During the SEA Boulder Planet event 2 weeks ago, I made a remark to one of the participants: "The number of finger and wrist injuries that I have seen in these 2 days is more than the number of hand and finger cases I have seen in my entire career combined!"
If you have missed it, here is the link for a recap of the event: https://www.yongkangtcm.com/post/nothing-out-of-reach-sea-bouldering-league-2024-round-1-event-recap-and-reflections
In sport, there are a few dimensions that need attention if the athlete wants to be able to dedicate a long time in the sport, however the definition of "long" might be different for each athlete. Generally speaking, the higher likelihood of both the repetitiveness, duration and atypical movements that are required in a sport, the more the athlete has to pay closer attention to recovery and pro-active strengthening (also known as 'prehab').
Type of sport | Repetitiveness | Atypical movements | Duration |
Road cycling | High | Low | Medium to Long |
Swimming | High | Low to medium | Short to Long |
Running | High | Low | Short to Long |
Muay Thai | Moderate to High | Moderate to High | Short to Medium |
Football | Low to Moderate | High | Short to Long |
Crossfit | High | Moderate to High | Moderate |
Bouldering | Moderate to High | High | Medium to Long |
Red = endurance sports
Blue = Contact sport, ball sports and crossfit
Orange = Bouldering
Typically, sports that involve a lot of unplanned movements like football or martial arts, generally have an increased injury risk owing to the nature of the sport. Preparing the muscles, joints and tendons has to be even more specific for sports like these as the injury risk is higher.
Some of the most common injuries I have witnessed during the competition were TFCC tears, finger tendon sheath inflammation and shoulder impingements. I will spend some time to talk about these three conditions in this blog post.
TFCC tears
The TFCC, or the Triangular Fibrocartilage Complex (TFCC) in the wrist is an important soft tissue structure that plays a important role to stabilise and provide shock absorbence for the wrist. It also functions like a suspension strut, distributing the forces between across the wrist. The TFCC is important especially in pronation and supination movements of the wrist, and is also commonly strained into wrist extension, often with excessive weight or trauma.
The TFCC is positioned between the pinky and the forearm, just over the wrist.
Common types of trauma to the wrist include falling on an outstretched hand, or from repetitive movements which are typically performed by athletes and manual labourers. This can also be a result of having poor biomechanics that load the wrist into an awkward position.
The common signs and symptoms of TFCC tears are clicking and popping sensations of the injured wrist, typically accompanied by pain directly over the wrist. Movements which are painful often involve lifting items across the wrist, twisting movements over the wrist especially with resistance (turning a doorknob or twisting a key).
Typically with TFCC tear rehab, there is first an immobilisation phase that should be adhered to. This is to give the TFCC ample time to recover before loading and stressing the tissues involved, as part of later stage rehab.
Finger tendon sheath strain
One of the other more common injuries I have seen is strain over the finger tendons that restrict the full natural range of motion that is present in the fingers.
The tendon sheaths of the fingers wrap around the finger on both the palmar and the dorsal aspect of the hand, and provide a path to guide the tendons. The muscles of the fingers originate from the forearm, and through this sophisticated system of pulleys, provide fine motor movement at the finger.
In climbers, the tendons are typically strained from the biomechanical strain of needing to be able to exert a huge force, sometimes for a prolonged period of time. This results on the tendon sheaths to be strained beyond their capacity, and will either present as stiffness (fingers cannot be bent all the way to form a fist) and/or with swelling and pain directly over the joint.
Netter's Anatomy
The best advice I can give for climbers, as hard as it may be to accept, when experiencing swollen joints and the inability to bend the fingers, is to take a pause from the sport. This is to allow the tendon sheath structures to fully recover from strain.
It might also be worth considering doing cross-training. An effective type of cross-training for climbers is to do strength training at the gym, specifically for row-type movements like pull ups, bicep curls. Exercises like these help to strengthen the wrist and the muscles supporting them, without straining them excessively.
Shoulder impingement
The rotator cuff muscles are an important group of muscles that stabilise the shoulder during movement. They consist of the Supraspinatus, Infraspinatus, Teres Minor and the Subscapularis. These muscles are responsible for a lot of the movements at the shoulder joint. The rotator cuff muscles work together with other muscles in the upper and mid back to perform athletic movements.
Shoulder impingements are usually a result of a imbalance in muscle strength ie. super strong muscles for one movement and weak muscles for the other, combined with either repetitive strain or a posture-related trigger.
Often, a muscle that is weak in one of these groups can create pain and discomfort. The most common area for pain above the shoulder is directly over the shoulder, and this is triggered either by raising the arm overhead, or by reaching behind the back.
The treatment for shoulder impingement is highly personalised, as the reasons for pain and weakness differs from person to person.
Muscle imbalances in the shoulder often development from repetitive use of the shoulder in a specific set of movements that do work more muscles than others, and are common injuries in sports like swimming and bouldering. For this condition, it requires a proper assessment in the clinical setting to determine what is the issue before rehab exercise prescription and recommendations can be given.
To summarise, these is a brief summary of the conditions which are common to climbers. To be able to keep doing the sport, some level of knowledge about rehab and recovery can go a long way. A general guide is that if pain from an injury lasts more than 2 weeks even with rest and medication, you should consult a healthcare professional like a GP, orthopaedic surgeon or a Physiotherapist to treat the problem soonest!
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