A interview with my climbing coach/ physiotherapist – Stian Christophersen
Over the last three years it’s been essential for me to have a coach I can trust 100%. Beside coaching the Norwegian climbing team, Stian Christophersen is a highly educated physiotherapist and one of Norway’s best climbers himself. After I got injured in 2012 he helped me through rehab and allowed me to return to where I am now. On his website you can read a interview he did with me and some of his thoughts around the process. If you happen to understand Norwegian you can read the interview here. Here is a english translation.
photo via www.nathanweltonphoto.com
Every once in a while you meet someone with a very special history and a very special personality. Rannveig is one of those people, and to be a part of her progression and development over the past three years has been an inspiring and educational journey for me. Her story is known to many, but in a nutshell she has a near fatal groundfall in Turkey but returned to elite level climbing with a fierce drive and motivation. You can read more here: http://www.rannveigaamodt.com/accident/. Rehabilitation goes through several stages, and given my point of view that Rannveig is a person to look to regarding this process I’d like to address some of the elements I find crucial.
S: When we met you’d already come far in your rehab in an impressively short time. Can you say something about the different stages you went through before we met and how you related to these?
R: The first month I was forced to stay in bed, because of the fractures in my pelvis, back, right elbow and both ankles. From day one, the goal was to move everything I could move as much as possible. At that point it involved only my toes, left hand and gradually I could start stretching my ankle and elbow. Although the small improvements I made seemed like tiny drops in the ocean, I quickly realized that those baby steps prepared my body for each new step of the way. No one could predict how much motion I would be able to recover in my ankles and elbow. According to my doctors I could just forget about climbing in the years to come. I wasn’t sure if I would ever find joy in climbing again, but I knew that I had to get out of the wheelchair and that I had an ocean to cross before then. In order not to lose my mind completely, the small improvements became more important than anything else.
Examples of goals that I made for myself: lifting the injured arm, lifting a spoon, bending my arm enough to feed myself, reaching the tip of my nose, brushing my hair, etc.
I lifted weights with my working arm (mostly to remember who I was and to feel that I had started the “fight” to get back).
After four weeks I could involve my back and pelvis in my training, and a lot of the exercises included red cord slings and a hot pool.
After five weeks I crawled around with volleyball pads on my knees to get around (I did not realize until later how important this had been as preparation for my pelvis and back rehab in the next phase.)
After ten weeks, I could gradually involve my ankles in the training. I worked out for 6-8 hours a day. I started relearning to walk, I took spinning classes, did chair yoga and more demanding strength exercises. After three months, I tried climbing again for the first time at an indoor climbing wall. I found that climbing gave me the same pleasure as it used to, regardless of the grades I could climb. At the end of my stay at the rehab center, I focused more and more of my training towards the goal of getting back into climbing.
(You can read more about the various phases and timeframe here)
S: Why did you reach out for more guidance after your stay at Cato? (a specialized Norwegian rehabilitation center)
R: Although I had highly skilled therapists throughout the rehabilitation process, I felt frustrated because no one quite understood what physical and mental challenges climbing demands from a rock climber, nor did they know the amount of training I was used to before the accident. On my own initiative, I always trained more than what my therapists recommended, because I didn’t trust that what they told me was enough.
I had a strong need for guidance from someone who understood what I wanted to get back into. Although I had come a long way in the rehabilitation process and had a lot of knowledge about how to train, it was difficult to know how to approach climbing. I had way more questions than there were answers. The fear of making the situation worse by exercising too much, too little, or wrong, was one of the hardest parts of the whole process. I therefore decided to seek help from Stian, who is a highly educated physiotherapist, the coach of the Norwegian climbing team, and one of Norway’s best climbers himself. It took a huge burden off my shoulders to have guidance from someone that I trusted 100%.
I was used to exercising a lot before I got injured and I had always used the pain threshold as a guideline for adjusting the amount and intensity of my climbing to prevent injuries. When I started climbing again after the accident the pain was constant (and indefinite), and it made it very challenging to determine which pain I had to listen to and which pain I just had to break through in order to become better.
I discovered how much fear that lies in pain, and how fear can limit progression. I found that my experience of pain while climbing changed radically when I trusted that the exercises and climbing I was doing wasn’t going to aggravate the situation. The relationship between fear and pain is a topic that can be focused on a lot more than it is.
With all the uncertainties that I experienced, having a good supervisor was was crucial for a positive progress. Stian has helped me to see my strengths and weaknesses, and I’ve learned to plan my training according to my goals. One of the most important things I have learned from Stian is to regulate the intensity of my climbing when I’m injured. In my experience there are very few situations that require you to completely stop climbing, and even fewer situations where there is beneficial to stop training completely.
S: How did the focus of rehabilitation change when we started working together compared to the previous stages of your rehab?
R: We quickly agreed that in spite my number of “disabilities,” I was ready to shift my focus from rehabilitation to training for climbing. It was the first time since the accident that I was encouraged to “release the brake.” He awakened my faith to aim high. The goal was not only to be rehabilitated, but to become a better climber than I was before the accident. My motivation to train grew stronger than it ever had before.
S: In retrospect, what motivated you through your rehabilitation, and which goals did you set out to reach?
R: The first months I was so grateful that I had survived, and everything else came second. Emotionally I felt like I had been peeled like an onion into my very core. My deepest needs would come to the surface, and leave little room for anything else. It became very clear to me what was most important in life, and a big part of that was to become physically active again.
I had been so close to losing everything. The thought of losing my ability to walk and climb again was unbearable, so it became easier to focus on everything I could do to get better.
I knew that I wouldn’t be able to live with myself if I later realized I could have been better had I worked harder for it.
I love the feeling of working hard to get where I want. I very much enjoy being in a “process.” It is not necessarily the ultimate goal that gives me the most pleasure, but the way I get there. Of course, sending a long term project gives me the feeling of success and full ending, but I really enjoy working on that project more.
I clarified for myself that climbing is not me, but something I do to express and challenge myself. Even if I lost the ability to climb again, I knew I was the same person with the same qualities, and with the ability to work hard and find joy in anything I do. This clarification awakened an almost reckless force in me, to give everything to come back.
S: Which elements of success can you point to that made you advance so rapidly from then to now?
R: I’m motivated and know what I want. Therefore, I also manage to recall motivation, even when the situation makes it hard to be motivated.
I’m driven enough to do what’s in my power to change, positive enough to not dwell too much over everything that I can’t do anything about, and cynical enough to prioritize the things that are most important to me. It is a constant learning process.
I’ve had incredibly good people around me and a good support system available. It was just up to me to use it.
S: What’s the status now, and where will you go from here?
R: I’ve reached the goal of becoming a better climber than I was before the accident. I’m still in a lot of pain because of arthritis in my ankles. Although my progression is not as measurable as it was in the beginning, I find that the pain becomes less and less limiting. The pain made me reprioritize my activities. I try to avoid carrying heavy bags, I go on bike rides rather than running, and I have chosen to focus more on sport climbing instead of long alpine climbs.
I love what I do and I’m motivated to explore my own potential in climbing. As long as climbing gives more than it takes, I intend to take it as far as I can.
S: One final question: What’s your first short-term goal, and how will you proceed to realize it?
R: My first short-term goal is to get in shape for a trip to Kalymnos in the fall. I have a project there, which I’ve set as my goal for this coming season. The route is boulder, unrelenting and sequency from start to finish. It requires a skill set that is very different from what I’m good at, which makes it way more exiting for me to work on.
To reach the goal I’ve analyzed what skills I need to work on, to meet the requirements of the route. Together with Stian, we’ve made a training program that optimizes my training.
Here are some of my thoughts regarding Rannveig’s rehabilitation:
Without defining a goal it’s hard to find direction. All processes in treatment and rehabilitation need goals, and I find it crucial that these are defined by the ”patient” (I purposely put ”patient” in quotes since I find the term stigmatizing, and that it might give the impression that I disempower the people I work with). One challenge in goal-setting in a rehabilitation process is that this can stand out as a process in which there is, in Rannveig’s words, an infinite number of uncertain factors.
One too ambitious and wide goal could potentially seem unreachable and therefore demotivating when it’s hard to see any progress. The use of smaller sub-targets might be the key to experience progress in a complex situation characterized by two steps forward and one step back, and it’s my opinion that how we used this was one of the key factors in Rannveig’s success story.
The focus I have as a therapist in a process like this changes from treatment, in the true sense of the word, to being one that supports and challenges, one that asks questions and contributes with suggestions for answers. There are few blueprints and few quick-fixes, and I find it important to create an equal relationship where both ”patient” and therapist are working together towards the sub-targets and explore together the opportunities we have in the rehabilitation.
One of many amazing aspects in climbing is the variation that lies in the nature of our sport, and with this the window of opportunities we have to create motivating and meaningful activity. Several of our sub-targets were big, fat and hairy, given the situation we were in, but a lot of them were realized. Some are still standing there as unrealized, but we accomplished a lot on our way towards them.
”Aim for the moon. If you miss you may hit a star.”-W. Clement Stone
Another important element I want to highlight is how one relates to his/her experience of being in pain. In Rannveig’s situation, a state of freedom from pain was a utopian goal. We needed to re-concept her pain experience, and instead of focusing on achieving freedom from pain we worked with defining some sort of a new baseline of pain to navigate around. This way we could experiment with different activities and workouts to see how this affected her pain levels. If we’d been afraid to provoke pain in a controlled manner throughout the process, it’s my opinion that we never would have progressed.
Pain is our response to actual or potential damage to the body, and we can affect how we relate to this response. With that I mean that if every experience with increased level of pain had led to uncertainty and fear, the responses would probably be reinforced and led to a higher level of pain. In contrast, if we could interpret these responses as natural consequences from a progressive rehabilitation, we could use pain as a “harmless” guideline in our attempts to introduce new movements and loading patterns.
With pain being an experience and not a “thing,” we can, as with all experiences, reinforce or weaken the intensity of it by assigning it different values and emotions. These are pure cognitive functions, and are a result of perception of our own pain-experience and our thoughts and emotions connected to it.
I’m not implying that Rannveig’s pain was just in her head: in her case, there is a very clear relation between actual tissue damage and pain. But this isn’t always the case, and there are many examples of pain experiences arising without any tissue pathology. I find it very important to avoid a dualistic view, separating mind and body and seeing the body as no more than a car with fixable parts that will eliminate the pain. Instead we should see it as an interactive ecosystem with infinite opportunities to stimulate and create change.