So here we are; the second chapter on the pathology and the prevention of injuries in sport climbing. In this section,we will talk about thehands, from ananatomical, a biomechanical and a preventive point of view.

The hand is the sensitive element of the kinetic chain of the upper limb, it is the first point of contact with the surface and therefore the first to receive information and adapt accordingly to correctly transmit the force needed to hold the hold. As in other areas of the body, the hand is made up of bones and ligaments that act passively to support and transmit strength; from muscle fibres and tendons that explicate an active role in the motor action.

The majority of the contractile component with the action on the hand (superficial and extensor deep flexor) does not come from the hand but from the forearm. That is why a good muscular balance between agonists and antagonists in the cranial segment allows the hand to function well and therefore there is a lower functional overload on the passive structures.

la fisioterapia della mano

The tendons of the muscles mentioned above are wrapped in a tendon sheath at the point where they arrive at the fingers; it is a thin coating that allows movement, protection and nourishment. The tendons are maintained in the correct position by the famous pulleys. The pulleys are ligamentous rings that are anchored to the bone with the aim of keeping the tendon in axis and to improve its lever. Tendons, sheaths and pulleys make up a complex functional unit and this is why an inflammation in many cases is not down to a single element but may involve more than one element from the functional system.

The majority of climbers (about 3 out of 4) have suffered an injury to their upper limbs at least once in their life. Of these, approximately 60% are hand injuries and in particular the tendons and the pulleys. The repeated movements, the important functional overload (thanks to the very specific and traumatic training methods, like the fingerboard and the campus board) and poor vascularisation (with a poor reparative-metabolic system) means that this is the most vulnerable and susceptible body part to injuries. Therefore, it is very important to educate oneself about the prevention, the recognition and above all the respect for the integrity of these structures.

The various studies reported in literature, agree that the arched position of the fingers while taking a crimp, significantly prompts the functional unit, considerably increasing the likelihood of injury compared to when taking other types of holds.

presa arcuata

From a clinical point of view, a pulley injury can be recognized from various symptoms:

• Painwhile flexing thefinger
• A sharp andsevere painat the baseof the first phalanx
• Swellingand/orbruising on thefirst phalanx
• At the time of the accident a loud pop was heard
• Protrusion of the tendon if two pulleys were broken

The therapy that is recommended for this type of injury is:

• Immobilization
• 4 to 16 weeks of rest depending on the severity
• NSAIDs (only if advised by a doctor)
• Ice
• Rehabilitation
• Protection with tape for 6 months (even if you do not feel any pain)

The Tendovaginitis (the inflammation of the tendon sheath and the tendon) from a clinical point of view is presented by the following:

• A deepandconstantpainin the hands, alsoduring movement
• Irritation
• Swelling
• Sensitivity to compression

The recommended therapy is as follows:

• Immobilizationof the finger
• Variable restaccordingto the damage
• NSAIDs (only if advised by a doctor)
• Injections / Mesotherapy
• Ice
• Physiotherapy
• Protection with tape

Because of the poor vascularisation, finger injuries take much longer to recover from. Therefore it is better to try to prevent these damaging events as much as possible. The basic rules for preventing any type of injury in climbing but also for any other sports are the following: an appropriate preparation, dedicating a descent amount of time to the warming up phase and a proportionate and progressive training leading up to the most physical phases; a good balance between the agonist and the antagonist muscles and finally good muscle-tendon flexibility.

More specifically for climbing, vary as much as possible the type of hold used and do not focus too specifically on the use of training tools such as a fingerboard or a campus board. Preferably during training avoid using the classic crimp position with arched fingers closing them with the thumb on top, replacing it with either partially arched fingers or open hand. Avoid using very small holds that do nothing but expose your fingers to unnecessary suffering and pain.

Be progressive in the warming up phase, firstly using large holds and then gradually decreasing the size of the holds. Dedicate yourself in every training session also to the reinforcement of the extensor muscles of the fingers and wrist; also concentrate on this while warming up.

allenamento mano

• 15 – 20 stretches extending the fingers and opening the hands for 4 or 5 sets
• 15 – 20 lateral stretches of the fingers with an open hand for 4 or 5 sets

estensioni

• 15 – 20 extensions of the wrist for 4 or 5 sets with a 1,2kg weight.

Strengthening the wrist allows for a better fixation of the fingers at the time when you take a hold thus helping to prevent inflammation of the elbow.

At the end of the session perform specific stretching exercises for the flexors and the extensors of the wrist and fingers (thus restoring the contractile unit to the correct length and flexibility).

Maintain the position of maximum elongation for at least 30-40 seconds for 2 or 3 times on each finger. Even for chronic pain, repeating this exercise many times helps to resolve the problem. In fact, the lack of flexibility of the tissue can cause compression of the nerve endings.

distendere le dita

Maintain the position of flexion and or extension for 40-50 seconds for 2 or 3 times on each hand. The exercise can also be performed by combining the lateral flexion of the arm, to increase the fascial and neural tension.

Perform small and light intermittent tractions on the joints of the fingers to encourage blood flow and therefore increase the metabolic exchange. The traction of the finger and of the various joints of the fingers must be very light.

trazioni

Make sure you carry out proper functional taping in case of some pain or if you are returning from a more severe injury. Apply the first piece of tape at the first phalanx near the joint with the second phalanx. A second layer of tape must be applied to the second joint around which you have to do double it up. Apply a third piece of tape over the origin of the other two pieces. While you place the piece of tape from one phalanx to the other keep your finger slightly flexed (about 30 °), to maintain good mobility.

nastratura

So now that you have been educated on looking after yourself, never underestimate when you feel pain.

Silvio Reffo