you focused primarily on kind of what grades are you climbing and just kind of round yourself out presently as a climber?
00:10:46:21 - 00:10:53:08
Speaker 2
Yeah. Yeah. So so presently I've worked my my way already into a pretty age trap, dead scenario. Right? So I'm a.
00:10:53:17 - 00:10:53:23
Speaker 4
Huge.
00:10:54:09 - 00:11:16:18
Speaker 2
Huge fan of good old five nine cracks. Right. And so that's kind of that's kind of fuel the stock of where we're at. But I do enjoy the sport climbing. I'm kind of mid 11 with the sport and about you know low low tens at the track. Right. So I'm still I'm still working my way up and really where where it's at is are just having fun so totally against the I'm project and harder set and hard but I am just having a good time.
00:11:17:06 - 00:11:33:07
Speaker 3
I think that it's important to share. I think that, you know, it can be focused on the grades, but it definitely doesn't define us as a climber. And like you just said, it is all about the fun. But it's important, you know, when people post pictures of someone climbing a route, I mean, they don't post the grade or they don't post the the route name.
00:11:33:07 - 00:11:50:00
Speaker 3
I always get frustrated. I'm just like, why? Like, why are you hiding that information? So I always love I always I always love to to just kind of get people to understand, you know, like this is the majority of climbers. You know, we aren't all projecting these hard routes. Like, that's not what this is about. You know, it's about, you know, five, nine cracks.
00:11:50:00 - 00:11:54:13
Speaker 3
You could climb that until you die and you could have an awesome well, hopefully until you're old age when you.
00:11:54:13 - 00:11:54:17
Speaker 4
Die.
00:11:56:06 - 00:11:59:08
Speaker 3
And you could have an awesome climbing career and that and that's what it's all about.
00:11:59:08 - 00:12:26:21
Speaker 1
So I think that's a great point. Kyle and Mike, you know, for me, like, I'm in the exact same boat with you, Quinn, like I'm trying to break into like deeper into the tent and really like my goal in climbing or what I want is like I want to be able to go on really sweet sec multi pitches wherever I, wherever I am around the world and I want to, I want five tends to feel like what five, seven, eight, five, nine feels like for me now you know what I mean where that's not the reality for me right now.
00:12:26:21 - 00:12:48:01
Speaker 1
So. But, but yeah, like that. That's it. You know, I want to just be able to get out and and enjoy amazing places and amazing adventures and obviously improve. But I think Kyle said it, it's like there there's so much hyper focus on just like being the strongest climber and sending and being fixated on grades in a really negative way.
00:12:48:06 - 00:13:06:05
Speaker 1
And yeah, that just that is the reality for people climbing, you know, like and I feel like that's the reality, that's what's portrayed in the media, but it isn't the reality of the majority of people climbing and nor should it be. Right. Exactly. You know, I think you said it. It's about having fun, right? There's like quote, I think it's I think it's Alex Love.
00:13:06:05 - 00:13:08:05
Speaker 3
Maybe it is. I think it is. Excellent.
00:13:08:06 - 00:13:09:17
Speaker 4
Audience Yeah.
00:13:09:17 - 00:13:22:22
Speaker 1
It's like, you know, the, the, the best climber is the one having the most fun. And I really try and remind myself of that because there are times where I'm like, out there, like trying to push for something and I'm not having a good time. And I'm like, I'm like, why am I doing this? You know what I mean?
00:13:22:22 - 00:13:31:14
Speaker 1
Like, try and, like, be in the moment and actually enjoy your day. Go have fun. Go do something like that. Go climb. So, yeah, it's interesting.
00:13:31:14 - 00:13:48:21
Speaker 3
So your, your, your path to physiotherapy, what kind of sparked that, that journey and was it injury related? Did you have an injury or someone close to you that had an injury that kind of pushed you into that career or inspired you to get into that career? Or was it was it a different path?
00:13:49:19 - 00:14:13:20
Speaker 2
Yeah. No, it wasn't really injury related and it wasn't it wasn't climbing injury related. It was some pretty lame stuff, right? So it was kind of a middle school. I twisted real weird and I, you know, I still to this day, after all my oh, my knowledge and experience, I still don't know how I did it right. But I basically ended up with with three open surgeries and that kind of landed me with like a solid year or two of of pretty intensive rehabilitation.
00:14:14:08 - 00:14:38:10
Speaker 2
And so, you know, I had a long exposure to this field and to the discipline of physiotherapy and just seemed pretty cool. Right. It's a it's a a position where we get to kind of help people improve their quality of life. Right. So it seemed like a fun way to take my career and I'm glad I did. The second thing is I started specializing a little bit more in hands as well because I had a pretty significant hand.
00:14:38:10 - 00:14:54:15
Speaker 2
Andrea I had two fingers cut off on a saw and those were surgically reattached and I'm really thankful for that. And they work just fine at this point. But again, I was back with a about another year of rehabilitation, kind of specialized into the hand side of things. So holy shit.
00:14:54:16 - 00:14:55:15
Speaker 1
Wow, I'm crazy, man.
00:14:55:19 - 00:14:57:17
Speaker 4
So with the with the knee.
00:14:57:17 - 00:15:02:08
Speaker 1
You're just like, were you, like, playing sports? Or you just twisted oddly, like, just a little bit like.
00:15:02:13 - 00:15:19:00
Speaker 2
Yeah, no, man, I was in gym class and I and I then I twisted, just just twisted and my foot didn't move and my body moves and it run when, you know, and it snapped my femur off. So I must not have been drinking enough milk at that stage. Right. And then you broke your labor.
00:15:19:00 - 00:15:19:21
Speaker 1
Your femur broke.
00:15:19:21 - 00:15:30:22
Speaker 2
Your femur broke and my my kneecap dislocated. Well, my kneecap dislocated and broke off the femur. A chunk of it is pretty gross. It's gross to think about, but it really kind of wrung the knee out like a towel and.
00:15:31:05 - 00:15:32:07
Speaker 4
Yeah, yes.
00:15:32:20 - 00:15:34:00
Speaker 2
It's yeah.
00:15:35:00 - 00:15:47:19
Speaker 1
Yeah. Brutal man. Three surgeries. Like that's that's just a lot to go through, man. So taxing on the body, such, like a long thing to, like, get and progress through. And especially like, you're young, you're athletic, you've got to do school.
00:15:47:19 - 00:15:48:05
Speaker 4
Like, there's.
00:15:48:13 - 00:15:58:08
Speaker 1
All these things, right? It's such a like just a just on itself. You had nothing to do in life, just going through that. It's just like such a monumental thing to get through, right?
00:15:58:12 - 00:15:58:22
Speaker 4
Oh, yeah.
00:15:59:15 - 00:16:02:07
Speaker 1
So. So can I call you Tommy Caldwell to point out.
00:16:02:16 - 00:16:07:10
Speaker 4
Cutting your fingers off with. Exactly. Exactly. Did you get better at climbing after.
00:16:07:10 - 00:16:08:11
Speaker 1
You cut your fingers off?
00:16:08:11 - 00:16:11:11
Speaker 4
That's what I want to know.
00:16:11:11 - 00:16:15:02
Speaker 2
I got my back on, so I.
00:16:15:02 - 00:16:16:18
Speaker 4
If you had less if you had left them.
00:16:16:18 - 00:16:18:13
Speaker 1
Off, man, you'd be like 515 by.
00:16:18:23 - 00:16:19:07
Speaker 4
Yeah.
00:16:19:15 - 00:16:20:06
Speaker 2
Unless you.
00:16:22:20 - 00:16:23:03
Speaker 4
What.
00:16:23:10 - 00:16:25:02
Speaker 3
What fingers were on one hand.
00:16:25:09 - 00:16:28:12
Speaker 2
It was, it was the middle finger and the ring finger on the right.
00:16:29:04 - 00:16:30:18
Speaker 4
Wow. Crazy. Yeah.
00:16:31:08 - 00:16:33:07
Speaker 2
Right, right. At the rate of the knuckle in the middle.
00:16:33:22 - 00:16:35:03
Speaker 3
Oh did it go through the.
00:16:35:03 - 00:16:36:06
Speaker 2
Geometry above or below.
00:16:36:06 - 00:16:36:17
Speaker 3
The joint.
00:16:37:06 - 00:16:38:04
Speaker 2
Right through the center.
00:16:38:18 - 00:16:40:13
Speaker 1
Now, how how old were you?
00:16:41:00 - 00:16:42:13
Speaker 2
Oh, I think I was about 14.
00:16:43:00 - 00:16:50:07
Speaker 4
Oh, my God. I was. Yeah, man, that. Oh, and shop class at school. Wow.
00:16:50:12 - 00:16:52:14
Speaker 1
I feel so bad for your teacher.
00:16:52:14 - 00:16:53:23
Speaker 4
You know what I know that's like.
00:16:53:23 - 00:16:56:04
Speaker 1
Turn around, have some kids, like, fingers flying.
00:16:56:04 - 00:16:56:21
Speaker 4
Across the room.
00:16:57:18 - 00:16:58:21
Speaker 1
The worst nightmare.
00:16:58:21 - 00:17:02:07
Speaker 4
You know? Wow.
00:17:02:15 - 00:17:02:23
Speaker 3
What a.
00:17:02:23 - 00:17:03:17
Speaker 2
Crazy story.
00:17:04:11 - 00:17:05:02
Speaker 4
Totally.
00:17:05:02 - 00:17:36:08
Speaker 1
Yeah. So, so brutal. Really, really interesting. Totally unfortunate for you, you know, although, I'm sure, like, you know, like Kyle, I've kind of learned like, obviously having injuries sucks, but you can't change things that are out of your control. But you can try and look at like the positive side of things. And like, I've learned a lot about myself, like mentally, physically, you know, through this process and like what I can actually deal with and overcoming through adversity and changing expectations and, you know, learning to just accept things.
00:17:36:08 - 00:17:47:12
Speaker 1
And there's just been so many, so many things that like, obviously, in the long run, I wish it hadn't happened, but, you know, it's not all negative that it did happen, if that makes sense.
00:17:47:14 - 00:17:53:21
Speaker 2
Yeah, right now it definitely gives you a present appreciation as well for for being able to empathize with patients. Right.
00:17:54:10 - 00:17:55:17
Speaker 1
I could imagine for you.
00:17:57:13 - 00:18:02:13
Speaker 4
Like trust me, been there. You're going to be okay. Yeah.
00:18:02:14 - 00:18:27:19
Speaker 3
Having that stuff happen to you at such a young age, I'm sure had a huge impact on your your growth and development cognitively and probably empathetically as well. It's definitely interesting. I personally haven't heard of of many stories of of someone so young going through such traumatic injuries so early. What do you feel like the biggest lessons you learned at a younger age during that time of development?
00:18:27:19 - 00:18:31:22
Speaker 3
Like what? What were your biggest takeaways from from kind of being in those shoes?
00:18:31:22 - 00:18:33:20
Speaker 2
Probably not. Not put my fingers in advance.
00:18:34:06 - 00:18:41:17
Speaker 4
Be honest. I don't know much.
00:18:41:17 - 00:18:52:11
Speaker 2
I've asked and got through it. And the fingers, certainly I don't have any limitations on the fingers anymore. I kind of stuck with my and then we got back to where I wanted to be. So I don't know.
00:18:53:11 - 00:18:54:22
Speaker 4
What's your what's your new like.
00:18:55:07 - 00:19:13:01
Speaker 2
The minute you know, you could be better. I will. I won't lie with that. And partially, that was that was my fault. I was I was quite young. I think I was 13 then. But the the knee I didn't I didn't take it seriously either. You know, it was I kind of slacked off a little bit and it's it's definitely given me some grief to to this day for sure.
00:19:13:20 - 00:19:21:18
Speaker 1
Are you like a potential like higher case for arthritis? Are you looking at a knee replacement? What's kind of like the long term outcome, do you think, for you?
00:19:21:18 - 00:19:41:21
Speaker 2
Oh, for sure. Yeah. So when I when when that surgery was done, I was basically told that I had have arthritis before I was 20. Right. Sort of thing. So where it's kind of at is I'm certain if you went and took a picture of my knee, I wouldn't want to see it see it like that. So I'm sure there's already some some good degenerative changes and, you know, it flares up time and time.
00:19:41:21 - 00:19:59:07
Speaker 2
But really, you know, I can still do 2000 meter days in the in the hills. I can still run downhill and still jog. So I'm pretty I'm pretty stuff where it's at. But I'm sure as as age kind of takes its toll that I will be looking at a knee replacement closer to that that 40 years old by.
00:19:59:07 - 00:20:12:08
Speaker 1
Yeah I'm probably looking at an ankle replacement and one ankle and arthritis like early on in life and stuff and so you know like part of like the ignorant side of my brain is just like praying for like technology and innovation. I'm just like, all right.
00:20:12:22 - 00:20:15:10
Speaker 4
You learn to just make like a full 180 and.
00:20:15:10 - 00:20:17:18
Speaker 1
Start doing like, joint replacements or something.
00:20:17:19 - 00:20:19:09
Speaker 4
You help. But yeah.
00:20:19:15 - 00:20:21:09
Speaker 1
I don't know how safe of, of that that is.
00:20:21:15 - 00:20:22:12
Speaker 4
But I am, I am.
00:20:22:12 - 00:20:37:18
Speaker 1
Kind of hopeful. I'm like where like where could, you know, joint replacement and orthopedic. So in the next 20 years, where can stem cells and those applications go then? So grafting but ultimately like banking on that's not really a good one.
00:20:37:19 - 00:20:38:09
Speaker 4
You know, that's.
00:20:38:10 - 00:20:39:00
Speaker 1
Just like I.
00:20:39:05 - 00:20:40:18
Speaker 4
Even in the back of my mind like.
00:20:40:23 - 00:20:48:06
Speaker 1
That would be really interesting and cool and I'm hopeful. But at the end of the day, like, it's, it's probably not what you want to rely on, right?
00:20:48:08 - 00:20:50:05
Speaker 3
Yeah. Is ankle replacement even a thing.
00:20:51:09 - 00:21:00:02
Speaker 1
Oh yeah. They can replace the ankle and stuff. They can use the ankle. It really depends. But I don't, I don't think it's pleasant to say the least.
00:21:00:02 - 00:21:00:15
Speaker 4
Like Yeah.
00:21:01:12 - 00:21:25:22
Speaker 1
Case scenarios, right. Yeah. For those things in my rudimentary understanding and looking at them. But yeah but I really, I did, I was reading a couple like studies a while back about stem cell grafting. So they were talking about using some kind of like an organic material and they go in the joint and the materials like infused are injected with stem cells and then they put that over that degenerative tissue.
00:21:26:01 - 00:21:34:05
Speaker 1
And hopefully, like that, the goal is to have that be able to grow into new tissue. But I think they're very far away from that.
00:21:35:14 - 00:21:43:00
Speaker 2
As is is I don't think in the text there yet. But the you know, the idea's definitely out there at this point.
00:21:43:20 - 00:22:05:18
Speaker 1
Maybe just like we could talk as if like someone like a listener who maybe does have an injury or they don't know, like, why would I go to a physiotherapist over a massage therapist or something? So, you know, maybe you could go over a little bit about that of like, like what separates physiotherapy and when does someone want to seek like a medical professional in physiotherapy?
00:22:05:18 - 00:22:25:19
Speaker 2
Oh, totally. Okay. No, this is a really good question because a lot of people don't don't really know. I don't think it's out there very well. The physios are kind of primary care practitioners. And so what that means is essentially we're trained with the same skills to kind of assess and diagnose and treat and make sure that we're screening out red flags and no end of refer.
00:22:25:19 - 00:22:43:11
Speaker 2
So you don't need a doctor's referral to go to physio. You don't need essentially to see a doctor, see anyone before going to physio. It's you can kind of just go in with whatever pain problem that you have and then see them. Where the evidence is kind of pointing is that you always want to take more of an active, active approach to your rehabilitation.
00:22:43:11 - 00:23:05:02
Speaker 2
So like massage and stop feels great, right? And if you like it, you like it, whatever. But if it's like something that is interfering with with walks of walks of life and like, you know, it's really starting to debilitate you with activities. And that's where I'd start to go towards physio, right? And it's where I would say Don't come to us is like if you just cratered and broke both your ankles, like if you go to the hospital right?
00:23:05:02 - 00:23:30:09
Speaker 2
Like, yes, I don't want to send you there anyway. Right. So there's a little bit of still that. But where where we do get a lot of people is they still go towards their their medical doctor for when they have kind of general musculoskeletal aches and pains. And it's just interesting because we get about the same amount of of education on pharmacological management as the as primary care physician.
00:23:30:15 - 00:23:50:05
Speaker 2
We'll get on a MSK care, which is about 2 to 3 weeks. Right. So they don't really learn much about the body and we don't really learn much about Med. So where a lot of people kind of I think there's a bit of time wasted is having to go and get that referral. So like I would say if you're struggling like go and see a physio right now would probably be your first and foremost thing.
00:23:50:05 - 00:24:10:08
Speaker 2
And then if you need it, they'll make the referral to to the given specialties. They'll, they'll help you. And there is there is a and on top of that there is you know, I'm I have to find this study and the reference for it but it was it was analyzing kind of care delivered with ankles, brains, kind of primary care, ankle sprains.
00:24:10:08 - 00:24:33:17
Speaker 2
And what was the advice given in the emergency room if you went just with an uncomplicated ankle sprain? Right. And it was not 95% of the time people were given advice that was not concurrent with the the current guidelines of rehab. And that's like an extraordinary number. And what ends up happening is you have about 30% of people who follow just this guideline and this adviser or of the advice that they're given in the emergency room.
00:24:33:17 - 00:24:49:04
Speaker 2
They end up with pain a year later, which is completely unacceptable with an ankle sprain. Right. It's a more or less a simple injury. And it's just like where people set themselves back really far just because they sought out the care that they think they need. And it turns out it just wasn't the appropriate type of care.
00:24:49:15 - 00:25:02:01
Speaker 3
Is there any sort of specialization or kind of like how would you describe your your your particular career right now? Like, all right, do you have any focuses, specializations or kind of like, where's your area of expertize?
00:25:02:15 - 00:25:27:23
Speaker 2
Yeah, I've started to branch out more into the concussion investigative side of physiotherapy and and it's kind of drawn me to it because it's different. It's got a lot more, a very variety to it. So the concussion side of things is is kind of an under it's a it's a sprouting field of rehabilitation where we're starting to realize that people with concussions actually do quite well if they're rehabilitated with with kind of the proper style of rehab.
00:25:28:07 - 00:25:45:08
Speaker 2
And that really is individually tailored to whatever systems they kind of have affected in their concussion. But with again, with our traditional management of concussion, we just kind of told people to sit in a dark room and rest there for until their symptoms went away. Right. And it's the same as if you told someone with an ankle sprain to stay on crutches for the next four weeks.
00:25:45:08 - 00:26:04:11
Speaker 2
Right. It kind of leads you into this this state of deconditioning and state of under loading where where it's easier to flare you up. And then people get really stuck in that kind of trench cycle with concussions where the same thing. It's kind of just it needs a little bit of that kind of coaxed rehabilitation, bring you out of that.
00:26:04:21 - 00:26:24:03
Speaker 2
So that's kind of the concussion side of things that I'm doing. And then the vestibular is is treating more that vertigo. And so that's that's kind of like the the dizziness and the rotational impairments that people can get, you know, from trauma, from whiplash. They can even get it kind of insidious just coming out of I don't know where like it doesn't really have to have a a start.
00:26:24:03 - 00:26:42:02
Speaker 2
But the the thing that draws me to that, it's got a very algorithmic style approach, like the the inner ear doesn't lie. It'll it'll kind of make your eyes do some funky things. And based on, on whatever your eyes are doing, it's it's something sometimes that we can treat in the same session. And it's the it's the closest thing to wizardry that you can do with the with my degree.
00:26:42:02 - 00:26:46:02
Speaker 2
So I'm kind of taking that side of things that we have.
00:26:46:20 - 00:27:02:14
Speaker 1
I was not actually familiar with the word vestibular and I did like look it up when I was looking at your bio and stuff. And so so is it all oriented in from the eardrum? Because I know like that has to do with like orienting balance in your body and stuff like that. Is that what like we actually derive the mechanism for vertigo?
00:27:02:16 - 00:27:23:08
Speaker 2
Yeah. So what vertigo essentially is, is it's a mismatch in your body's awareness of its position in space. And so there's kind of three main sources of where we get that information from. One is our inner ear. So this is kind of the the semicircular canals and that that little vestibular apparatus that changes in your head position will kind of relay information to your brain.
00:27:24:06 - 00:27:42:01
Speaker 2
The second is our eyeball. So our eyes ability to kind of visually process and orient us with our surroundings. And the third is, is our our kind of proprioception. So what is that? That's kind of like our our position sense, our muscles and joints. So those kind of relay a specific message to the brain about where your body is in space.
00:27:42:10 - 00:28:04:03
Speaker 2
And really a mismatch in any of those three systems will will create a sense of dizziness in your in your environment, that rotational dizziness that that typically stems from the inner ear. You can you can you can have about, you know, more rare cases. Obviously, it's coming from the from the brain in the central nervous system or stuff more severe like strokes.
00:28:04:14 - 00:28:10:01
Speaker 2
But for the vast majority of cases, it is it is kind of in your inner ear impairment or one of the two other systems.
00:28:11:02 - 00:28:29:00
Speaker 1
Yeah, I was actually just talking with my wife. She's kind of like my second mother in a way, but her name's Linda and she was saying she's like, just woke up one day and was like, had total vertigo. And like, it was like out of nowhere from no head injury or anything. And she went and she got checked out and the person said, like, yeah, it's vertigo.
00:28:29:00 - 00:28:38:02
Speaker 1
So what, what would bring that about if there was no initial trauma or anything like that? I'm just curious, maybe, you know, obviously it's like you can't diagnose someone without looking at them, but yeah.
00:28:38:08 - 00:28:57:14
Speaker 2
Yeah. So, you know, that's a really good, really good question. And sometimes there's is absolutely nothing. So really there is like different medications or there's there's you could be sick and have that infection kind of attack the inner ear or have that inflammation kind of affect. That nerve comes from the inner ear. But sometimes you just wake up with it.
00:28:57:14 - 00:29:18:16
Speaker 2
And that's that's the vast majority of cases I see that I treat are people who have really just kind of woken up with this kind of we call it benign capitalism or positional vertigo, but it's just those kind of crystals in your inner ear that are are for whatever reason, they came, dislodged, and they're just interrupting the fluid flow so that that's the most common case of that sort of thing.
00:29:18:16 - 00:29:25:10
Speaker 2
And then that's closely followed by an infection that's stimulant or itis is kind of the next one that people get.
00:29:25:20 - 00:29:27:13
Speaker 1
Is it normally correlated with age?
00:29:28:02 - 00:29:43:05
Speaker 2
It is, yeah. The older you get, the more likely it is that this happens. And there's some working theories, some some people think that the the kind of jelly that the the crystals sit on gets a little bit stiffer and less viscous with age and it's easier to fall off. But realistically, we don't know.
00:29:43:12 - 00:29:46:01
Speaker 4
And so what's the start?
00:29:46:01 - 00:29:47:14
Speaker 1
What's the crystal you're talking about?
00:29:47:19 - 00:30:05:11
Speaker 2
Yeah. So if you if you break open that the stimulus apparatus inside our inner ear, which is about that, it's really, really tiny, it's inside. You've kind of got these hairs. And the direction of those hairs as they flow in space is what relays that position sense to your brain. And on top of the hairs is a jelly substance.
00:30:05:11 - 00:30:24:15
Speaker 2
And on top of those jelly substance is little crystals called auto lists. And so those are actually, as you turn left and right, those are what's way so that the hair cells are fired. So it's a pretty wild system and it it doesn't have much room for air. So you can imagine that a very small impairment leads to pretty drastic changes.
00:30:25:10 - 00:30:27:11
Speaker 1
Wow. Wow. Super fascinating, man.
00:30:27:12 - 00:30:34:03
Speaker 3
I'm, like, turning my head, trying to feel my crystals in my ears.
00:30:34:03 - 00:30:41:10
Speaker 1
So what you're saying is that crystals for healing are real?
00:30:41:10 - 00:30:46:05
Speaker 4
Let me just put out by mood, water and yeah, I.
00:30:46:05 - 00:30:50:19
Speaker 1
Mean, sorry to joke it. All the people even star signs in crystal healing. But you know.
00:30:51:05 - 00:31:02:18
Speaker 2
I try not to say crystals of patients because they give you that look sideways. Right. So I would say also that that we're not confused with some sort of astrology dealers.
00:31:03:09 - 00:31:04:09
Speaker 4
So earlier on, you.
00:31:04:09 - 00:31:26:01
Speaker 1
Were mentioning about like concussions. And, you know, obviously we're talking about vertigo and stuff and your specialization. So I think that's probably a really great way to segue into there. And so you're saying like previously, you know, because I've heard that as well, see what you said, which is like, okay, you know, you got a concussion. I've had friends who've had them the recommended like, okay, like dark light, like dark room, no blue light.
00:31:26:19 - 00:31:38:10
Speaker 1
You know, stay in a dark place. Just rest that. I've heard that before from friends who've had concussions. So what has changed? Like what is what is more modern best practice? What has changed in dealing with concussion?
00:31:38:18 - 00:32:00:00
Speaker 2
Yeah, basically everything. Right. So it's very similar to kind of all of the styles of emergency management where what we're recommending now like it really used to be the traditional management was you sit in a dark room and you have symptoms. If you come out, you have symptoms, you go back into your dark room, right? Yeah. What we're starting to recommend now is you have a brief period of rest, so that's 24 to 48 hours without any visual input.
00:32:00:10 - 00:32:23:20
Speaker 2
And that really is kind of like you're reducing your screen time. You're not reading, you're not doing this, that the other thing, you're kind of just chillin. But after that brief period of rest, which is about that 48 hours now, we're going to start gradually exposing you back into the into activities and we're going to start getting you doing a little bit of aerobic exercise because truly the brain is is like any of the other systems that it will become sensitized if it's not exposed.
00:32:23:20 - 00:32:42:02
Speaker 2
And so we run into that, that problem where people get into what we call the trench, where it's they don't have air conditioning to sustain the the daily activities that they want to. And so they flare up and then they're their vice is to go and lie in the dark room until it goes away. But the thing is, is that doesn't give you any capacity.
00:32:42:02 - 00:33:03:07
Speaker 2
It doesn't give you any tolerance for activities of life. And so you almost become a little bit less tolerant to what you were before. And then, you know, you're going to flare up easier and then you go back and you lie in your dark room, and that's unfortunately what stems a lot of those. Those you can call them post-concussion syndromes or persistent concussion symptoms is really improper management of of the of the syndrome and.
00:33:03:19 - 00:33:04:16
Speaker 3
Wow, that's crazy.
00:33:04:16 - 00:33:05:19
Speaker 1
Wow. Fascinating, man.
00:33:06:03 - 00:33:13:14
Speaker 3
I'm not too familiar. I know there's like, minor and severe. Like, can you break down, like, the varying degrees of kind of the severity of a concussion?
00:33:14:07 - 00:33:35:08
Speaker 2
Oh, for sure. So that's the funny thing to us is we've we used to kind of grade them kind of grades one through three, right, where it's kind of mild, moderate, severe. And again, we've kind of scrapped that. So it's it's you know, they were kind of shaken up the playing field with this, but it's because we can't forecast the severity of a concussion until it's recovered.
00:33:35:08 - 00:33:58:06
Speaker 2
So we can look back retrospectively and say, oh, you probably had a mild concussion, but it's very difficult to actually say what the grade of concussion someone has, based on your assessment, because they take a basically a different a different course depending on on kind of the treatment, the management and the style of practice that they that they sought after.
00:33:58:19 - 00:34:32:07
Speaker 2
There is a couple there's a couple negative prognostic factors. And what that means is essentially, we can probably say with with reasonable certainty that your concussion is going to last more than 30 days if you kind of have a history of migraines, if you have a sensation of fogginess, the last more than three days, if you have kind of a direct strike to the awesome foot or a back of the head or a rotational impact, or if you if you kind of had, you know, insomnia or depression before this or more than two concussions in the past, those are kind of our our red or pink flags, I should say, where we're kind of saying,
00:34:32:07 - 00:34:54:00
Speaker 2
okay, this person might have a little bit more severe of a head impact, but it's really, really tough to actually say, is this mild, moderate, severe without looking back after they've healed to assess it, because really sometimes even the concussion symptoms are delayed. They don't necessarily have to come on right at the start. They can kind of come on as as it progresses and how the of the injury presents.
00:34:54:16 - 00:35:00:03
Speaker 3
Is there a particular side of the head that's more dangerous to have an impact, a concussion?
00:35:01:00 - 00:35:19:20
Speaker 2
So so we typically see a pretty nasty nastier symptoms with the also. But so it's in back of the head the back of the head is tends to be where we get a little bit more of a nasty presentation as well as temporal strikes. And the reason for that is the rotational impact of getting hit kind of on the temple.
00:35:20:05 - 00:35:26:16
Speaker 2
That's kind of where where we also see a little bit more of a of a longer presentation and a lot more severe symptoms.
00:35:27:08 - 00:35:38:18
Speaker 3
Is that just because it's like I mean, I might be super ignorant here, but isn't there like you're closer to your brain at this point here? There's not as much barrier as there is later in the skull. Or is that is that totally wrong?
00:35:38:18 - 00:36:00:06
Speaker 2
It's it's more the so I guess I kind of have to speak to the pathophysiology of of a concussion. It's a concussion essentially as a is a diffuse axon shearing. So the brain kind of stretches of it. It doesn't kind of slop the skull back and forth like we used to think back to kind of coop injury was a popular topic in the mid-twenties there and doesn't kind of slap the skull back and forth.
00:36:00:06 - 00:36:23:01
Speaker 2
What it does though is it kind of shear. So you kind of stretch the brain and you stretch the axons a little bit. And that stretching of the axon basically results in a widespread excitation of the brain. So what ends up happening is you have all these ions that were released and how the brain responds to that is asked to kind of pump all the ions back into the right place so you can kind of get on with your life.
00:36:23:01 - 00:36:43:11
Speaker 2
And how it does that is it uses ATP or it uses energy. And so you have this widespread energy crisis essentially. So it ranges blast through energy and so you kind of dump energy. And so you're you end up sitting at, you know, your brain's trying to operate at 100%, which only at 50% of the tank. You kind of you're running on fumes at all times.
00:36:43:20 - 00:36:53:20
Speaker 2
And that temporal impact results in a bit more of a rotational force, which results in more shearing. That's that's the more the more problematic.
00:36:53:20 - 00:36:54:12
Speaker 4
Side of that one.
00:36:54:22 - 00:36:56:19
Speaker 3
Okay. Yeah, that makes sense. Thank you for clarifying that.
00:36:57:18 - 00:36:58:01
Speaker 4
Yeah.
00:36:58:04 - 00:37:05:19
Speaker 1
Super, super fascinating man. Wow. Is is that info so cool, man? I'm stoked to be having this conversation with you. That's a wild.
00:37:06:18 - 00:37:07:04
Speaker 4
Yeah.
00:37:07:04 - 00:37:23:21
Speaker 1
So like, so I mean, obviously that's going to be a tough one, going to be based on like, you know, severity of, you know, like you're saying the amount of shearing and stuff like that. And depending on where you're struck. So but like do you have like an average, like, you know, general spectrum of like, okay, if you have a concussion, you could be dealing with this.
00:37:23:21 - 00:37:30:00
Speaker 1
And let's say first, first concussion, your healing time could be like X like is there something like a general guideline like that?
00:37:30:10 - 00:37:49:14
Speaker 2
Yeah, something like that. So really like, you know, I think the word concussion doesn't strike fear into people's hearts enough as it should. But it truly is a mild traumatic brain injury like it's it is it is a it is a severe incident. So if you if you could not sustain a single concussion, that would be great. Right.
00:37:49:23 - 00:37:59:01
Speaker 2
So does it. It's it's hard to say just how severe that's that impact. Oh, I forgot the question. Hit me again.
00:37:59:17 - 00:38:02:15
Speaker 4
Yeah. It's just like healing, healing, healing time process.
00:38:02:15 - 00:38:03:23
Speaker 1
Like are you looking at like two.
00:38:03:23 - 00:38:04:14
Speaker 4
Months.
00:38:04:14 - 00:38:06:01
Speaker 1
Three years? Like, yeah.
00:38:06:07 - 00:38:24:23
Speaker 2
Okay. So physiologically and this doesn't mean the absence of symptoms, this means kind of the brain is sucked itself back to the point where it was before, kind of it's it's it's gotten the energy back to where where it wants to for adults is about two weeks and for for adolescents is about four weeks. So right around is kind of the three week mark for your first concussion.
00:38:25:02 - 00:38:50:17
Speaker 2
We tend to expect symptoms to be pretty well. And obviously if it's a little bit more severe, then we go into that four week mark plus which is is more that persistent concussion signs. But that physiological healing time is kind of over by around two weeks and the rest is just the symptoms. But if you were to sustain a second concussion within that first period of healing, the second concussion is going to last three times as long.
00:38:50:17 - 00:39:11:20
Speaker 2
At minimum that the first did. So it's kind of like if you get two strikes in a row, you're really setting yourself back quite a quite a ways. And then obviously there's that, there's that second impact syndrome, which you might have heard of where where Rowan's law is come in. And this is essentially a kid who sustained two concussions kind of back to back and didn't tell anyone and it was fatal.
00:39:11:20 - 00:39:23:11
Speaker 2
So it can be quite severe. And and that's why it's quite important that when you you know, if you're in doubt in terms of of play or whatever, that you really sit that athlete out.
00:39:24:00 - 00:39:24:14
Speaker 4
What about what.
00:39:24:14 - 00:39:35:01
Speaker 1
About like friends I've heard where it's like like a year later they're still experiencing concussion syndromes. I guess it's like things like what? So is that is that common, uncommon? What do you think's going on there?
00:39:35:09 - 00:39:55:03
Speaker 2
So it's pretty nasty, but it is I do see a lot of patients who sustain symptoms for more than a month. And essentially what what it boils down to is, is that that persistent concussion signs and this is where my job comes in is to kind of identify why those are there. And those can be driven by a number of different symptoms.
00:39:55:03 - 00:40:16:10
Speaker 2
Right. So typically about 90% of the time, concussions manifest inoculum motor deficits. So kind of the eyes aren't working as well as they should and they're not kind of relaying the the information to the brain as well as they should have. But then also you get run into some symptoms like cervical genesis or kind of neck driven concussion symptoms.
00:40:16:17 - 00:40:43:10
Speaker 2
You run into vestibular driven concussion symptoms. You can run into autonomic. So kind of your body's flight and flight driven concussion symptoms and you can even run into like sleep impairments and all these things that create a longer lasting tension. And that's kind of where we jump in is after that kind of a two week mark. If people are still struggling, that's where we kind of come in to try and identify what's actually driving these symptoms and where where you need to tailor your rehab to kind of deal with it.
00:40:45:05 - 00:40:48:20
Speaker 1
Wow. Super cool. I mean, not cool if you're going through it, but.
00:40:50:09 - 00:40:52:09
Speaker 4
But fascinating in general, you know, like.
00:40:52:10 - 00:40:53:04
Speaker 1
You get what I'm saying.
00:40:53:12 - 00:40:53:21
Speaker 2
Yeah.
00:40:54:06 - 00:41:15:22
Speaker 3
My, my, my immediate thought on on recovery is it goes to nutrition. You know, we hear that, you know, fat intake is is really good for the brain. It's super healthy for the brain. Would you say that after a concussion that upping your fat intake would help and speed up the healing process for the brain and returning the energy?
00:41:15:22 - 00:41:17:00
Speaker 2
Oh, for sure.
00:41:17:00 - 00:41:18:01
Speaker 3
Yeah. Accidents.
00:41:18:01 - 00:41:41:04
Speaker 2
Yeah. Like our our recommendations are kind of like you're up in your omega three intake to about 3 to 4 grams a day. On top of that, you're also taking vitamin. You're trying to drink a lot of water because your brain kind of loses its ability to regulate kind of hydration as well sometimes. So people run into getting really dehydrated in those initial, initial stages.
00:41:41:12 - 00:41:58:17
Speaker 2
So, yes, nutrition is huge. And we kind of when we see a patient on the first time, we hand out a guideline of of foods that we kind of want them consuming as well as is kind of activities and behaviors we want them to to partake in for the next couple of weeks.
00:41:59:13 - 00:42:07:04
Speaker 1
Correct me if I'm wrong, but for the Omega three, it's a particularly is better for the brain, is that correct or is it just in general EPA?
00:42:07:04 - 00:42:11:19
Speaker 2
And that's a good question. I wouldn't know, but I can look into that.
00:42:12:14 - 00:42:29:11
Speaker 1
Okay. Yeah, I've just heard that like DHEA has a bigger effect for like your eyes and your brain. So I, you know, take it at a grain of sand. But yeah, I definitely want to read a study on that. But as you know, what about someone dealing with, you know, obviously not. I forget the name of the kid you were talking about with his where he was fatal.
00:42:29:15 - 00:42:48:12
Speaker 1
But what about repetitive concussions? You know, you hear of like whatever professional athlete, you know, if you've received a concussion and then a year later you get a concussion and then, you know, at what point is it like you're risking, you know, like serious, serious health side effects, you know, for for life kind of thing? Yeah. How is that going to affect you?
00:42:49:02 - 00:43:18:18
Speaker 2
It's tough to say. Like, it could really just be one like it doesn't have to be necessarily a cumulative effect, though. There is a cumulative effect. You become a lot more sensitive and a lot easier to concussed. And the severity of your symptoms definitely increases. But some people are doing pretty poorly after that one concussion. And that also just it's a bit of a complicated realm because the psychosocial side of things also plays into the the the length and duration and severity of the concussion.
00:43:18:21 - 00:43:32:16
Speaker 2
So it is a really tough realm. But I would say if you if you could go about not having a concussion, that would be better than than one that would be much better than two. But, yes, there is that that kind of cumulative effect where we're symptoms start to add up.
00:43:33:20 - 00:43:46:03
Speaker 1
Interesting. And so earlier you were mentioning that like I think it was depression, you were saying. So like if you're like if you dealt with like, you know, let's say chronic depression your entire life, does that, is that going to affect the outcome of the concussion generally?
00:43:46:17 - 00:43:57:23
Speaker 2
It's it absolutely. Well, yeah, that's kind of one of our biggest negative prognostic risk factors. And all that basically tells us is that we can be reasonably confident that you'll have symptoms that lasts longer than 30 days.
00:43:58:21 - 00:44:07:14
Speaker 1
Wow. So and do you know any like mechanism or reasoning for that? Is that to do with like serotonin, dopamine? Do they? It's kind of unknown, but we just know that they're related.
00:44:08:02 - 00:44:23:20
Speaker 2
Yeah, I'm sure there is. I wouldn't say that I know enough about it to speak to it, but yes, I would I would assume there is that relationship between the two. But yes, we just kind of look at it more as a risk factor that we identify and that we make sure that it's kind of factored into the treatment plan.
00:44:24:09 - 00:44:33:02
Speaker 3
They are there any diseases or other mental conditions besides depression that are also precursors, just like just like this depression.
00:44:33:02 - 00:44:46:10
Speaker 2
Anxiety as well? That's the big one as well, kind of anxiety and depression. But I don't know enough about, you know, schizophrenia or anything like that or if there's there's been a link established between any of that at this stage.
00:44:48:10 - 00:44:50:22
Speaker 1
I'm just writing down never get a concussion.
00:44:51:05 - 00:44:52:10
Speaker 4
So yeah, I've.
00:44:52:10 - 00:45:01:10
Speaker 1
Dealt with depression and anxiety for a lot of years. Like anxiety not as bad, but a lot of like chronic depression runs in my family as well too, and stuff. And so, you know, not that I was planning on.
00:45:01:10 - 00:45:04:09
Speaker 4
Getting one of them beforehand, but yeah, you're.
00:45:04:09 - 00:45:07:17
Speaker 1
You're motivating me here.
00:45:07:17 - 00:45:32:03
Speaker 3
I'm just curious to dove this a little deeper into age differences. So like, is there a an age period in our cognitive development where concussions are the most risk creating versus maybe later in life? Like, is there a disparity in age groups? And when like you're like, all right, age nine through 14, like do not get a concussion.
00:45:32:03 - 00:45:35:02
Speaker 3
Like, you know, is is there some sort of correlation there?
00:45:36:11 - 00:45:57:09
Speaker 2
Yeah. The younger ages, as your brain is developing, is a really good time to try and avoid knocking it. And that's just just due to the large scale developmental changes and also how it it kind of correlates with a longer physiological recovery, lets us know that we have good age really any time before you know. Yeah I would I would we would say adolescence.
00:45:57:09 - 00:46:17:19
Speaker 2
So I'm going to say anytime before age 20 would be an awesome time and really any time after would also be okay not to, not to sustain. But certainly those years of development are pretty critical. And, you know, kids bounce back pretty, pretty. Okay. But at the same time, it's you don't want to be mucking around, getting multiple concussions as your eyes are developing.
00:46:18:07 - 00:46:34:15
Speaker 3
Yeah. And I think that's pretty common with like sports these days in football especially, you've got kids playing football in middle school and just like slam it into each other and, you know, getting concussions left and right. So it's just it's interesting how how how common it is and I think how overlooked it is. And in a lot of these team sports.
00:46:35:08 - 00:46:52:16
Speaker 1
For sure, I think also like, you know, the long term implications, right? Like I believe lots of studies have been coming out now just and it's like well-established, you know, just like NFL players, particularly jazz people, have had repetitive impacts to their head. Do you do you know the name? What is it? It's like yeah.
00:46:52:21 - 00:46:56:00
Speaker 2
Like traumatic encephalopathy. So it's.
00:46:56:01 - 00:46:59:20
Speaker 4
Yeah, yeah. Oh, yeah, yeah, yeah, yeah.
00:46:59:21 - 00:47:03:02
Speaker 1
It's like it's associated with, like, violence. Early death. Yeah.
00:47:03:02 - 00:47:03:09
Speaker 4
I was.
00:47:03:17 - 00:47:07:04
Speaker 1
Just like, you know, like, all pre Alzheimers, like, just all these days.
00:47:07:04 - 00:47:07:08
Speaker 4
Like.
00:47:08:02 - 00:47:14:04
Speaker 1
Quite terrible, you know, I think a good sign that you don't want to go around banging your. Yeah, yeah.
00:47:14:06 - 00:47:15:02
Speaker 3
It makes sense.
00:47:15:14 - 00:47:31:22
Speaker 2
Really, really any, any loss of consciousness is a, is a very severe event and concussions only 10% of the time you lose consciousness. So like you're knocked out for 8 minutes, you, you've probably got some pretty severe deficits waking up if you do that is it's.
00:47:31:22 - 00:47:32:08
Speaker 4
Yeah.
00:47:32:13 - 00:47:34:20
Speaker 1
If you do it yeah that's a that's a good caveat.
00:47:35:17 - 00:47:36:18
Speaker 4
That one day maybe we will.
00:47:36:18 - 00:47:39:16
Speaker 1
Have to climb together. Quinn and then they can go, right? We can go.
00:47:39:16 - 00:47:40:12
Speaker 3
Rate concussions.
00:47:40:12 - 00:47:41:07
Speaker 4
In Hollywood movies.
00:47:43:03 - 00:48:02:22
Speaker 3
That's actually reminds me of a the closest thing I had to a concussion when I was a kid. I was snowboarding and I went off a jump and just no helmet and just like slap the back of my head on the hard ice. And I went, I didn't lose consciousness, but I lost my vision. I went completely black for probably like 30 seconds to 60 seconds.
00:48:03:04 - 00:48:11:22
Speaker 3
And it took me a solid like 35, 45 minutes till my vision was completely back. I was like really fuzzy and really blurry for quite some time.
00:48:12:21 - 00:48:29:21
Speaker 2
Yeah. Again, that's all super, right? That's that. Yeah, the vision center is kind of back there, so it's kind of our, our, our, our fine tune coordination center is kind of our cerebellum. So there's a lot of, a lot of important stuff back there. Yeah. And yeah, it's if you if your vision went like that, you most certainly had a concussion.
00:48:30:10 - 00:48:47:17
Speaker 1
Yeah, I had like I was on this like doc that was swaying. Like people are going side to side, like moving like a floating dock in like a rainbow lake in Whistler or whatever. And like some when I was really young and somebody fell on my head, like, that was probably the hardest thing I've ever had. And like, I didn't like blackout or anything, but I just remember being pretty messed up.
00:48:47:17 - 00:49:11:01
Speaker 1
I was pretty young too, so I don't know if I had a concussion or not, but like it was definitely that was the hardest impact have ever had in my head. So I feel like besides that, nothing too crazy. That's good. Although I did Tai Box for like three years and I'm sure that wasn't good for. Yeah. What's the, what's the medical diagnosis?
00:49:11:01 - 00:49:15:10
Speaker 1
Tai boxing. Good for the brain, bad.
00:49:15:10 - 00:49:23:15
Speaker 4
Yeah, yeah, yeah. I plead, I plead the fifth. Yeah.
00:49:23:17 - 00:49:28:23
Speaker 1
I guess. I guess for me, like I don't know any, anything else to add on on concussions. Your time.
00:49:29:17 - 00:49:49:18
Speaker 3
Yeah, I guess it's like circling this back around to climbing. I guess I have two questions here. First one is going to be pretty easy and I'll just link it to the second one. First one is I guess I'll just start with the first one. Helmets. This might be my question. Do they help against concussions? And if so, why?
00:49:49:18 - 00:49:53:09
Speaker 3
Like the physics behind it? Like how does it protect your brain from this?
00:49:53:09 - 00:50:20:12
Speaker 2
CHEERING Yeah, good question. So yes, helmets for sure. And it really kind of gives it gives me nervous seeing people climb without helmets just because it really doesn't take much. And it could be by accident to get that rope behind your leg and flip you upside down. And really, it's it's force over time is the big thing of of why a helmet will help you as is it reduces the amount or it increases the amount of time kind of the crumple space that it takes that force to be dissipated.
00:50:20:12 - 00:50:41:18
Speaker 2
And if you can increase that amount of time, you get less force through your skull and less less cheering as a result. And if you really, you know, you really want to be fancy the MIPS the MIPS technology is an excellent feature that climbing helmets are starting to do incorporate, I think the the BD vision and the the wall rider and and the normal all all kind of have this technology in it.
00:50:42:13 - 00:51:06:18
Speaker 2
It basically acts by emulating the cerebrospinal fluid you have around your brain. It kind of gives you an extra layer of friction. So it increases it reduces how much that rotational force has on your skull. And really, again, that rotational forces is kind of what creates more what can create more dramatic concussion symptoms. So the cards in your favor like wear a helmet.
00:51:06:18 - 00:51:12:10
Speaker 2
It really it really isn't isn't worth it for what can kind of occur even with with simple falls.
00:51:13:03 - 00:51:13:20
Speaker 4
Yeah. Wow.
00:51:14:04 - 00:51:32:21
Speaker 1
That's funny. I worked at a mac for quite a few years. I recently just quit in May, and yeah, you know, not a lot of climbers willing to buy MIPS in their house, but a lot of bikers, bikers were like, no problem, they'll buy MIPS, but climbers. But I'd be interested to see. I think that's going to change over the next little while.
00:51:32:21 - 00:51:33:12
Speaker 4
Yeah, but.
00:51:34:06 - 00:51:43:22
Speaker 1
But yeah, I do, I do think that's an interesting one that you're talking about the rope tangling your legs. I think a lot of people don't think about that. They think like like how am I going to, you know, like, how am I I'm not going to hit my head.
00:51:43:22 - 00:51:48:17
Speaker 3
Or if I get hit by a rock, I'm going to die anyway.
00:51:48:17 - 00:51:50:01
Speaker 1
Yeah, that's a possibility.
00:51:50:12 - 00:51:50:19
Speaker 4
But.
00:51:51:05 - 00:51:58:12
Speaker 1
But yeah, you know, I think I think that is that is a really interesting thing and something that probably not a lot of people are thinking about is.
00:51:58:19 - 00:52:17:02
Speaker 2
The number of people I see climbing without helmets. Right. Like the rope is perpetually behind your behind your legs. That's where that's yeah, it's, it's right. It's, it's kind of impossible to, to keep it in a place that would result in a clean fall a lot of the time. So yeah, I, if, if there's a take home, I would definitely endorse the helmet, use.
00:52:17:02 - 00:52:17:09
Speaker 4
Yeah.
00:52:17:22 - 00:52:27:12
Speaker 3
Have you seen any particular climbing head related or head climbing related, head injuries, maybe concussions that either you have dealt with or a colleague?
00:52:28:09 - 00:52:51:11
Speaker 2
Yeah, I actually caught a buddy fall who got his leg trapped behind the rope there and he flipped upside down and smacked his head and then broke the helmet. But he was fine. So it's it again, kind of solidifies that notion that like, yeah, you should be wearing a good helmet, right? And this was not on this is not on terrain that I would deem threatening, but it was enough that really it could have turned into a bad situation.
00:52:51:23 - 00:52:52:08
Speaker 4
Wow.
00:52:53:01 - 00:53:11:15
Speaker 1
Yeah. I've told this story before. I think earlier on in our in our episodes. But like a friend of mine, David, I think it was David, he was climbing with another buddy, Terry. And like, just like it was like snipers fall super easy, kill climbing in a rock dislodged and like smashed terry on the head and just, like, deflected.
00:53:11:15 - 00:53:31:22
Speaker 1
Totally fine. Had a helmet on, you know. And then another buddy of mine, Nathan, he was playing and he got like a small rock in his face or something, and his, like, had was just like bleeding. Like, like I was in there for this, but, like, you know, he's holding on and it's like, yeah, man, like, you know, pretty unsuspecting, easy places and, you know, like, it's, it's a big deal.
00:53:31:22 - 00:53:38:04
Speaker 1
It's really easy to just overlook. And also from a safety standpoint, if you're belair's not wearing a helmet and they're not on a Gregory.
00:53:38:10 - 00:53:38:20
Speaker 4
You know.
00:53:38:20 - 00:53:55:08
Speaker 1
It's like and they just get knocked mad or like concussed or something. It's like, boom, you're free solo soloing, you know? Yeah, totally. Like, you know, you probably want to think about that as as a hazard, you know? So yeah, it's so easy to overlook.
00:53:55:08 - 00:54:07:06
Speaker 3
And it's interesting because it's much more of a risk than the blunt force trauma like, yeah, you could die from blunt force trauma, but you could also have these lasting effects from a concussion, too, that I don't think a lot of people are taking into consideration for sure.
00:54:08:16 - 00:54:32:11
Speaker 1
Yeah. Yeah. I've been doing a lot of top rope soloing lately and I actually haven't been wearing a helmet for that. But in my own defense, I know the route. It's usually pretty vertical. There's no loose rock. And then it's like because I have traction devices on my fall is like zero feet. Yeah, if I fall. So I feel like it's not possible to like map or with my head it would have to be from a rock falling on me.
00:54:32:20 - 00:54:34:01
Speaker 4
So yeah.
00:54:34:01 - 00:54:35:00
Speaker 1
So I don't know.
00:54:35:21 - 00:54:38:10
Speaker 3
There is something freeing about not wearing it.
00:54:38:18 - 00:54:41:03
Speaker 4
There is. You know, I, you know, I used to not.
00:54:41:03 - 00:54:42:01
Speaker 1
Enjoy it, but now.
00:54:42:01 - 00:54:42:22
Speaker 3
I kind of do.
00:54:43:10 - 00:55:00:11
Speaker 1
So, yeah, I think I think the exception, though is like if you can climb like, you know, 13 plus and it's like this massive overhanging roof and it's like impossible for you to fall and get your like, I icon to the rope and it's like, all right, you probably have a pretty good case there to be. Yeah. All you.
00:55:00:11 - 00:55:00:16
Speaker 4
Know.
00:55:01:03 - 00:55:07:13
Speaker 1
Is like I don't like I don't wear I don't wear a climbing helmet when I go to the gym, like climbing like, you know what I mean? It's like.
00:55:07:13 - 00:55:08:12
Speaker 4
I'm like, no.
00:55:08:12 - 00:55:16:20
Speaker 1
Rock, everything's super vertical. I'm good, like, yeah, so but yeah, yeah. That'd be pretty funny though. If you saw somebody in the gym with a climbing.
00:55:16:20 - 00:55:17:14
Speaker 4
Helmet on, you know.
00:55:19:04 - 00:55:24:04
Speaker 1
It's got like 20 quick drawer, full rack.
00:55:24:04 - 00:55:37:05
Speaker 3
I think Cody Bradford even alluded to wearing a helmet in the gym. I think in in our episode kind of alluded to it. He's like, you know, if you're, you know, I wouldn't I wouldn't I wouldn't talk down on it, you know, because things can happen.
00:55:38:02 - 00:55:39:07
Speaker 1
Yeah. No, totally.
00:55:40:02 - 00:55:43:01
Speaker 3
Yeah. I mean, Max, for me, that's good on concussions. How about you?
00:55:44:04 - 00:56:02:01
Speaker 1
Yeah. No, I think we got so much awesome stuff there that was like, really fascinating and really cool. And I also just, like, love when I'm, like, diving through stuff like that and just learning tons and then also be it's like, hey, like, if someone in the future ever has a concussion, I can just like reference them to, like, come listen to Quinn here for a little bit.
00:56:02:13 - 00:56:16:07
Speaker 1
It's pretty cool. It's super sweet. So, yeah, I love doing the stuff, man. I guess like moving on here then. You know, just the question we had is like, maybe you could just talk about like in evidence based approach to physiotherapy and like what that is.
00:56:16:20 - 00:56:17:04
Speaker 4
Yeah.
00:56:17:12 - 00:56:41:22
Speaker 2
Yeah. Okay. Yeah. And that's I would say that's a loaded question, but it's, it's something that I think, I think needs, that needs to be talked about because it's, it's it's kind of tough for a field that has so much literature coming out, you know, every, every single day and week and month and year that it's really difficult to actually stay up with the literature if you're if you're doing nothing but reading articles, you might be able to do okay.
00:56:42:09 - 00:57:09:09
Speaker 2
But kind of the general practice of physiotherapy is, is in my mind been evolving from kind of the, the seventies, eighties, nineties and early 2000 from like a very passive standpoint and more of like an active evidence based rehabilitation, which is where we're just kind of taking, taking the best available evidence that we have and synthesizing a treatment plan and a practice approach that resides within that boundary.
00:57:09:09 - 00:57:24:17
Speaker 2
So we're kind of trying our best to take a critical look at what actually works, not just based on our anecdotes and what doesn't, and trying to kind of weed out the fluff. I would say. And there's a lot of flat empirical sense.
00:57:25:00 - 00:57:33:13
Speaker 1
Yeah, you just having a reason behind it and, and it's like a logical, you know, linear kind of progress ideally. Or at least that's the way I'm. Yeah.
00:57:33:14 - 00:57:55:14
Speaker 2
And the topic there too is it takes on average about 21 years for research to translate into clinical practice. So even a lot of this study came out in 2013, which is pretty critical methods of treating soft tissue injuries is still it's still lagging behind. So, you know, I think as a profession, we still have a lot of room to go.
00:57:55:14 - 00:58:06:22
Speaker 2
But I think most most of us are trying our best to kind of stay on top of it and and translate that that evidence that we do have into how we treat patients and how we kind of perform our our practice.
00:58:08:00 - 00:58:18:05
Speaker 1
In regards to those soft tissue injuries, is there anything that you can think of that stands out that maybe isn't like fully adopted in the physiotherapy today that oh.
00:58:18:05 - 00:58:38:18
Speaker 2
100%, yeah. I'm sure most people are familiar with the race concept and arrestees press elevate. Yeah we scrapped right and it turns out it actually kind of turns injuries a little bit more chronic a lot of the time than than it does help and it's been replaced I think this is the British Journal of Sports Medicine in 2013 with peace and love.
00:58:38:18 - 00:58:57:20
Speaker 2
So it's a less you know, it's it takes a little bit more out of that acronym. But we're kind of going on the on the idea of protecting for about a 48 hour time frame, really not pushing any more or so that we're going for kind of a resting for about a 48 hour time frame where we're not kind of going outside of pain.
00:58:57:20 - 00:59:27:02
Speaker 2
We're giving this tissue a break for about 48 hours. And then again, we're starting to gradually lower it or protecting it. And, you know, you can elevated you can compress it. It doesn't seem to make much of a of a difference within that education piece. So we're really trying to to push people away from seeking out passive care, seeking out tends ultrasound, you know, needless imaging, needless X-rays, needless imaging investigations and really just letting the body do its thing.
00:59:27:13 - 00:59:44:21
Speaker 2
And then we're starting to move as well away from icing. So we're really starting to recommend that we don't ice and we don't consume anti-inflammatories, which is kind of if you were to go to the hospital and say yet a an ankle sprain, I can bet you ten times out of ten that they're going to give you a anti-inflammatories twice and tell you to rest.
00:59:44:21 - 01:00:12:03
Speaker 2
Right. So that's the peace and love is I think this would even be worth including a reference in there is kind of a newer management strategy for soft tissue injuries and it comes as well with that love side of things which is load optimization vascularization so kind of pain free cardiovascular activity as much as you can do and then exercise, which is kind of where physio comes into the equation on that one.
01:00:13:00 - 01:00:16:20
Speaker 3
So real quick, it sounds and love. They're both acronyms, am I correct?
01:00:17:15 - 01:00:17:23
Speaker 2
Yeah.
01:00:18:08 - 01:00:21:16
Speaker 3
So so I got protect education. What's a avoid.
01:00:22:16 - 01:00:49:17
Speaker 2
That. Yeah you got protection rest and that's going to be for or sorry protect elevate let me let me get out here okay protect elevate avoid anti-inflammatories, compression, education and so and then the love is load, optimism, vascularization and exercise so it's loaded. But yeah, I like it.
01:00:49:22 - 01:00:50:19
Speaker 3
I like it a lot.
01:00:50:21 - 01:00:51:13
Speaker 2
I really like.
01:00:51:13 - 01:01:16:12
Speaker 3
The education piece to it. I think it's so important. I think that when we go through injuries like this, a lot of us don't really have a lot of education about our own bodies. Maybe we don't know how to move. We don't know our own muscular structure and how our body is moving around this world. And I think that when we do get into these situations, health care providers and people like you have such an awesome opportunity to teach people about their body, to educate them about what's on physically.
01:01:16:12 - 01:01:34:06
Speaker 3
People are smart. People want to know. For the most part, people want to know what's going on. And I think if you have this honest conversation with them and try to get them to understand what's actually happening, there's going to be a lot of benefit moving forward. And I think that, like you said, it seems like in the past it's just like, here's some anti-inflammatories, go rest in ice and that's it.
01:01:34:06 - 01:01:41:07
Speaker 3
They wash their hands and they move on and there's just this huge opportunity that's missed. So it's really cool that this is the new acumen. I'm down with it.
01:01:42:10 - 01:02:02:05
Speaker 1
Yeah. No, man, super cool and I think really needed for people to know, obviously. Right. So I'm sure there there's obviously caveats to that like that pertains a certain specific type or the more common like repetitive strain injuries like obviously if you get out of surgery or something like yeah.
01:02:02:21 - 01:02:08:09
Speaker 4
Yeah, I'm going to pop a few Tylenol. Unfortunately.
01:02:08:09 - 01:02:21:02
Speaker 2
Yeah, that's our that's our recommendations for for soft tissue for acute soft tissue injury management. So that would be like an ankle sprain. That would be like a muscle strain or something like that for front.
01:02:22:03 - 01:02:22:14
Speaker 4
I feel like.
01:02:22:14 - 01:02:50:09
Speaker 1
A common thread here and whether it's for precautions or anything is like in less it's like severe like trauma where you're like getting surgery or something's like really, really damaged and traumatic. It's kind of like active recovery, right? It's like, you know, that just sitting around doing nothing, not using it, you know, not pumping like fluid or blood or lint into the area and not moving it, you know, trying to suppress that inflammation that's doing healing like all that kind of stuff.
01:02:50:16 - 01:02:57:09
Speaker 1
You know, whether you're doing it in a dark room with a concussion or just sitting on the couch doing nothing for a week straight with your ankle up in the air is just bad for you.
01:02:58:04 - 01:03:06:05
Speaker 2
Yeah. Motion motions, lotion is what we like to say. And that really pertains to most, most of all injuries.
01:03:06:05 - 01:03:07:04
Speaker 4
I love that thing.
01:03:09:12 - 01:03:20:11
Speaker 4
Motion is lotion, man. I got to start saying that more. Yeah, well, I mean, I feel like this is a great, you know, motion is lotion.
01:03:20:11 - 01:03:35:23
Speaker 1
Is a great segway into like asking you about like, you know, maybe if you can just speak of like some common injuries maybe that you treat in in the, I guess, anything more relevant to the climbing community or the skiing community, that kind of stuff. Like what are common injuries, you see.
01:03:36:04 - 01:03:57:10
Speaker 2
Oh, for sure. So yeah, if we're, if we're talking climbing a, it's, it's classic shoulders and pulleys that's that's what I get nonstop. That's that's really seems to be a common climbing injury. The boulders tend to get a little bit more wrist action. I see a lot of kind of tacky. So kind of tears on the on the inside of of the kind of pinky side of the wrist.
01:03:57:19 - 01:04:21:02
Speaker 2
We have a lot of injuries that go on that side. And that's just more from kind of forceful, dynamic, high velocity movements can can kind of create some damage to that area. We're looking at skiing. I see a lot of ACLs that's a huge one with with the skiers. And then we also kind of have our muscle strains that go through through all realms of the body with with any climbers or skiers.
01:04:21:02 - 01:04:24:08
Speaker 2
That's that's really, really common.
01:04:24:08 - 01:04:47:18
Speaker 1
Yeah. And super cool. And so if we could just focus on maybe like shoulders and pulleys, since I think that pertains to our community the most, you know, like what's what's the mechanism, what's the outcome looking like general healing times and stuff like that. And maybe, I don't know, like it's the same thing. I think a concussion, like if there's degrees to a shoulder, like whether it's a dislocation or stuff like that, if you can just kind of touch on those things, I'd be awesome.
01:04:48:02 - 01:05:21:05
Speaker 2
Yeah. So if we if we go with the pulleys first, the mechanism of injury really is, it's forced extension of the tip of your finger with a flex the middle finger joint. And so the and really the, the thing about it is, a pulley can sustain an enormous amount of force, kind of close to 800, 2000 Newtons. And so it really has to be either a not warmed up, undertrained or underprepared for that for the situation, it has to be a very dependent grip type.
01:05:21:05 - 01:05:39:19
Speaker 2
It has to be kind of a closed cramp is typically where we'll see these problems and has to be feet blowing. So it needs to almost be a very dynamic movement or almost dynamic off a cramp is where we see this this issue come. But when you really break it down, it breaks down into the floating in the progressive nature of the mechanical stress that you place on your tissue.
01:05:40:03 - 01:06:03:02
Speaker 2
And if you've exceeded it. And so that that really is it. So if you look into or even just speak very, very quickly to the poly side of things, if you're looking to prevent a pull injury, you got to warm up, you got to progressively load them and you got to really work on all your hand grips. You have kind of a vast array of tools at your disposal and not just a more passive crimp position to utilize.
01:06:03:10 - 01:06:26:14
Speaker 2
And that's kind of the big thing with pulleys is that that's the big three, I would say with those shoulders on on that forefront, we see a lot of rotator cuff injuries. So that's that's and bicep lesions and that's kind of you know, some people might consider that part of the rotator cuff, but just those shoulder stabilizers, there's a lot of outward rotational force when you're climbing.
01:06:27:00 - 01:06:50:07
Speaker 2
And a lot of the climbers I assess have very, very weak rotator cuffs. So essentially, this is the muscles that hold your shoulder or your your arm bone into your shoulder blade. They have a lot, you know, really powerful, lots of very powerful, impressive drops and all these muscles that are kind of big and flashy. But when you really get down and kick it, they use it pretty measly rotator cuff strength.
01:06:50:07 - 01:07:09:01
Speaker 2
And, you know, it's injury prevention is a very difficult concept to speak to because when you go and you really analyze the data, you can't really predict who is going to become injured or not. But if I was to speak anecdotally, I would say that the strength deficits in those isolated muscle groups is is a huge problem in the climbing community.
01:07:09:01 - 01:07:22:15
Speaker 1
Yeah, for sure. I think also just proportion, you know, it's like what what is the average climber train like? You know, big powerful movements and strength and power to rotator cuff ratio like 1000 to 1, maybe 10000 to 1. You know, it's like.
01:07:22:22 - 01:07:24:17
Speaker 4
It's like one one count, one.
01:07:24:17 - 01:07:29:08
Speaker 1
Day a calendar year. You do a couple of like exterior rotations and you're like all right, like we're good.
01:07:30:13 - 01:07:31:16
Speaker 4
So, yeah, I'm.
01:07:31:16 - 01:07:44:12
Speaker 1
Not that surprised to hear that. That's something I've been trying to work on a lot more is do like a lot more opening and a lot more stuff with Theravance. And I find it does help a lot alleviate like even shoulder pain and stabilize a little bit more and stuff, right.
01:07:45:12 - 01:08:06:14
Speaker 3
For the shoulder injury. One thing I focus on a lot of my strength training is strain. It is strengthening the posterior delt muscle. Correct me if I'm wrong, there's like three heads. You've got the anterior, the lateral and the posterior. It seems like a lot of people rely more on the Rob Boyd's and the trips rather than focusing on the strength of that rear delt.
01:08:07:09 - 01:08:18:02
Speaker 3
Is that do you think do you think that's a a pretty good cause of a lot of these shoulder injuries is a deficient strength ratio of that particular muscle.
01:08:18:02 - 01:08:39:02
Speaker 2
Yeah. And like that, that rear delt complex is pretty difficult to separate from that underlying rotator cuff complex kind of that that we're dealt over lies the kind of enforcement it is in the arteries, minor in the muscles that kind of form that that deeper shoulder complex. And so that is where that strength deficit usually occurs is kind of on that posterior shoulder.
01:08:40:10 - 01:08:56:07
Speaker 2
So, yes, I think people do really over over rely on kind of the locks and the traps and whatever else. And when they get themselves into a situation which isn't that hard and climbing that they're really having to to provide some outward rotational force, they get themselves in trouble with the shoulder.
01:08:56:19 - 01:09:15:11
Speaker 3
Yeah, totally. It just happened to a friend of mine, and that's like just the first thing that came to mind. I'm like, Let me check your rear delts. They're probably underdeveloped. So it's interesting to hear that that that is that is that is pretty true. And the pulleys to circle back there real quick actually just sustained a pulley injury on my ring finger.
01:09:15:16 - 01:09:36:19
Speaker 3
So you said the so we've got three digits. You got the front, the middle and the lower section of the finger. You're saying that in a bent position, a pulley injury can happen where the front digit over extends it like hyperextended, and then you're stretching your pulley further past its anatomical position, therefore ripping the actual sheath that's holding the tendon in place.
01:09:37:11 - 01:10:04:01
Speaker 2
Yeah, pretty much. And that's that's the interesting thing is that boys are very unique injury to the climbing population. You don't really see them elsewhere. And it really is just because when you have your finger in that extended dip so that that furthest joint and that flexed pipe so that middle joint that's where that that tendon is essentially attempting to bow strings that kind of pull away from the bone there and kind of off the off the off the bone a little bit.
01:10:04:01 - 01:10:30:15
Speaker 2
And that's that's kind of the highest force position for for where where we see those pulley injuries. Now, the interesting thing is that when we examined pulleys back in the day, there is this kind of 400 Newton number. And if you actually look at if you were to put all your force on to onto a pulley in routinely exceed with about 500 Newtons of force and so we'd we'd be surprised that everyone's not blowing pulleys every single session.
01:10:30:15 - 01:10:52:00
Speaker 2
Right. Yeah. But it's progressively that overload this tissue can get thicker by about 50% and it can it can actually grow to sustain about 1000 Newtons of force. And, and really the only way to start exceeding that level of, of force is by either dynamic movements or slipping and really just kind of walking off. And an unanticipated fall just on that one finger.
01:10:52:04 - 01:10:52:14
Speaker 4
Yeah.
01:10:53:03 - 01:11:17:08
Speaker 3
Now so there's three there's three different kind of crimps you've got like the the open crimp you've got the like crimp where you're you're in that position and then you've got the full crimp with your thumb over top and the story goes that, that full crimp is the highest load. And people I've known people to avoid putting their thumb on top of their finger because they're like, Oh, I don't want to blow a pulley in my understanding of this.
01:11:17:17 - 01:11:26:14
Speaker 3
The thumb is actually taking more pressure off of your fingers because you're actually loading the thumb as as your fingers. Is that correct or my mistake in there?
01:11:27:02 - 01:11:52:00
Speaker 2
It well, it's okay. So there's a couple of things to dissect with that one, too. And it's it's it's funny that people avoid this position because this position is not only the most stable position of your of your hand to be in on smaller holds, it actually positions your center of gravity closer to the wall. And so the truth is, is when you get into a hold small enough, you physically won't be able to hold onto it in a different position.
01:11:52:07 - 01:12:12:08
Speaker 2
Yeah. And so what you ended up doing by not training this closed crimp position in a progressive manner is you've left this grip position almost more susceptible to injury and that's that becomes a, you know, it's, it's almost like someone avoiding sprints because they don't want to hurt a hamstring and then they run as hard as they can and they hurt their hamstring and.
01:12:12:08 - 01:12:37:11
Speaker 2
It's just like it's your body's not, it wasn't prepared for it, right? So yeah, it's, it's something that blows. So really when I'm rehabbing all these months with my patients, I do get them to, train the close position because it is a position that you're going to use. And it's not because it's not because you're not strong enough in the other positions, but because of how it alters your center of of balance and kind of positions you a little bit better with with the number of also.
01:12:38:09 - 01:12:59:20
Speaker 2
Yeah, the thumb on top of it it adds but it also brings you a little bit tighter into that position kind of locks things down a bit more. So it creates a does it add a little bit more force when you look at it in the studies? But, you know, three 300 Newtons shouldn't be blowing your pulleys if you've done enough of the upgraded exposure to these movements now.
01:12:59:21 - 01:13:17:16
Speaker 3
So it's interesting that you're saying it's adding more force. Can you dissect that a little bit more? Because to me, and this is my ignorance speaking to my understanding when I'm doing that full group because I love doing the full I, I watched it, I watched the video with Adam Ondra and he was like really obsessed with using his pinkies.
01:13:17:22 - 01:13:37:01
Speaker 3
I remember very clearly, he's like, I like to use the pinky like the way he said it. Like I was like, All right, cool. Like, I need to connect more with my pinkies and, like, rotate my hand, rotate my hand a little bit out so I can start to load the outside of my finger more rather it all being on these first two or three fingers and I do the same with the thumbs.
01:13:37:05 - 01:13:57:13
Speaker 3
I like to engage my thumbs and try to disperse a lot of weight onto my thumbs and the outsides and use the entirety of my hand while I'm holding on to especially a small hold. And so my understanding of using the thumb is trying to disperse that weight across my entire hand rather than it being located and isolated on specific fingers.
01:13:57:17 - 01:13:59:00
Speaker 3
Am I am I wrong? Oh, yes.
01:13:59:16 - 01:14:23:05
Speaker 2
Oh, okay. Yeah. So so it's more the geometry of the of the fingers of what putting the thumb on top will do without the thumb on top. Your fingers are almost in a little bit more of like a 90 degree. But if you were to if you were to notice what happens when you bring your thumb into that position as it closes off, it brings your palm closer to the tips of your fingers, and that changes the geometry of the of the finger joint there.
01:14:23:05 - 01:14:49:15
Speaker 2
So and again, it's not necessarily a bad thing. It truly is a door position that you need to use. And a lot of a lot of times and it's a position that's almost been demonized, almost like spinal flexion with with deadlifts or with squat threads. It's totally it's something that we've taken as a theoretical mechanical hypothesis and applied it to the practical nature without any any research to back that up.
01:14:49:15 - 01:14:49:22
Speaker 2
Right.
01:14:49:22 - 01:15:09:14
Speaker 1
So totally the principle is just like you need to just progressively overload it, right? So if you're worried about blowing your cramp, you know, go find a hanging board with a pulley where you can offset weight, start off super light, you know, and keep that on a regimented scale. And you could increase weight by like 10% or something.
01:15:09:18 - 01:15:13:08
Speaker 1
And then slowly build into that to maybe you get body weight or something.
01:15:13:15 - 01:15:14:05
Speaker 4
You know, like.
01:15:14:20 - 01:15:23:08
Speaker 1
Building into that and like getting your tissue to adapt. So I think, I think that's that's probably the best at least that I can think of so quick. Maybe you want to add something to that.
01:15:23:08 - 01:15:44:23
Speaker 2
But you know what? That's exactly it. It's, it's, it truly is that progressive overload. And that can be said with with way too many injuries. And that can probably even dissect a large portion of what I do for a job is that idea of progressive overload and the body will adapt in. And really it boils down to this, this mechanical stress quantification of it.
01:15:44:23 - 01:15:52:17
Speaker 2
You do too much, too soon, too fast or too nervous are going to get hurt. And if you prepare your body adequately won't get hurt. And so yeah, same thing applies with police.
01:15:53:22 - 01:16:02:20
Speaker 1
Yeah. I was wondering if you could maybe just talk because like I don't fully understand. So okay. So when you a police snap. I've had that happen once in my life, you know, you hear that audible.
01:16:02:20 - 01:16:04:09
Speaker 4
Click what is what.
01:16:04:09 - 01:16:20:20
Speaker 1
Is actually happening to the pulley they're causing the click like you know is this like dislocating? Is it detaching from the bone? What is actually happening? What is the mechanism? They're not the mechanism like what is the actual outcome there? And then, you know, and then why is it taking so long to heal?
01:16:21:23 - 01:16:43:04
Speaker 2
Yeah. So that's that's a that's a good question. And it's kind of gross. So inside of inside the hand, you kind of have, give or take, five annular pulleys. It really depends on the on the reference you look into and you have three cruciform pulleys, which you can just form these X's across your fingers and what those all work to do is they hold your tongue down to the bone there when you have a police nap.
01:16:43:04 - 01:17:03:15
Speaker 2
And depending on the severity it is, it is really just that the pulley itself is ruptured and so the tendon has both strong depending on how how severe your injury is, away from the tendon, away from the bone. So it really has created a situation where instead of nine things holding your tendon down to the bone, you got eight.
01:17:03:15 - 01:17:26:06
Speaker 2
And so it's why it takes so long as you basically need to scar over that injury, you need to heal that ligament and ligaments tend to have or fiber cartilaginous tissue tend to have a long healing. And that's that is why police kind of take so long. But it really depends on the severity, too. If you if you blow one bullet, you might be out for six weeks.
01:17:26:16 - 01:17:38:12
Speaker 2
If you if you blow kind of 18, three, four, you might be into a six month recovery. It really depends on where, where and how badly you did that. But it really is the rupture that is what you hear. And that's is what's kind of gross of it.
01:17:39:12 - 01:18:00:07
Speaker 3
It's yeah, to my understanding, it's like they're like little, little tubes that like wrap around the tendons and like the string, the ten it itself like cuts through the sheath and leaves it splayed, splayed open. And I'm pretty sure you can, like you said, different severities. Not only can you pull more to pull it, like you can pop more than one pulley at a single time.
01:18:00:13 - 01:18:27:04
Speaker 3
But I'm pretty sure you can also like partially rupture a pulley. Like maybe you just like tear the top of it and not all the way through. And that's going to be a faster healing process just because you have a smaller amount of anatomy to to heal and to to scar up, as you said. And in terms of recovery process for these obviously, nutrition wise, we're talking collagen, we're talking, you know, healthy diets.
01:18:27:10 - 01:18:45:15
Speaker 3
And, you know, the big rule of thumb for these injuries is to stay off of it. How long would you say that that process is important? And how at what point do you need to start loading that tissue again, just like the concussion, like you don't want to avoid it forever because you're not going to build that strength back.
01:18:45:15 - 01:19:02:15
Speaker 3
You're not going to get blood flow back to the area to promote healing. So at what point obviously this depends on the severity. What are maybe what are some clues that you can start to realize that it's time to start loading the hand, maybe you just by like maybe you're a 512 climber and you popped it on a tiny cramp.
01:19:02:15 - 01:19:09:14
Speaker 3
Like, when can you start climbing on jugs again? Like at what point is that process safe to start climbing and how can you listen to your body?
01:19:10:17 - 01:19:31:02
Speaker 2
Oh, for sure. So again, yeah, you're right. It depends on the severity, but more severe polyandry, that's one that you kind of heard inaudible pop. It's quite swollen, it got quite painful. We tend to try and immobilize those for about ten days and after that that brief mobilization period, we start to do very kind of gentle, active range of motion and passive range of motions.
01:19:31:13 - 01:19:57:11
Speaker 2
Once it's become a point where it's not so tender to the touch and we we can be reasonably sure that there's no large element of bolstering. So the tendons not flopping away from the the bone there we start doing kind of function specific exercise. So this is where we're just starting to gently load that pulley as early as kind of two weeks after this injury, not necessarily back into the gym and back into climbing, but we're loading in in a meet and a meaningful function specific way.
01:19:57:21 - 01:20:08:16
Speaker 2
Some patients really might take four weeks to get there, might take six weeks to get there. But I tend to have a lot of the police I see back into the gym climbing on drugs within kind of the 3 to 4 week mark.
01:20:09:17 - 01:20:10:01
Speaker 4
Cool.
01:20:11:05 - 01:20:27:02
Speaker 3
Awesome to hear. Yeah, thanks for that. Yeah, I just I just went through a poly injury myself four years ago. I ruptured the eight two on both ring fingers almost within two weeks of each other. And they were the first time I've ever injured those those pulleys before. So I had no idea what I was doing and I kept climbing on them.
01:20:27:07 - 01:20:49:14
Speaker 3
And so I like I'm sure I fully ruptured both eight twos because like the lower digit was swollen. It was super painful. So I noticed I couldn't I couldn't clench a fist all the way because like it was I wasn't able to clench of fist all the way without it being painful. And so that I knew I was really bad and this time I felt the pop and immediately let go of the wall and jumped down and stopped immediately.
01:20:49:14 - 01:21:13:22
Speaker 3
And that was about ten days ago. And today I just started climbing again and I was able to get up on jugs and stuff. I was just like super cognizant about like what fingers I was loading, how small the hold was, and I was able to get through any injuries and it feels really good. So it's just yeah, it's, it's interesting to, to hear the progression and there's definitely circumstantial kind of situations for, for everybody's injury for Sherman.
01:21:14:16 - 01:21:19:04
Speaker 1
Kyle I think that's a great place to wrap up on injuries and stuff. Did you have anything else you wanted to ask?
01:21:19:13 - 01:21:29:03
Speaker 3
No, man. Yeah, I think that for me, that's that's that's that's the meat and potatoes. I think we got most of it for sure.
01:21:29:08 - 01:21:38:11
Speaker 1
So, Quinn, I guess what some things that you're excited or passionate for in the mountains, you know, what's going what's getting you excited?
01:21:38:19 - 01:22:01:02
Speaker 2
Oh, man. That's, you know what? A lot of it. So it doesn't take much for me to have a good day in the hills. But my favorite my favorite time out is in the Alpine. That seems to be where where I thrive. And that's what I really, really dig. So that's you know, that's that's where that's where my heart is for sure, is getting up high and kind of moving fast in the Alpine and being as efficient as we can.
01:22:01:02 - 01:22:16:04
Speaker 2
And of cover in as much territory as we can. But again, you know, I'm out there for fun. I could have I could have a pretty close as as good of a day, just. CRAGEN or or, you know, going for a hike up the chief. It really doesn't matter to me, to be honest.
01:22:17:14 - 01:22:18:12
Speaker 4
Is there any.
01:22:18:12 - 01:22:25:22
Speaker 1
Is there any kind of specific like climb or objective that you kind of have your heart set on for for this summer, this season?
01:22:26:05 - 01:22:46:02
Speaker 2
Oh, man, I'm keeping my expectations nice and low. Well, whatever the bird takes us to, that's fair. I mean, I seem to get off work early on Tuesdays, and we we make our way up to Squamish and we've been able to to make an apron lap every every Tuesday for the last couple of weeks. So that's that's kept me pretty stoked for for the week so far.
01:22:47:00 - 01:22:48:03
Speaker 1
Awesome end favorite.
01:22:48:03 - 01:22:49:12
Speaker 4
Route on the apron.
01:22:49:12 - 01:22:57:00
Speaker 2
Oh you know what? We just did the sounds of rep and I was very pleasantly surprised that was Jim back there. Really, really cool.
01:22:58:01 - 01:23:00:08
Speaker 1
South Red just the left of Saint Vitus.
01:23:00:09 - 01:23:06:07
Speaker 2
Yeah, right to the left. Just snug in between. Right, right in the middle of 30 meters of really awkward bushwhacking.
01:23:07:00 - 01:23:12:21
Speaker 1
Yeah, yeah, yeah, yeah, totally. I've done that. It's a beautiful climb. It's a lot of fun. Yeah. Wicked man.
01:23:13:21 - 01:23:15:03
Speaker 4
Yeah, well, you know.
01:23:15:13 - 01:23:32:04
Speaker 1
You know, hopefully we can share a rope some time or go climbing. Know, I'd really love to. To meet you in person and stuff. And I just want to thank you for taking your time coming on the show. There's been a fascinating conversation, man, and you're very, very knowledgeable. And so it's it's been a blast and I've learned a lot.
01:23:32:04 - 01:23:33:05
Speaker 1
So I really appreciate that.
01:23:33:09 - 01:23:35:21
Speaker 2
Awesome. And my dear, thank you guys for having me.
01:23:36:06 - 01:23:46:19
Speaker 3
Definitely, man. Yeah, we do delve deep into these topics. I think it's been been really, really informative for for everybody, including myself and yeah. Thank you so much for your time and it's been a pleasure to meet you.
01:23:48:01 - 01:24:02:05
Speaker 2
Yeah Perfect. I guess. I guess before I let you guys go, maybe I'll just do a shameless, shameless plug and just say if anyone's struggling on the on the podcast with injuries I'm I'm on the north shore body sports and I'm downtown at Kinematic Sport Mountain Rehab if you need to get in touch.
01:24:04:01 - 01:24:32:18
Speaker 3
Thank you all so much for subscribing and listening to our podcast. We've seeing great reviews and ratings start to pop up on Spotify and Apple. This means so much to us and helps keep the fire going for this project. If you haven't already, please subscribe, rate and review us wherever you get your podcasts.
01:24:32:18 - 01:24:42:18
Speaker 5
Mm mm mm mm mm mm.