Many of you know my story I refer to as “The Hip.” A ski accident threw my pelvis out of place. Over the course three years I visited nearly a dozen health specialists: four different physical therapists, two physicians, a chiropractor, a naturopath, and an acupuncturist. Eventually I ended up in a surgeon’s office. A cortisone shot later and I was scheduling a major surgery.
Between then and the appointment to go under the knife, insurance required I continue to see a physical therapist. At this point I had given up on less-invasive healing measures. I had recently befriended a PT named Matt and his wife, Liz, at a local climbing crag. I had heard beaming reviews of Matt’s therapeutic talents and decided to schedule the interim appointments with him.
Unlike many of the PTs I had seen, Matt was hands-on with his review of my situation. He assigned exercises to do in-between our sessions, but during our appointments, he conducted gentle manipulations, skeletal tests, and critical reviews of my gait and stance. Through a combination of his thorough observations, my described symptoms, and analyses of my MRI and X-ray scans, he did what seemed like the impossible: he stabilized my hip.
After a couple months of working with Matt, my pelvis quit dislocating. I canceled my surgery. A year later and The Hip, though imperfect, doesn’t hold me back from doing the activities I enjoy.
I recommend Matt to all my friends in need of physical therapy. He’s the go-to guru in town for outdoor athletes: as an avid climber and skier, he understands the impact our sports have on our body as well as our desire to push ourselves physically. He’s brought his passion for climbing to his workplace, where he’s helped implement a “climbing lab.” You’ll read more about the lab below.
Matt and Liz are sincere and talented healers. (Liz is knowledgeable in ayurvedic medicine and once guided me through a cleanse.) I’m thrilled to share this interview with Matt, where he offers a few must-do exercises for climbers and tips for ensuring the longevity and quality of your outdoor lifestyle. Thanks, Matt, for taking part in the series and for your generous wisdom below.
Meet Matt Heyliger
Physical therapist and Outdoor Athlete
Kelsey: What is your occupation and why do you do it?
Matt: I am an orthopedic physical therapist and work at Excel Physical Therapy in Bozeman, MT. I chose this profession based on the observation that most everyone can live a more fulfilling and happier life if their body allows them to do the things they enjoy. Times when our bodies don’t let us participate in the activities we enjoy really take a toll on our wellbeing. So this was the primary drive, coupled with realizing somewhere along the way that I’m a total dork about human movement and biomechanics.
K: What sports do you enjoy?
M: I have dedicated a lot of years now to climbing and training for climbing as much as I can manage with an ever-busier schedule. I mainly sport climb these days but I do enjoy all disciplines of rock climbing. I am also a passionate telemark skier; (I can already hear the banter from the free-heel skeptics). I still lose sleep from the anticipation and stoke of a deep powder day.
One of my favorite ways to spend a day is touring in the backcountry with my wife, Liz. I also really enjoy mountain biking. I just love the efficiency of pedaling in the mountains, the ability to quickly cover a lot of ground and get haggard, and the down providing a quick dose of adrenaline to keep me young. I also can’t imagine my life without yoga. My practice is daily, simple and relatively brief but is really critical to my wellbeing.
K: How have your sports shaped your relationship to your career?
M: Being an athlete has greatly influenced my practice as a physical therapist. Physical therapists specialize in the analysis of human movement. Therefore, our understanding of our own bodies, which is learned to varying extents through our sports, training and personal injury management, can really impact our practice. While I have been fortunate to have to deal with relatively minor injuries, I have been managing my own injuries throughout my adult life.
Injury management requires one to be ever aware of his body’s reaction to activity and my experience with this over the years has really shaped my treatment approach with my patients. This most specifically has shaped my practice with treating climbers.
Injury prevention for climbers is rooted in body awareness and biomechanics.
K: What are the most common injuries you see with climbers?
M: I most frequently see overuse injuries of the upper extremity but I also treat post traumatic injuries from falls and as well as provide post-operative rehabilitation.
Subacromial impingement, rotator cuff and biceps tendinopathy and labral tears are the most common shoulder injuries I treat. I see a lot of elbow tendonitis, both medial and lateral. I also see a lot of wrist and finger injuries.
With any upper extremity overuse condition there is frequently a root cause stemming from mechanical dysfunction in the shoulder.
I have the unique opportunity at Excel to have created what we call the Climbing Lab. With a systems style wall and a Moon LED system, I provide slow motion mirrored video analysis to provide specialized rehabilitation and training opportunities for climbers. This has greatly enhanced my ability to optimize injury rehabilitation and identify mechanical dysfunction in climbers.
K Are there any muscle imbalances unique to the female body?
M: Females on the whole truly climb beautifully. I honestly believe I have learned more from watching and emulating female climbers than male climbers over the years; (sorry dudes, you’re beautiful, too).
Joint hypermobility is a factor that generally affects females more than males and can increase joint and soft tissue stress in climbers. This tends to manifest from repeated stress to the fingers, wrist, elbow and shoulder from overuse in hyperextended positions.
I was asked to comment on the female A-frame body type. With this body type more stress is placed on the upper extremities and the ability to activate antagonist muscles and core is increasingly important. In climbing we transfer our weight from our arms to our feet through our trunk and core musculature.
When more of a climber’s weight is disproportionately distributed in the lower half of the body, greater core strength is required to transfer weight to her feet. Static core exercise like planks and side planks with optimal posture, (i.e. flat back, tail bone tucked, navel drawn toward spine), are key foundational exercises. This should then be progressed to on-the-wall-training with an emphasis on using ones core to transfer more weight to their feet in progressively steeper terrain.
I also thinks it’s important to touch on climbing post-partum. First of all, this is totally bad ass. To go through the process of growing a human, giving birth and then getting back to climbing is an amazing feat. Barring any continence or women’s health issues, the obvious critical factor is getting one’s core back in good working order.
If you’ve never had formal training in intrinsic core exercise, I really recommend consulting with a PT to get a simple program as soon as you are up for this. Core is obviously critical to the protection of the low back. After all the various ligamentous stretching from pregnancy and birth, core becomes all the more important. Once your primary health care provider is comfortable with you getting back on the wall this is great rehabilitation. From what I’ve heard your body generally lets you know what is safe.
K: What physical therapy exercises would you recommend all climbers do for preventative measures?
M: Approximately 90% of climbers I evaluate are deficient in strength in the scapular stabilizers and the external rotators of the rotator cuff.
All climbers should supplement their general training with scapular stabilization emphasizing lower and middle trapezius strength. I’s and T’s on a physio-ball are great foundational exercises. Shoulder external rotation with theraband and small towel between the elbow and the body is the easiest option for cuff strengthening.
Each of these exercises should emphasize low resistance and very high repetitions per set: three sets of 30 reps is optimal. Climbers should also work their wrist extensors with standard weighted wrist extension; (this is critical with wrist hypermobility). Climbers should also practice some form of stretching and/or yoga for general flexibility. Key areas to focus on are hip openers and pec openers.
K: Any exercises women athletes in particular should be doing?
M: Training to your weaknesses is something we hear from the training gurus but rarely practice because it’s less fun. I think this is much more important to evaluate in your climbing than any women’s specific exercise.
The trend I am seeing through assessing climber’s movement and comparing this to general strength and mobility is that not only do we tend to train on routes/problems that emphasize our strength, but we even train to bias our dominant side; (this is not necessarily based on your dominant arm and may more relate to previous injury amongst other factors). This leads to a lopsided under-training of our core, trunk and upper extremity strength that only becomes more profound as we continue to choose the path of least resistance.
This can be challenging to self assess but performing mirrored movements on a systems wall is a great way to self-assess your asymmetries and attempt to iron out these inconsistencies.
The greater the asymmetry, the greater the risk of injury in climbers.
K: What does beautiful mean to you?
M; What an amazing question! Words that come to mind are grace, poise, confidence and humility. In my professional life, beauty is a patient re-gaining the ability to move like she used to or realize a new potential in her body.
Beauty is the joy of using one’s body to do the things she loves.
Beauty in climbing is learning a new movement, and then doing it again sometime without thinking about it—your body just knows what to do.
Physically as an athlete, beauty is the deep satisfaction of performing a difficult task with grace and poise—that deep sense of being in, and in control of, one’s own body. We are all beautiful in our own individual ways and, ultimately, beauty is surrender to your own strengths, weaknesses and everything that makes up you.
K: How have your sports and career shaped your body image and your relationship to your body in general?
M: At the root of it all I just plain love using my body as a vehicle to experience the world.
In all of my sports I have been impressed at my ability to continue to improve and, at this point, as I stare down the barrel of turning 40 at the end of the year, I know this is through improved efficiency of movement and body awareness.
What really makes me feel good in my body is doing something gracefully that was previously difficult. My experience as a PT has given me certain tools to keep me ahead of injuries and to attempt to optimize my body mechanics with training and climbing. And the total climbing dork in me thinks it’s so cool that we can continue to learn new movements and, through climbing, experience an ever-increasing sense of being in my body.
K: What advice would you give women and/or fellow athletes in general to better enjoy their unique bodies?
M: Since all of our bodies are unique, it is important to realize what your body is up for at a given time. As adaptive athletes impressively demonstrate, we can train our bodies to do most anything if we train appropriately. Pay attention to what causes apprehension with activities and where you feel weak.
If you feel vulnerable due to a lack of time emphasizing core training, then train your core. It’s amazing how important this foundation is for all things athletic. And if you truly are apprehensive about initiating or progressing with your sport, seek professional advice as this may save time and frustration with injury management down the line.
For athletes who have more free time, overtraining is likely going to hold you back more than undertraining.
Remember, recovery is critical to growth and performance. For those who are trying to get after it with less time, like the working parent who still wants to crush it, optimizing training based on your goals is critical. Sometimes we get confused and frustrated with not achieving our anticipated results from training. These folks will likely benefit from professional coaching to help create a path toward those goals. After all, improper training is also a great way to get injured.
I recommend finding self-care techniques to reduce your risk of injury and general myofascial pain. Pay attention to your body’s ability to recover from training and exercise and tailor your training to optimize recovery.
Challenge your balance. It sounds a bit hokey but nothing will push your limits more than learning to slack line or doing some other odd balance exercises or yoga poses to get you more in your body. I am amazed at the transference of these skills to more than just climbing but also skiing, biking, surfing and most all things athletic.
Most importantly, do your best to make whatever you’re doing playful and fun.
Thank you, Matt, for the thoroughness and care you brought to this interview. If you live in Bozeman, you can schedule an appointment with Matt at Excel Physical Therapy.