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Pathologies

 

Vous trouverez ici des informations sur les pathologies rencontrées dans notre activité: comprendre ce qu'elles sont, comment elles surviennent, comment les éviter et les traiter.

Les lésions musculaires (intrinsèques)


Élongation, claquage, déchirures sont des termes bien connus faisant référence à des lésions musculaires. Cependant, les connaissances scientifiques évoluant, il serait préférable d’utiliser désormais une nomenclature différente : celle de « lésion myo-aponévrotique ».

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Tendinopathies

  What we used to call tendinitis is now to be defined by tendinopathy. This appellation comprises several pathologies concerning the tendon, its attachments and its periphery. The injuries differ by the type of tissues that are damaged, which determines the prognosis and treatment.

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Jocelyn-William LOUBRIAT

Definition

Tendinosis refers to damage to the tendinous structure.
Enthesopathy refers to damage to the attachment of the tendon to the bone.
Paratenonitis comprises damage to the peripheral elements of the tendon: tendinous sheath (peritendinitis), synovial sheath (tenosynovitis), bursa (bursitis). Only these affections are real inflammatory damage, as denoted by the suffix “itis” in “tendinitis”.

 

Mechanism of the lesion

The tendon, its attachments with the bone (enthesis) and its peripheral elements (sheaths, bursae), suffer from strains of traction, rubbing, compression due to muscle contraction and the normal use of our body.
Just as climbing ropes wear out even if they are used in appropriate conditions, the tendon also tends to wear out. However, ropes are inert, whereas the tendon is alive and is able to regenerate as long as its physiology is not disturbed.

Arthroscopy of the long biceps tendon 
courtesy of Dr. Laporte

corde-usee3
Wear of a rope (©Béal)

If the strain load exceeds the tissue’s regeneration capacities, a tendinopathy occurs.
The possibility of an injury related to exterior traumatism should not be ignored either as, for example, when falling, the tendon may directly collide with a blunt element (i.e. a rock). This traumatism can damage the structures and disturb the tissue’s regeneration balance and thus lead to a tendinopathy.
Diagnosis

Even if the tendinitis is gone, its triad persists:
- pain when stretching,
- when contracting the muscle against resistance,
- and when palpating.
The modulation of pain at each test will lead the diagnosis to one or another type of tendinopathy.

Tendinosis: strong pain when stretching and contracting the muscle, less when palpating. This can combine with cysts or nodules on the body of the tendon.

Enthesopathy: pain when contracting the muscle and palpating. No pain when stretching.

Paratenonitis: pain when stretching (increased by the manual pinching of the sheath) and when palpating. No pain when contracting. This can combine with crackling felt when palpating and with permanent pain that can cause insomnia, with a potentially visible inflammatory reaction (redness, heat, swelling) and functional discomfort in everyday life.

An appropriate clinical examination by a specialist can be completed by supplementary tests such as scan and MRI.
echo-transversale
Ultrasound image of a section of injured tendon (left) compared to healthy tendon(right)
Prognosis

Repeated incidences can soon become pathological.
At the beginning, signs appear during warm-up and then disappear during the session.
If they persist after the warm-up, this is a sign of sharp worsening.

Tendinopathies are real injuries of the fibrous structures. At a certain level of evolution, some types of damage are irreversible. The fragility of the tissues may even cause the rupture of the tendon.

Early medical support, as soon as the first pains appear, contributes to the return to a normal state.

Neglecting the first signs will favor the evolution into irreversible damage and thus into chronicity.

We will deal with how to treat these affections next month in the “treatment” section.

References :

BRUCHARD A., DUEE T. : Les lésions tendineuses : conceptualisation et clinique. Profession Kinésithérapeute n°19, 2008.
CHANUSSOT J.C., DANOWSKY R.G. : Traumatologie du sport, Ed. Masson, 5ème éd., Paris, 1999.

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Pulley rupture

poulisam-s The pulley, that is the pulley of the finger flexor tendons, is a fibrous structure the role of which it is to maintain the tendon at its place along the bone..... 

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Francis HELIAS
Jocelyn-William LOUBRIAT

Definition

The pulley, that is the pulley of the finger flexor tendons, is a fibrous structure the role of which it is to maintain the tendon at its place along the bone.
We call it a partial or complete pulley rupture when one or more of these structures give way to excessive stress.

poulisam

poulilesm

Fig 1: Anatomy of the pulley digits
Fig 2: Damaged pulley

The rupture can occur brutally, with a sharp crack audible several meters away, but it can also rupture more progressively. It is often – but not always – accompanied by pain and an oedema.

The diagnosis can be made by an experienced medical practitioner or, in case of doubt, by use of CT scan or magnetic resonance imaging (MRI).


Mechanism of the lesion

Crimp holds leads the tendons to presenting a significant angle. The resultant of the forces exerted on the pulleys can reach their rupture point (around 200N – between 137N and 147N for A2, between 193N and 210N for A4), especially if the stretching manoeuvre is brutal as when landing after a dyno.

Fig.3 : Forces exerted on the pulleys 
(source: Photos S. GNECCHI, schemes inspired by the work of L. VIGOUROUX
Excerpts from the article of F. MOUTET and S. GNECCHI)



It is crucial to realize that the repetition of similar efforts or of the same movement (training of a specific move) may weaken the tissues. Most pulley ruptures occur after too much training and after having neglected the warnings (pain in the fingers, swelling).

Prevention

Technique correction:
Learn to grab the holds open handed and use crimp holds only if you have no other choice.

Correction of the planning:
Take a rest of one or two days between 2 intensive sessions for the fingers.
Respect the alternation load/unload and intensity/volume.

Correction of the physical preparation:
Training the finger muscles should only be done when they are stretched (unless that you decide voluntarily to pull on your pulleys, but then you yourself are responsible). Be aware of plyometrics on the Pan Güllich: load + inertia = DANGER.

Warm ups help to reduce friction and strain on the pulleys. Stretching favours recovery.


Treatment

Put ice on it as soon as possible

It is strictly forbidden to climb and you must see a hand specialist.

The injured finger should be immobilized by taping or as shown here if you can not get any thermoforming material. .
Once the diagnosis is made by the specialist, you must plan to undergo surgery if the rupture is complete, which involves stopping any climbing activity for at least 3 months.

In case of partial rupture, it is strictly forbidden to climb for at least 45 days; an appropriate physical therapy is also necessary.

References :

MOUTET F. et Al : Pathologies de la main du grimpeur, Kinésithérapie Scientifique, Ed. SPEK 2010; (511): 5-14

THOMAS D. et Al : Rééducation des lésion des poulies digitales chez le grimpeur, Kinésithérapie Scientifique, Ed. SPEK 2010; (511): 15-21

GNECCHI S. et Al : Les traumatismes des doigts en escalade chez le grimpeur "anciennement lésé", Kinésithérapie Scientifique, Ed. SPEK 2010; (515): 23-33

VIGOUROUX et Al : Estimation of finger muscle tensions during specific sport-climbing grip techniques. Journal of biomechanics 2006:2583-92

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Epicondylalgia

alta_avt-bras 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).

alta_avt-bras

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.

 
Mechanism of the  lesion

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

 
Prevention

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).

 
Treatment

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).

 
strap1 strap2

strap3

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Compartment syndrome of the forearm flexor muscles

coupe3 Effort-related compartment syndrome is a deficit of blood supply to the forearm muscles. To understand this, ...

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Lison RAULT

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.

coupe1coupe3

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.

Mechanism of the lesion

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.

Prevention

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.

trait1

trait2

trait3

traits4

 
Treatment

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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Cervicalgias

rachis-cervical 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.

rachis-cervical

Side view of the cervical spine

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.
Joint contracture or overuse can also lead to conflicts with nerves, that are numerous in this region (Arnold’s neuralgia which radiates “as a helmet” to the head, cervicobrachial neuralgia which radiates to the upper limb).

occ-cervical-post
Posterior view of the skull and the first cervicals

from Michel Dufour, Anatomy of the locomotive apparatus


Mechanism of the lesion

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…).

chantal-sans-CU


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,.

steph-sans-CU-position-corr
Corrected position, by working the opening of the thorax

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.

chantal-avec-CU
Position with the wearing of the CU glasses. (photo of the glasses : Pofroad)


[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.


Stretching of the neck muscles

Specific mobilization exercises for the neck

For prevention, it is necessary to remember not to crack the neck too often. Cracking maintains hypermobility of the cervical joints causing hyper solicitation and thus favours premature wearing.

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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Carpal tunnel syndrome

canal-carpien0002m-s 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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Jocelyn-William LOUBRIAT
 

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.


canal-carpien0002m

Fig 1: Transverse cut of the carpus,
by M.Dufour, Anatomy of the locomotive apparatus

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.

etirement_flechisseurs_dgtm

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.

postureextm postureflexm
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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Shoulder instability and dislocation

luxation 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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Jocelyn-William LOUBRIAT
 
Definition

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.

rx-luxation
X-ray of a dislocation
source wikipedia commons

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

The scapulo-humeral joint is made up by the glenoid fossa or cavity (articular surface of the scapula), the glenoidale labrum (a fibrocartilaginous rim) and the head of the humeral.

anat-epaule-1anat-epaule-2

Anatomy of the scapulo-humeral joint

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.

anat-epaule-3anat-epaule-4

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).


Prevention

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.

Treatment

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.

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Tenosynovitis

gaine_pouliem-s This term describes the inflammation of the synovial sheath that surrounds the tendon (fig 1). In climbing, it refers to the inflammation of a synovial sheath that surrounds the tendons of the flexors...

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Francis HELIAS
Jocelyn-William LOUBRIAT
 

Definition

This term describes the inflammation of the synovial sheath that surrounds the tendon (fig 1). In climbing, it refers to the inflammation of a synovial sheath that surrounds the tendons of the flexors of the fingers.
It usually appears suddenly, with acute pain around the first phalanx (P1). It is possible to have the pain radiate to the palm or even to the forearm. Sometimes you can see an oedema at P1 level.
It is often mixed up wrongly with a pulley rupture because of its sudden appearance but it is not as serious as a pulley rupture. However, it should not be left untreated.
A comparison can be made between the state of the sheath during a tenosynovitis and the state of the skin during a “steak”: imagine the little bleeding of the sheath and you will understand why it hurts

Fig 1: Situation of the sheath

Mechanism of the lesion

It appears during a crushing of the sheath between the pulley and the tendon or between the hold and the tendon.
It is the result of an intense mechanical impact that occurs only once or less intense impact that occurs repeatedly.
It is important to take into account that the repetition of the movement is really harmful for the structures.
When holding a crimp, the sheath is crushed between the tendon and the pulley (fig 2).

When grabbing an angular hold with an open hand grip, the sheath is pinched between the rock and the tendon, such as the bone (fig 3).

Fig 2: Friction between the pulley and the tendon

Fig 3: Friction between the tendon and an angular hold

Prevention

Technique correction:
Use open hand holds and slopers with an open hand grip, avoid angular holds or hold them in a way that is non-traumatizing.
Correction of the exercise schedule:
Respect the fact that progress is gradual, do not train too hard without rest, adjust the intensity and the work-out to your level.
You need to spend a period of 3 weeks with maximum the strength and the resistance training.
Correction of the physical preparation:
Progressive training of the muscles of the fingers before starting a maximum project, especially for one-finger, two-finger holds or crimps.

Warm-up and stretching exercises you should never forget.

Treatment

Stop the session.
Put ice on it the fastest you can. Then apply an anti-inflammatory gel.

Do not use you finger as long as the pain persists at rest.
Put on a ring of strappal® (fig 4), which enables you only to take open hand holds and keep it on day and night for ten days. Change it every day; put ice on it and then again the anti-inflammatory gel.

Fig 4: Tapping of the finger

Take up training again but do not use traumatic holds (open hand grip on angular and crimp holds) and avoid all pain (if it hurts: stop).
See the sport doctor if the symptoms persist (no infiltration).
Some physical therapy sessions with ultrasound can accelerate the healing.

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Finger flexor tendinitis

tendin1m-s The word tendinitis refers to inflammatory damage of the tendinous structure. Nowadays, it is recognized that most of the time this term is wrongly used to describe a tendinosis...

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Francis HELIAS
Jocelyn-William LOUBRIAT
 

Definition

The word tendinitis refers to inflammatory damage of the tendinous structure. Nowadays, it is recognized that most of the time this term is wrongly used to describe a tendinosis, that is a degenerative condition with micro-rupture of the tendon. In that case, the inflammatory condition is just one of the consequences.
In the case of fingers, the flexors of the tendons have to support huge pressure which could cause micro-ruptures.
Usually, a distinction is made between several stadiums in tendon conditions. These are:
1) pain during the warm-up which disappears once warm.
2) the pain persists after the warm-up and then also at rest.
The « tendinitis » is evident when pain is felt during palpation, contraction and stretching.

Mechanism of the lesion

The tendon wears out like a rope exposed to tension and high friction.
The higher tension and friction the more it wears out.
Crimp holds (fig 1) favour friction on the pulleys and exert tension on the parts situated in the convexity of the curve of the tendon (fig 2).
The impact on the tendons caused by the reception of a dyno (dynamic movement) are most probably the principal cause of this condition. The phenomenon is increased when crimping the reception hold.
Ones again, it is important to take into account that the repetition of the movement is really harmful for the structures.

Fig 1: Schematic strain of the tendon in a crimp

Fig 2: Strain on the convexity of the tendon

Prevention

Technique correction:
Use open hand grips as often as you can. Place your feet properly so as to relieve the tension in the tendons.
Correction of the exercise schedule:
Take a rest of 1 day between each maximum strength session for the fingers. The strength cycle should not exceed 3 weeks.
Do not exceed 3 strength sessions per week. Remember to vary your pleasure; resistance and continuity are also very important even in bouldering.
Correction of the physical preparation:
The training of the finger muscles occurs only in open hand position.

You should never forget warm-up and stretching exercises (fig 3).

Fig 3: Stretching of the finger flexors

Treatment

Ice treatment as soon as the symptoms appear, after each session by taking a bath or getting a massage with ice cubes.
Application of an anti-inflammatory gel after the ice treatment (respect the manufacturer’s directions).
Strict stretching exercises, before the effort (active stretching – refer to the stretching form), and after the effort (passive stretching – refer to the stretching form).
Reduce the intensity of the finger training sessions.
If the pain persists after the warm-up, do not overdo the training and consult a doctor (attention no infiltration).

Read more...

Finger sprain

anat_lgt_dgtm-s A finger 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)

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Jocelyn-William LOUBRIAT
 

Definition

A finger 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) (fig 1).

The collateral ligaments of the proximal interphalangeal articulation (PIP) of the fingers are generally the most affected.
The sprain is an accident with almost immediate pain and instant functional inability, and with an oedema that can be more or less severe.

The extent of the pain, the functional inability and the oedema depend on the severity of the lesion (from simple stretching to complete tearing of a ligament).

A probable effect of a sprain is a lateral laxity of the articulation due to a lack of support, because the ligament does no longer play its role.

 

anat_lgt_dgtm

Fig 1: Anatomy of the interphalangeal ligaments

Mechanism of the lesion

The fingers’ twisting is responsible for the sprain.

Some complex holds require twisting the fingers, as e.g. with oblique holds.
The risk is equally high when climbing in narrow cracks as it is with deep holes: the finger can get stuck in the hold.
A bad landing on a hold after a dynamic movement or on the ground after a fall can also be disastrous for the collateral ligaments of your fingers.

This might seem redundant, but it is important to understand that repeating identical strain on a structure, in this case a ligament, leads to damage to it.

 
Prevention

Technique correction:
Learn to better place your fingers, grabbing a hold with precision is extremely important.
Remember to make sure you can exit your fingers from deep holds when making dynamic movements.

Correcting the planning schedule:
Do not carry heavy loads without rest and do adjust the intensity to your level.

Correction of the physical preparation:
A rigorous warm up of the fingers allows waking up the nervous receptors which are able to inform the organism of wrong articulation placements.

 
Treatment

Stop the session immediately and put a lot of ice on it at soon as possible (ice cube massage).
Immobilise the finger with a syndactyly strap (strap to the next finger).
Continue to put ice on it, 3 times per day, and apply an anti-inflammatory gel for one week.
Continue to put ice on it if the pain persists after one week.
A sprain is no harmless lesion.
We strongly recommend that you see a specialist in sports medicine as soon as possible so that you will receive adequate treatment, which should include physical therapy. The sooner the lesion is treated, the lower the risk of persistent problems.
Be careful, in cases of serious sprains with a possible dislocation, consult an orthopaedic specialist for hands.

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Lumbrical tear

monodgt2m-s 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...

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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.

lombricm

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).
lombrical-tearm monodgtm
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).


monodgt2m

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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Treatment

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.

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Digital avulsion

section-dgt0001m-s Digital avulsion is a very serious condition that occurs more frequently than people generally believe.

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Jocelyn-William LOUBRIAT
 

Definition

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).

degantagem

Fig.1 : Degloving (picture Thierry Dubert)

section-dgt0001m

Fig 2: Complete amputation

Mechanism of the lesion

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).

section-dgt2m

Fig.3 : Mechanism of avulsion by a ring

A finger that is introduced in an expansion piton, can be subjected to the same fate.

Other mechanisms while falling: the leader sometimes tends to hold on to the rope tightly at the knot. If the rope is spiralled, one or more fingers can be severed (not as clean a cut as by a ring) the moment the rope is tightened.

It can also become dangerous for the belayer’s fingers during a high fall, because the rope can slide in the brake and get the fingers caught in the device.

All these examples of accidents have really happened.
 

Prevention

Technique correction:

Never climb with a ring.

Never put your finger in an expansion piton, a piton or a sealing.
Learn to fly, and train regularly to do it so as to lose the reflex of catching the rope in front of you.

 

Treatment

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

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Epitrochleitis

epitro-s The epitrochlea designates the inner part of the elbow, where the flexor tendons of the fingers and of the wrist are located...

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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).

epitro

Fig 1: Location of the epitrochlea

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.

Prevention

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).

etirement flech dgt

Fig 2: Stretching of the flexor muscles of the fingers and of the wrist
Treatment

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.

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Conditions of the shoulder

boursesm-s

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.

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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.


boursesm

Fig 1: Shoulder joint and serous bursas

Mechanism of the lesion

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


caim

casm

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

Prevention

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.
Treatment

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.

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Sprain of the tibial collateral ligament of the knee

lctm-s

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).

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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)


lctm

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


Mechanism of the lesion

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).


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

Prevention

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.


Treatment

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.

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Meniscal lesion

menisk2m-s Menisci of the knee are fibrocartilage elements whose role is to split the constraints which are transmitted from the thighbone to the shinbone... 

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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

menisk1

menisk2m

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

Mechanism of the lesion

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.

flex_max_gnm

Fig 3: Knee movement in maximum flexing


Prevention

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.



Treatment

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.

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Ankle sprain

flexmaxm-s 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).

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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.


Mechanism of the lesion

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).


inversm

eversionm

flexmaxm

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.

Prevention

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.


Treatment

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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Lumbago

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

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Jocelyn-William LOUBRIAT
 

Definition

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

localisation

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.

Mechanism of the lesion

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.


retroversion

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.


anteversion

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-lombaire

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".


Prevention

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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· {avrpopup type="lightbox" id="lecteur_11"}Latissimus dorsi muscles{/avrpopup}

· {avrpopup type="lightbox" id="lecteur_21"}Psoas iliac muscles{/avrpopup}

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· {avrpopup type="lightbox" id="lecteur_23"}Quadriceps{/avrpopup}

· {avrpopup type="lightbox" id="lecteur_24"}Hamstrings{/avrpopup}


Treatment

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.

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