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Saturday, 22 December

Dr 8a - Björn Alber in the online forum

As a service to the climbing community 8a will start an online forum on climbing related injuries, their triggering factors and how to treat and prevent them. Björn Alber will be the Dr 8a who will answer all your questions. This article is intended to lay the groundwork for the principles of the injuries and how to treat hem. When posing a question on the 8a forum this text is intended to help you formulate the problem and to more easily understand the answer forwarded in the forum.

Climbing related injuries – the one thing we all dread by Björn Alber

The most common areas of injury in climbers are in falling order of appearance; Fingers, wrist, forearms, bicep tendons, shoulder and knees. If we include injuries from falling with impact then ankle, back and neck injuries will have to be added.

I will make a short list of some of these problems and their remedies below but first I will make a recapitulation of the general problems

In principle there are two main kinds of injuries:
Acute – appearing more or less instantly most often due to a rapidly developed overload (falling and hitting something, jumping and catching a hold)
Chronic – developing over a longer period of time most often due to repeated use with to little rest and recuperation (overuse) or due to a inherited weakness in the injured persons musculoskeletal system.

The structures that can be affected are. Muscles, tendons, ligaments, joint capsules, bursas, cartilage, nerves and bones.

No matter how severe the injury the most common reaction is an inflammation. An inflammation is a bodily relation to the injury. The affected site is showing symptoms like: pain, swelling, reddening, heating up and impaired function. These four cardinal symptoms of inflammation is a telltale to make you cut back and initiate a healing process. The inflammatory reaction develops slowly (days in the acute kind and weeks to months in the chronic kind) if the trauma (acute overload) is violent enough or the chronic overload is going on for an extended period of time the bodily structures may actually break. You can have a muscular, ligament or tendon tear (partly severing the structure) or even a muscular, ligament or tendon rupture (fully severing the structure). In case off just inflammation or inflammation combined with a tear you are often able to continue activity but at a lower intensity and often with adjusted movements and load stress. In case of a rupture you will have to submit the injured structure to total rest for weeks to months. Do remember that the rest is only beneficial to the severely injured structure and that you by keeping the rest of the body active you are improving healing and also keeping you climbing ability. As soon as possible the injured structure should be subjected to repeated unloaded and possible range of motion-limited activity (rehabilitation training). This should successively be substituted by full range of movement with full power activity (strength and prohabilitation training).

As helpful aid to the healing process different medical strategies can be applied: Anti-inflammatory drugs (NSAID), these drugs exist as lotions as well as in tablet form. As a general rule lotions/creams are only effective on very small injuries that are lying close to the surface of the skin. More powerful anti-inflammatory effects are attained by Cortisone injections into joints or close to tendons or ligaments. This should always be done by a specialist in sports medicine If the joint cartilage is affected an in the body naturally occurring substance called Hyaleronic acid is a very powerful agent when injected into the joint. This said the best thing to do is to use strategies that as much as possible eliminate injuries; strength and coordination training. Adequate rest and food. Avoiding situations that will aggravate an already existing minor problem (e.g. climbing campus and/or crimpers when your fingers are already hurting). Even for the best climbers a general fitness strategy will not only make you a better climber but also more importantly make you less prone to injury. So don’t start training for a marathon or the next body building championship but keep you general fitness level high.

Most climbers are aware of that they should do some kind of warm up and to climb themselves ”up the grades” on the start of a climbing day. The fact is that a good warm up will not only substantially decrease your risk of getting injured but also increase your performance output by over 10%.  The speed of nerve transmission is lowered, oxygenation in the active tissues elevated, muscular strength and endurance elevated etc. so always put yourself though a really good warm up.

Below is a short list of common problems – we will elaborate on each one of them in the forum. Always consult sports medical expertise when unsure. In all cases healing might be speeded up with the aid of anti-inflammatory drugs or cortisone shots, If surgery is required this should be done by a well reputed specialist and he should preferably be qualified in ”arthroscopy” - peep hole surgery     

Top 4 injuries

    1. Fingers – cruciate ligament tears- as the fingers contain no muscles the power to bend the finger comes from the forearm muscles and is transmitted through tendons to the tip off the fingers – the tendons run inside tendon sheaths and are kept in place near the finger bones by the so called annular and cruciate ligaments- with acute overload or prolonged overuse these ligaments will be inflamed, swollen and might even break entirely. In a worst-case scenario the tendons might break. Cut down on climbing in general and specifically crimpers. Tape quite tightly just under the first finger joint as reinforment before climbing – tape an injured finger to the adjacent one to take the load off the injured one. Warm up the fingers by squeezing a foam or rubber ball/ climbing putty. But up strength an durability by rational strength training – e.g. ”hit strips”, barbell rolls, carefully executed campusing with adequate rest.

    2.  Forearms – extensor tensor origin inflammation – outside of elbow – e.g. tennis elbow- in order to obtain maximum grip strength the bending acting of the muscles on the inside of the forearm is counteracted by the extending action of the muscles on the outside of the forearm. The flexing muscles being far more powerful, the extending muscles will be overloaded and cramped up producing bad circulation in the tendon area witch in turn will enhance development of a usually very persistent inflammatory response. Specific strength training and stretching will prevent as well as heal this problem.

   3.  Shoulder instability and rotator cuff syndrome – 4 small muscles keep the upper arm bone rotating on the very small socket of the shoulders Scapula bone. Since climbing mostly affects the pulling muscles around the shoulder the pushing muscles as well as the specific rotation muscles of the shoulder will be to weak to keep the arm in the socket and a number of problems might arise. Prevent this in time by specifically strength training the pushing muscles as well as the stabilizing foursome of muscles in the ”rotator cuff”.

    4.   Knees – in the twisting motion of a drop knee, the pull and twist of a high heel hook or the high tension bending force in a wide stance the ligaments and so called meniscus (small cartilage disk) of the knee might tear or show sign of overload. A meniscus tear will forever leave your knee accident prone and unstable so putting some effort into stabilizing strength training is a good idea.

Welcome to the 8a doctor forum!
Bjorn Alber

MD specialized in sports and rehabilitation medicine, PhD sports physiology,

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