Jocelyn-William LOUBRIAT

 

Definition

The lumbricals are small muscles of the hand that are not attached to the bones but to tendons. They are located between the tendons of the flexors and the extensor tendons of the finger at the palm of the hand (fig 1).
Their tearing, such as any muscular tearing, leads to brutal pain and a functional inability.
The pain is located in the palm. It can be spontaneous or occur while grabbing a hold (even an open hold) and at palpation.
It is possible that an oedema and/or a bruise appear.

Fig 1: Situation of the lombrical muscle,
by M.Dufour, Anatomie de l'appareil locomoteur

Mechanism of the lesion

A one finger hold grabbed with a stretched finger while the others are bending, stretch the correspondent lumbrical muscle irreparably.
When the muscle is clinging to the flexor’s tendons of the middle and the ring fingers and one of these 2 fingers is maintained in extension while the other is stretched in flexing, the lumbrical is stretched between the 2 fingers (fig 2).
A muscle that is not correctly prepared cannot maintain such a load. On a one finger hold, risking appearing as Lapalisse, the body’s weight is entirely suspended on one (small) finger (fig 3).

Fig 2: Strain that causes the lesion of the lumbrical muscle with an one finger hold	Fig 3: High-risk one finger hold

Prevention

Technique correction:
It is imperative to modify the grabbing technique of one finger holds by never separating the middle and the ring finger (fig 4).

Fig 4: Risk free grabbing of a one finger hold

Correction of the physical preparation:
It is imperative to warm up the muscle first; a well prepared muscle is less likely to tear.
An extensible muscle tears less: specific stretching exercises of ones muscles should be done systematically after each session.

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Stop the session and put some ice on it immediately. You also might want to try a compression (not really easy in that area).
Repeat ice treatment 3 to 4 times per day for 3 to 7 days. Do not apply anti-inflammatory gel.
A specific physical therapy combining ultrasound therapy, mobilization and stretching can help to optimize recovery.
Stop training for 10 to 30 days (depending on the importance of the lesion, determined by a sonogram). When you start training again do so progressively by strapping the middle finger together with the ring finger and without using one finger holds.

Jocelyn-William LOUBRIAT

 

Digital avulsion is a very serious condition that occurs more frequently than people generally believe.

We differentiate between two types:
Number one is the degloving of the finger (fig 1):
The whole skin and the underlying tissue are separated from the bone. On one side of the hand is the bare bone and on the other side the soft parts like a cut glove finger (therefore it is called degloving).
The whole vascular nervous system is affected.

Number two is the complete amputation of one or several phalanx (fig 2).

A thin ring (such as a wedding ring) that gets stuck in a hold while the feet are sliding, can cut through all the flesh and thus separate the skin from the bone like a thread cuts through butter. 
In the same way, the finger can be severed completely by the ring (fig 3).

All these examples of accidents have really happened.

 

 

In cases of complete amputation or degloving:

Gather together the fragments,
Put them in a closed plastic bag,
Put the bag in ice.
On the traumatized hand: do not use a garrot,
Make a compressive dressing and keep the hand raised as much as you can.

Call the nearest hand surgery centre immediately.

 

To know the nearest centre in France, call the following number:
0 825 00 22 21

Francis HELIAS
Jocelyn-William LOUBRIAT

Definition

The epitrochlea designates the inner part of the elbow, where the flexor tendons of the fingers and of the wrist are located (fig 1).

Epitrochleitis is a tendonitis of this area.
The word tendonitis refers to an inflammation of the tendinous structure. The term is often wrongly used to designate a tendinosis, that is to say a degenerative condition by micro-rupture of the tendon. The inflammatory state is only a symptom.

The condition develops progressively, starting with simple discomfort that disappears with the warm up. If it is not treated, the symptoms may persist and increase.

Pain is felt during palpation, stretching and contraction.

Mechanism of the lesion

Excessive strain (amount and intensity) on the epitrochlear tendons (such as every other tendon) lead to their degeneration.

Maximal strain on the flexors of the fingers and of the wrist pull inexorably on the insertion at the elbow.

The inertia of a dyno landing increases the shock when grabbing a hold.

The accumulation of strain without complete recovery, the persistence of contractions between the training sessions and poor revascularization of the region lead to its degeneration.

Once again, it is important to remember that repetition of a movement is harmful for the structures.

Technique correction:
Do not stretch out the elbow completely during muscle training.
Do not load too much weight.

Correction of the exercise schedule:
Do not use too heavy or too voluminous a load

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 flexor muscles of the fingers and of the wrist after each training session (fig 2).

Ice cube massage, 3 times per day till the pain disappears.
Application of an anti-inflammatory gel after the ice treatment for up to 7 days (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.

Jocelyn-William LOUBRIAT

Francis HELIAS

Definition

The shoulder is a complex and fragile joint (fig 1) that is susceptible to injury when moved into positions where its anatomical elements hit against each other.

The raising of the arm is physically possible, but the anatomical elements can hit each other at some positions.

Protective elements called serous bursas play the role of shock absorbers. They can be damaged and inflamed.
The pain radiates to the shoulder when the arm is raised or during positions whereby the serous bursas is squeezed.

Over time this causes these protective elements to degenerate, and if no appropriate treatment is given, tendons will deteriorate or even tear.

The instability of the shoulder joint (past medical history of dislocation or sub-dislocation) favours these conditions.

Fig 1: Shoulder joint and serous bursas

The crushing of the serous bursas can occur when in rotation + adduction + raising of the arm, a position you adopt when doing a cross-over step (fig 2);
in abduction + inner rotation that you adopt when you try to grab a side hold (fig 3).
Extreme positions, such as “relax” hanging, push the bone structures to their limits.

Repetitive strain on these structures, which occurs every time you raise your arm, in addition to a bad position of the scapula due to the rolling up of the shoulders will definitely lead to their injury

Fig 2: Shoulder joint in inner rotation	Fig 3: Movement of abduction and inner rotation

Technique correction:
It is necessary to learn how to place your shoulder the best, in particular during low effort positions, when you try to relax in order to recuperate.

Correction of the exercise schedule:
Taking rests is absolutely necessary to enable the structures to recover between each training session.

Correction of the physical preparation:
Making systematic specific stretching exercises to fight against the rolling up of the shoulders will help reduce conditions.
Adjusting the control of the muscles of the cuff (relaxing of certain muscles, reinforcement of others) to stabilise the shoulder joint will be essential.

This work will be optimized by involving a reeducation professional; it is just for prevention.

As always, warm-up is essential.

Ice cube massages 3 times per day, combined with the use of an anti-inflammatory gel, can help to reduce the pain quickly.
However, you must remember that reducing the pain does not resolve the problem: an overall postural rebalancing is necessary.
The rolling up of the shoulders typically found among climbers increases shoulder strain tremendously.
A physiotherapist trained in the techniques using muscular chains (Busquet, Mézière…) may be of help.
The usual physiotherapeutic work to rebalance the shoulder will be necessary.

Jocelyn-William LOUBRIAT
Francis HELIAS

Definition

A sprain is the stretching or tearing of a ligament (fig 1).
A ligament is a fibrous structure that maintains the articulation (≠ the tendon which is part of the muscular apparatus).

In climbing, the tibial collateral ligament (medial collateral ligament = MCL) of the knee can be stretched too much and become distended or tear.

The sprain is an accident with immediate pain at the inner side of the knee and instant functional inability. The knee may tend to swell.
Depending on the importance of the lesion, after-effects of articular instabilities may occur.

(sprain of the cruciate ligament is no specific pathology of climbers, that is the reason why we do not deal with it here)

Fig 1: The tibial collateral ligament
by Michel Dufour, Anatomy of the locomotor apparatus

The tibial collateral ligament may tend to tear or stretch when they are under much repeated tension or when making one rough movement.

It is under tension during flexion + external rotation + knee valgus.

It is the position which is adopted when using the Lolotte method (fig 2) and which can be found also during a fall when bouldering (fig 3).

Fig 2: The Lolotte Method	Fig 3: A fall when  bouldering,  knee in flexion  external rotation

Technique correction:
Avoid useless Lolotte which would “tire” the ligament.
When bouldering, spotting is essential for a good fall.

Correction of the physical preparation:
The learning all the warm up, muscle training and stretching techniques should be done by strictly respecting the articular physiology.

Searching non-physiological articular amplitude weaken the articular stability and vigilance.

Put an ice pack on it as soon as possible.
Immobilise the knee and go to a sport doctor.
Undergo strict physical therapy.
To start climbing again soon is possible a splint should be used but only when the physiotherapist consents to it.

Jocelyn-William LOUBRIAT

Francis HELIAS

Definition

Menisci of the knee are fibrocartilage elements whose role is to split the constraints which are transmitted from the thighbone to the shinbone (fig 1).
They can break lengthways or transversely (fig 2).
In some cases, the meniscus can be cracked without the person feeling it.
In other cases, the fracture can occur with an acute pain and a very audible crack.
An important (or persistent) bulge is often linked to it

Fig 1: Frontal cut of the knee’s articulation	Fig 2: Superior view of the tibial tray

Menisci can get stuck between the thighbone and the shinbone and be subjected to more important constraints than their mechanical resistance.
It can occur during movements when the knee is flexed to its maximum, with a more or less important rotation of the shinbone.
When the person stands up straight on one leg (slab movement) (fig 3), the quadriceps have to contract strongly while the position of the knee in hyper flexing makes it impossible for the hamstrings to play their role:  controlling the position of the menisci.

A fall (in bouldering) can seriously damage these structures.

Fig 3: Knee movement in maximum flexing

Technique correction:
Avoid standing up straight on one leg.
When bouldering, spotting will be essential for a good reception.

Correction of the physical preparation:
All the exercises to warm up, to stretch and to strengthen the muscles have to respect the physiological axis of flexing and extending of the knee.
A good warm up and a good waking of the sensory receptors through active stretching techniques can prevent wrong movements of the menisci.

Apply an ice pack right after the accident 3 times per day till the oedema disappears.
See a sport doctor. According to the functional inconvenience, a surgical intervention to remove one part of the meniscus might prove necessary.
Successful rehabilitation might allow you to take up climbing again.

Jocelyn-William LOUBRIAT

Francis HELIAS

 

Definition

A sprain is the stretching or tearing of a ligament.
A ligament is a fibrous structure that maintains the articulation (≠ the tendon which is one part of the muscular apparatus).
The ankle is the joint most likely to suffer a sprain when doing sport.

The sprain is an accident with immediate pain and instant functional inability. The ankle tends to swell.
The pain and functional inability will depend on the importance of the lesion.

After-effects of articular instabilities may occur.

Different types of sprains can occur in the ankle:

The most common are inversion injuries (when you “twist” your ankle outwards) (fig 1),
Less common are eversion sprains (the ankle “twisted” inwards) (fig 2),
And the sprains in maximum dorsi flexion (fig 3).

Fig 1: Ankle inversion sprain	Fig 2: Ankle eversion sprain	Fig 3: Ankle sprain in maximum dorsi flexion

Sprains occur during falls, in particular when bouldering, on irregular grounds (roots, stones, slopes) or half on a crash pad… The risk should not be underestimated, especially when climbing along vertical walls or slabs

Also, be careful when jogging on an irregular ground.

Technique correction:
Favour de-escalation to systematic jumps when coming down from blocks.
The crash pad is an essential tool to preserve your ankles, but it does not replace spotting.

Correction of the physical preparation:
A good warm up and properly prepared sensory receptors thanks to active stretching techniques can prevent injuries when falling.

Immediate ice treatment and compressive bandaging (from the toe up to the calf).
If you are unable to make 2 steps, go to the emergency room to check if there is no fracture.
Immobilise with a removable splint (like Aircast®) for 15 to 21 days.
Kinesitherapy is essential to avoid risks of recurrence. Reeducation too often neglected after a “small sprain” can prevent a chronic condition

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Jocelyn-William LOUBRIAT

 

Definition

The term lumbago simply defines a pain in the lumbar region, meaning the lower spine.

localisation de la région lombaire

Lumbagos of climbers vary in either the type of pain or in their causes.
The different structures which may generate lumbagos are:

· the muscles of the lumbar region that are tense or cramped because of strain or to protect the underlying structure,
· the intervertebral ligaments that have been exposed to prolonged stretching,
· worn-out joints, i.e. arthrosis.
· the intervertebral discs that may be worn-out, crushed or herniated.
· the meninges, the envelope of the spinal cord that may be negatively affected e.g. by tension or pressure.

Except for isolated accidents du to “twist” movements or serious falls with vertebral fracture, several mechanisms may be at the origin of lumbagos:

- the prolonged position of the pelvis in retroversion, which places the posterior structures in stretch and therefore deprives them of a good blood flow. This is the position we adopt often in the harness or on a sofa.

Position in retroversion

- an imbalance between the anterior musculature (mainly the abdominal muscles) and the posterior musculature (the paraspinal muscles) with a predominance of the first one which favours the trunk winding forward, with a locking of the pelvis in retroversion (through the couple hamstring and rectus abdominis muscles)

- contrary to the locking of the lumbar region in hyperlordosis through the contraction of certain muscles due to a too strong solicitation (broadest muscles, psoas muscles, quadriceps), which places the posterior spinal joints in support.

Position in anteversion: 
tilting the pelvis forward leads to the increase of the lumbar lordosis

- the combination of anterior and posterior tension which causes a phenomenon of compression of the lumbar region.

Compression of the lumbar region through anterior and posterior tension

All these factors associated with the shocks occurring at falls (either in bouldering or in rock climbing) can lead to painful symptoms.

Repetitive falls in bouldering from variable heights are far from harmless. With the impact of each fall, the trunk bends forward suddenly and sometimes pulls violently on the whole structure and in particular on the meninges or even the nerve roots. Over time, these shocks can provoke a very painful and lasting phenomenon, known as the "whiplash syndrom".

Material correction:
Choose a comfortable harness with a large belt.
The use of crash pads is essential in bouldering. Crash pads are designed to cushion falls and absorb shocks. Traditional foams have quite a good absorption quality; however they have a bounce reaction that is transmitted in part during the impact. During the fall, usually the feet hit the pad which reacts to this first impact, then the buttocks land more or less delicately on the pad at the moment it reacts to the impact caused by the feet. The buttocks may also be subjected to the bouncing of the foam.
Viscoelastic foams offer a better shock absorption and the bouncing is markedly diminished. During the fall, using an air pad (Andréa Boldrini) made of viscoelastic foam reduces the impact on all joints and in particular in the lumbar region.

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Technique correction:
In bouldering, climb down rather than jump.

Correction of the physical preparation:
Core muscle strengthening work should not be done to the detriment of the range / freedom of movement of the joint and above all it should not lead to an increase of the compression of the lumbar region or to an anterior-posterior imbalance.
Train your abdominals in their whole range (indoor and outdoor run) and in all modes (concentric training, isometrics, eccentrics, if necessary plyometrics). Do not forget to train the opposing muscles (paravertebrals).
After each strengthening training session, you should do the following stretching exercises.

Maintaining the optimum mobility of the whole musculature will avoid overworking the lumbar region.
Therefore, regularly stretch the following muscles:

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A few physiotherapy sessions may help you relieve your pain, teach you how to improve your stretching and your understanding of how your “back” works and therefore allow you to better manage your lumbago.

Ostheopathy can help to free you of some persistent pain. One type of therapy does not exclude the other, on the contrary, they are complementary.

In the case of Whiplash syndrome, following a complete treatment like Mezieres/Muscular chains should be considered seriously. This would be a long term treatment.

Jocelyn-William LOUBRIAT

 

Principles:

Cold has:

- analgesic effects (that ease pain) because a decrease in temperature slows down the nerves’ conductivity especially the conduction of the pain message. As it has no priority, it no longer reaches the brain.

- anti-inflammatory effects (fights the inflammation) in particular through its vasomotory action, because the blood’s purpose is to carry the nutritive elements in the tissues and to carry the waste out.

- vasomotory effects: ice treatment provokes first a vasoconstriction (decrease of the diameter of the blood vessels) and then a vasodilatation (increase of the diameter of the blood vessels). In addition to the anti-inflammatory action, the activation of the return circulation is the main element of recovery: it drains the residues of the muscular effort.

- myorelaxant effects: it appears that - like a reflex - ice cube massage of a muscle helps it relax.

Ice treatment may appear to be simple; however some rules must be respected. Furthermore you may not have thought about the most practical way to apply the ice depending on the area.

Here is therefore a simple, efficient and safe manner of how to apply an ice treatment.

Ice cube massage

Ice cube massage is used for:
- inflammatory conditions (tendinitis, residual pain after sprains…) +++
- contractures. +/-

Apply for about 5 minutes, 3 to 6 times per day (wait 1 hour before applying again), for 7 to 10 days (or longer if pain persists) to fight inflammations.
Application of an anti-inflammatory like Flector® Tissugel® right after the ice treatment is strongly recommended.

Attention: ice may freeze the skin. Make sure that the skin gets its colour back instantaneously when you put your finger on it.
In case of little wounds in the area (blisters, cuts, scrapes), avoid ice treatment.

A cold pack is used for: - traumatisms like sprain, pulled or strained muscles, pulley rupture, punch… - trophic phenomenons (following surgery of the knee, the ankle, the wrist…) - the recovery. Apply for 15 to 20 minutes, 3 to 6 times per day (wait 1 hour before applying again). Attention: here again, ice may freeze the skin. Never apply the plastic immediately to the skin: cover it with a damp cloth (it allows a better conduction of the cold than a dry cloth).

Ice bath is used for: - traumatisms like sprain, pulley rupture. - trophic phenomenons (following surgery of the ankle, the wrist…) - the recovery. A bath of 15 to 20 minutes, 3 to 6 times per day (wait 1 hour before starting again), to fight against inflammations. Attention: do not enter you whole body in a bathtub of frozen water. Do you know what hyperthermia is?!

Jocelyn-William LOUBRIAT

	Bandage a circular base around the wrist with a 4 cm strappal.
	With a half-width strip (obtained by tearing the 4 cm strip in 2). Bind it around the joint at the base of the thumb from the base to the external side of the hand and come back on the inside, to…
	... finish on the base again. The strip comes together behind the joint.
	Repeat it by moving the strip forward compared to the previous one.
	You can add extra layers depending on the stability you wish to have. Attention: do not cut off blood circulation!