5 myths about scoliosis

SCOLIOSISMYTH #1: The watch and wait approach is a good approach. False!  Perhaps, this observational approach made sense back in the day when there was limited scoliosis treatmentoptions available namely, scoliosis bracing then scoliosis surgery.  But, today, experts have a better understanding of idiopathic scoliosis. Better understanding leads to better treatments. To wait around and do nothing while the curve is progressing is probably the worst advice anyone could heed.  You want to own your scoliosis and be active as soon as possible so it does not get out of hand because more likely than not the curve will progress.

MYTH #2: Scoliosis hard bracing will reverse my child's curve. False! Under the conventional scoliosis method, bracing is prescribed once the observational phase has lapsed and the curve has progressed to 25 degrees. The bracing goal is to stop progression or slow it down. It does nothing to reduce/correct the curve. It also does nothing in the way of re-training your brain for proper alignment/posture.  Any curve improvement you may see is short-lived. When the child is done growing, the brace comes off. But, what is there to keep the spine in place?  Muscles? The brain? No. The muscles have atrophied after years of being in a hard brace. And, the brain is communicating in the same manner it has done so in the past. It was never re-programmed to send correct posture holding signals to the spine/muscles. Conclusion: Bracing will not reduce your curve.  Bracing will not halt or slow down its progression. 

SCOLIOSIS MYTH #3: Surgery is inevitable; so why bother doing anything?  False!  Catch your window of opportunity (curves below 25 degrees) and proactively work toward reducing your curve and retraining your brain through the use of specific neuro-muscular re-education exercises and see the difference that makes. Equip yourself with a specific and intensive scoliosis exercise program like Early Stage Scoliosis Intervention, for curves below 25 degrees or Scoliosis BootCamp for curves greater than 25 degrees. These programs acknowledge the role the brain plays in your scoliosis and focus on re-training the brain to communicate effectively with the muscles around the spine. 

SCOLIOSIS MYTH #4: Post growth stage scoliosis does not progress.  False!  Just talk to an adult with scoliosis and get their story.  Usually a curve can progress anywhere from 1 to 3 degrees a year depending on the degree or the spinal curvature, age of the person, and activity level.

SCOLIOSIS Myth #5: Swimming is a good exercise for children with scoliosis. False! The spine is 3 dimensional.  If one of the dimensions shifts out of alignment the other 2 will have to shift to compensate for it. The issue with swimming is that is causes the thoracic spine to become hypokyphotic (the spine looses it sagital or side curve).  If the side curves are lost this will cause the scoliosis to become worse.  Now swimming in the pool with friends on weekends will not cause this but competitive or swimming for exercise will cause this to happen. So be aware. 

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Ganglion cyst

                                                                       Ganglion cyst

A Ganglion cyst is a mass or lump that usually arises from any joint and it can be felt easily under the skin. ganglion cysts can occurs in many places but back of the wrist is the most common place for this. Don't freak out if you have got one because it is not cancerous lump or even harmful in most of the cases. It can arise from those structures arising from the joints like ligaments, tendons or lining of the joint. This cyst is filled with the synovial fluid which is also present in the joints.

physio-therapy

Physiotherapy for Amputees

Physiotherapy for Amputees................................

LEVELS OF AMPUTATION

The decision to amputate a limb involves four principal considerations:
• preservation of life
• improvement of general health
• restoration of function
• reduction of pain.
The underlying causative factors that result in amputation are (Engstrom and Van de Ven 1999):
• peripheral vascular disease (arteriosclerosis, gangrene)
• diabetes mellitus
• renal disease
• trauma
• tumour
• congenital limb deficiency
• infection.
The level of amputation is decided by tissue viability. A limb needs to be amputated to a level which ensures that all necrotic tissue has been excised and that the residual portion of limb will heal and be viable. The decision must also take account of the length of
the residual limb and its suitability for prosthetic fitting, function and cosmesis. Table 22.1 lists the levels of amputation seen in clinical practice. The proprioceptive feedback from the joint receptors in joints is extremely important to gait re-education, so joints will be preserved if possible.

GENERAL APPROACH TO MANAGEMENT

The overall management of an amputee patient is aimed at improving general health, reducing pain and restoring function. A team approach with clinical reasoning, clinical effectiveness, evidenced-based healthcare and problem-solving at its centre is advocated.
Management spans all spheres of health and social care, from initial contact in a primary care setting through to tertiary care in a specialist centre. The partnership between health and social care is paramount to a successful outcome. Because amputation is the last resort when all other possible treatments have been exhausted, patients have often had other interventions such as angioplasty,
endarterectomy and pharmacological therapy (Pell et al. 1997; Robicsek 1997; Redhead 1984). Not all amputees are suitable for a prosthetic limb. Assessment of suitability is made by the multidisciplinary team and is based (for a lower-limb amputee) on the following criteria:
1 Does the patient want to walk?
2 Does the patient have the potential to walk?
3 Who will help the patient in the home setting?

PHYSIOTHERAPY MANAGEMENT
Basic Issues
Physiotherapy management includes assessment and management of all aspects of the patient's well-being. The physiotherapist needs to take into account the physical, psychological and social aspects of the patient's life. Rehabilitation is an inclusive process giving
due regard to the whole patient and not just his or her physical status (Buttenshaw and Dolman 1992). The overall aim of physiotherapy is to promote optimal independence in the use of a specific limb. The goals can be summarised as:
• recovery of good general health
• maximisation of functional outcome
• prevention of complications
• reduction of pain.
Accurate and ongoing assessment of the patient throughout the four stages of amputee management is an essential component of physiotherapy.

Principal amputation levels

Upper limb………………

Forequarter
Shoulder disarticulation
Transhumeral
Elbow disarticulation
Wrist disarticulation
Transmetacarpal

Lower limb……………………

Hindquarter
Hip disarticulation
Transfemoral*
Supracondylar
Transtibial
Gritti-Stokes
Knee disarticulation
Transtibial*
Symes
Choppat/Lisfranc
Transmetatarsal
* The most common levels seen in clinical practice (Fyfe 1990).
Initial assessment at the preoperative stage should be followed by regular reassessment and evaluation of the outcomes of the treatment process. A problemsolving approach to assessment is required. This type of approach allows the physiotherapist to 'tailor' a treatment programme that best suits an individual patient at any given time. The physiotherapist's knowledge of normal human movement is essential to provide effective limb re-education. The physiotherapist is involved in the management of a patient from the preoperative stage to the rehabilitation stage. Contact with the physiotherapist is often frequent and takes place over many months. The physiotherapist is instrumental to the decision regarding prosthetic prescription and works closely with the prosthetist to facilitate the best mobility outcome. It is often the physiotherapist who discovers problems with the prosthesis during the rehabilitation stage.
Physiotherapy intervention can be divided into four distinct stages: preoperative, postoperative, preprosthetic and prosthetic (the preprosthetic and prosthetic stages collectively make up the rehabilitation stage). Table 22.2 summarises these four stages of physiotherapy intervention, with lower-limb amputation used for illustrative purposes. Assessment is an integral part of
all stages.

The Preoperative Stage

The physiotherapist's full preoperative assessment should include the respiratory status of the patient, because the effects of anaesthesia can mean that this status is compromised following surgery. This preoperative stage is very important to the overall outcome as it is a time when the physiotherapist can explain to the patient what will occur postoperatively and prepare the person for the rehabilitation pro-

Table 22.2 Lower-limb amputation used to illustrate the four stages of physiotherapy management.

Stage of management Components

Preoperative………………Respiratory and musculoskeletal status Physical, psychological and social status Past medical, drug and social history Premorbid mobility Explanation of postoperative regimen

Postoperative……………………Respiratory status, Bed mobility exercises, Mobility and strength exercises for the residual limbs and trunk, Assessment for walking aid, transfers ,Wheelchair assessment, Balance and posture re-education ,Stump care and pain reliefAs above, plus:Use of pneumatic postamputation mobility

Preprosthetic rehabilitation stage (patient assessed for suitability for prosthesis)……………….. As above, plus:
Use of pneumatic postamputation mobility (PPAM) aid 7-10 days postoperatively Gait, posture and balance re-education
Activities of daily living (ADLs).

Prosthetic rehabilitation stage................................ As above, plus: Prosthetic management Continuing gait re-education Promotion of functional independence Stump care.

gramme. The physiotherapist is involved in the preparation of the patient for surgery (Cutson and Bougiorni 1996).
Ideally the preoperative stage involves assessing the patient several days prior to surgery. However, the decision to amputate may occur as an emergency, in which case the physiotherapist possibly has only a few hours to complete the assessment.

The Postoperative Stage

During the postoperative stage the physiotherapist is involved in the assessment of suitability for walking aids and wheelchair prescription. Early on, prior to the use of a temporary prosthesis, the walking aid of choice is a walking frame - except for the younger patient when crutches may be possible. Whilst there is no fixed protocol following surgery, Table 22.3 provides a guide to the type of programme used in clinical practice. The physiotherapist must work in line with the protocol stipulated by the operating surgeon, which may vary. An important role of physiotherapy during the postoperative stage is the prevention of contractures.
This is vital to ensure the success of the prosthetic stage. Contractures will severely hamper the rehabilitation process and could result in the inability to use a prosthesis. The physiotherapist educates the patient in the prevention of contractures through a range of exercises and posture management. The typical contractures associated with lower-limb amputation are transtibial and transfemoral:
• Transtibial contracture can be described as knee flexion. It is positional as patients may spend a lot of time sitting. The use of a stump board and regular supine lying will help to prevent this.

• Transfemoral contracture can be described as hip flexion. There may be abduction due to unopposed hip flexors and abductors. Adduction may be a problem with a long residual stump owing to unopposed adductor longus.

Table 22.3 Example of post-operative physiotherapy management

Day 7 - in bed
• Respiratory maintenance
• Exercises to include strengthening, mobility, balance
• Pain control

Day 2 - In chair
• Strengthening exercises (e.g. static quadriceps, upper limb exercise, knee flexion, bridging)
• Balance work
• Transfer practice
• Contracture prevention
• Assessment for wheelchair

Day 2-3 - Standing with walking frame
• Balance work
• Posture management

Day 3-4 - Walking with walking frame
Transfer practice
• Stump maintenance
• Balance work

Day 7-70
• Begin early walking (PPAM) aid
• Re-education in the gym: posture, balance work
• Continue contracture prevention and stump care

Day 10
• Discharge, or transfer to rehabilitation unit
• Refer to DSC for prosthetic assessment

The Preprosthetic Stage

Early mobility is an important element in the rehabilitation of the patient. Not only does it provide early ambulatory practice for the patient, it also provides a psychological boost. It helps to prevent the onset of contractures and to re-educate posture and balance,
two essential components of gait. The pneumatic postamputation mobility (PPAM) aid This mobility aid is advocated in the literature
(Engstrom and Van de Ven 1999). It is introduced approximately 7-10 days after the operation, provided the residual limb is healing and there are no complications. It provides the patient with the opportunity to bear weight through the residual limb. Care must be
taken when using the PPAM aid to ensure no damage to the stump. The PPAM aid uses inflatable bags inside a metal frame. The inflatable bags are placed over the stump and support the residual limb inside the frame. Owing to the vulnerability of the stump the bags should not be inflated beyond 40 mmHg. It is essential that a pump be used that is capable of measuring exactly the
amount of pressure in the bags. Over-inflation may compromise tissue viability. The decision whether or not to proceed to a prosthesis
is usually taken at this stage. Not all patients are suitable for prosthetic use. There is also little point providing
a prosthesis if it will gather dust in a cupboard! Some people are unable to cope with a prosthesis, for a variety of reasons. However, all patients should be assessed for prosthetic use on an equal basis. For those patients not going on to the prosthetic stage, an important
part of the physiotherapist's role is to promote wheelchair independence.

The Prosthetic Stage

The majority of amputees go on to successful prosthetic independence and often enjoy a greater degree of quality of life than they had prior to the amputation. The improvement in function after possibly years of pain, discomfort and poor function can mean that the
amputation has an eventual positive outcome. This does take time. Often it is the psychological impact of the change in body image that has a more significant effect on the patient (Henker 1979). For the lower-limb amputee this stage involves intensive re-education of gait, along with detailed education of stump maintenance. The ultimate outcome of physiotherapy at this stage is to ensure the functional independence of the patient with a definitive limb. Ideally the outcomes of this final stage should be:
• understanding of the components of the prosthesis
• independent fitting and removal of the prosthesis, and checking its fit
• care of the prosthesis
• independent mobility with or without a walking aid, inside and outside, and the ability to cope with obstacles
• functional tasks with the prosthesis
• ability to perform occupational and/or leisure activities
• ability to cope with falls.

Common gait abnormalities

The following lists are extracted from Engstrom and Van deVen (1999).

Transtibial
• Excessive knee flexion.
• Insufficient knee flexion.
• Delayed knee flexion during the swing phase.
• Early knee flexion ('drop off).
• Lateral shift of the trunk.
• Lateral shift of the prosthesis.
• Rotation of the foot.

Transfemoral
• An abducted pattern.
• Rotation of the foot.
• Circumduction.
• Uneven step length.
• Uneven timing.
• 'Drop off.
• 'Foot slap'.
• Uneven heel rise.
• Rising up on the toes of the opposite limb ('vaulting').
• Medial or lateral heel travel in swing phase ('medial whip'/'lateral whip').
• Terminal swing impact.
• Uneven arm swing.
• Lateral side bend of the trunk.
• Forward trunk flexion.
• Lumbar lordosis.

PAIN IN AMPUTATION
There are essentially two types of pain, residual limb pain and phantom pain.

Residual limb pain

Residual limb pain can be attributed to a variety of causes, including the formation of a neuroma - a nodule formed at the end of a cut peripheral nerve, whichfolds back on itself and creates an enlargement. Pain caused by an ill-fitting prosthesis is referred to as 'prosthetic pain' and has a number of causes. In addition, postoperative pain is likely.
Phantom limb pain

Phantom limb pain can be described as distressing pain sensation felt by patients in the limb that is no longer there. It is well documented and is a feature that can impact significantly on the life of a patient (Weiss and Lindell 1996; Williams and Deaton 1997; Hill et al. 1995). It is a pain that seems to be an increasing factor with increasing age (Houghton et al. 1994). The psychological status of the patient also has an impact on phantom limb pain. Phantom limb pain is described variously as cramping, squeezing, burning, sharp and shooting. Table 22.4 lists typical descriptions patients use to describe it.

Plantar Fasciitis

Plantar fasciitis is heel pain that is caused from an inflammatory process of the connective tissue, the plantar fascia. 
It is commonly caused by long periods of weight bearing and flat feet, as well as poor footwear, poor biomechanics, high arches, and/or running/walking long distance on hard surfaces.
The treatment is normally rest, ice, reduce inflammation and swelling, calf stretches, and finally, correcting what caused the problem in the first place, be that poor footwear, muscular imbalances etc. 

Achilles Tendinopathy

This has already been covered by a separate post here.

Ankle fractures

So, an ankle fracture, as you'd have guessed, is when a bone involved in the foot or ankle gets broken. There is no real preventative measure for this, and will normally occur from a fall. Therefore, the approach for a fracture is surgical intervention, or conservative treatment (which normally involves just casting the foot and ankle in plaster and waiting it to heal).
The time frame and approach is entirely dependant on where the fracture etc is, and what other structures are involved.
Post op/plaster, you should be referred to physiotherapy for rehab anyway.
So I'm just going to leave you with a tasty X-ray of an ankle fracture and repair!

Other problems

There are also other non-musculoskeletal problems hat can occur with the foot, such as corns, cuts, toe infections etc which just needs you to look after your feet!

Prevention

Just a few tips to try and prevent foot and ankle problems:

As previously mentioned, use of the wobble board or cushion can help prevent some ankle injuries.

Ensuring you have appropriate sized climbing shoes, or if not possible, remove them at all opportunities, or alternate your shoes for different routes

Parallel training to strengthen the muscles around the foot and ankle

Appropriate sized normal footwear

Foot hygiene

If you are a diabetic, please please please avoid tight shoes!! This is because of change in the sensation in the feet (neuropathy) that can be caused by diabetes, and can cause much more serious foot problems!

To avoid some ankle injuries, have some (decent!) spotters when bouldering, and try to have dynamic belay techniques when roped climbing, to avoid clattering into the rock and giving you time to slow down the motion with your upper legs rather than at the ankle!

However, the main take home message is that with footwear, pain is insane! here possible, make your climbing shoes fit properly, feel comfortable, and look after your feet!

Kids feet and climbing shoes

This will be covered in the next post, just to break up the amount of information I'm giving you! 

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Finger and Hand Anatomy, and Grip

Now, I thought I'd provide some information on the most commonly injured part of a climber - fingers! (As Logan et al 2004 report that of 545 climbers, 28% has sustained an injury to the wrist or hand - the highest percentage of injuries)

What I will discuss is the finger anatomy, grips commonly used in climbing and then I will follow it with a second post regarding injuries and their management.

So, to begin:

Anatomy

Now, not only am I going to discuss the anatomy of the fingers, but also the wrist and forearm, as some of the muscles involved in the movement of the fingers originate in the forearm.


The bones in the hand are shown here:

All relatively straight forward and not much to worry about there (apart from epiphyseal plates - but I will come onto that when I discuss injuries of fingers). The ligaments, on the other hand, are a bit more complex.

 
The finger flexor tendons are held in place by pulleys (A1-4 shown in the diagram). These pulleys ensure the action of the flexor muscle contracting bends the finger all the way to the tip across each different joint. This means that a lot of force and friction can be exerted on these tendons when a large load is put through the finger tips.

One thing worth noting is that the A2 pulley contains the tendons of both the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS), whereas the A4 pulley only contains the tendon of the FDP as the FDS splits and inserts to the lateral sides of the A4 pulley (see image below).

This means more force is exerted on the A2 pulley than the A4 (hence why climbers most commonly injure the A2 pulley)

 

The carpal tunnel is worth mentioning briefly. This is the area in which the tendons to the fingers, blood vessels and nerves pass through from the wrist to the palm of the hand, between the carpal bones and flexor retinaculum (a ligament). It is quite a compact area and so any increase in pressure in the area, such as dramatic increase in blood supply, or inflammation of tendons etc can cause tingling etc of the hand, fromcompression of the other structures in the carpal tunnel such as the nerves or vessels.
  

 Now, the muscles. The muscles that flex or extend the hand/fingers originate at the medial epicondyle (for flexing) and lateral epicondyle (for extension). The epicondyles are the corners of your elbow, if you like (see pictures).

 

 

There are a few other muscles within the hand to be aware of. Have a look at the palm of your hand. Notice the fleshy parts of your hand around the base of the thumb and little finger? Good (I hope you can see them!), these are the areas where the muscles that move your thumb and little finger are hidden away, and, as you can see, they have more movement than the other digits in the hand beause of these muscles. 

Finally, the last group of muscles in the hand are the lumbricals and interossei. 

• Lumbricals - (shown in the picture above) are responsible for flexion only at the metacarpophalangeal joint
• Interossei - are responsible for abduction and adduction of your fingers (see below)

  

Now, all this hand anatomy will be useful when we discuss injuries to the fingers and hand (in a later post).
Next, I will briefly discuss the significance of grip.  
  
Grips

When gripping any object, the optimum gripping position is when your wrist is atapproximately 10 degrees of extension. 

This applies even with the common climbing grips displayed below.

When a climber becomes tired, they tend to lose this 10 degrees of extension and rely on the passive structures of the upper limb. 
This creates strain on these passive structures and puts them at a higher risk ofinjury. 
This can often be seen when climbers start sticking their elbows out like chicken wings, as they are tiring and resorting to use of passive structures.


To prevent this passive gripping and chicken winging: pure and simple, train the active structures, and when tired, try and keep some control over your positioning, as otherwise you'll never change this

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Kinesio Taping: A Sceptic's View

So I'm beginning this post as a sceptic towards the use of kinesio tape. I aim to look at the research behind kinesio taping, review some of the papers, and we'll see if my stance changes.
Even as I begin to type this, I'm getting reports of success stories from the use of kinesio taping, however, there seems to be a lack of understanding of how kinesio taping works anatomically, and of robust studies testing it's use.

Firstly, let me explain about kinesio taping. Kinesio tape has many brand names (such as Rock Tape, KT Tape etc) and is different from the traditional use of taping.
Traditional taping is using zinc oxide tape and is what is commonly used with climbers to tape fingers etc, and is generally used to prevent a certain movement, for stabilization and support.
Kinesio taping, according the the Kinesio Taping Website, "is applied over muscles to reduce pain and inflammation, relax overused or tired muscles, and support muscles in movement on a 24-hour-a-day basis. The taping is non-restrictive and allows for full range of motion"

The tape is basically an elasticated therapeautic tape.

More information on Kinesio taping and how it is supposed to "lift the skin microscopically" is widely available on the web, but I'm going to now look more at the evidence published.
I will stick to kinesio tape applied to the shoulders, as I feel this is an area appropriate to climbers, rather than the lower limbs. I have also tried to look at the most recent papers I have access to, and a variety of outcome measures tested.

First paper I will look at compares kinesio taping to a programme of physiotherapy modalities for the treatment of shoulder impingement. This study compared 30 patients in the kinesio taping (KT) group to 25 patients in the physiotherapy (PT) group (5 dropped out in the PT group and were not included in the final data analysis) between the ages of 18-70 years old. 
Both groups had a home exercise programme. The PT group had daily intervention of TENS, exercise, ultrasound and hot pack. The KT group had just the home exercise programme and the taping, for a 2 week period.
There were no significant differences between groups at baseline. 
DASH scores (Disability of Arm, Shoulder and Hand) and pain scores decreased significantly in both groups compared to baseline. 
The pain scores for the KT group were significantly lower than the PT group at 1 week, but no significant differences were found at 2 weeks.
Therefore, this study found that kinesio taping is comparable to physiotherapy treatment for the treatment of shoulder impingement, but has a more immediate affect on pain scores. 
From a cost implication point of view, the kinesio taping was only applied 3 times in the 2 week period, compared to daily treatment of the PT group, therefore the kinesio taping could be seen as a more cost effective method to reach the same end-point. 
  

The second study I have read consists of 42 18-24 year olds complaining of shoulder pain. This study compared kinesio taping to a sham application of kinesio tape over a 6 day period with 2 applications of the tape.
This study was more robust that the previous study, with the participants randomly assigned to the groups and the study procedure being double-blinded.
They found that there was only a slight increase in shoulder abduction range of movement on initial application of the tape, but no significant differences were found after 6 days for range of movement, pain intensity or disability score compared to sham tape.
There was also no control group for comparison, and it must be noted that it has been widely published that taping has a high placebo affect (in the case of taping for patellofemoral pain).

The third study looked at kinesio tape vs placebo taping again, in 17 baseball players with subacromial impingement. There were randomly assigned to the kinesio tape or placebo group first, and performed both interventions. 
Outcome measures consisted of muscle activation, strength and scapula range of movement. 
The study found that kinesio tape increased lower trapezius muscle activation and strength but it is unclear whether this was significant change, and whether this is a beneficial change to the participant.

Finally, I also read a meta-analysis on kinesio taping in treatment and prevention of sports injuries, and they found similar results to me (regarding slight increase in range of movement), just in a much more scientific manner!


So, in conclusion, I still think that the evidence is weak for kinesio taping, but it has been shown to have a short term effect on range of movement of the shoulder abduction.
This doesn't mean I don't think it works, but it is difficult to measure the effect placebo taping has. 
Please feel free to share any anecdotal stories of success with kinesio taping.  

For further reading on how Kinesio tape works, see the following links:
How Stuff Works.com
Kinesio website

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Preventing Rotator Cuff Injuries: Advice and Exercises

I've now updated this post, based on some training I attended last week:

Today's post is based on the rotator cuff, and ways to, hopefully, prevent injuries via regular exercises and advice.

First off, as always, I will discuss the anatomy involved.

The space between the acromion and humeral head is where the rotator cuff tendons get impinged, especially when performing overhead activities.


What does the rotator cuff do?

The rotator cuff muscles internally and externally rotates the humeral head. These muscles help support and secure the head of the humerus into the glenoid fossa.
This means that the rotator cuff muscles are key to stabilizing the shoulder joint.

Preventative Exercises

Often, rotator cuff strengthening exercises are given as shown below, with internal and external rotation being strengthened in standing or in lying.

 

 

These exercises do strengthen the rotator cuff, but not in a functional way applicable to climbing, as the predominant movements involved in climbing are above head actions, therefore the rotator cuff should be strengthened in a similar manner.

It is the same movements as described, but with the arms above the head as shown. 

 

These movements can be performed in either standing, as above, or in lying, as below. They can be done using resistance bands, or free weights. The movements should be performed in a slow, controlled manner, ensuring the 90 degree angle at the elbow is maintained throughout.

Other exercises that can be performed to work the rotator cuff in a similar, over-head manner are displayed below. Again, these exercises should be performed in a slow, controlled manner, paying particular attention to the positioning of your scapula.

Important note: When performing any of these exercises, it is imperative that the shoulder complex as a whole is in the correct posture....

...as most climbers adopt the thoracic kyphosis posture, due to overtraining of the forward flexors. 
This also applies to when performing the exercises, if the shoulder blades don't stay pulled back and become rounded and forward while performing these exercises, with the head of the humerus becoming more anteriorly located (moves forward), either drop the weight, or perform the exercises without the arms above the head, as described at the start of this post.

Advice

So other preventative measures for looking after your rotator cuff muscles and shoulder joint in general, are such methods:

• climbing technique - remember to use your feet, don't stretch too far for the next hold, rather work your way up to it, to reduce the load on the upper limbs
• flexibility - there may be a lack of spinal flexibility, especially around the thoracic area, as this can cause lack of movement around the scapula; tight posterior shoulder capsule or posterior rotator cuff muscles may also do the same (see below for stretch that can be performed on the posterior shoulder capsule)

 

  

• posture - this relates to flexibility, as well as the movement relationship between the scapula and humerus, known as the scapulohumeral rhythm, that is a key component in rotator cuff impingement. Also, musculature imbalance is related to posture, which is especially prominent in climbers! In some instances, it may be necessary to retrain the scapula and perform scapula setting exercises.

I hope these exercises and advice can prevent an injury. These exercises need to be performed often, and with low weight, high reps, as they are stabilizing muscles.

Any feedback or queries, give me a shout! 


Further Reading

Roseborrough A, Lebec M 2007 Differences in Static Scapular Position Between Rock Climbers and a Non-Rock Climber Population. North American Journal of Sports Physical Therapy 2(1): 44-50

References

JE Budoff 2005 The Etiology of Rotator Cuff Disease and Treatment of Partial-Thickness Pathology. Journal of the American Society for Surgery of the Hand 5(3): 139-152

McCall C Presentation on shoulder conditions in rock climbing. BMC Climbing Injuries Symposium 2012

first article http://thomasbondphysio.blogspot.gr/