.....Make or Break: Don't Let Climbing Injuries Dictate Your Success
This is the best book on climbing injuries by a large margin. If you have ever been injured climbing you should read this book. If you have never been injured you are clearly not pushing yourself enough: read 9 out of 10 Climbers Make The Same Mistakes and try harder!
Make or Break is carefully described as a coaching manual, an honest appraisal of MacLeod's sports-science rather than medical background. It is much more than 9 out of 10 part 2 though: one of its strengths is how it inhabits the spaces between injury treatment, rehabilitation and training, linking them and filling gaps more clearly than a work from one for these worlds might do. An impressive breadth and depth of reading has gone into writing this. The author's approach is strongly influenced by his many experiences with injury. This personal perspective is a strength and weakness: clinicians and medical experts are not always good at seeing things from the patient's viewpoint, but MacLeod's experiences are not always representative of the broader church of climbing and climbers. Occasionally I want to say 'come on Dave, we're not all as single-minded as you'.
The fundamental message will be familiar from MacLeod's first book: become your own expert rather than looking to others to solve your problems for you. There is a section on how to negotiate the world of sports medicine practitioners, inspired by his own painful experiences. We sense self-reliance is a cardinal virtue in the author's household, an admirable characteristic though there are times when even the most independent-minded individual should seek help. I have a small concern related to this: very occasionally more sinister conditions can mimic sporting injuries. I recall a young patient whose painful knee, hurt playing football, turned out to be a bone tumor. The humble GP may still be an appropriate first point of contact even if they have limited expertise in climbing training and injuries. It might have been worthwhile to include a short section on identifying when things are not quite as they seem.
The books biggest strength is the emphasis on the multiple factors leading to injury rather than considering the finger, elbow or shoulder damage in isolation. The premise is pain and tissue damage are a final common pathway, the result of many contributions including posture, movement habits, or training choices. The underlying idea is repeated movement in a non-ideal fashion, associated with an imbalance of muscles' length and strength, accumulates leading to tissue damage and pain. This is a currently popular view, conceptually attractive, and has research support in highly repetitive activities like running, where athletes with ideal body symmetry are less prone to injury. It is much less evidence-based than is given credence here and more speculative when applied to climbing which is highly varied in movement.
Pain specialists know tissue damage is one factor of many contributing to pain and how we deal with pain. Mood, beliefs about pain and injury, health behaviours and social circumstances are important in determining who gets injured, which bit hurts and how much, and speed and extent of recovery. It is great to see the 'Know Pain' chapter start to acknowledge this, explaining how to interpret pain, and why pain is rarely an honest witness of damage. This is common knowledge in pain management but unusual to see it recognised so clearly in the world of sports and sports injuries. The full implications of this way of thinking are not explored as completely as they could be. In particular, the influence of anxiety and depression on injury and pain could be described more thoroughly. Low mood, psychological stress, and excessive anxiety all make injury more likely, and delay healing and return to climbing. These are also contributors to the final common pathway of pain and injury, and need to be addressed just as non-ideal posture and movement do.
Many people will be tempted miss out the first chapters and go directly to where their particular injury is described. Please don't! Take your time and thoroughly digest these early sections first. This may be infuriating for those who like to tell their doctor or physiotherapist 'it hurts here', expecting an immediate diagnosis and management plan (that's most of us at times). As with 9 out of 10 climbers, this is not the book to chose if you want a simple recipe. There are treatment suggestions for all the typical climbing ailments but to simply implement these would be missing the point.
The section on tendon injuries is one of the best I've read anywhere, clearly presenting what we know and don't know. It suggests specific treatment ideas but is happy to acknowledge when we don't know the best treatments or why treatments work. Many medical practitioners would benefit from adopting this humility.
Make or Break is well designed and attractively produced. It even has an index. At £30 it is exceptionally good value for a medical text-book.
Reviewed by duncan
. Duncan Critchley is a physiotherapist, lecturer and pain researcher at King's College London. He describes himself as "a poor advertisement for my profession, having climbed for 36 years and been injured for about 33 of them."