Process Physiotherapy

15/03/2026

This post was inspired by a patient who is neurodiverse and really struggles with organisation and routine.

Tweaks and injuries were just not responding to rehab. This was due to them being exhausted most of the time and eating on the go with fast food, when they remembered to eat; which wasn’t often.

This picture of their food drawer was one of the biggest ‘YES!’ moments I’ve had in recent times.

Over a few weeks we had built new structures. We removed barriers and made making higher quality decisions easier.

Research shows that much of our decision making is not about willpower. It’s about structure. The right structure (such as a kitchen drawer full of food that is full of quick to prepare food that is way better than take away) leads to more positive habits as it becomes easy. It’s about reducing friction, not trying harder.

Ease of choice builds consistency and with consistency comes improvement, in rehab and training.

You won’t heal, or get stronger, if you don’t have consistent, sustainable, habits around the basics. The basics are getting enough sleep and energy in to support what you want to do.

If you’re struggling with this it’s not because you’re too weak willed. It’s because you don’t have the structures.

Think about what gets in the way of good quality sleep and nutrition and what you can practically do to improve this.

It can be as simple as having a repeating online food order that guarantees you will have easy to prep, supportive, food choices in your kitchen drawer.

Get the basics in place before you start training@and if you’re struggling find a physio/trainer who can help you with lifestyle factors, not just sets and reps.

13/03/2026

02/03/2026

Second try for this reel with now non-racist captions - thanks Instagram 🙄

If you’re carrying a bit of a ni**le in your finger when you warm up you need to isolate it for two reasons.

1 - To see how it is and inform your choices for that session

2 - To recruit it fully so it can look after itself better

It’s very common for me to see two hands that can pull the same amount. But if you isolate the injured finger and compare it to the other side they can often be 50% different.

A 4 finger pull can’t be relied upon to tell you the truth.

The body is fantastic at working around and protecting things. That can be great, but there comes a time when we need to isolate and work the finger on its own.

By testing and recruiting it like this you get a much better picture of how it actually is before you climb. You don’t want to end up on a two finger pocket way above your last bolt /gear and suddenly discover it doesn’t like that.

Warm up well first and then isolate it in open, half crimp and crimp (if you think you’re going to use those grips on your climb).

I’d recommend giving it a little boost/test before each climb too

As ever if you’re not sure get it checked out by your trusted medical provider - not all finger injuries are pulley injuries but even if it is they need a proper rehab, not just rest until it doesn’t hurt anymore.

27/02/2026

I don’t often repeat info on here but this one is worth repeating.

We had good flight times, short haul, all went smoothly, no stress. I’d rested a day or two before travelling and still my HRV changed.

It doesn’t rule my life. It helps me make decisions, it doesn’t make them for me. I still climbed as it was our first day and we were meeting up with some friends at the crag.

But it shows that travel really does affect you.

Don’t train up to the day before travel and call that a rest day!

17/02/2026

I was filming this as a demo for a patient and felt it was worth sharing more generally.

This patient was experiencing wrist and shoulder pain in press-ups.

It’s important to point out that we’re working on the issues behind the pain - this is a temporary adaptation, not the solution.

3 adaptations to one exercise!

Parallettes are great to remove wrist extension and pronation related symptoms.

This particular set was quite thin which added a stability challenge to the wrist. So fat grips solved that. But I also noted it could work as a progression for their wrist issue. As can slowly turning the parallettes into pronation over time.

The block on the floor stops me going too deep and into the range that irritates the shoulder.

It’s a foam bench press range block. 3 different heights to select from in 1 block and you put it on the bar. They’re only a few pounds.

Why bother?

It keeps you in the game. If you enjoy pressing this kind of adaptation means you can carry on doing so.

Going through 90% of a bench press range gives you 90% of the benefits of doing a bench press. Stopping bench press gives you 0% of the benefits.

It’s very common to be able to work with injuries, not stop completely.

To stick with the bench press idea you could go to incline bench for a while, purposeful end range work, dumbbells if you have a wrist issue.

There is usually a way and most people only need one adaptation, not 3.

If you can’t think of one ask your trusted provider. Personally I love the lateral thinking these kind of issues bring and you end up with a box full of them to pull out when needed, especially for fingers and pull movements.

10/02/2026

Getting excited now!

I think we’ve cracked it after spending some time HQ this morning.

Customisable for ring, index and pinky lengths.

Sustainable UK hardwood.

Hand made.

Made 9 miles from where they are shipped.

Worldwide shipping available.

Watch this space……



Go to my website to see the benefits of unlevel edges.

08/02/2026

This is my current favourite exercise.

No complicated techno babble or super boffin science.

Just give it a go.

Stay on the toe of your standing leg throughout.

Keep the back foot long and low as long as you can.

Feel it pull you back into the glutes of the standing leg.

Great for all sorts of injuries and a good exercise in its own right.

Do be careful in a cable machine though. I don’t want to see you using your new phone holder to film you dangling upside down from your ankle

06/02/2026

If you may find this useful please come along and spread the word.

I’d love to start spreading the word to healthcare professionals who don’t often see climbers. Let’s start educating!

Full details below:

https://us06web.zoom.us/webinar/register/WN_MGKKpTjOTcCK06M711EcyQ #/registration

Link will also be in bio.

Join us for a specialist deep dive into the clinical management of the climbing athlete.

As climbing becomes a mainstream sport, clinicians are facing unique and complex injury patterns that require specific diagnostic knowledge. In this session, Specialist Physiotherapist, climber and coach, Andrew McVittie, explores:

- The Growth of Climbing: Clinical implications of the sport’s boom.

- Injury Patterns: Rates, common sites, and differences by gender and age.

- Hand & Finger Diagnostics: Differentiating pathologies and deciding when to scan, refer, or treat.

- Youth Injuries: Red flags and considerations for younger climbers.

The session includes a live Q&A. Attendance certificates provided.

Who Should Attend? Physiotherapists, osteopaths, chiropractors, and MSK clinicians looking to refine their management of climbing-specific injuries.

27/01/2026

Active grips/pulls have been around for a while now. But whenever I prescribe them in rehab people often think they’ve got it - but they haven’t…….

So here’s a cue I’ve found really useful inspired by Tyler at and his idea of pretending you’re squeezing an orange.

After trialling this (messy - not recommended) I figured you could just use something else.

Watch to find out more.

Although people watch output from people like me as we’re ‘experts’ a lot of inspiration comes from the people we work with. Problem solving together leads to some pretty cool ideas.

If you’ve got any ideas to share drop me a comment 🙏🏼

19/01/2026

News!

I’ve written some blogs for Depot Climbing.

Topics so far include:

- Finger care
- Warming up to crush (not just to prevent injury, 🥱 )
- How to train without being a stubborn robot

I hope you find them useful.

If you’d like me to look at anything training, injury prevention or treatment related just comment below.

Google 'Depot Climbing blog' and enjoy.

🙏🏼

21/12/2025

All done for Christmas holiday 🎄

A busy last clinical day yesterday: the usual case load, Issy the excellent physio student along for the day, a get together of the Association of Climbing Coaches, some coaching with Lucie and trying to manage a bad ankle sprain (? #) in the Chilean jungle via satellite phone.

This job is definitely interesting, varied and very rewarding.

I’m off to recharge my batteries clipping bolts in Spain.

I hope you all have a wonderful time too.