Orthopedic injuries in Climbing

“Snap, Crack, and Pop: Orthopedic Injuries in Climbing”

Intro:

We’ve all done it. Or maybe we’ve seen our partner do it. Maybe it was the guy a few lines down the rock. But sooner or later, we’re going to get hurt from climbing. That’s the bad news. The good news is that with proper training, first aid, follow-up care, and rehab, our injury-induced down time can be limited.

Most injuries from climbing are orthopedic in nature: they involve the bones, ligaments, and tendons. True, skin tears and cuts, bruises and bumps, stings and bites do happen, but the majority of serious climbing injuries are orthopedic in nature. We’ll talk a little about the injuries, what to do for them, and how to limit the chance of reinjury.

Prevention:

Without a doubt, good physical conditioning is the best possible measure to prevent getting an ortho injury. You should be in moderately good physical condition, with a proper balance of strength, flexibility, and cardiovascular conditioning. Strength training is covered in many different articles, so repeating that info is pointless. Suffice it to say that strength is a measure of power exerted over time, and stronger muscles will get injured less often. Flexibility allows the muscles, tendons, and ligaments to stretch and return to normal. A good stretching routine should be a part of every day climbing, as limber muscles will tear less, recover from exertion more often, and allow for better climbing. Static stretching is the best method: lean into the stretch until you start to feel muscles tighten, and stop. Hold that position for 10-30 seconds, and slowly release. Dynamic stretching, or ‘bouncing’ into a stretch, is not recommended, as it tends to injure the muscle more than it helps. Cardiovascular training is anything that increases the effectiveness of the heart and lungs. Running, cycling, swimming, stair-masters, treadmills, hiking, and other sports are all excellent cardiovascular workouts. The better the heart and lungs work, the better they can pump blood to the muscles. More blood in the muscles means less “pumpy’ or “burning” feelings.

Tendons:
Tendons connect the bones and muscles. They can be over exerted, and when this happens, you’ve got a strain. Most commonly felt as a burning sensation in one specific spot (usually over the tendon,) sometimes accompanied with a “snap” sensation, they are not frequently debilitating, though they can be painful. More common with tendons is chronic tendonitis. Tendonitis is an inflammation process resulting from repetitive movements, repetitive strains, or excessive stress. This condition is more painful, and will often recur days or weeks after the initial pain. Treatment of either a tendon strain or tendonitis is straightforward: PRICE. PRICE is an acronym that stands for Protection, Rest, Ice, Compression, and Elevation, and will be discussed in depth a little later. Post strain strength training will also help prevent re-injury.

Muscles: Every movement in the body is the result of a muscle. Without muscles, we’d never move at all (kinda like my cat, it seems.) The sport of climbing utilizes most every major muscle group: legs, chest, arms, and back. Over exertion of the muscle can cause pain. Excessive stretching of the muscle can cause a tear. Extreme over exertion and stretch can cause total muscular rupture (the climber will frequently report a hard “snap” sensation or even sound… not fun.) Stronger and more flexible muscles will not be injured as easily, hence the recommendation that you get into shape. Either way, muscle injuries are often described as a “sore” or “ache” sensation, usually spread out over the muscle, with more severe pain for a tear or rupture. Ruptures can sometimes be felt as a “divot” in the muscle (more easily felt in the calf, biceps, triceps, forearms, and thigh.) Strain or small tears will often heal themselves, but the pain can slow the process. Ruptures require surgical repair. Either way, a prescribed muscle relaxant will help with the pain and discomfort, and speed the healing process. After a tear or strain, it’s important to return to activity slowly, and include specific strengthening exercise, to help prevent re-injury.

Bones: Nice things, bones. They’re the part that keeps us from existing as shapeless blobs of tissue, lying on the floor (see: above reference to cat.) Stronger than most people can imagine (the femur, or thigh bone, can hold nearly 4000 – or 17 KN-- pounds of in-line force before breaking,) they have been known to break from time to time. When this happens, you’ll know it. There is a hard “crack” sensation, often audible, and the pain will be very specific: “It hurts right HERE!” There will be swelling, pain, and instability. You may or may not feel a grinding sensation as the bone ends rub together (known as crepitus.) Bone injuries always, repeat always require a doctor’s care. The fracture must be set and casted in a certain way to promote proper healing. Some fractures will need surgical repair to insert pins, metal rods, or other devices. Here are some pictures of a fractured femur with metal rod repair.



Don’t mess around with these… get to the ER, and do it quick. Bones can also dislocate, which means they slip out of normal alignment. This can be painful, but with quick replacement, they often do not result in permanent damage. Here are a few pictures of dislocated fingers.

Ligaments: The last part of the ortho injuries focuses on ligaments. These hold one bone to another, and are important in creating stability in the joints of the body. When they stretch, it’s called a sprain. When they tear or rupture completely, it hurts. Bad. Created by extreme excessive force, a ligament tear will feel like a “pop” in the joint, and there will be rapid and extensive swelling. Movement will be minimal, and pain is common. Again, severity determines treatment and outcome: sprains often heal with little intervention other than PRICE, and ruptures or tears might require surgery. Great advances have been made in orthopedic surgery, and what was once a career ending injury (ACL, or Anterior Cruciate Ligament) is now an inconvenience for 6-8 months. A good sports medicine doctor will be able to tell you more.

Treatment: Despite social dogma, there is no great mystery to medicine. Common sense should prevail in the ER, and it should also prevail at the local crag. First and foremost, make sure there is no serious bleeding. While strains and sprains won’t bleed, an open fracture of the leg can bleed a fair amount. If there is bleeding, try to apply direct pressure, and figure out a way to get help (though a good safe climber would already have an evacuation plan in place.) Now, if there is no bleeding, look at the injured part. Is it deformed (i.e. bent in a place it shouldn’t bend)? If there is any deformity, it is likely broken, and you’ll need to splint it. Splints can be made from any rigid material, and should extend to the joint above and the joint below the injury. Make it snug, so the injured part will not move, but not too snug, or you’ll cut off circulation to the extremity (that’s a bad thing, by the way!) If there is no deformity, look for swelling. Any significant swelling immediately after the injury means ligaments, and that means the day is done. Go with PRICE treatment, and get to a doctor. No swelling? Then you can test the injury GENTLY. Move it slightly, and check to see how much it hurts. If there is little pain, then try to put weight on the injured part. Again, if there is little pain, you might be able to get thru the rest of the day. If you decide to do this, understand that continued activity on the injury might make things worse.

PRICE:
Protection – best done with a splint, and designed to protect from further injury. Some commercial splints are available, but when at the wall, you might need to improvise. Pillows, blankets, magazines, tree limbs, and even a coil of rope will work in a pinch. Rest – Yeah, nobody likes to take time away from climbing, but the body needs time to heal, and continual stress on an injury will only prolong the healing process. Spend a few days off, and let it heal. Ice – The most commonly used treatment for sports injuries, good old fashioned frozen water will do several things: help limit swelling, help reduce the level of inflammation, numb the injured part and reduce pain. Chemical cold packs are available, but only last about 20 minutes. Cold water will do for a short time. Snow-filled zip lock bags are an excellent idea. Cubes of ice in a bag are best. Whatever method you choose, try to limit the application of ice to 30 minutes at a time, with a 15 minute period between each application. Too much ice can hinder circulation. Compression – A compression wrap will also help limit swelling, along with providing a small measure of protection. ACE wraps are the most common (elastic stretch bandage,) and easily carried. Wrap from the part farthest from the body, working your way towards the body (for an ankle, start at the toes, and work towards the knee.) Elevation – Letting gravity work for you. Elevating the injured part above the level of the heart will let the swelling drain back to the body core. Less swelling = less time away from climbing. Medication: Numerous medications exist, but the best are called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) and include such things as Motrin, Advil, Aleve, and others. These will help with pain, inflammation, and get you back on your feet more quickly. There are a few things that should be mentioned, however. First, if you plan to take NSAIDs, you should only take them if you have food in your stomach. NSAIDs have been known to cause irritation of the stomach lining, leading to ulcers. You should also use caution if you have kidney failure or kidney disease. Further, Tylenol should be taken with caution if you have any liver impairment or liver disease. When in doubt, consult with a doctor. None of the above should be construed as authoritative medical advice. The best advice is to listen to your body, back off when it hurts too much, and see a doctor for any serious injuries. Proper treatment will limit healing time, and get you back to the vertical world. Till next time, be safe, and climb on. -- Jaydoc and Reno