In a series of blogs with Dave Bowes, a Team GB paraclimber sponsored by Birchall Blackburn Law, we follow his fight back to fitness after a shoulder injury and gain insight into how his Traumatic Brain Injury (TBI) impacts on his aim to be ready for the Paraclimbing World Championships this September.
Dave suffered multiple brain injuries as a result of a road traffic accident in 2007, which left him with a neurological disability. He refused to let the injuries stop him from climbing. He has since become British Paraclimbing Champion, ranked second in Europe and fourth in the World, and even earned a place on the able bodied GB Ice Climbing Team.
His achievements are incredible when you know that his brain injuries left him with permanent symptoms of concussion, no sense of balance, a sleep disorder, over sensitive hearing, migraines, depression and a complete change of personality.
Dave injured his shoulder as a result of Barn Dooring during the finals of a national ice climbing competition at the end of last year (2015). A sports injury is a huge blow to any sportsperson but the stakes are even higher for someone like Dave who relies on his climbing to help him control his neurological disabilities.
The physical side of Dave’s rehabilitation, and hitting his target of competing in the IFSC (International Federation of Sport Climbing) Paraclimbing World Championships in Paris on September 14, is a tough ask. But ahead of the operation to fix his suspected Posterior Bankart Lesion (PBL), a muscle tear at the back of his shoulder, Dave was under no illusion that the toughest challenge would be psychological.
Dave said: “For someone with TBI there is no halfway point, it’s either all or nothing, which is a typical trait of a brain injury survivor. All I want to do is dedicate myself to the rehabilitation to ensure that I allow myself the best chance of competing in Paris. Holding back will be my biggest challenge.”
It will be a difficult balancing act between making the September deadline with a speedy rehabilitation and giving his shoulder enough rest to heal. If Dave allows his brain injury symptoms to dominate and push him physically too far, too fast, he will injure his repaired shoulder again and destroy any chance of competing in the World Championships. If he over compensates for his symptoms then his rehabilitation will be too slow and he will either not make Paris or at best he will not be in physical condition to compete for a podium place.
Despite a few surprises, Dave’s surgery last month (March) at Clatterbridge Hospital, Wirral, was a success. The surgeon actually found that Dave’s injury was an Anterior Bankart Lesion (ABL) and the force on his shoulder in the competition had ripped out all the anchors originally put in his shoulder following his road traffic accident in 2007. With the operation complete and new pins in, Dave surprisingly woke up with no aches or pains.
Another consequence of Dave’s TBI on his rehabilitation can be his perception of bodily pain. Since his brain injury, to a significant degree, Dave has suffered from a removed connection to his body’s senses, including pain and emotion. This has led to his perceptions of pain to be quite misleading and often hazardous. Sometimes Dave may feel pain in the normal way or he may feel no pain at all. Deciding between pain, strain, fatigue and hunger (Dave has to constantly remind himself to eat) is incredibly difficult.
A huge part of quality rehabilitation is listening to what your body tells you. Perception of when the injured part of your body is in pain, straining or tired, tells you how far you can push it before rest. But if the messages Dave receives in his brain about his body are misleading, then how does he know when to stop? As he does with many of his brain injury symptoms, Dave has found a way around the issue by using alternative methods of monitoring his physical body. While he may not always feel pain or strain on his body, Dave can visually see the stress on muscles, tendons and ligaments because his limbs will shake, twitch or simply refuse to do what he wants them to do. These visual signs tell him that he is pushing too hard.
After the operation, Dave rested for three days (the surgeon recommended two weeks) and then started with some simple stretches. With continual testing of the limits of his repaired shoulder, Dave moved on to passive and active stretches and exercises. What should have been a 10-minute session of stretching took an hour with careful analysis of his shoulder after each movement. Dave has to concentrate fully on what his body tells him because of the difficulty in figuring out a simple message from his body to his brain.
With the advice of Sports Injury Therapist, Phil MacDonald, who runs a climbing clinic as part of Sports Therapy Liverpool out of an office at The Climbing Hangar, Dave’s progress was fantastic. By the sixth day of rehabilitation, Dave had increased his stretch repetitions and frequency to morning and evening. His shoulder strength and mobility was compared to someone who would normally be six weeks into their recovery. Paris was on!
Then Dave pushed his repaired shoulder too far.
On the seventh day he visited Phil at The Climbing Hangar for his first full assessment. It only took 10 minutes with stretches to test the shoulder’s range of movement. Once the assessment was finished, Phil extended Dave’s routine of stretches and exercises to strengthen the shoulder. After such a positive day, Dave was elated and decided to do the additional work on his shoulder that very same day.
It was a mistake.
He pushed his shoulder beyond his limits and for the first time since the operation he felt pain in the repaired limb. For the next three days Dave could do nothing but put his shoulder back in a sling and dwell on the fact that he may have wrecked his chances of getting to the Championships. The effects of his TBI had prevented him from seeing the consequences of his over eagerness. And over the next three days his neurological symptoms would amplify his feelings of anger, disappointment, nervousness and the paranoia that he was not going to Paris.
If you want to read more about Dave’s journey back to the World Championships, from a climber’s physical point of view, then we recommend checking out Allcord’s blog HERE…