Climbers' hands: injuries, treatment and prevention. Prevention is better than cure! Part 2
By Tim Halsey
Consultant Hand & Orthopaedic Surgeon
Honorary Senior Lecturer, University of Sheffield, Visiting Research Fellow, Leeds Beckett University
Climbing open palm, and deliberately engaging both FDS and FDP shares the load across the whole pulley system, rather than the point load of the distal A2, which occurs in deep crimping (PIPJ hyperflexion and DIP extension). From an injury prevention perspective, the advice to actively flex the DIPJ (and thereby engage FDP) on has the potential to make climbing safer for fingers.
Figure 3: Actively engage FDP
Taping: does it work?
Lots of climbers use tape and I am often asked whether I think it ‘works’. Cadaveric studies has shown that the forces involved can never be overcome by simply wrapping the finger with tape (Schweizer). However, if used appropriately, then tape prevents deep PIPJ flexion, encourages engagement of the FDP and a more open palm technique, and so indirectly protects the pulleys by sharing the load across the entire pulley system.
Figure 4: Taping illustration
There are a number of different taping techniques, but the H-taping method has been found to be effective, is recommended in recovery from pulley injury and there is a helpful guide to taping online: https://youtu.be/WieIamRpH08
Teenagers: how are they different?
A2 pulley ruptures are the classic climbing injury and hopefully the discussions surrounding open palm technique and taping help with understanding this. There is another area of concern, which particularly affects climbers with open growth plates and has the potential to halt a young climber’s career.
The classic ‘little leaguer’s elbow’ is an example of how a certain patient group were noted to be susceptible to a particular injury with a combination of overtraining on open physes. Systems have been put in place to change the exposure that adolescent teenagers in America face from excessive baseball pitching. The PIPJs of teenage climbers are similarly at risk.