And systematic stretching of all upper limb muscles, the scapular belt and the neck (see stretching exercises).

Jocelyn-William LOUBRIAT

Recovery is an essential element of any sports training because it plays an essential role in performance. Training is not only an accumulation of workloads; it requires good fatigue management of the various strained tissues to favour what we call overcompensation. 
Two types of recovery can be distinguished: immediate recovery and secondary recovery.

Immediate recovery

It is the recovery between two efforts during the same training session, for example between two qualification routes or between two tries in natural surroundings, etc.
The aim is to favour an optimal return of the energy stocks at muscle level.
Therefore you need to act on bloodstream and nutritional intake.

Action on bloodstream:

• The active recovery consists in making moderate cardiovascular efforts, like slow running (or cycling) to maintain a moderate heart rate (between 80 and 120 pulse/min depending on everyone’s resting rhythm, which can vary between 50 and 70).
• Immersions of arms and forearms in cold water (about 15°C) 2 or 3 times during 5 minutes alternately with a few minutes of rest showed good results in a study carried out at the University of Lille 2 but seem to be quite difficult to execute except in rock climbing when a river runs at the bottom of the rock.
• Electrostimulation by active recovery programs does not show conclusive results according to the same study.

Action on nutritional intake:

• Rehydratation is an obvious fact. You must drink during the recovery time. Drink small amounts repeatedly rather than a great quantity at once. For example 2 or 3 small sips every 5 minutes.
• Quickly assimilated carbohydrate intake should be favoured. This intake may be contained in the drink taken for rehydration. You can buy energetic drinks, they are “isotonic”, if you follow the doses, and help the carbohydrates absorption without compromising performance. (Too many sweetened drinks may provoke too strong insulin secretion and cause a glycemic shock. Therefore avoid sodas and other energising drinks like Red Bull).

Secondary or late recovery

It is the recovery between two training sessions. During these phases, you want to try encouraging waste elimination and repairing micro-lesions, to restore a balance of the muscle tensions and to rebuild the body’s energy stocks.

• Hydration and nutrition: between two training sessions, you should drink 1,5 or 2 litres of water per day and eat in a balanced and varied manner. Fruits, vegetables, starchy food.
• Stretching exercises: the goal is to stop possible contractures and restore a balance of the tensions. This also favours a return to better tissue vascularization. It should be done with distance to the training sessions according to the principles exposed on the page “Stretching exercises”.
• Massage: not everybody has a physiotherapist at his or her disposal between each training session; however you may allow yourself professional help at certain moments of the season. A massage works as much on your bloodstream as on muscular relaxation.
• Sauna: by increasing heart rate, vasodilation and sweating but also for the general relaxation it generates, sauna is a non-neglectable way of recovery. Be aware of contraindications: circulatory and/or respiratory disorders (if in any doubt, ask your doctor).
• Relaxation: learn to let go, to know your body in another way than during contraction and effort, to control your breath but also to let it go… so many elements that enable the body to recover. Yoga, Qi Gong, Eutony, Relaxation therapy…
• Sleep: the accumulation of fatigue with a sleeping debt impairs performance and favours all the more injuries. Refreshing sleep and possible short naps – the most favourable hours for sleep are between 11 pm and 7 am and between noon and 3 pm. These are the keys for good recovery.

References :

- Heyman E, DE Geus B, Mertens I, Meeusen R. : Effects of four recovery methods on repeated maximal rock climbing performance. Med Sci Sports Exerc. 2009 Jun;41(6):1303-10.
- GUYON L., BROUSSOULOUX O. : Escalade et performance, Ed. Amphora sports, Paris, 2004. 
- ROUSSEAU V., CASCUA S. : Alimentation pour le sportif, de la santé à la performance, Ed. Amphora sports, 2005.

Definition

Effort-related compartment syndrome appears progressively when several factors come together The lack of recovery and of muscular relaxation during intensive exercising is a crucial factor. However, for the symptoms to appear, there must be a thickening of the aponeurosis, which can be caused by microtrauma (repeated impacts on the forearms), scars (compound fractures, surgery, etc.) on persons who have a predisposition for that thickening.

If there are no symptoms, regular stretching exercises will maintain the suppleness of the fibrous tissues.
From the first alerts, that is to say the sensation of tension, swelling, cramps, burns, compression or of tetanisation for an effort that is less than what you usually do (except the lack of training!) you must listen to the signs instead of “fighting pain with pain”:
- do not climb with the pain and plan times of recovery until it disappears completely (the suffering of the muscle causes the increase of the swelling and the definitive destruction of cells)
- perform stretching exercises combined with massages in the pain free periods (stretching increases the compression of the vessels) and when not having training sessions. The aim of the massage is to make the aponeurosis more supply by using strong pressure applied in a sliding movement towards where it meets the bone.

Surgery is currently the only solution to continue sports activities at the same level of intensity. The measure of the intramuscular pressure will determine if surgery is necessary. The operation is an aponeurotomy, the incision of an aponeurosis along its entire length, which restores the muscle’s ease. It has good results and enables you to take up a physical activity again after one or two month of convalescence and physiotherapy.

As a consequence of repeated friction on a hold, the skin suffers until the layers of the epidermis and of the dermis separates. This is provoked by the appearance of a pocket full of interstitial fluid. In fact, a “steak” is a blister.

A steak has a risk of bacterial superinfection due to the exposure of the deep layers of the epidermis. Therefore, it is important to treat it properly.

First of all, wash your hands with water and soap to wash away the dirt, the magnesia etc.

If the steak has not burst (appearance of a blister full of fluid), empty the blister (if possible use a sterile syringe, otherwise use a disinfected sewing needle), then with a pair of scissors that you have previously disinfected, excise the skin that has build the “roof” of the blister.

If the steak is open, cut off the dead skin in the same way with the scissors. Do not pull it up as to not increase the surface of the wound.

Then disinfect the wound with an antiseptic product that does not drain: Dakin’s Solution, Oxygenated Water, Biseptine, Dermal Betadine… Avoid eosin, which drains and Alcohol 70% which burns.

Next, apply a fatty cream like Homéoplasmine, Avibon (or possibly Biafine) in thick layers and protect the area with a sterile compress for the first night.
The Cicatryl ointment is also a good choice because of its antiseptic, anti-inflammatory and healing effects.

Definition

The carpal tunnel is the osteofibrous tunnel at the wrist by:
- the bones of the carpus on the back and the side
- a fibrous band called flexor retinaculum which arches over the carpus (fig 1).

The Carpal Tunnel Syndrome (CTS) is a condition the symptoms of which are tingling, numbing or swelling sensations, felt in the first 3 fingers of the hand (thumb, forefinger and middle finger). These neurological incidents are caused by the compression of one nerve – the median nerve – in this tunnel.

This is not a specific pathology of climbers, but a condition that occurs frequently in the general population.

It develops mostly progressively with some short lived symptoms that can worsen until they become so strong that they prevent you from sleeping at night. The pain can become diurnal and make it progressively impossible for you to hold heavy things.
At worst, some small muscles of the hand (intrinsic muscles) can become paralysed.

Mechanism of the lesion

The carpal tunnel is a narrow tunnel with many tendons running: the finger flexor tendon in there synovial sheath, such as the median nerve.

When climbing, the strain of the flexor tendons is very high and the constraints inside the tunnel can increase. The increased volume of the synovial sheath (tenosynovitis) can have a compressive effect inside the tunnel. Furthermore, a restriction of blood supply, ischemia, could be the cause of an oedema that obstructs the tunnel.

The nerve is compressed and the neurological signs appear.

Prevention

For prevention, make sure you have good physical preparation, favour a good recovery and avoid ischemic phenomenon linked to a restriction of blood supply in the forearms.

Regular stretching exercises of the flexors of the fingers (fig 2) enable you to keep good mobility of the tissues at wrist level, in particular those of the flexor retinaculums.

Fig 2: Stretch the flexors of the fingers

Long postures (about 30 sec to 1 min) of the fascias of the superior limbs (fig 3 and 4) will enable a good regulation of the muscle-aponevrotic tensions, which is the essential factor of the prevention of the CTS.

Fig 3: Posture of the fascias of the extensors	Fig 4: Posture of the fascias of the flexors

Treatment

It is essential to treat the CTS as soon as the first symptoms appear.
Appropriate physical therapy will in most cases prevent a worsening of the condition.
This treatment should give you back the mobility at the wrist tissues and also release all the tension in the upper limb. Using a wholistic treatment like the Mézières method, the Fascias method, is essential to release all the tension in the body and to treat the causes and not only the symptoms.
The techniques of the neuromeningeal tissue therapy, which aim at a good vascularisation of the nerve and its free movement, are useful tools.
Electrotherapy should be used mainly for the analgesic effect (TENS).
To be able to continue to practice climbing, try everything to avoid surgery, which resolves the problem with a bistoury cut in the flexor retinaculum. This reduces the muscle performance of the flexor of the fingers considerably, resulting in a loss of strength and sensation.

The shoulder is a complex part of the body made up of several joints.
The term “dislocation of the shoulder” refers to the dislocation of the scapulo-humeral joint (between the scapula and the humerus), meaning the dislocation of the head of the humerus comes out of its location.

If the joint dislocates easily or if the structures maintaining the joint are strained, it is described as “instable”. The term of “laxity” is also used.

Anatomy – physiology

Contrary to the hip, a congruent joint that confers stability (meaning its elements fit closely together), the shoulder confers great mobility to the detriment of perfect stability (non-congruent joint). This stability is mainly provided by the muscles of the “rotators cuff” (Teres minor, infraspinatus, supraspinatus, subscapularis muscles). These muscles provide the coaptation of the aforementioned parts of the joint.

muscles of the cuff
posterior and anterior

The function of the scapulo-humeral joint among “normal” human beings is either to move an object (carrying a load, and also throwing = open chain), to lean on something or hold oneself (=closed chain), but rarely to maintain a hanging position (open or closed chain using fixed point inversion).
Among homo-climbers, suspension which involves an over-solicitation of the coaptator muscles and therefore needs a perfectly integrated system is the main way of moving.

Mechanismof the lesion

Falls or shocks in most sports are at the origin of scapulo-humeral dislocations. When climbing, shocks are rather rare; but falls (when bouldering) are more common. A wrong position when landing on the arms and the humeral head dislocates. Especially when placing the arms behind, this puts the articulation in a weak position.
However, some dislocations may occur “during a movement” because our activity sometimes imposes special positions on us. If the articular elements are placed in a weak position at the same time certain muscles have strong contractions, the head of the humerus may come out of its location. This was the case with Loïc Gaidioz (interview here). The articulation can also dislocate when the dangling is not controlled the moment you grab a handhold after a dyno (dynamic movement). This happened to Jarno Zwiebel (interview here).
Dislocations are no light injuries and they can sometimes entail severe complications such as the detachment of the labrum (very common as for Loïc), fracture of the head of the humerus (or more rarely of the glenoid), affections of the nerves or the vessels that run in the axilla shallow (under the armpit), or even, as Jarno, stretching of the brachial plexus (in other words of the nerve roots of the arm).

Do not try to relocate a dislocation on our own or with the help of somebody else. This medical procedure must be carried out by a doctor, after having checked the entire the joint (no fracture and no nervous or vascular lesion). Trying to relocate it might entail irreversible damage.

After a dislocation without complications, the treatment consists of strict immobilisation, elbow against the body for around 3 to 6 weeks, followed by several weeks of intensive physiotherapy.

When suffering from instability (following an anterior dislocation), the mobility of the shoulder complex should be maintained and actively stabilized by exercising the appropriate muscles. Once again, preventive or maintaining physiotherapy may be better than suffering recurrent incidents.

In cases of frequent recurrences, surgery will be necessary.