Wednesday, August 11, 2004

Don?t downplay climbing injury

Advice offered on prevention of damage to vulnerable joints and muscles

Express Staff Writer

Kristin Syms, a certified hand therapist with St. Luke?s Idaho Elks Rehabilitation Center in Ketchum, cautions climbers to avoid socalled overuse injuries to vulnerable joints and muscles, and to treat injuries quickly. Photo by David N. Seelig

Rock climbing has increased in popularity over the last few years, and Idaho offers many areas for the avid climber to enjoy. With increased popularity of this sport is an awareness of potential risks for injuries, most notably in the upper extremity.

?The evolution from ?mountaineering? to ?free climbing? has brought with it better equipment, varied styles of climbing, and further athletic challenges,? said Kristin Syms, a certified hand therapist with St. Luke?s Idaho Elks Rehabilitation Center in Ketchum. ?The transition has also changed the types of injuries from acute emergencies to more injuries due to overuse or tendonitis.?

Hands are used for ascent and are specifically susceptible to injury, Syms said. Often fingers, wrists, elbows, and shoulders hold the majority of climbers? weight. The combination of repetitive positions and excessive weight bearing demands can lead to cumulative trauma. An awareness of the condition of rock climbing terrain, types of upper extremity soft tissue injuries that can occur, and training for climbing challenges can better equip rock climbers for outdoor adventures.

?While watching climbers, the graceful movements observed can make one forget the incredible amount of strength and technical skill it takes to ascend a rock face,? Syms said.

Climbers rely on several grip techniques that are commonly used in rock climbing.

?Climbers can appreciate such grips and holds more if the anatomy of the hand and forearm is considered,? Syms said.

The muscles and tendons that cause the wrist and the fingers to flex or bend come from the inside of the forearm on the medial aspect of the elbow. The wrist flexors insert just above the wrist. There are two finger flexor tendons that insert on the fingers, the flexor digitorum profundus (FDP) bends the tip of the finger, and the flexor digitorum superficialis (FDS) bends the second joint of the finger. These are the tendons used most when climbing.

?The thumb has a similar set up,? Syms said. ?All these tendons pass through the carpal tunnel along with the median nerve. Each tendon passes through a tendon sheath that is held in place by pulleys that are spaced along the finger to prevent ?bowstringing? of the tendons.?

Bowstringing happens when tendons draw away from the bone with any active flexion of the finger.

As climbers execute moves with their hands and arms, extensor muscles that originate off the outside or lateral portion of the elbow are also en-gaged.

?There are three wrist extensors,? Syms said. ?There is one specific extensor complex that extends the fingers, the extensor digitorum communis (EDC). The index and little fingers have their own extensor muscle in addition to the EDC. There are also several other muscles, tendons and ligaments inside the hand that enable one to spread and pull fingers in and rotate the thumb and wrist.?

An extremely complex entity, the hand provides manipulation from the first two fingers and thumb, and strength from the ring and little fingers. It is the first line of tactile feedback, it can sense light touch, deep pressure and temperature and discriminate textures and where the fingers are in space.

?In climbing the hand is being asked to perform everything at an incredible level of strength and finesse,? Syms said. ?Unfortunately, the nature of rock climbing and the anatomy of the hand do not always work in concert. Advanced climbers are as much at risk as beginning climbers, although on more difficult climbs increased stress loads are placed on the upper extremity. Both groups may encounter injuries as a result of contin-ued overuse or a sudden force or load to the fingers.?

The most common injuries that a rock climber sustains are said to be in the hand, most often in the ring and middle fingers. The middle joint of the finger tends to be involved the most.

The elbow and shoulder are also at risk for soft tissue injuries due to repetitive overhead reaching. Muscle imbalance between the chest and the back, the origin of elbow, forearm and wrist movement can also result in injury.

?Many injuries are minor and most injuries respond well to conservative treatment,? Syms said. ?It is important, however, not to dismiss correct diagnosis so that the appropriate treatment can be instigated as soon as possible.?

With any questionable pain or decrease of function, seeing a professional is recommended. Injuries that are not diagnosed or treated appropriately can result in long-term difficulties.

?The predominance of rock climbing injuries are due to overuse. So, it is important to address prevention of these overuse injuries in training even though they may be somewhat inherent to the sport itself,? Syms said.

In case of injury, the acronym RICE can be used for first aid treatment when out in the field: Rest, Ice, Compression, and Elevation.

?Respect the injury,? Syms said. ?Know when to take time off, how to treat the injury, and when to seek professional advice. An awareness of preventative measures to avoid injuries is important in balancing ease and gracefulness with strength and accuracy in the ascents of rock climbing.?

Peter Heekin, owner of Lost River Sports in Hailey and an avid climber, believes in prevention of injury though specific training exercises. In particular Heekin recommends using a tool called a ?Dynaflex?. The tool is used to gain strength and to avoid tendon type injuries. It is a gyroscope type ball that spins as one tries to hold onto it.

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