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Trad PT
A physical therapy and climbing blog.


Crack climbing Thumbs Up, 5/6/2020

The Trad Climber’s Bible by John Long and Peter Croft is an excellent book for any budding climber. There are countless lessons in this book but the most technical is crack climbing technique. John Long makes an excellent argument for learning to crack climb thumbs up. Thumbs up means putting your hand in the crack with the thumb oriented up versus pointing down.

This lesson best applies clean vertical cracks. Think Indian Creek’s Super Crack and Generic Crack. These are perfect splitters with solid hand jams for one hundred feet. Climbing this style rock is unique. It requires repeating the same move over and over. Unlike face climbing, the hold never changes, and you can place your hand wherever you want. This allows you to make moves as big or small as possible.

John Long makes a great case for thumbs up climbing. It allows you to make larger moves, reach higher, and therefore climb faster. When you place your hand in the crack, thumbs up, your shoulder and bicep are oriented for ideal contraction. You can pull yourself up much easier, as compared to the thumbs down position.
When placing your hand in the crack thumbs down your shoulder becomes internally rotated. Internally rotated and flexed, the shoulder is in prime position for impingement of the supraspinatus and bicep tendon. The supraspinatus tendon is most vulnerable in a flexed, abducted, and internally rotated position. This is the position many climbers use to lock-off while placing gear. A pronated hand easily wedges into the crack like a solid nut. It is great for locking off. However, this position makes it hard to move up. As you move up your shoulder must externally rotate. It is better to begin in an externally rotated position, thumbs up, and have a greater range of motion.

My advice for any new crack climber is to practice thumbs up climbing. Learn this technique when hand jamming in the gym or the crag classics. Practice moving efficiently, making fewer, larger moves. Save the thumbs down technique for lock-offs when placing gear or resting on route.


-Sky Palmer PT

Roll with the Rules, 4/7/2020

The lumbar roll is my favorite technique in the treatment of low back pain (LBP). It is fun to perform. After initial success, patients request it. They ask for it by alias, “can you crack my back?”

The Clinical Prediction Rule (CPR) for lumbar manipulation is a great tool for determining when to employ this intervention. This is how we use CPRs. The CPR identifies if the intervention will likely have a good outcome. The more closely a patient’s status matches the criteria, the better suited the intervention.

Here is a brief overview of the CPR for spinal manipulation taken from Dr. Childs 2004 validation study:

-the duration of LBP symptoms are less than 16 days
-symptoms do not go past the knee
-FABQ score is less than 19,
-there is a hypomobile segment in the lumbar spine,
-at least one hip has greater than 35 degrees of internal rotation

These criteria describe a patient who is well off. A patient who fits nicely into each criteria is likely to get better regardless of intervention. However, I would like to focus on the last criteria. Internal hip rotation greater than 35 degrees. This criteria is most important because it is the one we can impact the most immediately. Why does hip mobility correlate with a positive outcome? It could mean the problem is not in the hip, it is definitely LBP and therefore a simpler issue. It could be a third degree correlation such as young people have good hip mobility and young people get better faster. It may indicate the patient has loose external rotators. The glutes are not guarding.

This last presumption is useful. Adequate internal rotation means compliant external rotators. Soft tissue manipulation to the external rotators, the glutes and even into the lateral thigh prior to lumbar manipulation will improve the likelihood of a positive outcome. Empirically it will improve the quality of the manipulation.

Think of the CPR as a guide telling you what to address before the intervention. It is a hint on how to perform a better lumbar roll. Being raised by a chiropractor, as a student, and educating coworker’s I have been on the table countless times. I firmly believe a manipulation feels better when it is preceded by soft tissue work to the glutes, IT band, and lateral hamstring. The stretch feels more focalised and the thrust is better absorbed. There are countless ways to perform this prep work. Active release, IASTM, using your forearm for a massage can do the trick. Take the time for this extra step and make sure your favorite intervention is utilized with the best opportunity for a positive outcome.

-Sky Palmer, PT

Located at 100 Dover St New Castle, DE 19720. Phone: (302)-656-1390