Review of "Make or Break: Don't Let Climbing Injuries Dictate Your Success" by Dave MacLeod

Photo of the front cover of 'Make or Break'

Is climbing a sport?

It used to be not in the old days. It wasn't sophisticated like modern sports. Climbing is at its heart an adventure. Training? What's that? Men just go out climbing as often as they can! What else would you need?

Things have changed since. Or at least, if you want to be good at climbing, that is not the case any more. Why? Because,

Sport by its very nature encourages you to find your limits. (excerpt from the book)

and when many participants of the discipline (climbing) followed that, the bar has become higher and higher, like any other sports. Then what will follow is the obvious:

And it's at those limits where injuries will always happen. (excerpt from the book)

There is no surprise I don't know any Extreme climber with a decade or more experience that has never suffered with any climbing-related injury or pain, even just in my small circle.

How do you deal with those (climbing-related) injuries? As soon as you try to work it out, you would realise how little information is available. Bits and bobs of information are here and there, but there is hardly any reliable literature that describes the subject in the systematic way. Googling doesn't help much, either, as at best the answers you may find don't fit your situation well, or contradict each other, or worse, be simply wrong and may make your particular conditions worse.

You may just visit and consult medical professionals like your GP. Of course you should, and without delay, but unfortunately even that has serious potential problems, as described well in this book, Make or break. What are they? Here are some reasoning's (practically a sneak preview of the book!).

First, the primary goal of, and expectation to, general doctors, such as (random) GPs, are the immediate treatment of an existing injury. Naturally, prevention or mitigation of injuries, and/or rehabilitation, has a lower priority for them. Hence, their typical advice can be, rest for 6 weeks, or worse, try another sport (as Dave has once experienced), which is the last word climbers want to hear.

Second, specific demands in climbing mean some climbing-specific injuries are very special. For example, moves like Egyptians or full-crimps are highly stressful to the joints, ligaments and/or tendons, in a very specific way that happens only in climbing. Indeed, Hochholzer and Schoeffl, one of the world best medical experts of climbing-related injuries, has pointed out: there is no sport where the forearms, hands, and fingers play as important a role and take as much abuse as they do in rock climbing.

And let's face it. A number of people that participate climbing is limited, and so is the number of those patients medical professionals regularly see. Therefore, general sport physiotherapists, let alone random GPs, are unlikely to be particularly knowledgeable about climbers' injuries and physiology at best.

Third, a specialist is a specialist, and they may not, or will not or even can not, go beyond their specialised field. Even the best sport physiotherapist is not qualified to prescribe a drug, for example, even if it is the best treatment in a particular case. In the ideal world, you would want the medical team devoted for you to achieve the best possible result for you as a climber, from prescribing drugs, monitoring your recovery, planning rehabilitation, to arranging massages and more. In reality, for us ordinary climbers, as Dave very rightly points out, you alone must take overall control of managing your response.

Then the question is, how? What you would need is a good overall knowledge in the medical and physiological fields in the climbing-specific way, and of how to apply them to your daily climbing, including prevention of, and rehabilitation from, injuries. However, no literature devoted for the subject for amateur climbers has been available for such a niche market — until this book Make or break came out (with one exception).

If I describe this book in a single sentence, it is an excellent starting point to understand the injuries, as well as its treatment and prevention, of climbers, by climbers, and for climbers.

As for the structure of this book, the first half explains the basic to understand climbing-related injuries, desired attitude and practical means as a climber to tackle with the existing and potential injuries, real-world problems such as dealing with medical professionals and/or systems, psychological aspects, and some notes for young people like teenagers. If you were like me, waiting an injury to happen and then just blindly trusting the medical professionals, this part would be an eye opener. Also in that sense this part is recommended to read for not only climbers but for any sportpersons in any discipline, because the attitude and points to note against sport injuries must be pretty universal among any sports.

The second part of this book describes injuries commonly seen among climbers in section by section for each body part. Climbers who are already suffering from an injury must be very interested. But even if you have not got the injury yet, it is definitely worth a read, as you will be aware of the risk and learn how to prevent them in the future.

The author Dave MacLeod is undoubtedly the best all-round climber in the country and perhaps in the world, having established both the hardest trad and winter routes, as well as performing at the very top level in bouldering and sport climbing. The fact that such a specific knowledge about climbing-related injuries has not been readily available meant Dave himself has inevitably suffered from countless and variety of injuries from head to toe during his two decades of career to push the boundary of climbing. Yet he has somehow managed to deal with it and to keep being at the top level. It is not difficult to guess (and as vividly explained in the book) that would not have been possible without his tremendous efforts and devotion to gain the accurate knowledge of physiology and about injuries and to seek for appropriate treatments at times. It is apparent this Make or Break is a culmination of his career to live with, and manage, injuries caused in climbing.

You might still think, however, he may not be the best author to speak about the injuries in climbing, as he is not a medical professional. But then, who else? Do you think there are many medical professionals in the world, who are experts at climbing-specific injuries ranging for the wide spectrum, understand the specific need for climbers in treating and preventing those injuries, know how and which rehabilitation works as the first-hand knowledge, and are keen and smart enough to devote to research the subject and to compile all in single literature, aimed for climbers? None is the answer (with an exception — see the Appendix).

Dave is not only a top climber, but also has studied Medicine and Sport Science at high level, obtaining MSc. The reference section of Make or Break lists 160 literature, most of which are taken from academic papers or reviews, with the published dates right up to 2014. The contents of this book can not be more up-to-date (at the time of writing, May 2015). I should note that to keep up with a front line in a scientific field requires a tremendous effort and brain-works few could manage, as any one that has worked in any cutting-edge field in science must know by heart. Just imagining his hard effort makes my jaw drop.

Another little thing that impressed me was how he treated his experience of a modality treatment by himself. When he applied, he felt it had made a difference and so was successful. Yet, his later research found his (guessed) reasoning was not backed up with science. Then he openly states in the book his guess was wrong. That is what I call the scientific attitude. A personal experience, which is usually not done in the strictly controled environment but just happens, is nothing, compared to the solid results of the scientific experiments. Many know it by head, but few can dismiss a personal experience in reality, when it seems to contradict the established fact, as it is a human nature to value, and be biased towards, our own and real experiences. I admire at him and it makes his writing all the more credible.

After reading the book, I am convinced Dave is one of the best in the world to speak about this subject. And as a climber, who has some chronic injuries/pain just like many other climbers, I massively appreciate this book is available to us now.

Is this book enough and all you need to understand and deal with the climbing-related injuries? Definitely not, as Dave emphasises repeatedly. I am afraid and guessing there is no easy path, but to keep learning. But this Make or Break must be the best starting point available for general climbers as in 2015.

Finally, if you feel it (to keep learning) to be a little daunting, here is the wise word from Dave. Make the most of your climbing life without, or even with, injuries!

By following the principles laid out in this book, you can not only maximise the effects of the body's ability to heal and regenerate, but enjoy the process of doing so.

by Masa Sakano

Details of the book reviewed

Make or Break: Don't Let Climbing Injuries Dictate Your Success
Dave MacLeod
Publishing date
February 2015
Rare Breed Productions

Other reviews of this book

Appendix: Comparison with predecessors

Is there any potential competitor for Dave's Make or Break? There are.

First and foremost, many research results have been available in the form of academic literature, of course. But they are hard to find and get for amateurs, tend to be more detailed and very specific than concisely summarised, and are hard to read and understand for non-medical-specialists at best. So, they are hardly an option for laymen.

There are several books devoted for training to improve climbing. Usually those books have some mentions on the climbing-related injuries, particularly for prevention. They are of course noteworthy, especially if you follow the training scheme introduced by those books.

However, by far the best existing literature in English about climbing-related injuries for climbers is, to my best knowledge, One move too many… by Thomas Hochholzer and Voker Schoeffl, published originally in German in 2001, translated into English in 2003, revised in 2006.

There are three major differences between One move too many… and Make or break.

  1. First, "One move" is written by the medical doctors, and expectedly in great details with full of medical terminology. To be honest, I find it is a hard job to read for me, a non-medical person. Having said that, the format and description about each injury climbers are likely to get are very clear and good, and so I think this is an essential reference for climbers in that sense.
  2. Second, "Make or break" gives a lot of practical advice of what to do for (non-medical expert) climbers, from how to choose doctors and physiotherapists to how to deal with the anguish of injury. Whereas "One move" is more like academic description of each injury, "Make or break" well bridges the gap between the academic facts and measures to take by each climber.
  3. Third, "Make or break" is far more up to date, published in 2015, some 10 years later after "One move", and it is apparent the author Dave has made the best effort to keep up with the modern progress both in understanding, treatment and prevention in the climbing-related injuries. Indeed, the majority of the references in "Make or break" was published in the 21st century, up to 2014. Given the rapid development of this field in recent years, as climbing has been gaining popularity as a sport all over the world, this recentness seems to be essential for accurate understanding.

Then, what's my verdict?

Simply, get both! As described, their emphases are different, and you would probably like to understand this subject as much as possible. As Dave rightly put it, becoming the expert on your own injuries is an essential part of sustaining a lifelong career in climbing, and so, more the merrier. But I dare say, "Make or break" would be more suitable for your first book, unless your bookshelf is already full of related medical references. It gives the good overview of the subject and provides a sextant to navigate through this hard-to-grasp and developing field. Then, "One move" will be the next essential book you should have (read!) to deepen your understanding.


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