Process Physiotherapy

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Process Physiotherapy

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As a climber, climbing coach and physiotherapist I am ideally placed to provide clarity and directio

01/11/2026

It’s no surprise to find youth injure their growth plates (PPSI).

They’re vulnerable as they develop and they will respond negatively to stress before other tissues in a young person.

Also adults don’t have them anymore so they can’t injure them 😆

But what if we also discovered that grip type preference didn’t seem to affect PPSI injury risk? 🤔

Neither did level of climbing or training hours. 😯

However this may have been because they were all high level climbers who trained up to 25 hrs a week. Yes, 25 hours 😮

That seemed a bit odd at the time. But we’re still seeing as many (more?) PPSI’s now and there’s hardly any crimps nowadays. Current thinking is that energy into the hand (slapping paddle dynos anyone?) could be disruptive to growth plates.

So taking them away from crimping during PHV may not be enough 🤷 but we don’t know.

In other news 📰 boys ignore injuries until they are so bad they have to take way more time off to heal 🤦

Carers and coaches - we should be alert to this and create environments where they feel able to talk.

Next up Maisie is going to take a look at what other sports do.

Because we keep doing these studies, agree that youth injure differently and that we need to do something about it, but then don’t do the research that may inform us what to do. So as usual we’re copying from other sports…..⚽️ 🏏 🏉 🏀 🏈 🏊

20/10/2026

I’m using boards as an analogy for what I see behind many injuries - change. Boards are great. Very effective, fun and efficient. They are not the problem. How we use them may be.

Injury causes are multi factorial and complex. But often there is a more prominent cause that stands out amongst the others. One we can learn from.

It’s usually something different - a change.

Today I had a chat with someone whose fingers were feeling tweaky. All variables were pretty static - except they’d recently started a creatine cycle and quickly gained a couple of kilos. This is temporary but increased the load on their fingers.

A small change that can have significant effects.

Each time you climb on a different board this is different. Even the same board at a different angle or size version is different.

Being conditioned to a board means you are conditioned to a board, not all boards.

2026 Moonboard is very different to 2014 Moonboard.

The style, hold types and movement patterns of a Kilterboard are very different to a Tension board 2.

Then there are all the woodies out there. Each as individual as the person who made them.

You should always be thinking “Is what I am doing different to what I have recently been doing?”

This takes an extra layer of thinking. Not just I am still board climbing. But is that specific activity really the same.

How to change over to a new board? Gradually. Not months of build up. You are (hopefully) strong and robust.

1) Warm up (which should be to an appropriate level for board climbing) - 15 - 30 mins on the new board - rest of the session as normal.

2) Warm up - 30 - 45 mins on the new board - rest of the session as normal.

3) Warm up - 45 - 60 mins on the new board - rest of the session as normal.

Etc.

You get the idea. That ‘normal’ may be on a commercial set (if you’re introducing yourself to board climbing for the first time) or your current regular board.

Adjust numbers to suit.

This same principle goes for any changes you make in your climbing and training.

A gradual introduction means that if it does trigger a negative response it’s small.

#

07/10/2026

We’re in production!

The result of years of tinkering behind the scenes by myself and Paul and the addition of a new team member - the CNC machine.

We’ve still got the good old 20mm unlevel primer.

We’ve updated the unlevel 40mm big lifter and I believe we’ve created the most stable and comfortable lifting platform out there. Those who know me and Paul know we’re not natural salesmen or boasters. It’s a big claim but we’re sticking by it.

What’s really new is taking the developments in 3D printed fingerboards and carrying that over to good old Ash.

Variable depths to account for different finger lengths as well as heights. 4 versions available AND we will be able to make bespoke versions for those who need it.

Not only that but Paul has put his 20+ years of handcrafting holds and boards and made a change that makes us wonder why it’s not been done before. The flat edge is graduated into the vertical back wall. It feels more comfortable, stops skin bunching and encourages active pulling rather than passive hanging.

Follow myself and Paul to get these when they come out. This will be in the next few weeks and in time to treat yourself for Christmas.

29/09/2026

TICKET LINK IN BIO. £5 FEE DONATED TO CAC.

A practical and empowering workshop to help you overcome common age related issues and stay ahead of the ageing curve from a climbing specialist physiotherapist.

This workshop is for you if:

You have reduced your activities due to pain, such as sore knees or lower back

You have stopped doing certain things because of fear/anxiety

You believe you can’t do something anymore because of your age

You may not consider yourself ‘old’ yet but are concerned about what the future may hold

Ageing is a process that happens to all of us, but there are simple actions we can take to keep ourselves as active as possible for as long as possible.

This practical and positive workshop will look at why many commonly held beliefs are not true, just because a lot of people say they are, and what we actually need to do to improve our chances of keeping going as long as possible.

Not everyone ages the same, some are more unlucky with age related issues than others. But we can all improve our situation. If you’d like to gain confidence in your movement, climbing and daily life this is the workshop for you.

There will be a short presentation, a practical session on how to improve confidence in falling and an open question and answer session.

Please contact me if you’re not sure if you are suitable for the workshop and we can discuss your personal situation.

The ticket price does not include entry to the climbing wall for climbing

26/09/2026

A real shame that this research became grossly affected by COVID.

As it stated at the time there is a real lack of research into this area where we know all mature sports have had issues in the past.

So obviously there will have been more done since 2022 right? Right?

Wrong…….

This and the previous paper from 2015 are the sum total of 💩’s we’ve given about whether our children are getting injured, dropping out from sport etc.

Around 200 children in total.

Due to the very low sample size and related confidence intervals etc all the findings of this paper must be taken with caution.

Yet I’ve seen the stats and behaviours noted quoted without that context being given.

2.7/1000 hrs is reasonably low. Quite a lot lower than the previous paper that had a much higher sample size and better confidence. So I’m not convinced.

The numbers that do stand out to me are the 36% being fingers. In youth these are likely growth plate issues. That’s a high percentage of a very avoidable and potentially very serious injury.

24x more likely to be re injured if you return to climbing while still in pain certainly tickles my biases. But if I’m going to say treat the other findings with caution that must be too.

What it can tell us is that education of climbers, coaches and care givers could have greatly reduced that 36% of finger injuries and that it’s likely youth climbers need some guide rails if they are climbing by themselves. They need to know how much is enough and when to stop.

Intelligent athletes

Intelligent coaches

Informed care givers

All communicating regularly

23/09/2026

I am sure this has been done before but I’ve not seen it and the idea popped in my head on my drive in this morning.

It works better this way than with the pads the other way round.

But I think it’s a very useful way to load femoral rotation equally through range (unlike bands) and with a lot of support so you can go heavy.

You can also get a really good end range capsular feel out of it if you’re trying to improve hip mobility.

I had to overcome some hesitation of being ‘that guy in the gym using the equipment wrong’ to do and film this today.

That’s interesting in itself as I’m all about supporting people to do what they want to do and not to judge others.

If anyone should feel confident in a gym space it’s me: male, middle aged, white, physio. But I still felt a bit silly. A good reminder.

Anyway, let me know what you think of this. I’m expecting some interesting DOMS tomorrow…..

19/09/2026

LUMBRICALS

If you climb on commercial sets (not boards) in a modern wall I think you’re more at risk of a lumbrical injury than a pulley. That’s certainly what I’m seeing in my case load presently.

Open handed grips, dynamic movement (leading to fingers having to adapt to higher peak loads, faster) and pinky fingers dropping off (or not making it onto a hold) as we make big moves.

Modern setting stresses the hand differently.

DIAGNOSIS - the injury happens in an open hand position and/or where the pinky finger has dropped off a hold (undercut crimps for example).

Symptoms are sudden and in the palm of the hand and sometimes the wrist and forearm.

It can feel like a pop or a shift or even a zap⚡️ down the forearm.

Test it (thoughtfully) in a 4 finger open pull. Then slowly drop the little finger off and curl it down. If this increases symptoms it’s likely (not certain) to be a lumbrical injury.

THE GOOD NEWS - lumbricals heal quite well and quickly on their own. They will often become pain free quite fast and we can usually return to adapted climbing reasonably soon with the fingers buddy taped together.

THE BAD NEWS - pain free does not mean fully rehabbed. The lumbrical is the 🧠 of 🖕. It coordinates the incredibly complex system between 2 flexor and 2 extensor tendons across 4 joints.

If you return to cranking hard with an uncoordinated finger you will experience the reason why I have been prompted to write this.

It will start to feel irritated as you increase your level. That feels normal - it is recovering from injury after all.

But that sucks us in to pushing on. That low level irritation at the end of a session increases to being in a session, between sessions and then constant.

Synovitis, tenosynovitis and capsulitis are all the long-term outcomes of non-rehabbed lumbrical injuries.

They can take much longer to rehab and require much more adaptation to activity than the original injury.

So get them checked out and don’t try to manage it on your own.

MORE GOOD NEWS - lumbricals are easy to rehab and not a long process usually.

But you need to go and see your trusted climbing specific medical professional.

11/09/2026

Still loving the new hip machine 🥰

People seem to really like a burn in the glutes to feel like they’re doing the right thing - whatever that may be.

There’s certainly plenty of hashtags about them!

Pushing into the stirrups with your heels will really bring this on if that’s your kind of thing 🙃

10/09/2026

I found these pics when sorting through some old pics the other day. There are many I don’t have pics to hand for and those I don’t have insta contacts for. This was just one day at one comp.

But the point of this reel is that they are all still climbing. Some still competing, some organising competitions, some coaching and instructing. But in some way they are all still engaged with climbing.

We all went on a journey and they developed life skills and learnt about themselves on the way. So did I.

No burnout, no defining themselves by results, just enjoyment of seeing what they can do and how far they can go.

It was a privilege and is directly what has led to my research into youth climbing injury.

The answer to who the climber with the whack beta is (it was always amazing how she’d choose her own way and make it work) was .climbing she’s still doing it now 😆
gpayne .coops .lewi18

04/09/2026

What we have here is one of two research projects into how often our comp climbing children are getting injured.

This is from 2014. Very forward thinking 👏

The other study is from 2021 and also looked at around 50 children. Maisie will present that one next.

100 children is the sum total of the work we have done to see whether climbing is following the same route that history tells us has happened in all major sports as they grow.

Funnelling and ‘talent identification’ leading to drop out, burn out and physical and mental injury.

When we consider how rapidly climbing has changed since 2014 and even 2021 I don’t think we can rely on what they tell us anyway.

What are the recommended youth guidelines to help coaches and carers make positive decisions?

There aren’t any!

None.

We’re winging it 😳

With our kids……. 😮

We know children injure differently than adults. So we can’t do what they do.

We know from other sports there is huge potential for survivorshio bias and focus on medals over duty of care.

We should not think climbing is any different because most climbers are lovely people (which they are 😎).

I’ve been banging on about this for a few years now and as nothing is happening I’m going to do it myself 🙃

So if I see you at a comp soon and ask you to fill in a questionnaire please humour me, it’s for a good reason 🙏

Thanks must go to Kaikanani for speaking to me about her research (this article and other quality studies in climbing) and helping me with mine.

Address

Preston
PR58AN

Website

http://www.processphysiotherapy.co.uk/

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