An Interview with Climber, DPT, and Cert MDT, Esther Smith

You do a myriad of things, including manual physical therapy, high performance training, dry needling, McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT), and specialize in using all of the above with the climbing community. 

Can you share a bit about your professional journey and your connection to the climbing community?

Sure. I decided to go to PT school at the University of Utah because it has such a great program and offers access to world class skiing and climbing. While I was in PT school I was an active, high level climber myself and I started to notice that my friends and community didn’t have the same support as other more mainstream sports like soccer or tennis. Back then, climbers were considered somewhat of a rogue group of individuals. It hadn’t become the recognized, formalized sport that it is now (to the point that it is now included in the Olympics).

So as soon as I graduated and began working in the outpatient clinic in Salt Lake City, I asked climbers to come see me so I could learn about their finger, shoulder, elbow, and ankle injuries and rehab protocols. I made connections with local climbing gyms and Black Diamond (equipment manufacturer for climbing, skiing and mountain sports) and ended up treating hundreds of climbers from all over the country.

Again and again, the primary therapy I applied was the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT). MDT differs from other therapies. As a mechanical diagnosis and treatment platform, it helps us to both understand and treat the problem. So for a lesser understood finger injury I could apply a MDT treatment principle to it that is well understood intrinsically throughout the body, like how to manage a tendon problem, and get predictable positive results for climber-specific injuries.

One of the protocols I am most proud of is a finger rehab protocol I developed and published through Black Diamond. The protocol continues to be used by climbers around the world with great success. Previously these types of injuries would most likely either persist or remove them from sport because they couldn’t rehab it effectively. 

Injury prevention education has been huge working with the climbing community (Read more on the management and prevention of injuries HERE). 

I’ve heard the MDT training is rigorous and the protocol effective. Can you share a bit about what makes this method unique and how you integrate it with your other modalities?

MDT provides really clear tools to work with the body’s intrinsic healing mechanisms. And those healing mechanisms are with us for our lifetime. 

I went into PT to answer the question, “Can we keep climbing (or insert your activity) and abolish injuries we know are going to happen AND get older at the same time?” 

With MDT, the answer is yes.

A fundamental element of the practice is that before you add strength, it is vital to first resolve injuries that might show up as pain, stiffness or weakness in our range of motion and establish baseline assessments in order to measure progress. 

I add other tools and modalities to expedite the recovery process and understand it better. For example, dry needling can be both therapeutic and diagnostic. So in the case of lower back pain, MDT can be used to understand the most relieving stretches and therapeutic movement for someone and I can use dry needling to activate dormant core muscles. Thus, helping their nervous system find balance and create a sense of homeostasis in the body. 

Then, once pain is reduced, range of motion is restored, and muscles are activated, we can then apply a higher level of strength and conditioning to this improved baseline. All this brings someone back to their activity, sport or whatever they want to do. 

You recently moved here from Jackson, WY. What drew you to working with Health in Motion Physical Therapy + Wellness?

I was told to check into Health in Motion by people that live here because it is such a wonderful clinic of practitioners that use an integrative approach. As I was looking for a home for my PT practice, within the first 5 min of speaking with Lori it was obvious that Health in Motion was it. 

I think the power (in Health in Motion) is in that we all have a similar perspective. We create this web of offerings that compliment each other. It feels really supportive to me as a practitioner and to our community to function as a team. I feel that is unusual in health care these days. I am honored to be a part of a clinic that is very forward thinking and using cutting edge therapies and practices. 

What’s your number one piece of advice to support athletes as well as weekend warriors to continue enjoying the recreation for years to come?

Resistance is your friend. As we get older we tend to avoid things we haven’t done for a while. Or a mindset that bc I’ am older my body is breaking down. Yet we still have the same healing mechanisms intact and the ability to achieve high performance as we age. So trusting in our bodies and seeking providers that support and challenge us in safe ways would be my advice. 

I have written a number of articles for Outside Magazine aimed at helping us to take care of ourselves and get stronger safely. 

You can find Esther’s article archive HERE