Lean and Mean? Some thoughts on optimising body composition

i thought I’d write a quick piece about body composition this week, following the recent tragic story of a student who died after taking diet pills she bought online. Now I know that nobody reading this would be dumb enough to do that type of thing but climbers have been known to worry about their weight. So I thought it worthwhile to visit the topic and give my perspective on healthy ways to think about weight and body composition as well as some suggestions on how to control it.  There’s not much rocket science here and that is maybe my biggest point: there is a multi-billion industry selling you workout plans, diet plans and funny little pills to give you the physique you always wanted. Some of these methods work while some will only lighten your wallet.  Some are healthy and some are downright dangerous. Not only can some online diet pills kill you (some use a pesticide called DNP that raises metabolic rate)(but is toxic) but some of the “natural” supplements can also be almost as dangerous. For example, some companies sell Aloe Vera as a diet aid. When used in the skin aloe is safe but ingesting Aloe latex has been linked with kidney failure, hepatitis and cancer. Some years ago, the FDA in the U.S. banned the use of aloe latex in laxatives due to health risks. Buyer beware!!!!

But before we get into how to optimise body composition, we need to understand why you might want to do this and what this means. Your optimum body composition for climbing is the weight and body fat percentage you climb best at. This means that potentially you may need to adjust your target body composition depending on your goal. I know personally that my ideal weight for long routes is a few pounds more than my best bouldering weight. If I get too thin I lose stamina.


It is personal to you and you can only find out by trial and error. If you’re carrying excess weight, that could hold you back, if too thin you may lack the power or stamina to perform. In the book “Racing Weight” the author Matt Fitzgerald explains this in more depth. The days of all top climbers being super skinny seem to be over with the top athletes now possessing a more powerful physique. Power to weight ratio is important in climbing, but don’t lose the power by overdoing the weight loss!

So how do you manage your weight to reach your climbing goals?

There are no shortcuts, and it is firstly about diet, secondly about exercise. You can’t outrun bad food.

Just as there are a multitude of diet pills of varying efficacy and safety, so too are there a wide range of diets. Some work (briefly) and others are a more long term change. And again different things suit different people. The approach I favour is to try to avoid processed foods and refined carbohydrate. If you can’t pronounce or recognise the things on the ingredient list, don’t eat it. This is trending towards a clean eating/paleo viewpoint, if you want to give it a label. Our metabolism has evolved over millions of years but the wide availability of sugar has been with us for a few centuries at most;our body can’t process this healthily. The resultant blood glucose and insulin spikes not only drive fat deposition but more importantly will lead you into type 2 diabetes in later life. What about fat? Some fat in the diet is necessary and the current  received wisdom over low fat diets is being challenged. My view on this is that eating fat does not make you fat, but eating a shedload of calories (fat is very calorie dense) will make you fat. Which brings us to the idea of calorie balance.

If you eat more calories than you burn you will store fat and gain weight, if you eat less than you burn you will lose body fat. This is a good strategy for a species that had intermittent access to plentiful food when hunter gatherers but causes problems in the era of 24 hour drive throughs! So to lose body fat you need to create a calorie deficit. The accepted recommended figure to aim for is 500kCal a day, any more than this and you’re making life harder for yourself in terms of willpower and day to day energy. You also run the risk of slowing your metabolism down- too big a deficit and your body starts acting as if there’s a famine and stats saving and storing every calorie it can. You can prevent this by exercise. Exercise raises the metabolic rate and maintains it. The fitness world seems intent on arguing about HIIT vs cardio as a means of burning calories. The evidence is probably that both work (and as someone who spends his day job begging people to do some exercise at all, stop arguing). It’s always good to mix up your training to stop the body adapting too much, but if you’re looking at hit or cardio think what your longer term aim is. Are you training for bouldering or alpine climbing. If the former, HIIT training will develop metabolic pathways suited to short intense bursts of activity whereas if you aim to climb long alpine routes then long hours of cardio are for you.

The final macro-nutrient to mention is protein. You need sufficient protein in your diet to allow your muscles to recover from training sessions and preserve muscle. If you are looking to build muscle you need more protein but be aware than losing fat and building muscle at the same time is not recommended, for the simple reason that building muscle needs a calorie surplus while losing fat needs a deficit. I’d always recommend trying to get adequate protein from real food but in a busy schedule, given the recommendation to ingest protein within 20minutes of the end of a session to aid recovery, supplements are useful. I use a plant based protein supplement instead of whey for reasons I outline here and it’s working for me. No stomach side effects, easy to use and effective. I have arranged a discount on this product (and the rest of the range). If you want to take advantage of this, please contact us here.

Finally, to return to the original starting point of this article; diet pills. Most are best avoided. There are some supplements that do seem to aid the loss of body fat and are safe. Green tea extract has some good evidence and green coffee is also marketed for this. Chilli and other hot spices in fact do raise your metabolic rate by up to 15% and aid weight loss. But really do your homework and check every ingredient. Some of the proprietary “fat burners” available on the high street use huge amounts of caffeine to increase metabolic rate and would be inadvisable with certain health issues. Another option is conjugated linoleic acid (CLA) that appears to help fat increase fat metabolism. All these products have a marginal effect and can only ever be a very small adjunct to a well thought out plan.

So is a dodgy online diet pill worth the risk for such a small margin?

If you need any advice surrounding this, email me. I can recommend “Racing Weight” as a good resource for performance sports nutition and although not pitched at climbers, it’s ethos transfers very easily.

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Posted in nutrition

Finger Injuries: Snap, Crackle and Pop!

Finger injuries are the most common injuries suffered by climbers and are getting more common as indoor climbing gains popularity and standards rise. I don’t want to go into great anatomical detail about this as that has already been well done elsewhere, such as Dave Macleod’s book “Make or Break”.

However, as these are so common amongst climbers I thought I’d do a really basic summary as a pointer towards how to avoid them and how to treat them.

The most common type of injury is to the flexor tendon pulleys. These pulleys are fibrous bands that hold the flexor tendon close to the finger bones. When we flex our finger joints the tendon (which start in the forearm) would love to cut the corner; it’s the pulleys’ job to prevent this. These injuries most commonly occur when high loads are applied through flexed fingers: crimping is the most frequent finger position.

The most commonly injured pulley is the A2 pulley, followed by the A4 and the ring finger is the most commonly affected. In the case of the A2 pulley, this is the injury commonly associated with the full crimp position. This will cause pain around the base of the finger where it joins the palm.  The A4 is less likely to be injured, but can be damaged even  in an open handed position on a small hold (1 pad or less) and typically will give pain on the palmar side of the intermediate phalanx (the middle bone of the finger).


In both these scenarios the mechanism of the injury can broadly be described as the force on the pulley exceeding it’s capacity. Seems obvious? But if we look at these 2 variables we can reduce the risk of this happening. Firstly, the force applied. This force depends on a few things; namely position of the hand, relative momentum and position of centre of gravity and the stability of the climber. If the body of the climber is accelerating downwards due to a mistimed dynamic move or foot slip you will be trying to counteract that momentum, which equals mass time speed; a force that could exceed your body weight considerably. If your holds are poor  this means a LOT of force on the pulleys, especially if you’re crimping. Even swapping hands can create this downward acceleration if mistimed. Even with your feet on the holds, if your centre of gravity is moving you are at risk.

So how do we mitigate this. The main thing is technique. Make sure your footwork is precise and that your feet are staying where you put them to minimise unexpected slips. A good coach can analyse your movement and help you optimise your technique in a way that is really hard to do yourself. Practice dynamic moves to get the timing right so you load the hand hold as close to the top of the movement as possible so there is no momentum to deal with.

Physically, a strong core can help by controlling your centre of gravity in relation to the limbs attaching it to the rock and spreading any sudden forces to all 4 limbs (and helping keep feet on in the first place). Using an open handed grip reduces the risk of a2 injuries as well. But the other factor is he inherent strength of the pulley. The good news is that training, such as finger boarding (take care, please!) will lead to adaptations making this stronger. The bad news is that the training will increase your muscles’ ability to exert the force quicker than the tendons and ligaments can adapt to withstand it (this is why you must take care). This is because the rate of adaptation is governed by the rate of healing of a tissue and a major factor in this is blood supply. Muscles have excellent blood supply so get everything they need to heal and adapt (get stronger) quickly. Tendons and ligaments have a relatively poor blood supply so they heal and adapt more slowly. So a patient approach will make you injury resistant, whereas rush it and you’ll just be injured.

Overtraining and overuse can predispose you to developing a pulley injury. The physiology behind this is complex (a series of articles on overtraining will follow), but in the briefest terms if you have not recovered from your previous training session before starting your next one, the pulleys can become weakened by repeated micro trauma which has had insufficient opportunity to heal. Then a sudden force can lead to a pulley rupture at a lower than anticipated load.

So what happens when you do get an injury? The pulley may tear partially or completely. A complete rupture is often accompanied by a loud crack or popping noise but can be relatively pain free. A partial tear is always painful as you’re still loading a damaged structure.  Treatment differs depending on the severity of the damage: if you have the misfortune to tear more than one pulley (pain at more than one level in the finger and loss of function ) you may need surgical repair; if you think this is the case you need an ultrasound scan. This can be arranged through your GP or privately and if you need advice, email me here.

The general rule of thumb for the vast majority of pulley injuries is immobilising and supporting the injured pulley for up to 2 weeks followed by progressive rehabilitation. This (theoretically) gives time for the damage to be repaired and then the rehab rebuilds the strength in the repaired structure. I’m not going to give you a timetable or regime here. Everyone is different and this needs to be done properly to get the best results, so the program needs to be tailored to you.

You can find further information about how these injuries occur and how to treat them in both Dave Macleod’s excellent book “Make or Break” and in “One Move Too Many” by Thomas Hochholzer and Volker Schoeffl (who has done a lot of the research in this area). If you need some help or advice with getting treatment for your injury then contact me and we can get the ball rolling.


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Posted in Injuries, Uncategorized

Why am I doing this?

Why am I offering my assistance for climbers with injuries for free? A fair (and recently asked) question. Let me try give a brief answer.

First of all I enjoy musculoskeletal medicine: it’s one of my specialist areas within my own practice in Ripon. So I tend to see a lot of injuries and joint issues. After completing my medical degree at Cambridge, my first job was in orthopaedic surgery and I maintained my interest in sports medicine through GP training to the present day.

I’m particularly interested in climbers though, because I’ve been climbing for 20 years and have a wide experience of injuries! In the past 2 decades I have experienced (in no particular order) A2 and A4 pulley injuries, finger flexor tendon strains, a dislocated shoulder, broken ribs, broken metatarsal, the odd head injury, overtraining syndrome, rotator cuff syndrome, anterior knee pain, cruciate ligament damage, lumbar whiplash (that is unusual but happens when your head stops and your feet try to accelerate past it) and now I’m seeing some of the longer term issues like dupuytens syndrome in my hands.  So I have a VERY personal interest in this type of thing! And the advice I’ve had over the years has been so variable. I’ve also had an interest in training methods and the physiology behind them since the time I started climbing so have seen this field develop. We now have quite a decent knowledge base about climbing injuries but while attending the BMC international  Injury Symposium last year it occurred to me that there were 60 people in the room who had this specialist knowledge and thousands of climbers “out there” with no obvious way of linking the two. It was also apparent that most of the treatments needed were accessible through the NHS but that the average frontline clinician wouldn’t always have the knowledge of how climbers specifically injure themselves to refer or treat correctly. So here we are. I see my role as getting this knowledge “out there” and to help get people through the treatment labyrinth  to get the best outcome. 

And maybe even some research of my own; more of that later!

Posted in Uncategorized

Fuelling the Machine; some thoughts about Nutrition

There’s been a few articles about nutrition and protein powders recently, so I thought I’d add my own viewpoint. In gyms it’s now common to see protein shakes being consumed whereas at climbing walls I don’t think I’ve seen one yet. This may be due to climbing being behind in terms of sports science and nutrition. But it might also be due to climbers’ paranoia about gaining weight. There is some truth in this: a recent article in ukclimbing stated that whey protein is the most effective protein source for increasing muscle synthesis. That’s why body builders use it (amongst other things). 

As a climber I’m not using protein to bulk up: I don’t want to look like Arnie. I use protein shakes to aid recovery from a workout and support my ability to train again as soon as possible while avoiding overtraining. A small academic trial found that rice protein was as effective as whey at supporting recovery but did not cause the weight gain associated with whey.
In the past I’ve used whey protein powders of various brands. Some mix well, some don’t. Some taste nice, most don’t. They all gave me gastric side effects of bloating, indigestion and other things I won’t share with you. In fact up to 15% of people are known to be dairy intolerant, and if you fall into this category then whey protein is NOT for you. Neither is it an option if you’re vegetarian or vegan. Then there’s the ethical dimension to the intensive production of dairy produce which is where most whey comes from. I’m not vegetarian but I do try to buy organic food wherever I can. This isn’t just about ethics, but also about the repeated use of antibiotics and artificial hormones used in intensive farming methods. This is done to prevent infections spreading between the densely populated animals and to maximise yield. As there are some concerns about these antibiotics increasing resistance to antibiotic drugs in humans, these drugs are entering the food chain. And that means you. You can’t avoid it but I personally choose to minimise my exposure to it.
But why use protein shakes at all? In an ideal world, the best way to obtain the protein after exercise would be to eat a balanced, healthy meal. The problem is, for most people workouts and gym sessions are fitted in around everyday life and it is frequently not possible to sit down and  eat. It can be done with some prior planning and preparation and if you can do that, that’s great. But for the rest of us, protein shakes fill the gap.
For the past 3 months I’ve been using a vegan protein supplement, based on a blend of pea, brown rice and cranberry protein (no, I didn’t know cranberry was a source of protein either!). I find it tastes good (much better than other vegan proteins that frankly tasted like mud and better than most wheys I’ve used), mixes easily and doesn’t upset my gut. It also contains a decent vitamin mix and some fibre which means if I miss breakfast and have a shake instead, I can withstand moderate cake stress until lunchtime.
It does contain some raw cane sugar, but that is, in my view, a better option than artificial sweeteners (lots of disputed claims of carcinogenic risks-no thanks) or an off putting taste which reduces the chance of me taking it.
Does it work? Well it’s maybe hard to say for sure but in the past 3 months I have lost some weight, gained some strength and gone up a grade indoors. I am back to where I was before my shoulder injury 18 months ago and am able to train again properly without overtraining or injuring myself. I would like to lose more weight but I also like cake, and no protein powder can instal fresh will power! I have to declare a slight interest in this, as I get this product through my wife who now works for the company. This means that I get these products for a substantial discount and if you quote this blog you can access an introductory discount too!!! Furthermore, long term discounts are available after your introduction. If you want to take advantage of this offer contact us here.
And it is a good offer!! Trust me, I’m a doctor! 😉
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Posted in training

The Core Issue

What is your core? Put simply, your anatomical core is every musculoskeletal structure between your shoulders and hips. This includes abdominal muscles but also the deep muscles of the abdomen and back and also the muscles that stabilise the shoulder blades. 

The core needs to be strong to stabilise and orientate the centre of gravity and body to make the moves generated by the limbs. If the core is unstable and unable to hold the body position required the climber is at risk of sudden movements of the centre of gravity. This in turn adds unpredictable loading to fingers, arms and shoulders. You might fall off. You might fight like hell to stay on but this is one way traumatic injuries happen ( think of a suddenly loaded finger and a popped tendon pulley).

It is perhaps more helpful to think of the core on functional terms: ie what it  really does in a given activity such as climbing. The core connects the arms and legs which provide the upward movement in climbing. The “core” muscles are the ones that hold your position on a climb prior to and during a move. They stabilise the orientation of your joints and therefore body and provide the stability to generate upward movement.

I would argue that the stabilising muscles of the shoulder (the rotator cuff) and similar structures in the hip also come under this functional definition. 

This “extended core” is important as it has a bearing on injury prevention. If a training regime targets the locomotive muscles of the arms and legs and the anatomical core there is a risk of developing a comparative weak link in the muscles that stabilise the shoulders (and hips). This weak link has potential for getting injured. In the case of the shoulder, if the rotator cuff is weak the shoulder will not lie in the optimum position. When the big muscles try to then pull you upwards some of this energy will go into moving the joint further out of alignment. It reduces efficiency. But even worse you’re on the path to an overuse injury.

Sometimes the big muscles end up trying to stabilise the shoulder themselves but this simply doesn’t work. The reason for this is that the stabilising muscles throughout the body are comprised of slow twitch muscle fibres. They have small motor units allowing really fine tuned controlled movements and adjustments to joint position. They are mainly aerobic as they have to work all day. The big muscles are different; they have big powerful motor units to develop powerful movements. These are not precise enough to fine tune a joint’s position. They also use a mixture of aerobic and anaerobic energy pathways so will fatigue much faster, especially if you’re using them to make a big movement as well. 

This means that you might get away with weak rotator cuffs or core muscles for a time but it will reduce your efficiency and power of movement before breaking down with a risk of injury.

So how do we prevent this ? There are lots of articles on core workouts so I won’t reinvent the wheel by doing one here (but this recent one is good). For exercises for the rotator cuff and more on rotator cuff injuries I will soon do 

But one important point: remember these stabilising muscles are aerobic. Therefore the intensity required to train them is low. If you’re getting out of breath, you’re engaging anaerobic pathways and therefore using your big muscles. Slow it down to an intensity where you are doing nose breathing. It will feel that you’re not trying hard enough. It’s not about getting a 6pack: it’s about getting a stable core.

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Posted in training

Review: Training for the New Alpinism by Steve House and Scott Johnston

After reading this book, I think it could be a useful resource not only for those looking to head to the big mountains but also to many other climbers as well. It can be a little heavy going but it’s explanation of the physiology of endurance, strength and training is one of the most thorough I have come across. For instance, it makes a solid case of how the aerobic system determines your ability to recover from anaerobic activity via the “lactate shuttle”. It has a systematic approach to training which includes a comprehensive conditioning phase that is often skipped over in other books. Not only does it tell you what to do and how to do it, but it also explains why you need to. 

It is squarely aimed at those heading for the hills and for any would be Alpinist (or even winter climber) I would say this is required reading. The conditioning program and advice is valuable for anybody looking to undertake a training regime as it will prepare your body for the job in hand and help you maximise your gains.


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Posted in training

Climbing Injuries and Diagnostic Imaging

Although many injuries can be diagnosed by careful questioning and examination, not all can. This is partly why Rockdoctor exists: to help you access these tests on the NHS by providing advice to both you and your GP.
However, the NHS does suffer from limited resources. This means that some tests might not be available or might require a wait of some weeks.
This can be an issue, especially if you want a quick answer (eg is the injury bad enough that I have to pull out of a competition?).
I am happy to announce that I can now refer you directly to Dr Daniel Fascia at the BMI Hospital in Harrogate for private scanning. Dr Fascia is a clinical radiolologist specialising in the diagnosis and treatment of musculoskeletal injuries. This service will obviously cost money but to give an idea of costs, a basic ultrasound scan is about £150. If you have private insurance, this will cover these costs.
If you’re interested in accessing these services, please get in touch.

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Posted in Diagnostic services