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The epicondyle refers to the lateral area of the elbow, at the insertion of the fingers and wrist extensor tendons ... |
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Jocelyn-William LOUBRIAT
Definition
The epicondyle refers to the lateral area of the elbow, at the insertion of the fingers and wrist extensor tendons (fig 1).
Fig 1: Localisation of the epicondyle
Epicondylalgia refers to all pain in this area. This term is now preferred to the one of epicondilitis, just as tendinopathy is used rather than tendinitis. Moreover, if some epicondylian pain is due to the local pathology of the extensor tendons, others can originate from the joints (humerus-radius/radius-ulna joints), the cervices (cervical joint dysfunction which causes a projected pain) or the nerves (strangulation of the nerve where it passes through the elbow).
In the case of a lateral elbow tendinopathy (commonly referred to as “tennis elbow”), pain is felt at palpation, stretching and forced contraction.
With a local joint dysfunction, pain is felt at the palpation of the joint space.
When the epicondylalgia originates from the cervices, pain is felt at palpation but not at forced contraction.
With a radial nerve injury, the usually nocturnal pain is accompanied by sensitive signs of the dorsal side of the forearm.
In cases of a tendinopathy:
Putting the tendons under excessive strain (of volume and intensity), accumulative strain without complete recovery, persisting contractures between the sessions contribute to their degeneration, in particular because of poor revascularization of the area.
Pinch grips put enormous strain on the extensor muscles of the wrist.
In cases of joint dysfunctions of the elbow:
The inertia of a dyno landing, the brutal and uncontrolled coming down during traction work may overwork the elbow joint and contribute to small joint “movings”.
In cases of joint dysfunctions of the cervical:
The persistence of contractures at the scapular belt and the neck favours compensatory posture which may disturb the correct mobility of the cervical joint surfaces. Climbing uses a great number of muscles that cling to the scapular belt and the cervical rachis. Cervicalgias are common and are favouring factors.
Once again, it is important to remember that the repetition of a movement is harmful for the structures
Technique correction:
Do not stretch the elbow completely during muscle training and make sure that during tractions you always control the descent.
Do not charge too much weight.
Correction of the exercise schedule:
Do not charge too much weight or volume.
Schedule regular rests.
The quality of the training is more important than the quantity.
Correction of the physical preparation:
Strict warm up.
Gradual increase of training loads.
Systematic stretching of the extensor and flexor muscles of the fingers and the wrist after each training session.
And systematic stretching of all upper limb muscles, the scapular belt and the neck (see stretching exercises).
Ice cube massage 3 times per day till the pain disappears.
Application of an anti-inflammatory gel after the ice treatment for 7 days maximum (respect the manufacturer’s directions).
If the symptoms persist more than one week consult a sports doctor and ask for a prescription for reeducation sessions.
Early care by professionals can prevent the condition from becoming chronic.
In cases of joint dysfunctions of the elbow or cervical, osteopathy sessions should be scheduled as soon as possible.
Strapping: the application of a non-elastic support bandage (like Strappal or Omnitape) may in some cases give relief to the area when taking up training again.
Before you apply the strapping, shave the area: the bandage will stick better and you won’t make a funny face when taking it off!
Wrap the bandage around the forearm twice by passing precisely at the point of pain and tighten it slightly (the bandage should be tightened a little, but not to the extend that the circulation is cut off or movement inhibited. It should give you proper support).
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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. |
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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:
Action on nutritional intake:
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.
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.
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Effort-related compartment syndrome is a deficit of blood supply to the forearm muscles. To understand this, ... |
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Definition
Effort-related compartment syndrome is a deficit of blood supply to the forearm muscles. To understand this, you must know that muscles do not form a single mass around the bone but that they are separated from one another in compartments, called muscle compartments, whose borders (or aponeurosis) are not extensible.
Muscle compartments of the forearm,
by Michel Dufour, Anatomy of the locomotive apparatus, ed. Masson.
During an effort, the muscular activity leads to blood influx in the vessels provoking a temporary increase of 20 to 30% of the muscle volume. However, if these aponevrosis are thick and rigid, the muscle is compressed. The loge, which is too narrow for the muscle, acts like a tourniquet on the venous network, that is no longer able to evacuate the oxygen low blood. As a result the muscle suffocates and pain appears.
Compartment syndrome affects mainly young (20-30 years), athletic men. The main symptom is pain, which appears during physical effort. If you to stop the physical effort the pain disappears in ten or more minutes. The pain may be a sensation of tension, swelling, cramps, burns, compression or of tetanisation. In the worst stages, the pain can be followed by a disruption of the hand’s ability to feel and a loss of muscular strength. If the activities are not reduced, the condition might develop into a state whereby the pain appears faster and disappears more slowly.
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.
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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.
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How to treat a "steak" |
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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.
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How to tape a finger |
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Remove a small strip of one third of the strap (Strappal 4 cm or Omnitape 3,75 cm) of about 20 to 30 cm.
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Start at the distal end of the phalanx (=to the tip of the finger).
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Apply the strip around the phalanx by partially overlapping the previous layer and in the direction of the proximal end of the phalanx (=to the palm). |
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The strip should cover the whole phalanx.
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The strips have to be tight to provide a good support. However make sure to not cut off blood circulation: if the finger becomes dark red, it is normal, but if it becomes purple-blue, take the strip off and bind it less tightly.
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Do the same for the second phalanx.
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The aim of these two strips is to limit the strain on the pulleys. By themselves, they do not prevent a rupture. |
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Remove a small strip of two thirds of the width of the roll and apply it in the same way to include the first two phalanxes.
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This last strip restricts the flexion of the finger.
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The term cervicalgia refers to all the different types of conditions in the cervical region i.e. the neck. The cervical spinal column consists of seven cervical vertebrae |
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Jocelyn-William LOUBRIAT
Definition
The term cervicalgia refers to all the different types of conditions in the cervical region i.e. the neck. The cervical spinal column consists of seven cervical vertebrae. Its great mobility enables us to position the eye according to a movement. This function is completed by a great number of small and big muscles, whose role it is to assure the important motility of this region (ability to make a lot of different movements), and also the stability of the neck and the head.
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Side view of the cervical spine
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Causes of cervical pain include tense muscles or muscle cramps in this complex and constantly used musculature, blockage in intervertebral joints, and cervical arthrosis (cervicarthrosis), a condition of chronic wear. |
![]() Posterior view of the skull and the first cervicals
from Michel Dufour, Anatomy of the locomotive apparatus |
In climbing, you generally suffer from the neck when belaying.
The climber, who becomes a belayer, must raise the head to look towards his partner. He thus places his spinal column in a position of hyperextension and uses only this cervical mobility. It is due to this practice, that through anterior muscle tension, the rest of the column tends to stay locked in flexion (shoulders roll up, dorsal hyperkyphosis…).
Other factors, like having suffered from shock at a car accident (e.g. the whiplash syndrome) or falling from a high bloc may favour cervicalgias.
Cervical arthrosis is a phenomenon that develops over time. The combination of muscular contractures (increasing the strain on the joints) and repeated movements in hyper extended cervicals favours its emergence, sometimes even in very young people.
Prevention
It is possible to act on two levels: reduce hyperextension and reduce the contractures of the cervical musculature.
Working on the position and anterior tension of the trunk (stretching of the {avrpopup type="lightbox" id="lecteur_09"}abdominals{/avrpopup}, {avrpopup type="lightbox" id="lecteur_07"}minor and major pectoralis{/avrpopup}, {avrpopup type="lightbox" id="lecteur_21"}psoas{/avrpopup}…) you “kill two birds with one stone”: you place the base of your cervical column in a position of less flexion and this diminishes the lordotic curve (extension), and you reduce the the muscle tension that spreads from the trunk to the neck,.
CU© glasses (prism glasses) avoid hyperextension. They are far from being a gadget, and given the comfort they offer, how easy it is to use them and the real mechanical relief they offer the cervical column, their use should be more common.
[You can buy them on www.powernplay.com, a Web site in English or German you can fully trust.] You can also have a look at the test carried out by our friends of Pofroad athttp://www.pofroad.com/blog/node/1428.
You may also reduce the muscle contractures of the neck by stretching the posterior, anterior and lateral muscles of the neck and by working actively on the mobilization of the different levels of the cervical column.
Treatment
In case of isolated pain while belaying, try to modify your position and make the stretching exercises mentioned above to relieve the pain.
If the pain becomes more regular, ask your doctor to prescribe reeducation sessions to harmonize your posture. The choice of the practitioner is very important because it is not only a question of massaging your neck or “putting the vertebra back in place” to alleviate your pain, but more importantly of making you work on your posture as to reduce the long term strain on the cervices. Classical symptomatic reeducation therapy will not be efficient, cracking osteopathy will not necessarily have long term effects if it is practised alone, so you should favour postural reeducation therapy.
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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 |
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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.
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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.
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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) |
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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).
It is difficult to prevent a purely “accidental” accident, however the good functioning of the shoulder complex may avoid too much strain on certain structures at the expense of their function. In particular, making sure that the scapula has good mobility may avoid the increase of constraint on the scapulo-humeral joint.
Correction of the physical preparation:
Stretching exercises for all the shoulder muscles: the rhomboid, deltoid, pectoral, latissimus dorsi, biceps and triceps brachii muscles.
It is not possible to relax certain muscles on one’s own. One should therefore consider consulting a physiotherapist for preventive measures, especially since we are not always aware of the limitations of our mobility. An ounce of prevention is worth a pound of cure.
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.