TREATMENT AND DIAGNOSIS Injury

GRADE 1 Pulley strain

GRADE 2

Complete rupture of A4 or partial rupture of A2 or A3

Therapy Immobilisation Functional therapy Pulley protection

Easy sport-specific activities

Full sport-specific activities

Taping through climbing

Conservative None 2-4 weeks Tape

After 4 weeks 6 weeks 3 months

Conservative 10 days 2-4 weeks Tape

After 4 weeks 6-8 weeks 3 months

Table 1: Therapeutic guidelines for injury grades 1-4 (Schoffl et al, 2003)

pulleys and their role in preventing flexor tendon bowstringing, it would be logical to assume that taping would lend some pro- tection to the pulley. Two and a half turns of 1.5 cm width zinc oxide tape has a breaking strain of 500 N (4). However, studies have demonstrated that circular force is minimally effective at reducing force on the A2 pulley (9), and there is no statistically significant difference in load to A2 pulley failure between taped and un- taped finger pairs (10).

Biomechanical studies have also shown that taping over the distal end of the prox- imal phalanx may be marginally more effective than taping over the A2 pulley (9). However, the taping can only relieve pulley load to a significant extent when the external force is low. That is, the greater the force applied to the fingers, the less effective the taping or, the better the standard of rock climber, the less they benefit from taping.

Pulley injuries are largely based on finger position. While the crimp grip allows the most secure hand hold, it also places the greatest strain on the flexor pulleys. Avoidance of the grip during training peri- ods, by using the open grip may be the most significant preventative measure available (10).

Other authors have recommended an ade- quate warm up period and stretching prior to climbing. One study estimates that the average time spent warming up before

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climbing or training was eight minutes, and 45% of responders to the question- naire did not warm up at all (1).

Reducing the chance of slipping on hand holds should also reduce the incidence of shock loading on the finger tendons. Li et al demonstrated that the use of chalk (magnesium carbonate) in climbing actual- ly reduced the friction co-efficient by mak- ing the skin drier and less compliant and by acting as a slippery granular layer (11). The authors recommend that dry hands produce the best grip and that if chalk is used to achieve this all traces of it should be removed prior to climbing.

Climbers must appreciate the stress that they are putting on their bodies and that climbing should be viewed the same as any other sport with regard to proper training, early recognition of overuse injuries and adequate rest between periods of activity.

THE AUTHORS Marie Brookes BSc, MCSP, FRGS, is a military physiotherapist specialising in sports injuries and rehabilitation. She is a member of the high altitude development team for the Army Everest West Ridge expedition in 2006 and has provided physiotherapy sup- port to Team GB Ultimate and to Airborne forces during the invasion of Iraq in 2003. Dr Mike Brooks BMed Sci, BM, BS, FRGS is an army medical officer with an interest in medicine in the hazardous environment. He is a member of the faculty for the UK Diploma in Moutain Medicine and team doc-

tor to the Swaledale Moutain Rescue Team.

References 1. Bollen S. Soft tissue injury in extreme rock climbers. British Journal of Sports Medicine, 1988;22(4):145-147 2. Bollen S. Upper limb injuries in elite rock climbers. Journal of the Royal College of Surgeons Edinburgh 1990;35:18-20 3. Klauser A, Frauscher F, Bodner G, Halpern E, Schocke M, Springer P, Gabl M, Judmaier W and Nedden D. Finger pulley injuries in extreme rock climbers: depiction with dynamic ultrasound. Radiology 2002;222(3):755-761 4. Holtzhausen L and Noakes T. Elbow, forearm, wrist and hand injuries among sport rock climbers. Clinical Journal of Sport Medicine 1996;6:196-203 5. Schoffl V, Hochholzer M, Winkelmann M and Strecker P (2003) Pulley injuries in rock climbers. Wilderness and Environmental Medicine 2003;14:94-100 6. Marco, R. Sharkey, N. Smith, T. & Zissimos, A. (1998) Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. Journal of Bone and Joint Surgery 1998;80(7):1012- 1019 7. Klauser A, Bodner G, Frauscher F and Gabl M. Finger injuries in extreme rock climbers-assess- ment of high-resolution ultrasonography. American Journal of Sports Medicine 1999;27(6):733-737 8. Foreman S and Gieck J. Rehabilitative man- agement of injuries to the hand. Clinical Sports Medicine 1992;11:239 9. Schweizer A. Biomechanical effectiveness of taping the A2 pulley in rock climbers. Journal of Hand Surgery 2000;25(1):102-107 10. Warme W and Brooks D. The effect of cir- cumferential taping on flexor tendon pulley fail- ure in rock climbers. American Journal of Sports Medicine 2000;28(5):674-67 11. Li, Margetts F and Fowler I. Use of ‘chalk’ in rock climbing: sine qua non or myth. Journal of Sports Science 2001;19:427-432

www.sportex.net GRADE 3

Complete rupture of A2 or A3

Conservative 10-14 days 4 weeks

Thermoplastic/ Soft-cast ring After 6-8 weeks

3 months 6 months

GRADE 4

Multiple ruptures, as A2/3, A2/A3/A4 or single rupture (A2 or A3) combined with lumbri- calis muscle or ligament damage

Surgical repair Postoperative 14 days 4 weeks Thermoplastic/Soft-cast ring

4 months 6 months >12 months