tag:blogger.com,1999:blog-46926907426178635952024-03-17T20:04:02.806-07:00Tom's Physiotherapy BlogAnonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-4692690742617863595.post-29561004456047885452016-08-21T01:52:00.002-07:002017-04-18T22:17:47.600-07:00Big Move<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">Hi all</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">So.......some news.<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">I have now moved to New Zealand on a <span style="font-family: "arial" , "helvetica" , sans-serif;"><b>permanent basis</b> an<span style="font-family: "arial" , "helvetica" , sans-serif;">d so will not be making any changes to this blog or replying <span style="font-family: "arial" , "helvetica" , sans-serif;">to </span>any messages, as my focus has now s<span style="font-family: "arial" , "helvetica" , sans-serif;">ome<span style="font-family: "arial" , "helvetica" , sans-serif;">what changed<span style="font-family: "arial" , "helvetica" , sans-serif;">. I will be leaving the blog <span style="font-family: "arial" , "helvetica" , sans-serif;">u<span style="font-family: "arial" , "helvetica" , sans-serif;">p as a reference though. Thanks for reading!</span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">Please note, the post of footwear and climbing shoes was a guest post, so I can't answer any questions related to that</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">Thanks</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">Tom</span></span><br />
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<br />Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com2tag:blogger.com,1999:blog-4692690742617863595.post-59333676295549221432015-03-03T12:56:00.001-08:002015-03-03T13:01:41.272-08:00Inshoe foot pressures and forces whilst indoor climbing.<br />
<span style="font-size: large;"><span style="font-family: "Courier New",Courier,monospace;">So, there has been a lack of posts recently, I apologise, I've been working on an application for the Physiotherapy Board of New Zealand. This has been a lot of work and so taken up a lot of my time. However, below is a guest post by Robert Bradshaw-Hilditch, a podiatrist from Staffordshire:</span></span><br />
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">A recent straw poll of delegates attending the 3rd BMC Injury Symposium 2014 indicated that almost everyone has experienced some form of foot pain whilst climbing most often relieved by removing their climbing shoes. I am pretty certain that they are not alone in fact it was precisely this observation that led to this research being undertaken.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">The traditional approach to choosing a pair of rock shoes has been to go for something that is snug or tight fitting, I can certainly remember being given the salient advice of " go for something that a size smaller than you normally wear " by the longstanding members of my first climbing club. To this end countless published research (Killian (1998), Buda et.al. (2013), </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Sch%26%23x000f6%3Bffl%20V%5Bauth%5D" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline;">Schöffl</span></a><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> & </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=K%26%23x000fc%3Bpper%20T%5Bauth%5D" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline;">Küpper</span></a><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> (2013), continues to show evidence that climbers tend to go for a shoe size smaller than their normal shoe size. This research showed that this trend was still present, having said that we did have a number of subjects that were using like for like sizes or larger rock shoes. One of the interesting facts that the research did show was that when normal shoe size, rock shoe size and a measurement of the subject’s foot using a Brannock device was made and all three were on occasions different. All subjects were adults and let's face it for most of us it’s a long time since we had our feet measured for shoes. A point of conjecture regarding rock shoe sizes and the equivalent sizes of a normal shoe revolves around each manufacturer interpretation of shoe size, the process of measuring the size and how this is influenced by rock shoe design and lasting. (</span><a href="http://www.sciencedirect.com/science/article/pii/S0003687001000047#BIB1" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">van Egeraat and Snijders (1987)</span></a><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">,</span><span style="background-color: transparent; color: #2e2e2e; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">C.J. Snijders et.al. (1984) van der Putten (2001))</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">So what did we do, each subject was asked to complete a series of trials on the indoor bouldering walls a AWCC Stoke during which inshoe data was collected using a FScan (Tekscan) system. The inshoe data collected allows us to see pressure and force loadings occurring at the interface between the sole of the foot and the insole of the rock shoe. So what did we find, whilst climbing a right to left traverse our male subjects were producing an average loading force of 1531.60(sd 396) Newtons (N) under the left 1st MTPJ and 1653.11(sd 852.29) N under the right 1st MTPJ. The difference between the two values we feel is a representation of the direction of travel i.e towards the right and may well indicate how we use asymmetrical forces to produce equilibrium of movement. Whilst the loading rates are high what was also evident was how long the load was applied for in one case it was noticed that this load was applied for 8-10 seconds. This may not sound long but the next time your down the gym try leg pressing 168kg and holding it for 10 seconds, not forgetting you are using both legs and applying the load to whole of your forefoot. This reading was taken from the base of the 1st MTPJ an area of around 1cm2. We also collected impact data from a drop of 2 metres onto a 30cm crash mat giving us the following readings; average 2203.95(sd 656.95) N or 225kg and pressure data of 1371.55 (sd 575.60) kPa.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">So what does all this mean, firstly we how have imperial data demonstrating the force and pressure loading being experienced by the foot whilst climbing indoors, this data shows the magnitude and duration for which the foot is exposed to these load. Obviously these values will vary dependent upon a person’s physical mass, foot wear being worn, the complexity of the route being climbing, how long the footwear is worn for and whether you are leading or seconding.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">The data from the size of footwear reinforced existing research but may have hopefully started to show a new pattern is footwear size especially amongst those subject who only climb indoors and have recently started climbing. It is the combination of these factors that will combine to produce the discomfort that we have all experienced at some point along with whole host of other environmental, physiological and psychological factors. In essence each of these factors are exposing the forefoot structure to forces and pressure that could result in the occurrence of repetitive strain based injuries especially on longer climbs, climbing holidays or when training.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">The research team recognise that to change the mind sets and habits of any sporting population is a complex and difficult task but if we can help to influence those who are just venturing into the world of rock climbing and to maybe suggest that two pairs of shoes could be used. A pair that are your normal shoe size for training in and warmup use and if you wish a snug closer fitting pair for those projects or sends that you are working towards. </span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">So once again the simple take home messages are:</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Get yourself two pairs of climbing shoes, one pair that are your normal shoe size and only if you wish a snug closer fitting pair for competitions, projects or that send you have been working towards.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Take your rock shoes off between climb – give your feet a break.</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Take care of your feet as these provide the rock climbing attachment point for your main powerhouse muscle groups comprised of the core and upper leg. </span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZQviVGTuuesbzKjud52GsElFx1e7VmA12fNj2iWBRl9jN1TA-2uE-H3uDti1pV7L0rWzfuCkqKmpxixJFcKpjBpkkOGBl1g98xp2jxRGXR-uj20Fhs5sxl6mgoU0vkrzpZeJklqOxVI0/s1600/Untitled.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZQviVGTuuesbzKjud52GsElFx1e7VmA12fNj2iWBRl9jN1TA-2uE-H3uDti1pV7L0rWzfuCkqKmpxixJFcKpjBpkkOGBl1g98xp2jxRGXR-uj20Fhs5sxl6mgoU0vkrzpZeJklqOxVI0/s1600/Untitled.png" height="640" width="450" /></a></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: underline; vertical-align: baseline;">References:</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Buda R, Di Caprio F, Bedetti L, Mosca M, Giannini S, (2013) Foot Overuse Diseases in Rock Climbing An Epidemiologic Study. J Am Podiatr Med Assoc 103(2): 113-120</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">C.J. Snijders, W. Vuisting, A. Brokx. </span><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">Verbeterde beroepsschoenen</span><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">. Tijdschr. Soc. Gezondheidszorg, 62 (25) (1984), pp. 989–990 in Dutch</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Egeraat, J.M. van, Snijders, C.J., 1987. Een schoenmaatsysteem voor de nieuwe gevechtslaars PSU’80. Internal Report, Erasmus University Rotterdam/Inspectorate of Army Medical Service of the Royal Dutch Army in Dutch. </span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Killian RB, Nishimoto GS, Page JC 1998 Foot and ankle injuries related to rock climbing. The role of footwear. J Am Podiatr Med Assoc. 88(8):365-74.</span></span></div>
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<span style="font-size: small;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Sch%26%23x000f6%3Bffl%20V%5Bauth%5D" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline;">Schöffl</span></a><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> & </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=K%26%23x000fc%3Bpper%20T%5Bauth%5D" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline;">Küpper</span></a><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> (2013) Feet injuries in rock climbers World J Orthop 4(4): 218–228.</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">van der Putten E P, Snijders C J. Shoe design for prevention of injuries in sport climbing. Appl Ergonomics 2001. 32379–387.387. </span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: underline; vertical-align: baseline;">Additional Reading:</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn). Lochner Verlag: Ebenhausen. </span></span></div>
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<span style="font-size: small;"><a href="https://www.thebmc.co.uk/climbing-shoes-is-pain-insane" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Morrison A 2009 Climbing shoes: is pain insane? BMC</span></a></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Morrison AB, Schoffl VR 2007. Physiological responses to rock climbing in young climbers. Br J Sports Med 41;852-861.</span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Peters P. Nerve compression syndromes in sport climbers. Int J Sports Med 2001. 22611–617.617. </span></span></div>
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<span style="font-size: small;"><span style="background-color: transparent; color: black; font-family: "Helvetica Neue"; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Schöffl & Winkelmann (1999). Foot deformations in sportclimbers. Sportmed. 50:73–76.</span></span></div>
<span style="font-size: large;"><br /></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-60969377395971969312014-10-25T10:19:00.000-07:002014-10-25T10:21:11.441-07:00Goals and Cross Training<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now, I apologise for the lack of posts recently, it appears life has gotten in the way, but I'm going to try and kickstart these posts again.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">One reason why life has got in the way, is that I've just returned from a week's long climbing trip in Kalymnos. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now, over the week, I climbed harder, more routes and longer routes than when I first visited the island 2 years ago.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Yet I've been climbing less than I was prior to the first visit.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, what's changed?</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Firstly, I think knowledge of the island helps and the style of routes, therefore I was able to pace myself better and set some clear goals for the trip - of which I achieved.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Why did I achieve them? Because they were clear, concise, and realistic.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Secondly, I'm cardio-vascularly fitter than I was last trip, due to doing a little more running and cycling of late. This has meant that a) the walk-ins haven't knackered me out before I've even started and b) I've recovered quicker and easier on those longer routes</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This, combined with bouldering more, I've been able to complete harder moves on routes by viewing them as boulder problems and then making use of the rests on the routes. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Utilising all these methods also meant I didn't get injured, meaning I could climb every day and succeed in achieving my goals, and have a good holiday! </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, in summary, I think it's important in climbing, as with lots of other sports:</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">1. Set clear goals, make them SMART (Specific, Measurable, Achievable, Realistic, Timed)</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">2. Cross-train; i.e. do other activities/sports, not just climbing to ensure an all-round fitness. This applies to climbing different disciplines too, i.e. bouldering can help succeed on the harder moves on trad routes, etc</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">That's all I have to say this week, but there will definitely be two posts coming very soon, one on amputees in sport, the second will follow the next BMC Climbing Injuries Symposium</span></span><br />
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<br />Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-65410461120795873842014-09-02T13:06:00.003-07:002014-09-02T13:09:31.594-07:00Knee Injuries<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now, with knee injuries in rock
climbing, there are no specific injuries that climbers get due to our
sport – we get “normal” knee injuries, such as meniscus
problems and ACL ruptures. The only thing that differs is the
mechanism of injury, such as falls from doing an “Egyptian” or
heel hooks, phrases your standard doctor or sports physiotherapist
may not understand!</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But first, as always, to discuss the
anatomy of the knee, to aid your understanding of what's going on in
your joint:</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Knee anatomy</span></span></b></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now, the knee is a lot simpler to
understand compared to those joints with more movement such as the
shoulder, as it predominantly is a hinge joint, so moves forwards and
backwards only.
</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, there is a slight degree of
rotation and translation (moving forwards and backwards of the bones
without gross movement of the leg), and it's mainly these movements
that cause damage to the structures of the knee.
</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Bones</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN_SSzLHZoRRvG1OTxsI07Dpo6F_xFR_RqHjhg8mYTsokikNvoQYBDtLd8PxjXGq3HH8Q9CjqgoTZAGZy8riVKZXPN-ZTXql2p1IxXKynXsDAcClyluxEFsqTmTk4dPwWfFbft2P0uJcg/s1600/KneeJoint1.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN_SSzLHZoRRvG1OTxsI07Dpo6F_xFR_RqHjhg8mYTsokikNvoQYBDtLd8PxjXGq3HH8Q9CjqgoTZAGZy8riVKZXPN-ZTXql2p1IxXKynXsDAcClyluxEFsqTmTk4dPwWfFbft2P0uJcg/s1600/KneeJoint1.jpg" height="200" width="143" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFQyuUe3covB_zYeoQzrcPnIracg227YR140DqHqUHzNTlaOn0yLX_ebA5rw-C-SoInvy5RcbpmE7-Tvvu35qQEhchuscs0afTdtLxF_MSPNIcYY57FFu7YdddugCTyiSCsQUz3m3GHw0/s1600/KneeJoint.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFQyuUe3covB_zYeoQzrcPnIracg227YR140DqHqUHzNTlaOn0yLX_ebA5rw-C-SoInvy5RcbpmE7-Tvvu35qQEhchuscs0afTdtLxF_MSPNIcYY57FFu7YdddugCTyiSCsQUz3m3GHw0/s1600/KneeJoint.jpg" height="200" width="128" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ligaments</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Within the knee, there are 4 main
ligaments, two on the outside edge of the knee called the collateral
ligaments, and two on the inside of the knee called the cruciates;
and two sections of cartilage called the menisci.
</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr-wMLjIdb6CwNxJ_bS4i1qRoyUBLc4svWvS3faGXja-A8MUkaBdR_6G8F5dVzGpVOQn_Ez0v-8QPCjYn0NIPrBsaiDrXisEFqvKsILtgVE75lnaN0b3wneV_ARqHUtB0wOl0RPjRXebk/s1600/knee-joint-ligaments.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr-wMLjIdb6CwNxJ_bS4i1qRoyUBLc4svWvS3faGXja-A8MUkaBdR_6G8F5dVzGpVOQn_Ez0v-8QPCjYn0NIPrBsaiDrXisEFqvKsILtgVE75lnaN0b3wneV_ARqHUtB0wOl0RPjRXebk/s1600/knee-joint-ligaments.jpg" height="242" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgJ6kNT8YZfmS5mxGrGme_w3OWbY1c3RxVbCtjNbsMVqpPz7L_7stO1Kaf77i6gcQ8oaYezjGa7KoZOA4jBm2h65vFWk0n49VIN4zw3bW7GQOqtjICqmMs75FVP4lLw1YcacpfDIfTTE/s1600/knee+menisci.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgJ6kNT8YZfmS5mxGrGme_w3OWbY1c3RxVbCtjNbsMVqpPz7L_7stO1Kaf77i6gcQ8oaYezjGa7KoZOA4jBm2h65vFWk0n49VIN4zw3bW7GQOqtjICqmMs75FVP4lLw1YcacpfDIfTTE/s1600/knee+menisci.jpg" height="208" width="320" /></a></span></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Muscles</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The
muscles of the knee provide the gross flexion / extension movements,
which is provided by the hamstrings for flexion, and the quadriceps to
extend the knee.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKOfLXtWSNNPWQfUrTd5sZuH3qYnI1yAvPAlpvnhmny7MEahEmM-vPl01ohexMEAg7v_YKyDX2EELqLtT88dXvFNw-ycTDKQgH5A34Wj_fPxBq1oa_j7qNAJdHDP9oyuLD34CrsFP1pUQ/s1600/knee+muscles+2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKOfLXtWSNNPWQfUrTd5sZuH3qYnI1yAvPAlpvnhmny7MEahEmM-vPl01ohexMEAg7v_YKyDX2EELqLtT88dXvFNw-ycTDKQgH5A34Wj_fPxBq1oa_j7qNAJdHDP9oyuLD34CrsFP1pUQ/s1600/knee+muscles+2.jpg" height="297" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG_JuhHQXxFVqSpPtJqbh0a46jgYbPEKnwSwsHzDpvr5HrNE7q2dI8JFKuHtizgW18VW9keeBGaGquccGW6qQjA-XQnT4PUy_tQBVfzuU04v4S3fzBPFkm7PRoqA87CKOtKpwoiEi80Xg/s1600/knee+muscles.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG_JuhHQXxFVqSpPtJqbh0a46jgYbPEKnwSwsHzDpvr5HrNE7q2dI8JFKuHtizgW18VW9keeBGaGquccGW6qQjA-XQnT4PUy_tQBVfzuU04v4S3fzBPFkm7PRoqA87CKOtKpwoiEi80Xg/s1600/knee+muscles.jpg" height="235" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1Lie-4fbrwJ-tpTMyDY9VyxC9GiJjzbr2I8SPCy_d2lX93sb7545_JLo72k-Sku1FxOm2LqYwsHP3i1jYngfUaFbamNv5BJcGBpnDHrXmglG23SBEFyj8tC5UclP8bVqdcGfYmDj0Fmo/s1600/Knee-Muscles+and+tendons.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1Lie-4fbrwJ-tpTMyDY9VyxC9GiJjzbr2I8SPCy_d2lX93sb7545_JLo72k-Sku1FxOm2LqYwsHP3i1jYngfUaFbamNv5BJcGBpnDHrXmglG23SBEFyj8tC5UclP8bVqdcGfYmDj0Fmo/s1600/Knee-Muscles+and+tendons.jpg" height="208" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"></span></div>
<div style="margin-bottom: 0cm;">
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Movements</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As
previously discussed, the gross movement of the knee is flexion and
extension of the knee, however there is a degree of lateral translation
of the knee and some rotation.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJuIe5rXaEl7bho5OdOCQoJyMZhkhmSOGplvlXBsqkFZF0CxTbP-R_ZDm7k9sCMN9ABGbR6CBhNnU8Rc8FgUQg8YMp_js2EzcWUKTeGJKCyszPby2fSsdpvazcUR1aGT5mUctLhyphenhyphenvbAdQ/s1600/roll+glid+of+knee.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJuIe5rXaEl7bho5OdOCQoJyMZhkhmSOGplvlXBsqkFZF0CxTbP-R_ZDm7k9sCMN9ABGbR6CBhNnU8Rc8FgUQg8YMp_js2EzcWUKTeGJKCyszPby2fSsdpvazcUR1aGT5mUctLhyphenhyphenvbAdQ/s1600/roll+glid+of+knee.jpg" height="285" width="320" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><b><u><span style="font-size: large;">Cause for injuries</span></u></b></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Eqyptian / Drop Knee</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3POEQ5w1Uz0LrNWu3WJYJohEBxC94VVYuLS31Ldi1iTQKHCV-0gYROiDUI69jlRi1hdaJ_iilLixjL6GbvGCpX2nL547V-Uo5hsP-hGuE13t3yupG0x94TyWuc-qhjZA7fBTl7mIvZ2g/s1600/drop+knee.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3POEQ5w1Uz0LrNWu3WJYJohEBxC94VVYuLS31Ldi1iTQKHCV-0gYROiDUI69jlRi1hdaJ_iilLixjL6GbvGCpX2nL547V-Uo5hsP-hGuE13t3yupG0x94TyWuc-qhjZA7fBTl7mIvZ2g/s1600/drop+knee.jpg" height="200" width="150" /></a><span style="color: black;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnLvG3Old1gfq8g9O_iRAyuDwHy0wyl6EwMqri25JgG1d5iB8rnfSKB0CTB6yJz8dWSoRkUjm1ZsfTCf5Vm1S5oIYT1Eqxs5exk16qjIWMSYvjenda20Kzz989N8nGRbNhho7ZCocG-d8/s1600/dropknee2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnLvG3Old1gfq8g9O_iRAyuDwHy0wyl6EwMqri25JgG1d5iB8rnfSKB0CTB6yJz8dWSoRkUjm1ZsfTCf5Vm1S5oIYT1Eqxs5exk16qjIWMSYvjenda20Kzz989N8nGRbNhho7ZCocG-d8/s1600/dropknee2.png" height="200" width="152" /></a></span></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="background-color: white; font-size: large;">These
moves tend to stress the hamstrings and therefore can cause muscle
strains or tears. They also put pressure on menisci and ACL/MCL which,
in conjuction with a fall from these moves, can cause rupture and injury
due to the unusual orientation of the knee.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="background-color: white; font-size: large;">This is caused by passively
‘sitting’ on the medial collateral ligament (MCL) that runs down the
inner side of the knee. </span></span><br />
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Heel hooks</span></span></u></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Falls</span></span></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Especially when bouldering, falls onto an uneven surface can cuase damage and rupture to ligaments and muscles around the knee. This can even cause a cascade effect when one ligament fails, it shock loads the next and causes multiple injuries.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Common injuries</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Common climbing injuries related to the above movements, as already mentioned, are:</span></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Meniscal tears</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u>Anterior Cruciate Ligament / Medial Collateral Ligament</u></span></span></div>
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Patella Dislocation</span></span></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u>Hamstring and other muscular tears</u></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwY686UypPT8He_9fxk_b0VYn5kNPRGm5kh1DHUov1uBILgJbkhWL5N_eMgk_p_HyrhjeKYorPBrpHtdF0UjVUnLQxotao4zbCTOP58NMUBNpnZKMRY7m5R5hb3wi8mUzyvkSf-yui_lo/s1600/Torn_hammie.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwY686UypPT8He_9fxk_b0VYn5kNPRGm5kh1DHUov1uBILgJbkhWL5N_eMgk_p_HyrhjeKYorPBrpHtdF0UjVUnLQxotao4zbCTOP58NMUBNpnZKMRY7m5R5hb3wi8mUzyvkSf-yui_lo/s1600/Torn_hammie.JPG" height="320" width="214" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I
could go into much more detail, but then this post would turn into an
essay and you'd be asleep by about....now! Further information on any
specific injury can be provided, or as future posts.</span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Symptoms</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Symptoms
of a knee injury will depend on the degree of damage and the structure
damaged, however, you will tend to find one or more of the following
symptoms:</span></span></div>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Locking of the knee</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Localised swelling/tenderness/pain</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Inability or difficulty in weightbearing</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Clicking/grinding</span></span></li>
</ul>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Symptoms of an injured muscle will be the following:</span></span></div>
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<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tightness</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Swelling/Bruising/Redness</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Weakness</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain </span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> Inability to fully stretch</span></span></li>
</ul>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Treatment</span></span></b></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The treatment
to a specific knee injury depends on the injury, the extent of it, and
whether a surgical intervention is required. However, much of the rehab
will focus on training those muscles around the knee, so below are some
sample exercises discussed.</span></span><br />
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<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Exercises: open and closed exercises</span></span></u></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8TQIYs__pJ2eB6vxtQMle6xBVjypKr4srHwVb4AcL5pNoxrgzof0DO1dyBTlq-XhfQlk20O7ZQEaOX5lF8QdhyKZWfRWxk9H_2fH3XzQkg2Zs6mcyx6YQh1avpEZnecIIqdXsKJ3lHVk/s1600/F3.large.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8TQIYs__pJ2eB6vxtQMle6xBVjypKr4srHwVb4AcL5pNoxrgzof0DO1dyBTlq-XhfQlk20O7ZQEaOX5lF8QdhyKZWfRWxk9H_2fH3XzQkg2Zs6mcyx6YQh1avpEZnecIIqdXsKJ3lHVk/s1600/F3.large.jpg" height="119" width="320" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Simulated loading cases: A, closed kinetic chain</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">or squatting (WB, body weight). B, open kinetic chain leg</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">extension (WT, tibia weight). C, open kinetic chain loaded</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">(WT, tibial weight; M, external moment on tibia)</span></span></td></tr>
</tbody></table>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In
a closed chain the end of the chain farthest from the body is fixed,
such as a squat where your feet are fixed and the rest of the leg chain
moves. In open chains the end is free, such as in a seated leg extension
- See more at:
http://www.afpafitness.com/research-articles/closed-chain-exercise-for-legs-and-knees/#sthash.pEvSRn4h.dpuf</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In
a closed chain the end of the chain farthest from the body is fixed,
such as a squat where your feet are fixed and the rest of the leg chain
moves. In open chains the end is free, such as in a seated leg extension
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Closed chain exercises are
better, as they provide more stability to the joint, less shearing forces
therefore less chance of injury, increase stability, engages more
muscles, and are more functional.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Some evidence says closed improve strength, however open chain exercises maybe nessecary if you are unable to weight bear on the injured knee.</span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To increase difficulty of these exercises, fix proximal point on unstable surface e.g. stand on a gym ball to increase stability and control</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">See some more sample exercises listed below. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Swimming and/or cycling are good later stage activities - non-weight bearing strengthening</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Prevention</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Again,
much of the prevention work for knee injuries is strengthening of the
muscles around the knee, and below is a sample of exercises from
Climbing.com. Much of the other preventative work is repetitive
information, but again is listed!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">1. Strengthening work</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="color: #990000;">Three Exercises That Protect Your Knees</span></b></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><i style="margin: 0px 0px 10px;"><b>Note:</b> Ramp up gradually — building connective tissue can take two years.</i></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="color: #0066ff;">1. Hamstring Curl on a Physioball</span></b></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>How:</b> Lie
on your back with heels on the ball, knees straight. Tighten your
abdominals and bridge your hips up, and then bend your knees to roll the
ball toward you. Try two sets of eight reps with good form; work up to
three sets of 15. Advanced challenge: single leg atop the ball!</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Why:</b> The
ACL prevents forward movement of the tibia. Your hamstrings assist in
preventing that motion (particularly in this exercise).</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="color: #0066ff;">2. Floor Touches</span></b></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>How:</b> Stand
on one foot with your knee slightly bent. With the opposite hand, touch
the ground outside your standing foot. Keep your back straight. Repeat
on the other leg. If tight hamstrings restrict your reach (and your
lower back rounds), bend your knee more and reach only halfway. Begin
with two sets of 12 slow, controlled reps, and work up to holding a
three-to-10-pound weight in the hand reaching the fl oor. Advanced
options: reach to the front, then inside your standing foot.</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Why: </b>Multi-joint
proprioception and eccentric hip control. This exercise enhances the
body’s positional awareness, to improve protective reflexes, and
strengthens the hip muscles that maintain knee alignment.</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="color: #0066ff;">3. Sidestepping with a Theraband</span></b></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>How:</b> Place
both feet atop a Theraband and hold opposite handles, with your arms
crossed. Slightly bend your hips and knees, and then step left with your
left foot, stretching the band. Lift (don’t drag) the right foot, and
then step it left to narrow your stance slightly, keeping your feet
greater than hip width apart — use core muscles to steady your
shoulders, with your feet forward. Begin with 15 to 30 steps in each
direction (depending on the band’s tension) and work up to 100.</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Why:</b> ACL
injury can also occur when the knee is forced into a valgus
(knock-kneed) position; your hip abductors and external rotators can
minimize this vulnerability. Traditional exercises and day-to-day
activities don’t strengthen these muscles, making the ACL injury-prone
in certain climbing positions.</span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><i style="margin: 0px 0px 10px;">Thomas Rosenberg, Stacy McCooey,</i><a href="http://www.climbing.com/skill/injury-proof-knees/"><span style="color: #333333;"><span style="line-height: 18px;"> http://www.climbing.com/skill/injury-proof-knees/</span></span></a></span></span></div>
<div style="background-color: white; margin-top: 10px;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #333333;"><span style="line-height: 18px;"><br /></span></span></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #333333; font-size: large;"><span style="line-height: 18px;"><span style="color: black;">Also, performing the moves will help train and strengthen the ligaments and joint in question, however start easy and simple and build up with repetition.</span></span></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #333333; font-size: large;"><span style="line-height: 18px;"><br /></span></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #333333; font-size: large;"><span style="line-height: 18px;"><br /></span></span></span></div>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">2. Correct any muscular imbalances</span></span></u><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Personally,
I know my hamstrings are quite strong, however this means my quads may
not be as strong, therefore I perform cross-training, I run to ensure
equal training of my lower limb muscles.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">3. As always, improve technique to avoid falls and stressing your knee in strange positions because you have rubbish technique!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">4. Down climbing to prevent falls / look at stable landings</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Including using bouldering mats to protect landings. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">5. Ensure good lower limb mobility</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Make sure you have good range of movement at the ankle, knee and hip to limit damaging specific structures.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">6. Stretching</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ensure muscles are correctly stretched, not overstretched, to aid performance at their optimal range</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">7. Listen to feedback from your knee</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If it starts to hurt, or ache, or twinge, stop doing the move that's aggravating, or else something may well go pop! </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">8. Warm up!</span></span></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tendons and ligaments are stiff when cold, more elastic and better proprioception when warm.</span></span><br />
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b><span style="color: #990000;">Sample warm up for knees</span></b></span></span></div>
<div style="background-color: white; color: #333333; line-height: 18px; margin-top: 10px;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> Try
the following before climbing: •10 lunges on each leg, to open your
hips and warm up your legs •10 floor touches (exercise No. 2 above)
•Single-leg balance on the ground for 20 seconds — close your eyes •Two
30-second quad stretches (hold your foot in your hand and bend your
knee, with your heel touching your behind)</span></span><br />
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">COMING SOON: a post on lower limb amputations, as I'm currently treating a gentleman and learning lots in the process!</span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">References</span></b></u></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<a href="http://www.afpafitness.com/research-articles/closed-chain-exercise-for-legs-and-knees/#sthash.pEvSRn4h.dpuf"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://www.afpafitness.com/research-articles/closed-chain-exercise-for-legs-and-knees/#sthash.pEvSRn4h.dpuf</span></span></a><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Jewell DV. Guide to evidence - based physical therapy practice: Jones & Bartlett Learning; 2008</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med 2004;32:1122-30</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Bakhtiary AH, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. British Journal of Sports Medicine 2008;42:99-102</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span><a href="http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Open%20versus%20Closed%20Kinetic%20Chain%20Exercises%20for%20Patellofemoral%20Pain%20Syndrome_Tsai.pdf">http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Open%20versus%20Closed%20Kinetic%20Chain%20Exercises%20for%20Patellofemoral%20Pain%20Syndrome_Tsai.pdf</a><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span><a href="http://ajs.sagepub.com/content/29/4/480/"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><cite><span class="slug-pages">Cohen, Hrvoje Roglic, Grelsamer, Henry, Levine, Mow, Ateshia 2001 </span></cite></span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><cite><span class="slug-pages">Patellofemoral Stresses during Open and Closed Kinetic Chain Exercises An Analysis Using Computer Simulation </span></cite></span></span></a><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><cite><a href="http://ajs.sagepub.com/content/29/4/480/"><abbr class="slug-jnl-abbrev" title="The American Journal of Sports Medicine">Am J Sports Med</abbr><span class="slug-pub-date" itemprop="datePublished">
July 2001
</span>
<span class="slug-vol">
vol. 29
</span><span class="slug-issue">
no. 4
</span></a><span class="slug-pages"><a href="http://ajs.sagepub.com/content/29/4/480/"> 480-487 </a> </span></cite></span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><cite></cite></span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><a href="http://onlineclimbingcoach.blogspot.co.uk/2013/05/injury-case-study-knee-ligament-tear.html">Dave Macleod; Injury case study, knee ligament tear</a><br />
<br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com1tag:blogger.com,1999:blog-4692690742617863595.post-90110843078819604172014-06-04T14:08:00.000-07:002014-06-04T14:15:32.429-07:00Mirror Neurons: How we learn by watching<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">You here it all the time, don't you....</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div style="text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red; font-size: large;">Watch better climbers and you'll learn to climb better </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">And it seems to work, we see someone shift there body position slightly, maybe twist into the wall a bit more, and can then reach that elusive hold. Then we can recreate it.</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlUaGQbJMqP8ykDQDbLvdnCiTS_zy5eizk5qtS9nLO8D8g_wd4fiBTYo7yCw7nIBQqJQXYL-KSHrQTcluqee2CZRsfw-VYOOJxb6YiEdiKENPdclHVhtJiWYKB0GaquJ-hYCl-mCOIWg/s1600/brain-neurons-firing-2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlUaGQbJMqP8ykDQDbLvdnCiTS_zy5eizk5qtS9nLO8D8g_wd4fiBTYo7yCw7nIBQqJQXYL-KSHrQTcluqee2CZRsfw-VYOOJxb6YiEdiKENPdclHVhtJiWYKB0GaquJ-hYCl-mCOIWg/s1600/brain-neurons-firing-2.jpg" /></a></div>
<br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But how does it actually work? </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Well, I went to a very interesting lecture last week on mirror neurons, with the thoughts that there are a certain set of neurons within your brain that fire whilst you are doing a task, and whilst watching someone do the task, for instance, you reach for an object, XY and Z neurons fire. You watch someone else reach for the object, XY and Z neurons fire again.</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpHxEjB2mBwWt-fgEswHMoIUaH5Lqxas9HG-rbRn_f5MvP1Cs98DzYLmqyYAGF5LDh9HPRSVDyi70YwlnoaM8KB7Gsh56sfsZcqO81bhPnLLutZFS8khp8SLZQECnBW1caw6jeLINmns8/s1600/120-MirrorNeurons.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpHxEjB2mBwWt-fgEswHMoIUaH5Lqxas9HG-rbRn_f5MvP1Cs98DzYLmqyYAGF5LDh9HPRSVDyi70YwlnoaM8KB7Gsh56sfsZcqO81bhPnLLutZFS8khp8SLZQECnBW1caw6jeLINmns8/s1600/120-MirrorNeurons.jpg" height="212" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br />This is a new concept, as previously it was thought that when learning (or relearning) a new task, the brain observes, analyses, breaks down step-by-step, then recreates the new task. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But it's much more of an instinct as that.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">With one provision:</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div style="text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="color: red;">There must be a goal, a purpose to the task</span></span></span></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="color: red;"> </span></span><span style="font-size: large;">If there is no goal, say, just a hand making a fist shape, then the mirror neurons get bored, and therefore don't fire. The task has to be purposeful, like reaching for food or an object (or climbing a route!) </span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The brain sees the initiation of the movement, understands the task in hand, and almost figures out the "filler" bit in the middle of how to achieve it. </span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This helps us understand lots about how we learn new tasks, and can be used in a context of a child's learning, or in the re-learning of tasks, for instance, after an acute brain injury.</span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It also helps explain how we feel empathy, as when we watch someone fall off a problem, miss a hold, miss a penalty, whatever the analogy, then it's like we are the person doing it, the same neurons in the brain are firing.</span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The lecture I went into went into a lot more detail, however, I'm going to leave you here, further reading is available below, or some TED talks that are always worth a watch! </span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Any questions, comment below!</span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">References</span></b></u></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Harriss JP 2014 Mirror Neurons. Presented at Annual Brain Lecture</span></span></div>
<div style="text-align: left;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.pbs.org/wgbh/nova/body/mirror-neurons.html">http://www.pbs.org/wgbh/nova/body/mirror-neurons.html</a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://blogs.scientificamerican.com/guest-blog/2012/11/06/whats-so-special-about-mirror-neurons/">http://blogs.scientificamerican.com/guest-blog/2012/11/06/whats-so-special-about-mirror-neurons/</a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Papers</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/20414184">Franceschini M 2010 Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med.</a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.nature.com/nrneurol/journal/v5/n1/full/ncpneuro0990.html">Rizzolatti G 2008 Mirror neurons and their clinical relevance. Nature Clinical Practice Neurology</a></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b><span style="font-family: "Courier New",Courier,monospace;"><u>Further watching:</u></span></b></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.ted.com/talks/vs_ramachandran_the_neurons_that_shaped_civilization#t-346538">Ramachandran 2009 The Neurons that shaped civilization. TED Talks</a></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">And a heart warming story to end, to show that it does work:</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.ted.com/talks/roberto_d_angelo_francesca_fedeli_in_our_baby_s_illness_a_life_lesson">R D'Angelo, F Fedeli 2013 In Our Baby's Illness: A Life Lesson. TED Talks</a></span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-52871462617730073432014-03-19T12:01:00.000-07:002014-03-19T12:01:06.199-07:00Fingers: Ganglion Cysts<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, I've noticed a few posts on certain climbing websites discussing ganglion cysts within the fingers, and so decided that I would write a post about them, considering there were one problem I omitted from the original <a href="http://thomasbondphysio.blogspot.co.uk/2012/12/finger-injuries-symptoms-and-management.html">finger injuries post</a>.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">What is a ganglion cyst?</span></b></u></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHjbli7jFwbT93YJ2gQfv60XJOp9pdna2tyPPNuZ_Zhejy8IeiddTfaFOsz-8ct-IgV1P7ksTP-QRTIjAv941Fkb7SvAtgA5Gu1tbZcQrBkylSKVepTDX8ucPCHCBNsW0tWtMY0NTaNSo/s1600/ganglion-cyst.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHjbli7jFwbT93YJ2gQfv60XJOp9pdna2tyPPNuZ_Zhejy8IeiddTfaFOsz-8ct-IgV1P7ksTP-QRTIjAv941Fkb7SvAtgA5Gu1tbZcQrBkylSKVepTDX8ucPCHCBNsW0tWtMY0NTaNSo/s1600/ganglion-cyst.jpg" height="320" width="278" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A ganglion cyst is a liquid filled area within a joint capsule or tendon sheath that has bulged out to a particular side.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">These cysts are caused by a congenitally weaker part of the capsule or sheath that cannot handle the extra pressure of over-creation of synovial fluid, which is created by over use and chronic stressing of joints. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">They can vary in size from pea to golf ball sized, and can occur anywhere in the body but most commonly in wrists and fingers. The size is often related to the amount of stress placed on the joint, therefore more stress = larger cyst, and this is why they most commonly occur in flexor tendon sheaths of climbers, just before the first finger joint. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ganglions are normally harmless but can cause pain, especially if they irritate a nerve. </span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Symptoms</span></b></u></span><br />
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<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Visible swelling of a lump</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Decrease in mobility around the joint</span></span></li>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRh0Hw22zLC-5PGLBDXICLCfwQ4tgbbcGiIAnz197A3zz4y31qdDPl_KQEIxiX9-AeXmSKKs7Amc-pl4qNgBv_cFz7FY36r9Ufzh0p3vLN-tYT-DfqWGW_h16hJ4W3TcyCFBuNtq0_DKA/s1600/finger+cyst.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRh0Hw22zLC-5PGLBDXICLCfwQ4tgbbcGiIAnz197A3zz4y31qdDPl_KQEIxiX9-AeXmSKKs7Amc-pl4qNgBv_cFz7FY36r9Ufzh0p3vLN-tYT-DfqWGW_h16hJ4W3TcyCFBuNtq0_DKA/s1600/finger+cyst.jpg" height="240" width="320" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Treatment</span></b></u></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The old adage of "smack it with a book" doesn't really work for cysts, no matter how much someone encourages you! As, even if it works and gets rid of the cyst for a little while, it will only refill. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Common treatments involve aspiration, steroid injection, or surgical removal of the cyst, however, some have suggested ultrasound as a treatment for the pain caused by the cyst.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii68egwrzkaOMK5XMnZh5BIJ67vuCzE2gNOBzC4_-1aXqpdh2awmUEFBdrfOOXiE6OLi_sLQEs_NPIyq_J4JSI-BAn-5_BJznBJGVYjJwmzOfooyoTROMDxZGNCVwAKyiGiXPNOgmeGZs/s1600/cyst+aspiration.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii68egwrzkaOMK5XMnZh5BIJ67vuCzE2gNOBzC4_-1aXqpdh2awmUEFBdrfOOXiE6OLi_sLQEs_NPIyq_J4JSI-BAn-5_BJznBJGVYjJwmzOfooyoTROMDxZGNCVwAKyiGiXPNOgmeGZs/s1600/cyst+aspiration.jpg" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Some people have steroid injections into/around the cyst to relieve the pain, however it is worth noting that steroids have been known to weaken tendons and tissues and so could cause further problems with the cyst. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Varley et al (1997) found that there was equal success rate of removing a ganglion cyst (33%) with aspiration (insertion of a needle and draining the fluid, as depicted above) compared with aspiration and injection of steroid.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The other option is to have the cyst surgically removed, which has a re-occurrence rate of the cyst of only about 5%. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHcIAXdD-Eb0e5a6OHB3qVNjfqNi5VNBeVkKCN4TmMhUcp36cVW0Vwzcfyysy40EH2nMwyr7Lq9ZfDkYxEm3xnIqhDo2VgwktEf_Vx5MO-RPYiiD0610O-JORiunjQK9Op4XUm0g100sI/s1600/wrist_ganglion_treatment03.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHcIAXdD-Eb0e5a6OHB3qVNjfqNi5VNBeVkKCN4TmMhUcp36cVW0Vwzcfyysy40EH2nMwyr7Lq9ZfDkYxEm3xnIqhDo2VgwktEf_Vx5MO-RPYiiD0610O-JORiunjQK9Op4XUm0g100sI/s1600/wrist_ganglion_treatment03.jpg" height="266" width="320" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Prevention</span></b></u></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Unfortunately, there is no current way of preventing a ganglion cyst, however they could be caused by unnecessary stresses on your joints, so avoiding or adapting the effect of these stresses could help, for instance, adapting / changing your climbing style, climbing more efficiently.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ensuring full range of movements within your joints will also reduce the stresses put on the joint.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As usual, ensuring proper warm up/cool downs and eating well will aid the prevention of injuries.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">References</span></b></u></span><br />
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span>Hochholzer T, Schoffl VR 2006 One Move Too Many. Lochner-Verlag, Germany</span></span></span><br />
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.nhs.uk/conditions/excisionofganglion/Pages/Introduction.aspx">NHS Choices</a></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: small;"> Varley GW, Needoff M, Davis TRC, Clay NR 1997 Conservative management of wrist ganglia: Aspiration versus steroid infiltration. Journal of Hand Surgery 22(5): 636-637</span></span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com1tag:blogger.com,1999:blog-4692690742617863595.post-16424008767129518882014-02-19T13:45:00.001-08:002014-02-19T13:45:32.635-08:00Compartment Syndrome<div dir="ltr">
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">So we all get pumped when we are out climbing, in our forearms. This is natural, but we expect this pump to ease after the route, or at the very most the next day. </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">So what happens when it doesn't go the next day, our even gets worse? Then it's quite possible that you're suffering from functional compartment syndrome of the flexor muscles, otherwise known as chronic exertional comparment syndrome (CECS).</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Chronic exertional / functional compartment syndrome is much more common in the tibialis anterior muscle compartment in runners and walkers, but has recently been reported in the forearms of those requiring strong grip, such as climbers, motocross riders and rowers.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Physiology and Anatomy </span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Within the forearm, all the muscles are surrounded by a thin sheet of fibrous tissue called fascia, which holds all the muscle fibres together in their bundle.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw7YUxhyqczuCXvdzQGc-xHagCQeRyAnZjJU_qrlmaEuN7bBjYUzMk_EQ7-YlSOoNWeMWymLX4yjls4pivjSeULhftYbWSy-WvbOt8H4RotKTbdJraZCg6rPxQN_w4MWdoKqHMXt4liKs/s1600/armpump1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw7YUxhyqczuCXvdzQGc-xHagCQeRyAnZjJU_qrlmaEuN7bBjYUzMk_EQ7-YlSOoNWeMWymLX4yjls4pivjSeULhftYbWSy-WvbOt8H4RotKTbdJraZCg6rPxQN_w4MWdoKqHMXt4liKs/s1600/armpump1.jpg" height="243" width="320" /></a></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">CECS occurs when there is an increase in muscle mass but not in fascia that envelops the muscle tissue, which happens with high intensity training resulting in hypertrophy of the muscles) i.e. muscles grow quicker than the surrounding fascia).</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The only space left is veins and arteries and so the vessels become constricted by the muscle mass and creates a back flow of blood and an "instant pump" The muscle still creates lactic acid, but the blood supply cannot remove it, resulting in the pump/burn, that can take days to recover. </span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This process can also occur after infectious disease compromises an athletes immune system, but much less common.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb30itxST-YWGXsylIMJQIeXQ-t2BLUapikmkODgc4aP3DesB2bx32Qrdy8ChnjNM23dbJ8VvtJ_pK60oG5GADU9_LyH2g9RZtEcavaPAhhf8txPDRNiWlB3C8uIy4nzf8zsKGlPOiP3E/s1600/image024.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb30itxST-YWGXsylIMJQIeXQ-t2BLUapikmkODgc4aP3DesB2bx32Qrdy8ChnjNM23dbJ8VvtJ_pK60oG5GADU9_LyH2g9RZtEcavaPAhhf8txPDRNiWlB3C8uIy4nzf8zsKGlPOiP3E/s1600/image024.jpg" height="240" width="320" /></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Acute compartment syndrome normally occurs post fracture or crush injury, and requires urgent medical attention. This is not the focus of this post.</span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Symptoms</span></span></b></u><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Pain in forearms during and after stress</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Pumped sensation that does not decrease in the usual time frame </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Pump reached way lower than your normal peak levels</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><b><u><span style="font-size: large;">Diagnosis</span></u></b></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Diagnosis of CECS is using inter-compartmental pressure measurement during the sport specific stress (i.e. climbing) using the devices similar to below.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNi2nuVPsmHrITOPcDsbGDF1zvz84UNyazvKhQGVpvYjsgPDMrAf4VRKpk9yZUD_C_sGhTXt5gSfwt0q94Pby6l9w8faw2XTGalTVMpD2a0c7nFx1NIH8FfJxH8Nbf33FHxBWA3JE-6E0/s1600/678525.fig.001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNi2nuVPsmHrITOPcDsbGDF1zvz84UNyazvKhQGVpvYjsgPDMrAf4VRKpk9yZUD_C_sGhTXt5gSfwt0q94Pby6l9w8faw2XTGalTVMpD2a0c7nFx1NIH8FfJxH8Nbf33FHxBWA3JE-6E0/s1600/678525.fig.001.jpg" height="192" width="320" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCFW0tOZpiCqFPIfGs8CmRTEz64M1qHywPFs2Nzzw9P3lJ7CrUKh_xxxmt2jaWQaeEkaLNvt76CwBpBEg4VNcdvAwv6LN0S36PqYVubnWBMXSz8YOZ_NnSU5oU0ionlpxMGInQFVi-eVo/s1600/index.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCFW0tOZpiCqFPIfGs8CmRTEz64M1qHywPFs2Nzzw9P3lJ7CrUKh_xxxmt2jaWQaeEkaLNvt76CwBpBEg4VNcdvAwv6LN0S36PqYVubnWBMXSz8YOZ_NnSU5oU0ionlpxMGInQFVi-eVo/s1600/index.jpg" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Schoffl et al (2004) set an algorithm as below for diagnostic of CECS dependant on the pressure found within the muscle compartments.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsNNAD_-_J2tTFCdplD6e1xYOzgTQr_wOK55zlfR9ayl0bJN5GhQjX80OwyZREl3Zc54GJmdvQWgJOUXJefRy8OnPSJiXWLqZ5YkYdUowskIy4dTueADjx2TjhzTO-r-w9RgYQmU8OlvM/s1600/compartment+syndrome+algorithm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsNNAD_-_J2tTFCdplD6e1xYOzgTQr_wOK55zlfR9ayl0bJN5GhQjX80OwyZREl3Zc54GJmdvQWgJOUXJefRy8OnPSJiXWLqZ5YkYdUowskIy4dTueADjx2TjhzTO-r-w9RgYQmU8OlvM/s1600/compartment+syndrome+algorithm.png" height="160" width="320" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Differential diagnosis for the symptoms of CECS could be </span></span><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">ulnar </span></span><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">stress fracture or nerve entrapment</span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Treatment</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<ul>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">stress reduction i.e. cease to perform the activity, but I know climbers, and they won't stop climbing!</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">stretching</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">massage</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">ice</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">anti-inflammatories</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">activity modification - analyse your climbing, change your climbing style, crimp less etc. </span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">surgical procedure - fasciotomy</span></span></li>
</ul>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzk4ULam-3ff4rdY5PbuiFKAj7-R7EqE6hGmjECc1oPPzCSBz6-DzIq1e6986F9mOV65k5NjIMGF6V4x8MTuqnF2MGYMVpkp41HbqFXxd0yigHbUJ78eKf9zZqkUrtIL-U2TNMmTobTls/s1600/forearms.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzk4ULam-3ff4rdY5PbuiFKAj7-R7EqE6hGmjECc1oPPzCSBz6-DzIq1e6986F9mOV65k5NjIMGF6V4x8MTuqnF2MGYMVpkp41HbqFXxd0yigHbUJ78eKf9zZqkUrtIL-U2TNMmTobTls/s1600/forearms.jpg" height="320" width="272" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Fasciotomy</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPnFY_Ld2gJHO8lE4fxyb-PCKjK4RbqJVRFp5sQ_lHwOdwxkpavzPtvnf5qFbwR34Bwgw-QeuEV60peKpB7IML7uvYPhEc1SJ-d3NmHv2TXLOCokLcX2-4saMHoDrsUv3tKWftp8YqGNY/s1600/compartment+incisions+2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPnFY_Ld2gJHO8lE4fxyb-PCKjK4RbqJVRFp5sQ_lHwOdwxkpavzPtvnf5qFbwR34Bwgw-QeuEV60peKpB7IML7uvYPhEc1SJ-d3NmHv2TXLOCokLcX2-4saMHoDrsUv3tKWftp8YqGNY/s1600/compartment+incisions+2.png" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">A fasciotomy is one of the surgical options to reduce CECS. It consists of two incisions into each of the different forearm compartments to reduce the pressure within the compartments. They may require a skin graft if the muscle bulk is still too large to close the skin around it.</span></span><br />
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<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Outcomes</span></span></b></u><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> Painful sensations in
the forearm were reduced from 53 to 7 VAS, and m</span></span><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">ore than 95% (23/24) of the motocross patients
were satisfied with the postoperative result of a fasciotomy after 5 follow-up. (Winkes et al 2011)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Post fasciotomy of 12 patients reported
percentage improvement after surgery was 88%. Median time to return to full activity was 9 weeks. </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">(Brown et al 2011)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">In 8 post fasciectomy patients, all had resumed their sport in the 6 weeks after the surgery, and 3 returned to their previous level, 5 improved their
level. No complications and no recurrences were reported
during an average 2-year follow-up. (Croutzet et al 2009)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Physiotherapy post operatively would be to follow the post op guidelines to regain range of movement and strength.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Although surgery is highly effective for most people, it's not without
risk. Complications of the surgery can include infection, permanent
nerve damage, numbness and scarring. </span></span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNLPEjKJrU5rT1u3hoWgWEuMHna01yVYCzzSwaYJKinfrmahlF3Ee-ZyUlEvw06V7jRYgRQZuyjU6vBsVbL1HcbtIK3IDnMWvsu2AIXGlikujkJc5ktC34_sij8QzbDtR9ozK7Oh9tbes/s1600/compartment+incisions.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNLPEjKJrU5rT1u3hoWgWEuMHna01yVYCzzSwaYJKinfrmahlF3Ee-ZyUlEvw06V7jRYgRQZuyjU6vBsVbL1HcbtIK3IDnMWvsu2AIXGlikujkJc5ktC34_sij8QzbDtR9ozK7Oh9tbes/s1600/compartment+incisions.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pre and post fasciotomy</td></tr>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;"><br /></span></b></u></span>
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Prevention</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Unfortunately, there is no real prevention for CECS except to remember that it is really important to build up training and intensity slowly and steadily to ensure all structures within your body adapt to the changes at the
same rate, as muscle bulk grows quicker than tendon strength, fascia;
and this can lead to problems, imbalances and injuries.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This doesn't mean that all the usual advice doesn't apply, such as warming up and cooling down properly, keeping well fed and hydrated, and "no pain, no gain" is a myth, if your in pain, stop! </span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-YNNJbUd8VLADDFTqGAiC_FCWGkeXByxroIbI7-7h6dmxZ1zG73-txS0A-UDUI-9ZWWCKwYQSnVOoU5ehEWkM4wjOmSuoTEnR3igYu4GiSdL-ohA9AaiIBOkxgnGayxw_nza-aBEzj2g/s1600/font.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-YNNJbUd8VLADDFTqGAiC_FCWGkeXByxroIbI7-7h6dmxZ1zG73-txS0A-UDUI-9ZWWCKwYQSnVOoU5ehEWkM4wjOmSuoTEnR3igYu4GiSdL-ohA9AaiIBOkxgnGayxw_nza-aBEzj2g/s1600/font.gif" height="320" width="214" /></a></span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Am J Sports Med. 2012 Feb;40(2):452-8. doi: 10.1177/0363546511425647. Epub 2011 Oct 26.<br />Long-term results of surgical decompression of chronic exertional compartment syndrome of the forearm in motocross racers.<br />Winkes MB, Luiten EJ, van Zoest WJ, Sala HA, Hoogeveen AR, Scheltinga MR. </span></span><br />
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Br J Sports Med. 2004 August; 38(4): 422–425.<br />doi: 10.1136/bjsm.2002.003996<br />PMCID: PMC1724897<br />Evaluation of physiological standard pressures of the forearm flexor muscles during sport specific ergometry in sport climbers<br />V Schoeffl, S Klee, and W Strecker </span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">J Hand Surg Eur Vol. 2011 Jun;36(5):413-9. doi: 10.1177/1753193410397900. Epub 2011 Feb 21.<br />Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy.<br />Brown JS, Wheeler PC, Boyd KT, Barnes MR, Allen MJ.</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Tech Hand Up Extrem Surg. 2009 Sep;13(3):137-40. doi: 10.1097/BTH.0b013e3181aa9193.<br />Mini-invasive surgery for chronic exertional compartment syndrome of the forearm: a new technique.<br />Croutzet P, Chassat R, Masmejean EH.</span></span></span></div>
Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com5tag:blogger.com,1999:blog-4692690742617863595.post-2986592265901373632014-01-20T10:15:00.000-08:002014-02-01T13:44:34.437-08:00Helmet or not to helmet?<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, the idea of this blog is to discuss injuries and injury prevention, so I thought I'd share some discussion on helmet wearing within rock climbing, as that clever piece of brain matter is quite vital!</span></span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgr8G6CIRf-JIi0ERDivDXVd9ZZOgbtU220HaDNhhAVliZebDIIMHXSkC-5wPLddPb2jbTGKIc6DS2a19n3413ZFLyqhkmQs7v1wK00HxPPvlILeOvSGvSJkJhv_ZAnf3Yllmsm_kH_-g/s1600/DSC_0767.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgr8G6CIRf-JIi0ERDivDXVd9ZZOgbtU220HaDNhhAVliZebDIIMHXSkC-5wPLddPb2jbTGKIc6DS2a19n3413ZFLyqhkmQs7v1wK00HxPPvlILeOvSGvSJkJhv_ZAnf3Yllmsm_kH_-g/s320/DSC_0767.JPG" height="214" width="320" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: x-small;">The author climbing "Looning the Tube" E1 5b in the Dinorwic slate quarries, helmet in situ.</span></span></span></span></td></tr>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now, there are plenty of sports that wear helmets, horse riding and cycling are the immediate sports that spring to mind.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Yet, out on the crags, we see climbers choosing not to wear helmets, yet a lot of them will wear helmets when they are involved in other sports such as cycling.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I understand that there are no rules and regulations that <i>require </i>climbers to wear helmets, that it is a personal choice (unlike, for instance, horse riding competitions), so I just thought I'd share ideas about wearing helmets.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Below is the BMC video from last year that canvassed opinions from climbers out on the Eastern Grit about helmet wearing.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/EKA8qafMlUM?feature=player_embedded' frameborder='0'></iframe></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Some people do have the opinion that a helmet limits visibility, impairing balance and cause overheating, however, modern helmets nowadays reduce this, and from a personal point of view, my helmet does not limit my climbing!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Sometimes, I think it's vanity, but luckily this is starting to change, with rock climbing magazines and guidebooks proudly displaying pictures of hard climbing/climbers wearing helmets! Helmets now also fit better and look slightly more aesthetically pleasing.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Also, some people only think that helmets protect you from falling objects, so some that will choose to only wear a helmet at crags that are classed as "unstable", such as quarries such as Horseshoe Quarry, however, most head injuries I've seen have been from falls have been where the climber has inverted by catching their leg behind the rope (such happened to a friend at Pen Trywn - luckily, he only had minor concussion and was right as rain after a few days), or from swinging underneath an overhang or round awkward corners (seen this a few times on the grit, fortunately no serious injuries).</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In contrast to this, in Paul Pritchard's recovery from his head injury from a rock fall in Tansania , on the Totem Pole, which resulted in his hemiplegia, the doctors who initially assessed the extent of his injury reported that if he had been wearing a helmet, the angle at which the rock hit his head <i>could </i>have resulted in him being killed outright instead of resulting in a recoverable (albeit long!) head injury.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">And statistically speaking, head injuries account for 12.2% of accidents in the US (similar figure acquired by UK Mountain Rescue Teams), and the majority of these being lacerations rather than serious injuries. There is a higher likelihood of a fracture or overuse injury. But it's still 12.2%! </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">From a personal point of view, I don't wear my helmet when bouldering or indoor climbing, although some will argue that there is a place for helmets in these environments. From my point of view, it's a calculated risk, as I'm generally not high balling routes when bouldering, and most indoor routes are straight lines and well thought out for clipping etc. When soloing, I don't wear a helmet, as it's not going to be much use if I fall off! </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">When I'm out trad or sport climbing, the helmet is always in the bag, and the decision is made on arrival at the crag to wear it or not, dependant on the crag and route. I generally wear a helmet sport climbing in the Peak, on the limestone, do to the nature of the rock, whereas trad on the grit is normally a route-by-route decision. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I took my helmet out to Kalymnos, and rarely wore it, and at times wish I did, due to some routes still being loose and friable (especially on Telendos), but when you come back without incident, it gives you time to reflect and ensure you do so next time. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So there you have it, take from it what you will, but do remember, recovery from a head injury such as a bleed or hemiplegia is much longer than from a finger injury, and much more serious (if anybody knows someone who's had a stroke will know it can be a long road to recovery).</span></span><br />
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<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYPDG50iAeFtVB0AVptnSvnv0M6J3N21i6pdxgR23NvylaIp0I47QABbADXO8D6DZYKZnyxRQKKo18ACIzGmKl3n0em-C5YxTFvWu3XKo9DAptPj5SF1v0pnb5PSZjb5YHCAL8exfAG4M/s1600/image017.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYPDG50iAeFtVB0AVptnSvnv0M6J3N21i6pdxgR23NvylaIp0I47QABbADXO8D6DZYKZnyxRQKKo18ACIzGmKl3n0em-C5YxTFvWu3XKo9DAptPj5SF1v0pnb5PSZjb5YHCAL8exfAG4M/s1600/image017.jpg" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: x-small;">Paul Pritchard's craniotomy in 2012<br />Copyright Paul Pritchard</span></span> </span></span></td><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></td><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></td></tr>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So next time you go to the crag, will your helmet be packed? Personally, I know mine will. </span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References/Further Reading</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Paul Pritchard 1999 Totem Pole</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">BMC articles: </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://www.thebmc.co.uk/head-case">Head Case</a> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://www.thebmc.co.uk/keeping-a-head-a-head-injury-case-study">Keeping a head; a head injury case study</a> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://www.thebmc.co.uk/tech-skills-why-to-wear-a-helmet">Tech skills; why wear a helmet</a> </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Personal experience! </span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-28440626283072300882014-01-20T10:05:00.000-08:002014-01-20T11:34:44.120-08:00Long QT Syndrome and Sudden Cardiac Deaths<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, a slight deviation from the norm, but I figured I write something on this topic following on from my recent physiotherapy in-service training I did on cardiology.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, Long QT Syndrome became well known in the press in 2012 when Fabrice Muamba of Bolton Wanderer's collapsed on pitch during a FA Cup football match against Tottenham Hotspur.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It's one of the main reasons now that all sporting clubs should have defibrillators as standard, and why there are more being used in public places such as shopping centres. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Long QT is a disorder that is associated with the umbrella term of "Sudden Cardiac Death", which is described as "non-traumatic, unexpected event that occurs due to sudden cardiac
arrest". In order to be clinically considered SCD, the event must occur
within 6 hours of previously witnessed typical health (Pugh, Bourke,
& Kundian, 2011), and also includes such conditions as Wolf-Parkinson-White Syndrome and Myocarditis.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The "QT" in "Long QT Syndrome" is related to the electrical impulses transmitted within the heart. The QT interval on an ECG is the time taken for the ventricles to repolarize (return to their normal electrical status in preparation for the next impulse/heart beat). This timing should be approx 1/3 of each heart beat cycle for the QT interval, and when this is longer than it should be, it could trigger abnormal heart rhythms called arrhythmias, which can lead to sudden cardiac arrest/death.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjle0LiLWVYy5HY41tUMbhtuiMfBDBExlOuWiQSGodmpW_q5j_UEOp2ANf5RO1Rykzx7guuLJLdOM2Xs38tqW4tXuF-e3FMhKWAbbSLvadg9kEt0jJF-5nVz9nWVW28x96N18aTzBy6t_0/s1600/ECG_Principle_fast.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjle0LiLWVYy5HY41tUMbhtuiMfBDBExlOuWiQSGodmpW_q5j_UEOp2ANf5RO1Rykzx7guuLJLdOM2Xs38tqW4tXuF-e3FMhKWAbbSLvadg9kEt0jJF-5nVz9nWVW28x96N18aTzBy6t_0/s1600/ECG_Principle_fast.gif" height="320" width="280" /> </a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Long QT Syndrome is a congenital condition, and the first symptoms clinically could be that of sudden cardiac arrest, however, some may experience sudden faints, seizures or arrhythmias. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It affects roughly 1 in 2000 people, and causes roughly 1-2 deaths per 100,000 athletes per year. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Those who are thought to have Long QT can be diagnosed via ECG, genetic testing or stress test.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Long QT is thought to be caused by lack of ions or ion channels, such as sodium, calcium or potassium ions in the heart that when move across the heart cell boundaries, they stimulate the electrical impulses within the heart.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If Long QT Syndrome is confirmed, certain lifestyle changes should be incorporated to avoid strenuous activity, such as removal from competitive sport, and some are advised to purchase an external defibrillator as part of their standard kit, or smaller changes such as adding more potassium-rich foods to dietary intake (such as bananas). </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Treatment may also consist of beta blocker medication to slow down the heart rate, to reduce the risk of Long QT causing sudden cardiac death.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Surgery may be required, either to fit a Implantable Cardiac Defibrillator (ICD - see below) or to regulate the nerves of the heart to maintain a normal rhythm. </span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">ICD </span></span></b></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">An implantable cardiac defibrillator is much like a pacemaker, and can actually do the same job, providing regular electrical impulses (NOT shocks) to ensure the heart stays in the correct rhythm. The additional bonus of an ICD is that, when required, if an abnormal heart rhythm is detected and is unable to correct with pacing, can provide an electrical shock to the heart to restore normal rhythm.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">They sit just under the collarbone on the left and are around the size of a matchbox. They have electrical wires that feed down the blood vessels into the heart. </span></span><br />
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" /> </span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Post ICD Insertion</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Normal post-surgical precautions</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">No contact sports incase of dislodging wires or implant</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Take care around other devices/objects that omit electrical pulses which may confuse the device</span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Living with Long QT Syndrome</span></span></b></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If Long QT is confirmed, it may be worth taking precautionary steps, such as having a plan in place if sudden fainting or cardiac incident occurs, which involves letting colleagues, friends, family know about your condition.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, Long QT doesn't mean all has to change, athletes such as Dana Vollmer, an American swimmer who won a gold medal at 2012 Olympics. She was diagnosed with Long QT at 15 years old, but still continued to compete with a debrilliator on the sidelines, and has still had a successful career.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Read more <a href="http://well.blogs.nytimes.com/2012/07/31/overcoming-a-heart-condition-to-win-olympic-gold/?_php=true&_type=blogs&_php=true&_type=blogs&_r=2">here </a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If anyone has any experiences of this condition, I'd love to hear about it, via email (thomasbond.physio@gmail.com), Twitter (<a href="https://twitter.com/Tombondphysio">@Tombondphysio</a>) or just comment below!</span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References</span></span></b></u></div>
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<a href="http://well.blogs.nytimes.com/2012/07/31/overcoming-a-heart-condition-to-win-olympic-gold/?_php=true&_type=blogs&_php=true&_type=blogs&_r=2">O'Connor A 2012 Overcoming a heart condition to win Olympic gold. New York Times Blog </a></div>
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Pugh, Andrew, John P. Bourke, and Vijay Kunadian. Sudden cardiac death among competitive adult athletes: a review. <i>Postgraduate medical journal</i> 88.1041 (2012): 382-390.<br />
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<a href="http://www.nhlbi.nih.gov/health/health-topics/topics/qt/">National Heart, Lung and Blood Institute 2011 What is Long QT Syndrome?</a><br />
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<a href="http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484075/k.F8EF/Heart_disease__What_is_Long_QT_Syndrome.htm">Heart and Stroke Foundation 2011 What is Long QT Syndrome?</a><br />
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<a href="http://blogs.bmj.com/bjsm/2014/01/04/understanding-long-qt-syndrome-a-cause-of-sudden-cardiac-death-in-athletes/">Khan 2014 Introduction to Long QT Syndrome: A Cause of Sudden Cardiac Death in Athletes. BMJ Group</a><br />
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<a href="http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=35ea33a1-a757-457d-9ae7-2862f3596011&version=-1&title=Implantable+Cardioverter+Defibrillators+%28ICDs%29+English&resource=HIS19">British Heart Foundation Implantable Cardiac Defibrillator Patient Leaflet</a></div>
Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com2tag:blogger.com,1999:blog-4692690742617863595.post-65371977826944590972013-10-20T13:33:00.001-07:002013-11-06T08:45:01.772-08:00Youngsters: Epiphyseal Plate Injuries<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Getting children involved in climbing is fantastic, especially as
climbing can be viewed as a life-long sport. However, we'd like to
keep it that way, and the process to do this is prevent any injuries
that will impact the kids in the future.</span></span><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The main problem with injuries in children is any damage to the
growth plates of any kind, and the most likely growth plate to injure
is those that are sustaining high stress forces through them, such as
the fingers. This post will aim to explain what growth plates are,
the incidence of these injuries, and how best to avoid them. </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Remember, children are children, not just “mini adults”!!!</b></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">What are growth plates?</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">As a child grows, all their bones start of as cartilage, and
develop into bone as they get older. This is why a child's rib cage
is much bouncier than an adults (please don't test this out!). This
is why children are more likely to get greenstick fractures than pure
fractures (this is where the bone bends and splinters, rather than a
pure breakage – try this out with a freshly cut tree branch and try
and snap it). As these bones develop, there are areas where the bone
needs to grow.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The epiphyseal plate (or growth plate) is where new bone is formed
to make the bone grow in a longitudinal direction, and on the
otherside of the plate, the new bone growth becomes calcified. There
is one of these growth plates at either end of the growing bone.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRsvRT36fPYiI11H1udayLt-tWq-svOyKR0GzHLg6W2JOQGsfRoOzULboZzmZuFfhwQGvldrCdkdo1ap_w99vDGwzNNm1dGMwBCo3CWX42lt1V06uQvjpTlLI3Zb6Q5Fvy0sP3yxEjb7o/s1600/GrowthPlates.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRsvRT36fPYiI11H1udayLt-tWq-svOyKR0GzHLg6W2JOQGsfRoOzULboZzmZuFfhwQGvldrCdkdo1ap_w99vDGwzNNm1dGMwBCo3CWX42lt1V06uQvjpTlLI3Zb6Q5Fvy0sP3yxEjb7o/s320/GrowthPlates.jpg" width="320" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">When this growth plate is damaged, the growth of the bone can be
changed, from direction, to rate of growth or even stop growth
altogether.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Whilst growth plates are still growing, they are the weakest area
of the growing skeleton, 2 to 5 times weaker than adjacent ligaments.
This is due to the connective tissues needing to allow for the growth
of the bones.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Once growth has stopped, the epiphyseal plate is replaced with
solid bone through calcification, and ceases to be an area of
weakness.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Obviously, weight bearing is key for bone development and growth,
however, it is the overuse and over-stressing of these structures
that we are concerned about.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Time line of growth plates</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">If I remember correctly, during the closure of growth plates, the
larger bones will fuse first, then the smaller joints. Also, the
dorsal aspect of the growth plate closes last. </span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCYHJT2ZQih__qavsf8MOPvDamif7Y5HSZMo7-C6PN3DrGgHiPxzjKdbFn6jdx6cD-K4-A46wuriCASbcr3JR-s0P8tXtGRFMYcUKsHm1wfajhO_714Q0xjnZJLde3jSm0P28MVhfAdrg/s1600/finger.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="131" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCYHJT2ZQih__qavsf8MOPvDamif7Y5HSZMo7-C6PN3DrGgHiPxzjKdbFn6jdx6cD-K4-A46wuriCASbcr3JR-s0P8tXtGRFMYcUKsHm1wfajhO_714Q0xjnZJLde3jSm0P28MVhfAdrg/s320/finger.jpg" width="320" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This means that the fingers are susceptible to injury longer than
larger bones such as the femur or humerus, and the dorsal aspect of
the epiphyseal plate is usually where an overuse injury will occur in
a child’s finger.</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNwky050i_x7qcZKjiMY3aZlZ3sv5q_tglqoH_aq2l4qyKpXStgg7IoBPYXCcbbzPg4kQn8gRDt9zBD2x8vUn7IhyphenhyphenRss3miCOKd2dkhRuQE1sBuYXLfqF55N9sL0ok3sBJKdK-otpbE90/s1600/15+year+old+Salter+3+lesion.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNwky050i_x7qcZKjiMY3aZlZ3sv5q_tglqoH_aq2l4qyKpXStgg7IoBPYXCcbbzPg4kQn8gRDt9zBD2x8vUn7IhyphenhyphenRss3miCOKd2dkhRuQE1sBuYXLfqF55N9sL0ok3sBJKdK-otpbE90/s1600/15+year+old+Salter+3+lesion.jpg" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The picture above demonstrates this area of weakness, with a grade
3 Salter-Harris fracture.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Fingers stop growing at a biological age of 17 years old, but key
timings to note is that of growth spurts, occurring from around age
12-13 for girls, and 13-15 for boys.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Especially for boys, this is key to note, as growth spurt plus
testosterone = temptation to train harder due to the ease in which
muscle bulk is put on in this period.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Incidence of growth plate injuries</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Amongst junior competition climbers studied within the German
National Junior Team by Volker Schoffl and friends found two-thirds
who trained regularly on the campus board got fractured growth plates
in a finger.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Shigeo Omori and Hajime found over 3 years, 182 junior competition
climbers aged 7 to 19 had their fingers medically examined and 77.6%
of these climbers had abnormalities, mostly deformation and light
flexion contracture (can’t place hand flat on table).
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">In general, non-climbing public:</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Growth-plate injuries comprise 15 percent of all childhood
fractures. They occur twice as often in boys as in girls, with the
greatest incidence among 14- to 16-year-old boys and 11- to
13-year-old girls. Older girls experience these fractures less often
because their bodies mature at an earlier age than boys. As a result,
their bones finish growing sooner, and their growth plates are
replaced by stronger, solid bone.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Approximately half of all growth plate injuries occur in the lower
end of the outer bone of the forearm (radius) at the wrist. These
injuries also occur frequently in the lower bones of the leg (tibia
and fibula). They can also occur in the upper leg bone (femur) or in
the ankle, foot, or hip bone.
</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Mechanism of injury</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Can be acute injury such as a fall, or can be a chronic onset
caused by intense training, campus boarding or over-use of the crimp
hold grip which causes compression or shearing of the growth plate.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">It has been found that these injuries normally occur in climbers
within the training scenarios rather than competitions.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Crimping or campus boarding has been found to be a cause of growth
plate injuries due to the high loads put through the fingers,
therefore causing an overload of growth plate (repetitive stress).</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Signs and symptoms</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Lack of mobility in fingers</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Constant pain</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Chronic swelling</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Lack of crimping ability due to pain/swelling</span></span><br />
<br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The old mandate of “No pain, no gain” is crazy! If it hurts,
get it checked out!</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghmikvTFxqbmB0uQtPdkNdgcd7zssBs5pAYfULi8FwtU7uxn0hgwTSK-Nol73KuzHmCg7-la1Z3pk8Enfzgy7xEtfQBnVCoCIeIgfbuKuHiaJvdHix3tJSIu3vUY-nLYJoUIFxx9dfi0c/s1600/plate+injuries+fingers.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghmikvTFxqbmB0uQtPdkNdgcd7zssBs5pAYfULi8FwtU7uxn0hgwTSK-Nol73KuzHmCg7-la1Z3pk8Enfzgy7xEtfQBnVCoCIeIgfbuKuHiaJvdHix3tJSIu3vUY-nLYJoUIFxx9dfi0c/s320/plate+injuries+fingers.jpg" width="320" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Diagnosis of injuries</span></span></b></u><br />
<br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The diagnosis and classification of a growth plate injury is
normally via x-ray, and is classified as 1 to 5 Salter-Harris
fracture.</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCJ2s5BK_s2-qruXBB6c3TVvf7zY2pmU8_CnCLEddQVX9q2lLBqmZPMBkN488xAF5ZJQB8pvHljZwJUKkFeV5SSr8C5EJQVWKRuZN6K6gzDv93ZKNyOY19iUjx-6q5IvTb28JVXbNg6kk/s1600/Salter+Harris+classification.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCJ2s5BK_s2-qruXBB6c3TVvf7zY2pmU8_CnCLEddQVX9q2lLBqmZPMBkN488xAF5ZJQB8pvHljZwJUKkFeV5SSr8C5EJQVWKRuZN6K6gzDv93ZKNyOY19iUjx-6q5IvTb28JVXbNg6kk/s320/Salter+Harris+classification.jpg" width="320" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Treatment</span></span></b></u><br />
<br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">As with all fractures, this depends on the severity of the
fracture, but will probably comprise of:</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Immobilization</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Manipulation or surgery</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Strengthening/Range of movement exercises</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Implication of these injuries</span></span></b></u><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj4b0hkXTRRpDe7wePfyMafGFytibtZ5Zglzj44iE3uymOII220RTXjsUKeKy3kvamg-pdXXjthpxAElE6DkuqNQqw-fuLeRbQXSeCJJoWuZ_2zqVoBVH-bzXWqlZL_xtcp3pHytw3pCg/s1600/Continued+climbing+despite+advice.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj4b0hkXTRRpDe7wePfyMafGFytibtZ5Zglzj44iE3uymOII220RTXjsUKeKy3kvamg-pdXXjthpxAElE6DkuqNQqw-fuLeRbQXSeCJJoWuZ_2zqVoBVH-bzXWqlZL_xtcp3pHytw3pCg/s1600/Continued+climbing+despite+advice.jpg" /></a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Rotation/shortening of finger</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Incomplete growth</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Deformity</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Some papers suggest there is a link between climbing from an early
age and early degenerative changes later on in life such as
arthritis.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">These will all obviously affect the child later on in life.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">How to avoid these injuries?</span></span></b></u><br />
<ul>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Avoid campus boarding under 18 years of age. Many famous
climbers never touch a campus board – Steve Mclure, Tyler Landman
so why does the kid?!</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Excessive Crimping – try and promote versatile grip
strengths</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Long / intense training sessions</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">No need to train strength pre-pubescent – due to motor
skills still need to catching up with growth spurt.</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Avoid additional weight when climbing</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Dynamic moves – limit</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">When training, try to discourage competition, as it will
inevitably lead to someone getting an injury</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Train other areas, such as core, antagonists, balance,
movement technique
</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Respect growth spurts.</span></span>
</li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Maintain good nutrition</span></span>
</li>
</ul>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>No campus boarding (feet-off or dynamically) for under 18's!
</b><span style="font-weight: normal;">(to allow margin of error for
late developers) UIAA approved advice!</span></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<b><u><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References</span></span></u></b><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Swiss medical weekly</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Hochholzer T, Schoffl VR. Epiphyseal fractures of the finger
middle joints in young sport climbers. Wilderness Environ Med.
2005;16:139–42.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">One Move too many</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.medicinenet.com/growth_plate_fractures_and_injuries/article.htm">http://www.medicinenet.com/growth_plate_fractures_and_injuries/article.htm</a></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.thebmc.co.uk/should-u18s-use-campus-boards?s=1">http://www.thebmc.co.uk/should-u18s-use-campus-boards?s=1</a></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.dpmclimbing.com/articles/view/kid-crushers-training-youth-climbers">http://www.dpmclimbing.com/articles/view/kid-crushers-training-youth-climbers</a></span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-79289934184907232612013-10-06T13:56:00.000-07:002013-10-22T09:19:35.020-07:00Injures in Indoor Rock Climbing: New Research<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now the winter is fast approaching, all but the most tenacious of
climbers will scurry indoors. But just how "safe" is indoor climbing?</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiINOsre4wAUbvWHWyEQqw-IxbJf43P2RnX27eXnyd6LXd9M_DS5QwRa_a6l3se6KOsTY8q-nI9ak_0uT4h99U8FbzuNDYCL4eGbK8Hh8gTZske9Vx1M5eGdoC7BDTp33iN5XroDtMPsyo/s1600/402005113104240BMC+Check+Or+Deck+WEB+FORMAT.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiINOsre4wAUbvWHWyEQqw-IxbJf43P2RnX27eXnyd6LXd9M_DS5QwRa_a6l3se6KOsTY8q-nI9ak_0uT4h99U8FbzuNDYCL4eGbK8Hh8gTZske9Vx1M5eGdoC7BDTp33iN5XroDtMPsyo/s320/402005113104240BMC+Check+Or+Deck+WEB+FORMAT.jpg" width="226" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Well, a new paper has been published this year by Schoffl,
Hoffmann and Kupper in Wilderness and Environmental Mecicine has
reported on the rate of injuries reported in an indoor climbing wall
in Germany.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This study was performed over a 5 year period and was performed
prospectively, rather than retrospectively as previous studies have.
This meant that less bias could be introduced to the study, due to
the events not having already occurred and the results unknown.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This study also had the advantage that climbing time could be
monitored exactly due to an electronic entry and exit system at the
climbing wall used.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">There was a large number of participants registered in the study
(515, 337), but this could of been higher due to those involved in
group sessions not being counted separately.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Demographic data of the study found 63.6% of climbers were male,
the remaining female, with ages between 8 and 80 years old (median
being 34 years old). Average climbing time was 2 hours 47 minutes.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The authors reported 30 injuries in total over the 5 year period;
6 cases whilst bouldering, 16 lead climbing, 7 toproping, and in 1
case as a third person (not climbing or belaying) while watching
another climber. Bouldering injuries were mostly the result of falls
onto the mat, whereas in lead and toprope climbing various scenarios
happened, but mostly resulting from belaying mistakes. Fifteen (50%)
injuries were UIAA MedCom grade 2, 13 (43%) were grade 3, and 2 (7%)
were grade 4, with no fatalities.</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfaS_tT95rjSl_dsqyOhNkaSTIZ5RHOs2htodsDclW56pJuHS0wGN1apr6nb3BpPdBrvU0-7354iDQVSJ6T26TCxVT62QRf4u7XwZNhbvBmzQx5dbnBHYoLh4vc_3SHRfVXetNzmU3UYI/s1600/UIAA+MedCom+Grades.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfaS_tT95rjSl_dsqyOhNkaSTIZ5RHOs2htodsDclW56pJuHS0wGN1apr6nb3BpPdBrvU0-7354iDQVSJ6T26TCxVT62QRf4u7XwZNhbvBmzQx5dbnBHYoLh4vc_3SHRfVXetNzmU3UYI/s320/UIAA+MedCom+Grades.png" width="262" /></a></span></div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Injuries happened in beginner
climbers in 5 (16.7%), in intermediate climbers in 16 (53.3%), in
experts in 6 (20%), and in professionals in 3 (10%) cases.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In studies such as this, the safety aspect of a sport is given as
a number of injuries per 1000 participation hours. The authors
concluded that this study had 0.02 injuries per 1000 hours of
climbing time, (similar to previous studies) and also much lower than
other sports, such as surfing (13 per 1000 hours of competitive
surfing (Nathason et al 2007)) and rugby (91 injuries per 1000 player
hours (Brooks et al 2005)).</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj34jsJxlxskkfAB8IIOS9LKJ1H48gHEAM35WULiHFwwuNaS8TzQw46u_dcbjzUrUZSeTIY6yMo3kDQQNxrgal_tG0OqnAmQY_x2PMvLQT9yg7A6HolURwwDVgb2Xyiib1tAG8ywO2ja18/s1600/131-surfing-with-sunset-hd-wallpaper.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj34jsJxlxskkfAB8IIOS9LKJ1H48gHEAM35WULiHFwwuNaS8TzQw46u_dcbjzUrUZSeTIY6yMo3kDQQNxrgal_tG0OqnAmQY_x2PMvLQT9yg7A6HolURwwDVgb2Xyiib1tAG8ywO2ja18/s320/131-surfing-with-sunset-hd-wallpaper.jpeg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Of the injuries that occurred, the authors report that many of
them were preventable, such as belaying or knot tying mistakes.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, this study did have some flaws, of which are discussed
below:</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<ol>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This study was only performed in one climbing gym, which may
have been a particularly well run gym, and therefore have a better
safety record, which the study recognises</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Climbing time less than 30 mins and over 5 hours was omitted
(due to probability of less than 30 mins not going to have been a
climbing visit, or over 5 hours someone forgetting to log out).
However, how many of us pop in to our local wall for a lunch time
session, or spend the whole day there and stop for lunch etc?!</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Only injuries that occurred while at the wall that required
medical attention then and there were recorded. No overuse/chronic
injuries, or those that may have been discovered after the climbing
session were recorded.</span></span></li>
</ol>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But there you are, relative to other sports, indoor rock climbing has a much lower risk of injury. </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This article is also available on the <a href="https://www.thebmc.co.uk/experts-release-climbing-injury-stats">BMC website</a>, along with information on preventing becoming an indoor wall injury statistic yourself! </span></span><br />
<ol></ol>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b><u>References</u></b></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Brooks JHM, Fuller CW, Kemp SPT, Reddin DB 2005 Epidemiology of
injuries in English professional rugby union: part 1 match injuries.
Br J Sports Med 39:757–766</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Nathanson A, Bird S, Dao L, Tam-Sing K 2006 Competitive surfing
injuries: a prospective study of surfing-related injuries among
contest surfers.A m J Sports Med. 35(1):113-7.
</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Schöffl VR, Hoffmann G, Küpper T 2013 Acute injury risk and
severity in indoor climbing-a prospective analysis of 515,337 indoor
climbing wall visits in 5 years. Wilderness Environ Med. 24(3):187-94</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-58649627361535880982013-09-23T13:40:00.005-07:002013-09-23T13:42:17.112-07:00IFSC International Paraclimbing Cup<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So I've just returned from a very busy weekend, volunteering at the <a href="http://www.westwaysportscentre.org.uk/">Westway Sports Centre</a> as a physiotherapist for the GB Paraclimbing Team, as part of the <a href="http://www.ifsc-climbing.org/index.php/news/latest-news/item/368-ifsc-paraclimbing-cup-london-2013">IFSC International Paraclimbing Cup</a>.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1prcUXq8ExWC8xesbfQIzrdtbmBtznJunasPW02S0sqMLgcGSd6A0wSvpotWK2gPkDZnjovly0T4H_lkxISioDf11UijPUz9q8mkk3lTj5grKiB8Lc8qQhyphenhyphenIpcsv6m_CGOFLuLMShro8/s1600/IMG_3029.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1prcUXq8ExWC8xesbfQIzrdtbmBtznJunasPW02S0sqMLgcGSd6A0wSvpotWK2gPkDZnjovly0T4H_lkxISioDf11UijPUz9q8mkk3lTj5grKiB8Lc8qQhyphenhyphenIpcsv6m_CGOFLuLMShro8/s320/IMG_3029.jpg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It was a fantastic weekend, with teams from USA, India, Italy, France and Spain, along side the GB climbers. The competition was hosted by the BMC and the IFSC. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Over the weekend, I got to meet Mark Wilkinson, of <a href="http://www.paragonphysiotherapy.com/">Paragon Physiotherapy</a>, who specializes in spinal injuries and had done some previous work with the <a href="http://www.gbclimbingteam.co.uk/gb-climbing-team/paraclimbing-team-member-profiles">GB Paraclimbing Team</a>. We did some joint assessments on a couple of the Team who required some guidance on their rehab, such as an ankle, wrist, and the obvious finger injuries. This was great learning as we got to brainstorm different theories and share knowledge.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Then, the climbers got on with the two qualifying routes. It was really inspiring to see climbers who were visually impaired, had a neurological physical disability, or had an amputated limb climb hard routes with such style and finesse, you wouldn't think they had a disability once they were on that climbing wall. </span></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiokr8O3abZS4uhB8pTYC1s3_VfuRN6HO_Cu1IXe_UeSL3-Ieh1rKSguK_8HqEpEL2FLLlYVoggWWhckgIEbMDVfF5MEIkkwKsVSLCYYKTa8DR1lz9l7HXp8Wo7e69HLt571D2-RCNvv3A/s1600/IMAG0846.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiokr8O3abZS4uhB8pTYC1s3_VfuRN6HO_Cu1IXe_UeSL3-Ieh1rKSguK_8HqEpEL2FLLlYVoggWWhckgIEbMDVfF5MEIkkwKsVSLCYYKTa8DR1lz9l7HXp8Wo7e69HLt571D2-RCNvv3A/s320/IMAG0846.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Lower limb amputees warming up</span></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXyPi4dWjKAZvEAEzAy_7azNiH5daLCT-Bi_X3OH9iZJgO0OVq0ar7pGLds5twr00fb0hhqB6JjFQP170lE0kHP9KlohFySPG4lDCFsgva58aV8XqQPUVjMQmXMHyydXsLzdulfufHoak/s1600/IMAG0836.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXyPi4dWjKAZvEAEzAy_7azNiH5daLCT-Bi_X3OH9iZJgO0OVq0ar7pGLds5twr00fb0hhqB6JjFQP170lE0kHP9KlohFySPG4lDCFsgva58aV8XqQPUVjMQmXMHyydXsLzdulfufHoak/s320/IMAG0836.jpg" width="212" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Fran Brown (GB) on the qualifiers</span></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBa6jMDHMuZP2a1RnzNl5Rrvw7J7KFzARnFf6NggaWaqDMCDgReG0h4JSOmN-SWA1f72JS7abzmOVRMxUqyFdQaDOb9P4Xq8Yrh2IR_QFEv-Ol9TVMWLNDBr3gpS2H8tJFZnq-_Cm7mP8/s1600/IMAG0835.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBa6jMDHMuZP2a1RnzNl5Rrvw7J7KFzARnFf6NggaWaqDMCDgReG0h4JSOmN-SWA1f72JS7abzmOVRMxUqyFdQaDOb9P4Xq8Yrh2IR_QFEv-Ol9TVMWLNDBr3gpS2H8tJFZnq-_Cm7mP8/s320/IMAG0835.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Sianagh Gallagher (GB) on the qualifiers</span></td></tr>
</tbody></table>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The following day, the climbers entered isolation and proceeded to exit one by one to compete in the final. The hardest of these routes, on a steep, overhanging wall, were up to F7c+ and it was impressive, and inspiring to see the climbers work the way up these. </span></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCfmt7RkJ9DdSuI3KDtRQ-xNPO55Z7JBwINbuWkaRiuNZFrzoeoUgaX5Th042kTBr6VeIyt5J_aplwY8X787arHJIYV9t1UUTUMd075Tyq6lPtoarL5sJbBTXEiIYIKU6v4Y3tHTB5aaE/s1600/IMAG0829.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCfmt7RkJ9DdSuI3KDtRQ-xNPO55Z7JBwINbuWkaRiuNZFrzoeoUgaX5Th042kTBr6VeIyt5J_aplwY8X787arHJIYV9t1UUTUMd075Tyq6lPtoarL5sJbBTXEiIYIKU6v4Y3tHTB5aaE/s320/IMAG0829.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Ronnie (USA) on the qualifiers</span></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-iVSUeCQGu-RgFzMiV1wDXJF7OG6zULM4LxLo6NkHl7XF68pjVCZ-PwfLKj4YQ_r2Le_aUzLzPu5Km30Fhei1bSbaV2mx8s19z3HDv-vobAysCrFa6lL82uH96u1JR7wrWBDFltzM08I/s1600/IMAG0832.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-iVSUeCQGu-RgFzMiV1wDXJF7OG6zULM4LxLo6NkHl7XF68pjVCZ-PwfLKj4YQ_r2Le_aUzLzPu5Km30Fhei1bSbaV2mx8s19z3HDv-vobAysCrFa6lL82uH96u1JR7wrWBDFltzM08I/s320/IMAG0832.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Tom Perry (GB) on qualifiers</span></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXrOLSVXTydvqQXUt4EFmdFpGpNGhppkDeLNC7O7boj2zm2z3eyyO-327a1Rgl-yyChIzOHh1fqT_xpGTC6aN5pmk9ZwG17PH7D3aPcpcBi2mNxOXnINB2bdnaafXzot7wOguvdjb9jCg/s1600/IMAG0834.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXrOLSVXTydvqQXUt4EFmdFpGpNGhppkDeLNC7O7boj2zm2z3eyyO-327a1Rgl-yyChIzOHh1fqT_xpGTC6aN5pmk9ZwG17PH7D3aPcpcBi2mNxOXnINB2bdnaafXzot7wOguvdjb9jCg/s320/IMAG0834.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">One of the French visual impaired climbers on qualifier</span></td></tr>
</tbody></table>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Over the weekend, I got to meet many people just as invested in paraclimbing as the paraclimbers themselves, such as Graeme Hill (GB Team manager), Andy Colbart (GB Team assistant manager and IFSC Paraclimbing President), John Ellison (of <a href="http://www.climbersagainstcancer.org/">Climbers Against Cancer</a>), the family, friends, supporters, spectators, photographers, route setters....just too many to mention. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It was fantastic to meet some of the athletes themselves, such as the USA climbers Ronnie and Jon, GB Team Fran Brown, Tom Perry, Sianagh Gallagher and Reanne Racktoo. </span></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMYVGK9dk1N1GxWffPBHzBVS8A2cSo_dRp0zvnxYcCtNOA5Wy2sBgFS2tx55PxSWlNsF7M24-xJZU5NRNtqwenTioLbblPtgRBQ_-ToEg9m3UYtbvzefftemdCFb0zM8bedHmah1lGvq4/s1600/IMAG0868.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMYVGK9dk1N1GxWffPBHzBVS8A2cSo_dRp0zvnxYcCtNOA5Wy2sBgFS2tx55PxSWlNsF7M24-xJZU5NRNtqwenTioLbblPtgRBQ_-ToEg9m3UYtbvzefftemdCFb0zM8bedHmah1lGvq4/s320/IMAG0868.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">One of the French climbers on the final route</span></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3rDpfc9Q9rooyYgaplrm9G60SohDHYC2qAaicItZFYrxc_8SCjeyfTn-ki2UnDWnclm_ZsTv7_ZVtL3g8XeX10QOMVpfppnWSFoJ1KrlF6XU9RGFXIi5dEogBjcYeOJRAJmRlxyjebM4/s1600/IMAG0876.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3rDpfc9Q9rooyYgaplrm9G60SohDHYC2qAaicItZFYrxc_8SCjeyfTn-ki2UnDWnclm_ZsTv7_ZVtL3g8XeX10QOMVpfppnWSFoJ1KrlF6XU9RGFXIi5dEogBjcYeOJRAJmRlxyjebM4/s320/IMAG0876.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Spanish finalist being lowered from his high point</span></td></tr>
</tbody></table>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I also thoroughly enjoyed watching the <span id="goog_764467975"></span><span id="goog_764467976"></span>skill and balance that these climbers demonstrated and the mature attitude shown by all the climbers involved. It was also brilliant to see the comradeship of those competing with each other, with all athletes cheering each other on. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I came away awed, with more knowledge than I had previously, and I am very much looking forward to future work with the GB Paraclimbing Team.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Hopefully more pictures will follow as they surface!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Check out the <a href="https://www.thebmc.co.uk/ifsc-paraclimbing-cup-inspiring">BMC report</a> on the competition.</span></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh8SqIqGeApZb2KYHdlmymc-pJinF1K5UY7Uavipbyl1owGepR7sLzm1MXMvnQqmHjYMkh4hOFLYtl3IwcywVIYV5i0Pok6-6eKPrM_DwLhU64Q0cAQsVzNoNhzxzsHl4WSbWJJfi_iAA/s1600/IMAG0889.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh8SqIqGeApZb2KYHdlmymc-pJinF1K5UY7Uavipbyl1owGepR7sLzm1MXMvnQqmHjYMkh4hOFLYtl3IwcywVIYV5i0Pok6-6eKPrM_DwLhU64Q0cAQsVzNoNhzxzsHl4WSbWJJfi_iAA/s320/IMAG0889.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Lower limb amputee podium</span></td></tr>
</tbody></table>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-74934860695537433582013-09-20T12:19:00.003-07:002013-10-20T13:34:54.001-07:00Children's feet and footwear<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYU1tybvbhKzGxT39XDQH3EJNzwa6mdafhYcUX_sxY8P6aEHQX4c1rhr7C61ra8rhkl9WUfnjeRXLqhYlj_mU9mDxfdEZQfHgm7pBc_Am4ViR9g16ijk1AAUxXPAaJYyspjsiL4b6H_2A/s1600/kids_top.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYU1tybvbhKzGxT39XDQH3EJNzwa6mdafhYcUX_sxY8P6aEHQX4c1rhr7C61ra8rhkl9WUfnjeRXLqhYlj_mU9mDxfdEZQfHgm7pBc_Am4ViR9g16ijk1AAUxXPAaJYyspjsiL4b6H_2A/s320/kids_top.jpg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">"The foot is the foundation, and if that isn't working
correctly, nothing will"</span></span></b><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">We all know children grow, most of the time, too quickly.
Especially their feet.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So how do we target this, and what is the impact if we don't? This
blog post is to discuss the impact of rock climbing footwear on
children's feet, especially due to the growing market of climbing
shoes available for the younger climber.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The first thing to note is the rate of growth in children's feet.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In girls, the foot grows linearly fashion in both width and length
from 3 to around 12 years old, and stop growing completely around 14
years old.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In boys, the foot grows in a linear fashion in both width and
length from 3 to around 15 years old, and stop growing around 16
years old. </span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhHBCPQt2KVRpSw-L1WM1nxR3eL7AwmyktPjvo6YQlhFR3X5YRHvt_OXU3JrTwLoARGZDWcpCB4s-ROSvxflhwoc4IZ7KeTpE6iR4cPJKYjYT3871uhiGwEdwU1ypVdA2lu71yfFBaTwU/s1600/measuring-childrens-feet-is-important-to-ensure-the-perfect-fit.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhHBCPQt2KVRpSw-L1WM1nxR3eL7AwmyktPjvo6YQlhFR3X5YRHvt_OXU3JrTwLoARGZDWcpCB4s-ROSvxflhwoc4IZ7KeTpE6iR4cPJKYjYT3871uhiGwEdwU1ypVdA2lu71yfFBaTwU/s320/measuring-childrens-feet-is-important-to-ensure-the-perfect-fit.jpg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A child's foot can grow 3 sizes in a year, so it is really
important to monitor growth closely.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Children's feet also sweat more, so need more ventilation from
their chosen footwear to prevent poor foot hygiene.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A study done into the German Junior National Team found a higher
incident of hallux valgus in those members who had spent a relatively
longer time active in indoor competition climbing, as well as 74% of
the team having feet pressure marks compared to 28% recreational
climbers, indicating tight fitting shoes (even though the importance
of tight fitting shoes in indoor walls is less important due holds
being relatively larger than outdoors, enabling children to wear
shoes too long if required).</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Another problem with the climbing shoes is the supinated foot
position as mentioned in the previous <a href="http://thomasbondphysio.blogspot.co.uk/2013/08/feet-and-rock-climbing.html">foot and ankle post</a>, which can
put a child more at risk of ankle injuries. With children, this puts
them more at risk of ankle growth plate, as their growth plates are
not fully formed until the age of 17 years old.</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfqb8nRrZCBAsKJ9gA7baT9F3_EdDXouRDl0aOR_CLBf3fKR5G-FYFgn3uZmgN_RpEhn7rnLzvnlEJJGJ69f5Y-aKES_M8SqZ6umbiopgxNNdoJSKFvkzZdLqAjGeSLXG5thYDErj3EHM/s1600/SalterHarris2010.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfqb8nRrZCBAsKJ9gA7baT9F3_EdDXouRDl0aOR_CLBf3fKR5G-FYFgn3uZmgN_RpEhn7rnLzvnlEJJGJ69f5Y-aKES_M8SqZ6umbiopgxNNdoJSKFvkzZdLqAjGeSLXG5thYDErj3EHM/s320/SalterHarris2010.JPG" width="240" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Rigid shoes or too much cushioning can limit the development of
the connective tissue, muscles and bones, due to these structures
requiring the mechanical stimuli to aid the growth. This is
especially important as the connective tissue strength and foot
flexibility does not stop forming until the age of 15.
</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Finally, shoes that do not cut into Achilles tendon are
recommended, as this can cause shortening of the tendon when the calf
is flexed, causing torsion in the plantar fascia leading to a higher
arch causing a change in the biomechanics of the foot.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Any children's shoes that are too tight or too small will limit the
growth of a child's foot at the key stages of their development. A
poorly developed foot will impact a child for the rest of their life.</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_UPCeA2RlnPNCKu4JaJZR4PNj5xBKvk-dNHKZqZ8xHXFigpQBF7XtNsx-uRUMD210-PYOxKSMJaVG6cBF0e6dntmlO3TfO2DZ4pX5Dlp4yqJ9qqYSHpmPsq5nlh4fieER3J1lCkRI3T4/s1600/sample+of+rock+climbing+shoes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_UPCeA2RlnPNCKu4JaJZR4PNj5xBKvk-dNHKZqZ8xHXFigpQBF7XtNsx-uRUMD210-PYOxKSMJaVG6cBF0e6dntmlO3TfO2DZ4pX5Dlp4yqJ9qqYSHpmPsq5nlh4fieER3J1lCkRI3T4/s320/sample+of+rock+climbing+shoes.png" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In summary, a child's climbing shoe needs to be:</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">flexible</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">not cutting into the Achilles tendon</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">not too much cushioning</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">not restrictive</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">needs ventilation</span></span><br />
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">review the sizing often</span></span></li>
</ul>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Coming next, will be the impact of climbing on children's fingers. </span></span><br />
<ul>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"></span>
<br />
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">References</span></span> </b></u><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn).
Lochner Verlag: Ebenhausen.</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Morrison A 2009 Climbing shoes: is
pain insane? BMC</span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.thebmc.co.uk/climbing-shoes-is-pain-insane"><span style="font-weight: normal;">https://www.thebmc.co.uk/climbing-shoes-is-pain-insane</span></a></span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Morrison AB, Schoffl VR 2007. Physiological responses to rock
climbing in young climbers. Br J Sports Med 41;852-861.</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;">Walther M, Herold
D, Sinderhauf A, Morrison R 2008 Children sport shoes—A systematic
review of current literature. Foot and Ankle Surgery 14(4): 180-189</span></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-38758237177832896472013-08-26T14:03:00.000-07:002013-08-27T10:02:32.194-07:00Feet and rock climbing<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So you're out climbing, and you pull
your climbing shoes out the bag. What size are they? One size smaller
than your normal shoes? Maybe two? Well, this post is to discuss the
links between feet, footwear and climbing, and other foot injuries/problems. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwwrDgPVFqyG4JuRDCKIMg9iCZhG5NPxVb5zOAbyKBK4JUS76jw9bXYROOZkqeHQPkXwn4R_jVZoUycIpiUSosVcZbrGsxS0wajI6wVfMnT1jMuOPv21k56_n-VWbmmF4o4kS_bzDt49I/s1600/climbing+shoes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwwrDgPVFqyG4JuRDCKIMg9iCZhG5NPxVb5zOAbyKBK4JUS76jw9bXYROOZkqeHQPkXwn4R_jVZoUycIpiUSosVcZbrGsxS0wajI6wVfMnT1jMuOPv21k56_n-VWbmmF4o4kS_bzDt49I/s320/climbing+shoes.jpg" width="320" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Do remember, however, that we aren't the only sport or hobby to do
this to our feet.....</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
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<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMTtuQZ9FXt0Qq7mf1MwQOjpQSG7cDRJahRu1YKWGOFHRy3THJpZwE4Tuw7qTLX1g3wTLrnsmuh_9cWDg90nTfQ4Xt5HTT8GVFTl6LNcbj7vZGyJx9TEKoB5uShK7UnfZN3VUGXiZziQE/s1600/xray+ballet+shoes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMTtuQZ9FXt0Qq7mf1MwQOjpQSG7cDRJahRu1YKWGOFHRy3THJpZwE4Tuw7qTLX1g3wTLrnsmuh_9cWDg90nTfQ4Xt5HTT8GVFTl6LNcbj7vZGyJx9TEKoB5uShK7UnfZN3VUGXiZziQE/s320/xray+ballet+shoes.jpg" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">In a study of 104 rock climbers, Killian et al (1998) found that
81% suffered from an acute or chronic pain or pathology in the foot
and/or ankle during or after rock climbing. They suggest that this is
in relation to the biomechanics of wearing small rock shoes.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">First, as always, I will discuss the
anatomy of the foot.</span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Ligaments</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj85MkjFqPTv630LJRfiH739lg2C03xDyCs-16VgH-OKZzuE3sJWUyzcMMldkXtXteGxTxfw_OUiCqCBghxN-dYM6ohJUMJf5yneWbhWWa5RLL9JxE81m7jLKvP8nTviPE0wAdjXPtVgSs/s1600/plantar+fascia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj85MkjFqPTv630LJRfiH739lg2C03xDyCs-16VgH-OKZzuE3sJWUyzcMMldkXtXteGxTxfw_OUiCqCBghxN-dYM6ohJUMJf5yneWbhWWa5RLL9JxE81m7jLKvP8nTviPE0wAdjXPtVgSs/s320/plantar+fascia.jpg" width="320" /></a></span></span></div>
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Muscles</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0uCqp1UZ_VrF4y0Vs3jRRQKV6JDT_ciVu2FSZnRXNQQLiiCZ883gUsgd2moBj-tCJtrhfSX-nrC5HKDPq9Fym_NIzv1-ZNYRgnAWpP0wsao_UwBA5fhKbozjr0DG4EMVSxKGElgMq99s/s1600/muscles+of+ankle.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0uCqp1UZ_VrF4y0Vs3jRRQKV6JDT_ciVu2FSZnRXNQQLiiCZ883gUsgd2moBj-tCJtrhfSX-nrC5HKDPq9Fym_NIzv1-ZNYRgnAWpP0wsao_UwBA5fhKbozjr0DG4EMVSxKGElgMq99s/s1600/muscles+of+ankle.gif" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tibialis anterior is also the main dorsiflexor of the ankle.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The gastrocnemius, soleus and plantaris are the plantarflexors of the ankle (there are more muscles involved with platarflexion due to needing to lift the entire body weight, whereas dorsiflexion only consists of lifting the foot.)</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP2m90stIg3IfpfQW1s4KiWo2rlkgS5UQwG3K4u1bjGGNxVx3Dcfvg7JZuPK0pzRhaOn02V68AVM-B07z9eM04P5LPtwA-eOWziG35SVZQ6DMx6VjaEW2RXEIQx9PGt91Ol_uvTqjKN_o/s1600/attachment.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP2m90stIg3IfpfQW1s4KiWo2rlkgS5UQwG3K4u1bjGGNxVx3Dcfvg7JZuPK0pzRhaOn02V68AVM-B07z9eM04P5LPtwA-eOWziG35SVZQ6DMx6VjaEW2RXEIQx9PGt91Ol_uvTqjKN_o/s320/attachment.jpg" width="320" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Movements of the foot</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeiJSyHkOIKZoKf0GgwIz5qr0oUul1Mc2_L64DNYOls15rSEEzYjLUuWAemM55_Deuvs79eW2RLOljd6rVuKPsiaznNKZUjZkwGTE3gw3YEbzvmt58IFY8pFZ5h_RkOJbW22wAohvti0I/s1600/dorsiflexion-plantarflexion.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeiJSyHkOIKZoKf0GgwIz5qr0oUul1Mc2_L64DNYOls15rSEEzYjLUuWAemM55_Deuvs79eW2RLOljd6rVuKPsiaznNKZUjZkwGTE3gw3YEbzvmt58IFY8pFZ5h_RkOJbW22wAohvti0I/s320/dorsiflexion-plantarflexion.jpg" width="320" /></a></span></span></div>
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Feet position within climbing shoes</span></span></b></u></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHO80j0B8n7BsWyJMC-d5N4FbTuj3NQVuxPXJ9-ipgAflMxXwGiJ3EXegxWeQtc-CIEGCYf5J-s2CC2PsZhxTyQQAitAGYTun13w5P72Lw6ZPd6l8nsiD_XIUJmdJxdA_1gKD2gYBaqeo/s1600/foot+withouts+shoes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="294" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHO80j0B8n7BsWyJMC-d5N4FbTuj3NQVuxPXJ9-ipgAflMxXwGiJ3EXegxWeQtc-CIEGCYf5J-s2CC2PsZhxTyQQAitAGYTun13w5P72Lw6ZPd6l8nsiD_XIUJmdJxdA_1gKD2gYBaqeo/s320/foot+withouts+shoes.png" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwjgsDHbbx8rpPZehGnUbfDXxI97X5UfQ0wjjKBqE2VtF4I5VzTByz2CMDHegOKYgoH_F5ZzFmdu87gJAY0Eg1Pnd0jkJQP6CVZ2RJF2LLwcAvExYdUq1dBWwHOXb8k3cFjBilFTwEobY/s1600/foot+with+climbing+shoes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwjgsDHbbx8rpPZehGnUbfDXxI97X5UfQ0wjjKBqE2VtF4I5VzTByz2CMDHegOKYgoH_F5ZzFmdu87gJAY0Eg1Pnd0jkJQP6CVZ2RJF2LLwcAvExYdUq1dBWwHOXb8k3cFjBilFTwEobY/s320/foot+with+climbing+shoes.png" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1tje_HRiztM1U-BxnBJsjovlDRRM86TFVruWHK7pp-s2GDkqgo9vKFGI7HgIPAkopRvaWACvXgu3HZyYlFkKzWgGlZhpOCqCZ4_RI6O2_ZPFIlyc_I9onjeD_38OL9kYXlZr9XMY-bb0/s1600/tumblr_mkgf6vZcIG1r233uno1_1280.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1tje_HRiztM1U-BxnBJsjovlDRRM86TFVruWHK7pp-s2GDkqgo9vKFGI7HgIPAkopRvaWACvXgu3HZyYlFkKzWgGlZhpOCqCZ4_RI6O2_ZPFIlyc_I9onjeD_38OL9kYXlZr9XMY-bb0/s320/tumblr_mkgf6vZcIG1r233uno1_1280.jpg" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6Ra1RZppdeJbo_H2n4Srlt4JSYp_4eaSzrD8Ui_fKBPMV60gGIs8w68zW-IwZWDVotuyyWqPlND6K9-3Toh0ZNI8BRADBVuARay9LrRaIcyiykFic0MTdGhJlkDqdQ7KRHzKD-qzDHrc/s1600/IMAG0438.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="276" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6Ra1RZppdeJbo_H2n4Srlt4JSYp_4eaSzrD8Ui_fKBPMV60gGIs8w68zW-IwZWDVotuyyWqPlND6K9-3Toh0ZNI8BRADBVuARay9LrRaIcyiykFic0MTdGhJlkDqdQ7KRHzKD-qzDHrc/s640/IMAG0438.jpg" width="640" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Arches of the foot</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqT2jOoWHtV67OyZ1OY8WQ-tpprgNOFcjNqtzMyk2xjasgRfFdqam5Yr24WuMudFuUocDptSO9xGRkwrOnYu0eZCX10kYiTI7O9DiIqKur0ES9fm7OW-5t8CQwTX03N1HEfNJkC-_Z6kQ/s1600/3+arches+of+foot.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqT2jOoWHtV67OyZ1OY8WQ-tpprgNOFcjNqtzMyk2xjasgRfFdqam5Yr24WuMudFuUocDptSO9xGRkwrOnYu0eZCX10kYiTI7O9DiIqKur0ES9fm7OW-5t8CQwTX03N1HEfNJkC-_Z6kQ/s320/3+arches+of+foot.png" width="204" /></a></span></span></div>
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<b><u><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Forces through feet when climbing</span></span></u></b></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Robert Bradshaw-Hilditch and Gary
Gibson (yes, THAT Gary Gibson) are both podiatrists who have been
conducting some brilliant studies in collaboration with Staffordshire
University regarding the forces that are exerted through climbing
shoes, and where. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV4nepoDZG8LEuVEZcmGAxXqSI6lFHLDZP89C51_lI_Mz4y0vCtPcUgFwBMREDhnDJYP659vYp4yCCwLa9VwJGBtRPnQOEG0TGVgEqmKdwCao_ZUTXq1H77XVlxN-BGA2UCFb2SmlJg6s/s1600/IMAG0434.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV4nepoDZG8LEuVEZcmGAxXqSI6lFHLDZP89C51_lI_Mz4y0vCtPcUgFwBMREDhnDJYP659vYp4yCCwLa9VwJGBtRPnQOEG0TGVgEqmKdwCao_ZUTXq1H77XVlxN-BGA2UCFb2SmlJg6s/s400/IMAG0434.jpg" width="400" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Their research has found that the
forces when front pointing on the hallux (big toe) during climbing causes more
force through the metatarsal head, and puts the plantar fascia under
tension.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">During edging, the forces through the
hallux again puts most of the force through the hallux metatarsal
head, and stresses the plantar fascia, but also places the foot in a
supinated position.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This is just the tip of the iceberg for
this research, and Rob and Gary are looking at expanding this much
further, as this was only looking at the plantar aspect of the foot
in an indoor climbing situation.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But what does it mean?</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This means that the feet are more prone to ankle injuries due to the supinated position (see below), and this increase in pressure on the plantar fascia could cause plantar fasciitis (see below as well). The forces being placed through the metatarsal head will change the biomechanics of the foot through the strength of certain muscles, and could cause problems with the arch of the foot (see below) and these problems will surpass what happens on the rock alone. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So what can be done? </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Read on...</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b><span style="font-family: "Courier New",Courier,monospace;">Problems with the feet</span></b></u></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Hallux-Abducto Valgus (commonly known
as bunions)</span></span></b></div>
<div align="LEFT" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Hallux
valgus is defined as a 20 degree difference between the axis of the
first metatarsal and the axis of the proximal phalanx of the toe, and
was noted in both feet in 53% and in one foot in 20% of climbers
participating in the sport for more than 5 years and climbing UIAA
degree IX. (Peters 2001)</span></span></div>
<div align="LEFT" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Bunions are not actually caused by wearing tight shoes, but climbing shoes can worsen the
deformity. Bunions are most often caused by an inherited faulty
mechanical structure of the foot. </span></span></div>
<div align="LEFT" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Treatments include wearing bunion pads, orthotics or different footwear and pain killers, or there is the surgical route if the pain is severe. There is no physiotherapy intervention that can help here, therefore prevention is the best cure, by avoiding wearing tight shoes and decreasing the effect of escalating the problem. </span></span>
</div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Vessel Compression</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">65% of sport climbers have found to
have tingling and/or pins and needles in their feet, thought to be
caused by medial to lateral compression of blood vessels and nerves of foot by smaller climbing shoes. This usually
dissapates quite quickly once the shoes are removed. If it doesn't,
I'd get it checked out by a professional fairly quickly.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Arch Disorders</b></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Rock climbing has been found to have a beneficial impact on longitudinal arch of the foot (due to strengthening), but does cause an increase in frequency in transverse arch disorders such as tansversal platypodia (flat foot),and an increased frequency of abnormal toe-to-surface adhesion.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Both these problems affect the frontal areas of foot, caused by climbing footwear - changes in the biomechanics of the foot, can cause weakness in muscles controlling 1st metatarsal head extension.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ankle sprains</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ankle sprains are an injury that don't
just affect rock climbers, as you may well realise. They are much
more likely to affect other sports persons such as fell runners,
however, with climbing, due to the already supinated/inverted (turned
inwards) position of the foot means that there is an increased risk
of an ankle sprain, normally due to jumping/falling off (this has
happened to a few friends, one bouldering in Font, the other trad
climbing at Stanage – and both those walks out seemed to take forever!)
Hochholzer & Schöffl (2006) found that 24% of climbers have
suffered from an ankle sprain.
</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ankle sprains are normally caused
because the muscles around the ankle don't act quick enough to stop
the ankle surpassing it's normal range of movement and the ligaments
have to take the brunt of the force.It is normally when the ankle is inverted.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Therefore, the preventative measures
you can do to improve the acting of your muscles around the ankle
would be to improve the proprioception of the ankle (knowledge of
where your body is in space).
</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To do this, you can use the use of a
wobble board or wobble cushion. Stand on the board/cushion on one leg
until you can do it for 1 minute. Then close your eyes and try to
reach one minute. This can also be used as late stage rehab for an
ankle sprain.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSkcOaW5P-ArxCw3Jwr76Irg6cXV0CNeaskEKwvaFQW8ditPG5QPXHMwit4wIPiwgakXQ8Sr4l5y1-rlRaxD7M4bWHYjvOUG0WNR62jCH1qkVl6QHqVisMqS1ekx0WqttCE0Dw7DLE6Nc/s1600/wobble+board.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="153" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSkcOaW5P-ArxCw3Jwr76Irg6cXV0CNeaskEKwvaFQW8ditPG5QPXHMwit4wIPiwgakXQ8Sr4l5y1-rlRaxD7M4bWHYjvOUG0WNR62jCH1qkVl6QHqVisMqS1ekx0WqttCE0Dw7DLE6Nc/s320/wobble+board.jpg" width="320" /></a></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgazIzw4Y1hZw_ObtlHuHMsNKQY-vNivazNmzGffgYd6nwjQu6RkkFAI0OngpU_uQ28pOrpWlRfnb6r88pnPe4-bxyNP_BFnRxHrXMqkXsKOSDFuYWP2fT2ggaRltsNdAgGnBNRKJ8d3N0/s1600/wobble+cushion.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgazIzw4Y1hZw_ObtlHuHMsNKQY-vNivazNmzGffgYd6nwjQu6RkkFAI0OngpU_uQ28pOrpWlRfnb6r88pnPe4-bxyNP_BFnRxHrXMqkXsKOSDFuYWP2fT2ggaRltsNdAgGnBNRKJ8d3N0/s1600/wobble+cushion.jpg" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> Early stage treatment for an ankle
sprain would be to follow the <a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">management of acute injuries</a>, along
with maintaining range of movement in a non-weight bearing manner.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Taping can also be used to support the
ankle if injured, such as the technique below, to prevent further inversion:</span></span></div>
<div style="margin-bottom: 0cm;">
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcMYNWKPxKMlXo8UD1h4LdIejAUhs2Hm_iG20fE2-dSqvEfJNf-6c57-8Pq9to3tHILFLTpjDWyHK5DhxdO7540sPmgqGCktfVggS6lP1h46TzvWMfMlF4EtnPj1AJujLC7w0XzEq9Afk/s1600/stirrups+taping.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcMYNWKPxKMlXo8UD1h4LdIejAUhs2Hm_iG20fE2-dSqvEfJNf-6c57-8Pq9to3tHILFLTpjDWyHK5DhxdO7540sPmgqGCktfVggS6lP1h46TzvWMfMlF4EtnPj1AJujLC7w0XzEq9Afk/s320/stirrups+taping.png" width="240" /></a></span></span></div>
</div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To read more about ankle sprain and
preventative measures, check out <a href="http://globaltherapies.wordpress.com/2011/09/09/sprained-ankles-is-there-anyway-to-avoid-them/">Global Therapies</a> recent blog.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Plantar Fasciitis</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwci_6EybvB91B5h_DbXITn61BbtC2Z2IOnKq3VPmyw-IHX7N07JGFY7biAuJPDg_wh05peM8EL-l93udGxhVKwh8mTD04q2S0P9aw-NOjGBph1oFGnmnvQdMqW3thKO1YKaQ-eCwdvhw/s1600/plantar+fascia+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwci_6EybvB91B5h_DbXITn61BbtC2Z2IOnKq3VPmyw-IHX7N07JGFY7biAuJPDg_wh05peM8EL-l93udGxhVKwh8mTD04q2S0P9aw-NOjGBph1oFGnmnvQdMqW3thKO1YKaQ-eCwdvhw/s320/plantar+fascia+2.jpg" width="306" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5vmAhpPRb-EgjWYfzOVjO3NXsees4R_hes8otRbalLZc7ONOd_KgJNM6rQxEgLgEHJHrDh7q_P8zs_YnekJbixRrPm58lnHF26w-rsDhajkLBJDvxZWfz3jpM92F7AWyCB3JErkMbSXc/s1600/plantar+fascia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5vmAhpPRb-EgjWYfzOVjO3NXsees4R_hes8otRbalLZc7ONOd_KgJNM6rQxEgLgEHJHrDh7q_P8zs_YnekJbixRrPm58lnHF26w-rsDhajkLBJDvxZWfz3jpM92F7AWyCB3JErkMbSXc/s320/plantar+fascia.jpg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Plantar fasciitis is heel pain that is caused from an inflammatory process of the connective tissue, the plantar fascia. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It is commonly caused by long periods of weight bearing and flat feet, as well as poor footwear, poor biomechanics, high arches, and/or running/walking long distance on hard surfaces.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The treatment is normally rest, ice, reduce inflammation and swelling, calf stretches, and finally, correcting what caused the problem in the first place, be that poor footwear, muscular imbalances etc.</span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Achilles Tendinopathy
</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This has already been covered by a
separate post <a href="http://thomasbondphysio.blogspot.co.uk/2013/07/achilles-tendinopathy.html">here</a>.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ankle fractures</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, an ankle fracture, as you'd have guessed, is when a bone involved in the foot or ankle gets broken. There is no real preventative measure for this, and will normally occur from a fall. Therefore, the approach for a fracture is surgical intervention, or conservative treatment (which normally involves just casting the foot and ankle in plaster and waiting it to heal).</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The time frame and approach is entirely dependant on where the fracture etc is, and what other structures are involved.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Post op/plaster, you should be referred to physiotherapy for rehab anyway.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So I'm just going to leave you with a tasty X-ray of an ankle fracture and repair!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpXIGmww2DMpehXgD-8xuT8y52nBJT3_ZrCriflTOtwHBoAe5IFR3bl_Hsun6UUynoyR0pG46g97H91GvWaNSPxrtJtib7AWjygxCgrFFR7EVJRNEiLT1tivcnmbLA2A5UAjbpVi64Jzw/s1600/ankle+fracture.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpXIGmww2DMpehXgD-8xuT8y52nBJT3_ZrCriflTOtwHBoAe5IFR3bl_Hsun6UUynoyR0pG46g97H91GvWaNSPxrtJtib7AWjygxCgrFFR7EVJRNEiLT1tivcnmbLA2A5UAjbpVi64Jzw/s320/ankle+fracture.jpg" width="320" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Other problems</span></span></b></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">There are also other non-musculoskeletal
problems hat can occur with the foot, such as corns, cuts, toe infections etc which just needs you to look after your feet!</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Prevention</span></b></u></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Just a few tips to try and prevent foot and ankle problems:</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As previously mentioned, use of the
wobble board or cushion can help prevent some ankle injuries.
</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ensuring you have appropriate sized climbing shoes, or if not possible, remove them at all opportunities, or alternate your shoes for different routes</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Parallel training to strengthen the muscles around the foot and ankle</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Appropriate sized normal footwear</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Foot hygiene</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If you are a diabetic, please please <i>please </i>avoid tight shoes!! This is because of change in the sensation in the feet (neuropathy) that can be caused by diabetes, and can cause much more serious foot problems!</span></span></div>
<div align="LEFT" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To avoid some ankle injuries, have some (decent!) spotters when bouldering, and try to have dynamic belay techniques when roped climbing, to avoid clattering into the rock and giving you time to slow down the motion with your upper legs rather than at the ankle!</span></span><br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">However, the main take home message is that with footwear</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">, pain is insane! here possible, make your climbing shoes fit properly, feel comfortable, and look after your feet!</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b><span style="font-family: "Courier New", Courier, monospace;">Kids feet and climbing shoes</span></b></u></span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This will be covered in the next post, just to break up the amount of information I'm giving you! </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References</span></span></b></u></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="font-style: normal; font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Peters
P 2001 Orthopedic problems in sport climbing. Wilderness and
Environmental Medicine, 12; 100-110</span></span></div>
<div align="LEFT" style="font-style: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.thebmc.co.uk/climbing-shoes-is-pain-insane">Morrison A 2009 Climbing shoes: is pain insane? BMC</a></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<br />
<div style="font-weight: normal; margin-bottom: 0.5cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Killian
RB, Nishimoto GS, Page JC 1998 Foot and ankle injuries related to
rock climbing. The role of footwear. J Am Podiatr Med Assoc.
88(8):365-74. </span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">Morrison AB, Schoffl VR 2007. Physiological responses to rock
climbing in young climbers. Br J Sports Med 41;852-861.</span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">Hochholzer T, Schöffl V. 2006. One move too many… (2nd edn).
Lochner Verlag: Ebenhausen.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">Killian RB, et al. 1998. Foot and ankle injuries related to rock
climbing. The role of footwear. JAPMA 88(8);265-74.</span><br />
<span style="color: black;"><a href="http://www.drjuliansaunders.com/resources/feature_articles/ankles_away/"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></a></span>
<span style="color: black;"><a href="http://www.drjuliansaunders.com/resources/feature_articles/ankles_away/"><span style="font-family: Arial,Helvetica,sans-serif;">DrJulian Saunders 2009 Ankles Away</span></a></span><br />
<br />
<span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">E. Demczuk-Włodarczyk, E. Bieć, T. Sipko, E. Boerner, R. Jasiński 2008 </span></span><br />
<span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">ASSESSMENT OF MORPHOLOGICAL ARCHITECTURE OF FEET IN ROCK-CLIMBERS </span></span><br />
<span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">Biology of Sport 25(1)</span></span><br />
<div style="margin-bottom: 0cm;">
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Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com4tag:blogger.com,1999:blog-4692690742617863595.post-64918171332168621122013-07-09T13:41:00.000-07:002013-08-25T10:24:28.753-07:00Achilles Tendinopathy<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjM-DihDIoDReSEpp9jhgFMUD85g9KzWitCiJ_RvnGJvethZeK9CZDJQrQtJWGm5D-IVI8VH9DoMKWM0-8S1zNRNmjottFYrv2J8pOgVwHwrSZivJOKhbUv5lTEMRCAUWUjvZpe1O62QiI/s1600/ancient+greece.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjM-DihDIoDReSEpp9jhgFMUD85g9KzWitCiJ_RvnGJvethZeK9CZDJQrQtJWGm5D-IVI8VH9DoMKWM0-8S1zNRNmjottFYrv2J8pOgVwHwrSZivJOKhbUv5lTEMRCAUWUjvZpe1O62QiI/s320/ancient+greece.jpg" width="320" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So I'm going to take you back to
ancient times, where Gods ruled the lands, and the Greeks invented
the Achilles heel! This weeks post is going to focus on Achilles
Tendinopathy. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Other common rock climbing foot issues
will come in a later post.</span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQKaHAOSH_OnfzAbULsgf6Bv-FJ5Ekg1rT5rDJS7e5VOMg7Q5m5m82MMKCD4tgveCtpb7s9ZM32bmOusi_xUwtIZx4dTV79bZL5OBl1S_0ZvJrvtb94Arz_CR6Ym7WGv6uxwunHyx8AQQ/s1600/achilles-heel1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="303" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQKaHAOSH_OnfzAbULsgf6Bv-FJ5Ekg1rT5rDJS7e5VOMg7Q5m5m82MMKCD4tgveCtpb7s9ZM32bmOusi_xUwtIZx4dTV79bZL5OBl1S_0ZvJrvtb94Arz_CR6Ym7WGv6uxwunHyx8AQQ/s320/achilles-heel1.jpg" width="320" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Achilles tendon anatomy</b></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL7FbJVh-JDN2jdNvqIJDuNmFa_f7WIVZ4kqYz6JawpDQz1nwdpW9yPJjUmHy9mgEvc6ni-AE-6QRekXguJtfLzEoRrFWB8HceZ2AEA-ajKknd2PyYqvHPInzFs6JoDIR68ilf7rDLx7M/s1600/ankle-bones-on-health-advisors.org.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL7FbJVh-JDN2jdNvqIJDuNmFa_f7WIVZ4kqYz6JawpDQz1nwdpW9yPJjUmHy9mgEvc6ni-AE-6QRekXguJtfLzEoRrFWB8HceZ2AEA-ajKknd2PyYqvHPInzFs6JoDIR68ilf7rDLx7M/s1600/ankle-bones-on-health-advisors.org.jpg" /></a></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL-a122g14X9MmP8FZopfMrF_x5Qm37LH-IPia5f9A09cj-vCg72asFkTVuN0wDCNvKDJaHMb2Vp9JhEuiygmzhAT3usz9LlTPhrTgK5dWroQVpCRJ3Ue18MmQk2bjaqje5xPmM2BWxpk/s1600/x-ray-anatomy1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="132" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL-a122g14X9MmP8FZopfMrF_x5Qm37LH-IPia5f9A09cj-vCg72asFkTVuN0wDCNvKDJaHMb2Vp9JhEuiygmzhAT3usz9LlTPhrTgK5dWroQVpCRJ3Ue18MmQk2bjaqje5xPmM2BWxpk/s320/x-ray-anatomy1.jpg" width="320" /></a></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP2m90stIg3IfpfQW1s4KiWo2rlkgS5UQwG3K4u1bjGGNxVx3Dcfvg7JZuPK0pzRhaOn02V68AVM-B07z9eM04P5LPtwA-eOWziG35SVZQ6DMx6VjaEW2RXEIQx9PGt91Ol_uvTqjKN_o/s1600/attachment.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP2m90stIg3IfpfQW1s4KiWo2rlkgS5UQwG3K4u1bjGGNxVx3Dcfvg7JZuPK0pzRhaOn02V68AVM-B07z9eM04P5LPtwA-eOWziG35SVZQ6DMx6VjaEW2RXEIQx9PGt91Ol_uvTqjKN_o/s320/attachment.jpg" width="320" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Movements of the Achilles</b></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeiJSyHkOIKZoKf0GgwIz5qr0oUul1Mc2_L64DNYOls15rSEEzYjLUuWAemM55_Deuvs79eW2RLOljd6rVuKPsiaznNKZUjZkwGTE3gw3YEbzvmt58IFY8pFZ5h_RkOJbW22wAohvti0I/s1600/dorsiflexion-plantarflexion.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeiJSyHkOIKZoKf0GgwIz5qr0oUul1Mc2_L64DNYOls15rSEEzYjLUuWAemM55_Deuvs79eW2RLOljd6rVuKPsiaznNKZUjZkwGTE3gw3YEbzvmt58IFY8pFZ5h_RkOJbW22wAohvti0I/s320/dorsiflexion-plantarflexion.jpg" width="320" /></a></span></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Function</b></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The Achilles tendon supports 6-15 times
your body weight and provides spring like action.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><span style="font-size: large;"><b>Tendonitis/tendinosis/tendinopathy,
what is the difference?</b></span></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Tendonitis </b>– inflammation</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Tendinosis
</b>– chronic tendinopathy</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Tendinopathy </b>– a disorder of the
tendons – an umbrella, catch-all term</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Obviously, depending on -osis/-itis
depends on the management strategies (to counter the inflammatory
process or not).
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The common consensus is that these
conditions are a tendinosis rather than a tendonitis.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div align="LEFT" style="font-style: normal; font-weight: normal; line-height: 100%; margin-bottom: 0cm; text-decoration: none;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: black; font-size: large;"><span style="text-decoration: none;">Enthesopathies</span></span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The entheses is where the tendon
attaches to the bone, and an achilles tendinopathy that occurs within
the first 2cm of the tendon attachment to the calcaneus is an
enthesopathy.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><span style="font-size: large;"><b>Differential</b></span></u></span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoRe36f6aAKSLVXWq1OxElJghhk5qsA2TKrIMHali5gfnyS-AFiAQSTZqFkoT0XGeYK2jeU0kPPDKCSpAJviA4c_9tgviTxMPVCj9RrzaqPNrYdBmlNIfsYhOclx0WqSGWL5TGlzaYtSE/s1600/calf+squeeze+test.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="165" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoRe36f6aAKSLVXWq1OxElJghhk5qsA2TKrIMHali5gfnyS-AFiAQSTZqFkoT0XGeYK2jeU0kPPDKCSpAJviA4c_9tgviTxMPVCj9RrzaqPNrYdBmlNIfsYhOclx0WqSGWL5TGlzaYtSE/s320/calf+squeeze+test.jpg" width="320" /></a></span></span></div>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Rule out complete
tendon rupture using the calf squeeze test. See above picture.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Posterior ankle
impingement</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Os trigonum
syndrome</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">retrocalcaneal
bursitis</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Posterior Tibial
Tendon Dysfunction
</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Haglund's
deformity</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, to
discuss what all of these things are would take a whole blog post
unto itself, so I'm just going to leave it there!
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<u><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;"><b>Symptoms</b></span></span></u></div>
<div style="margin-bottom: 0cm;">
<u><span style="font-family: "Courier New",Courier,monospace;"><br /></span></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain in the
heel/around the tendon</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">?swelling </span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">- if a tendinitis</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">?heat - if a tendinitis</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Painful to touch
or on movement</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Early morning
stiffness</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Difficulty
standing on your tip-toes (/single leg stress/repetitive/hop)</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYQ4ohjkLbZaZMDKJ07Prc83pHp2Aav6W3n6JiL-Kr3oOILgrpjZpSrer1BmriOTL4APaCbhVR51oJKPuT0yng6ww93UZSd7UtKa5buQgEQzzDSQMqO-S4RWakQmf1C1PujQJFEIlkMV8/s1600/the-great-warrior-achille_4b61c2fbd97a9-p.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYQ4ohjkLbZaZMDKJ07Prc83pHp2Aav6W3n6JiL-Kr3oOILgrpjZpSrer1BmriOTL4APaCbhVR51oJKPuT0yng6ww93UZSd7UtKa5buQgEQzzDSQMqO-S4RWakQmf1C1PujQJFEIlkMV8/s200/the-great-warrior-achille_4b61c2fbd97a9-p.gif" width="184" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><span style="font-size: large;"><b>Causes</b></span></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Tendinopathy</b>:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Repetitive strain
on tendon</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">overuse</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">inappropriate
footwear</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">poor technique</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">high-arched foot</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">increase intensity
in training regime</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">lots of jumping</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">tight calves</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">excessive
inversion or eversion</span></span></li>
</ul>
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<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Achilles tendinopathy is more a problem for
runners or walkers, but can affect climbers, especially as many
climbers are mutli-sports persons.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Enthesopathies: </b>compression of calcaneus from repeated platarflexion e.g. aggressive climbing shoes and/or dynoing etc. as climbing shoes with an aggressive heel, such as 5:10's, could cause this repeated compression on the calcaneus. (obviously, other aggressive climbing shoe are available!) </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDuwjTypu8uCDB_flSPkbYEWhUEPf9D8wEYd6aitxyPCNgaMJ-825DPFu7Uh3TZ9-ZxV8j4f8wcP-9MvaeSoQ-N6UtTzoRUgZdwoNMnsPgVIChTGUSMf-HqzC2qV6J25Utag7UPem2AKc/s1600/1184_BLUE_colors_d.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDuwjTypu8uCDB_flSPkbYEWhUEPf9D8wEYd6aitxyPCNgaMJ-825DPFu7Uh3TZ9-ZxV8j4f8wcP-9MvaeSoQ-N6UtTzoRUgZdwoNMnsPgVIChTGUSMf-HqzC2qV6J25Utag7UPem2AKc/s1600/1184_BLUE_colors_d.jpg" /></a></span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><span style="font-size: large;"><b>Treatment</b></span></u></span></div>
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<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If you suffer from the "5:10 syndrome" as mentioned above, you could try this method of editing your climbing shoes by <a href="http://www.llanberisresoles.com/pages/mods.html">Llanberis Resoles</a></span></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>NSAIDs....?</b></span></span></div>
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</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I mark this with a
question mark, because it depends on your school of thought –
whether it is a chronic overuse, or an inflammatory response. If you
find it is swollen, then NSAID's may well help, but there is a school
of thought that they may inhibit healing if used inappropriately.</span></span></div>
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</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">There is also the
dangers of overuse of NSAID's, as listed in <a href="http://thomasbondphysio.blogspot.co.uk/2013/05/the-risks-of-ibuprofen.html">Risks of Ibuprofen post</a></span></span></div>
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</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqvHOcYNiDU8nhdcextIZm_PQApgA_KXwcBFm6SJvUy5C4GbAy_CpIwmGJyazjyHmDrya_yA19qkqr-GdgkAsZMhLzjDCPHW_s28SR7c5IeYeC3P7FK72NmJdvEI_CdxMiLLW2ODk8gKs/s1600/ibuprofen.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqvHOcYNiDU8nhdcextIZm_PQApgA_KXwcBFm6SJvUy5C4GbAy_CpIwmGJyazjyHmDrya_yA19qkqr-GdgkAsZMhLzjDCPHW_s28SR7c5IeYeC3P7FK72NmJdvEI_CdxMiLLW2ODk8gKs/s200/ibuprofen.jpg" width="200" /></a></div>
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<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Acute management </b><span style="font-weight: normal;">(see
</span><a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">Management of Acute Injuries</a> post<span style="font-weight: normal;">) – again, may not be necessary if the tendinopathy is
not an inflammatory process. e.g. if you use RSI of the wrist as an
example.</span></span></span></div>
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<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>GTN (</b>Glyceryl trinitrate)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This is the same
as the spray commonly used for angina, but is utilised topically –
i.e. localised patch of GTN. However, the reasoning behind why it
works is unclear, and commonly patients exhibit headaches and/or a
rash as side effects.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Steroid</b></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A corticosteriod
injection may help, but has been shown to only have a short term
pain-relieving effects, and not much else. Also, these injections <i>may
</i><span style="font-style: normal;">increase the risk of tendon
rupture by weakening the tendon.</span></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Surgical</b></span></span></div>
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</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A surgical
intervention is rarely required for Achilles tendinopathy, and would
always be a last resort. A very last resort!</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">There are other
such treatments such as extracorporeal shockwave therapy and
sclerosing injections, but they are rarely used.</span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The best bet is for physiotherapy, and using specific protocols, outlined below:</span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><span style="font-size: large;"><b>Physiotherapy</b></span></u></span></div>
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<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Mobilisations </b>of
the Achilles tendon</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/erLfZCVPYGs?feature=player_embedded' frameborder='0'></iframe></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Ultrasound </b>– useful if the
tendinopathy is a tendonitis, as ultrasound can be used to reduce the
inflammation.</span></span></div>
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Protocols/Exercises</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Eccentric</b> – Alfredson et al 1998</span></span></div>
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<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Two types of Eccentric Exercises will
be used: (Refer to Photo A, B, and C)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The calf muscle is to
be eccentrically loaded with the knee straight.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To maximize the
activation of the soleus muscle, also performed with the knee bent.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Perform each exercise
3x with 15 repetitions.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Use your hand on the
wall as a guide for balance</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Begin with weight
bearing load, progression to backpack weight when patient can perform
the</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">exercise routine without pain or
discomfort (Photo D). Advanced progression under therapist’s guidance may include
resistance from weight training equipment such as a Smith machine or a squat machine.</span></span></li>
</ul>
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<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Eccentric-concentric</b> – Silbernagel et
al 2007</span></span></div>
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</span></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVjR1qIKmEOgabNg2Mr1Vka27xEPhjY9OJy38PSKvyImzXfaH5G1BUuIRB0Kd-zMco8-vFn73lv7OP7wK2jPfBXCHFxdvuSoK5TG2TrmXueel0gLesMlH_WgiDs6q5S0FU5_88kspUKbI/s1600/eccentric-concentric+silbernagel+protocol.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVjR1qIKmEOgabNg2Mr1Vka27xEPhjY9OJy38PSKvyImzXfaH5G1BUuIRB0Kd-zMco8-vFn73lv7OP7wK2jPfBXCHFxdvuSoK5TG2TrmXueel0gLesMlH_WgiDs6q5S0FU5_88kspUKbI/s640/eccentric-concentric+silbernagel+protocol.png" width="291" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Timeframe</span></span></b></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">These exercises need to be performed regularly, and for a time period of at least 3-6 months if not much longer!</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b>
</div>
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span></b>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Why do these work?</span></span></b></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Effectiveness of eccentric exercises
has been proved, however, there are differing theories on why it
works.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Some say it affects type 1 collagen and
production and, in absence of repeated aggravation, may increase
tendon volume over longer term. As such, this increase the tendons
tensile strength.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The repetitive stretching of the tendon
with a lengthening of the muscle-tendon unit may have an impact of
the capacity of the unit to effectively absorb load.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Another theory is
that it changes the mechanism of pain-producing nerves by an
alteration of neovascularisation (which is an increase of blood flow
to an injured area, and along with this, an increase in nerve fibres,
meaning increased pain), as the repetitive nature may damage these
nerves and vessels.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b>
</div>
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span></b>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Exercising during rehab</span></span></b></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Due to the length of rehab being
several months rehab, many patients ask “Do I have to stop
exercising?” Silbernagel et al 2007 found that if the pain in your
Achilles tendon does not exceed 5/10 on visual analogue pain scale
(VAS) (during or after sport), then it is ok to carry on with your
sport, whilst continuing with the exercise protocol.</span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilKhjZhhiddTDOVYfNCnDP14auyoWm6Ew0krXWFTJ_GMH4vxfWCR2L3LwQc_fJjFwYTc4yr1l0wn_OLnrz5x5Dt9TYx-WGnmF_vuu8HFGOHWhLJ1vw6d3ZyNaUKJQ3CrQGGYiDEhey3cI/s1600/Visual+analgue+pain+scale.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilKhjZhhiddTDOVYfNCnDP14auyoWm6Ew0krXWFTJ_GMH4vxfWCR2L3LwQc_fJjFwYTc4yr1l0wn_OLnrz5x5Dt9TYx-WGnmF_vuu8HFGOHWhLJ1vw6d3ZyNaUKJQ3CrQGGYiDEhey3cI/s640/Visual+analgue+pain+scale.jpg" width="640" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Risk of rupture?</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">80% of ruptures completely asymptomatic
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">97% associated with underlying
pathology</span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidS-lbvLOv_EWnFZWqKYfv_D3bFuzsgcjke1N2KutDljgKcyRiygQbPk070weVOSh8h5it2UxM8k8MSY0zAmHA9wLmZySjk0FR-GzPGWwz9kJJH7yRKpTeeGfq-bKSiLDggbbarCj1yCM/s1600/Achilles+tendon+rupture.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidS-lbvLOv_EWnFZWqKYfv_D3bFuzsgcjke1N2KutDljgKcyRiygQbPk070weVOSh8h5it2UxM8k8MSY0zAmHA9wLmZySjk0FR-GzPGWwz9kJJH7yRKpTeeGfq-bKSiLDggbbarCj1yCM/s320/Achilles+tendon+rupture.jpg" width="320" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As always, if in doubt, always seek advice from a professional!</span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">References</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Alfredson H, Cook J 2007 A treatment
algorithm for managing Achilles tendinopathy: new treatment options
Br J Sports Med. 41(4): 211–216.</span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Silbernagel KG, Thomeé R, Eriksson BI,
Karlsson J 2007 Continued Sports Activity, Using a Pain-Monitoring
Model, During Rehabilitation in Patients With Achilles Tendinopathy:
A Randomized Controlled Study. American Journal of Sports Medicine
35(6): 897-906</span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Alfredson H, Pietilä T, Jonsson P,
Lorentzon R 1998 Heavy-Load Eccentric Calf Muscle Training For
Chronic Achilles Tendinosis American Journal of Sports Medicine
26(3): 360-366</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-69955763408708990452013-06-13T11:39:00.000-07:002014-01-20T11:43:02.571-08:00"Climber's elbow" - Brachialis Tendonitis<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So this post is to explore the other
problems with elbows – specifically "climber's elbow" –
a differential elbow pain to that of <a href="http://thomasbondphysio.blogspot.co.uk/2013/02/medial-and-lateral-epicondylitis.html">tennis or golfers elbow</a>. Less
common than biceps brachii injuries but quite common in climbers.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvOrEY94IwDju1AexQs9L_SKBobiA6cVzK23NMtuw6RVP44ySxtvppAmgsT9-u5o246cKrbcw6O_IlEIstut6HMREcireFdgELWwnYMLXwbnRlpqsMg7i3sy9eoT-qOjcfdhbDp48jCbc/s1600/brachialis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvOrEY94IwDju1AexQs9L_SKBobiA6cVzK23NMtuw6RVP44ySxtvppAmgsT9-u5o246cKrbcw6O_IlEIstut6HMREcireFdgELWwnYMLXwbnRlpqsMg7i3sy9eoT-qOjcfdhbDp48jCbc/s320/brachialis.jpg" height="320" width="213" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Climber's elbow is caused by tendonitis
of the brachialis muscle. The brachialis muscle lies deeper than the
biceps brachii muscle and originates on the upper humerus and
attaches to the ulna.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Brachialis is a true flexor of the
elbow as it attaches to the ulnar (rather than attaching to the
radius which rotates over the top of the ulnar during pronation and
supination. N.B. Biceps brachii attaches to the radius)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Therefore, because of the broad origin
on brachialis and it's only function is to flex the elbow, the
brachialis can be considered the strongest elbow flexor.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3jq1wrdAgJizXRQ16Oo-iU8WwYOeA5oGBCeaaGBEkUeELKMZLNe2rxnKGGZdmxCJl4uMpe5EKDHKexOw0K_iI8396SIn8zsyc9bx2P-FPAeMCLDKcdPa7wKtIogPSVUd55aZ0tB81Ed4/s1600/Biceps+Brachii.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3jq1wrdAgJizXRQ16Oo-iU8WwYOeA5oGBCeaaGBEkUeELKMZLNe2rxnKGGZdmxCJl4uMpe5EKDHKexOw0K_iI8396SIn8zsyc9bx2P-FPAeMCLDKcdPa7wKtIogPSVUd55aZ0tB81Ed4/s320/Biceps+Brachii.jpg" height="240" width="320" /></a></span></span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbvqNGtcTvaA0mSGaiaX2zdxdwgkr6E0yLjXkeBLaQUtyIQ4Y2x0maFqvld5Ug0FnLLvLL0s5jhEzdII_HIMYcZg_OzKJADZtG7djhcY8NeD39vc3dMPRQnqdknwXgLNJklqOzz7TneJ8/s1600/Kent_Fig1LG__1_2_9869.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbvqNGtcTvaA0mSGaiaX2zdxdwgkr6E0yLjXkeBLaQUtyIQ4Y2x0maFqvld5Ug0FnLLvLL0s5jhEzdII_HIMYcZg_OzKJADZtG7djhcY8NeD39vc3dMPRQnqdknwXgLNJklqOzz7TneJ8/s320/Kent_Fig1LG__1_2_9869.gif" height="192" width="320" /></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This injury, if a gradual onset, is
most likely to be tendonitis. If there is pain in this area of the
elbow after a specific incident/fall, it could be a rupture of
ligaments or muscle tendons. </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b>N.B.</b></u> Pain in this area of the elbow,
could be, as mentioned above, could be from biceps, from brachialis,
or even from problems with the proximal ulna-radial ligament. Always
worth getting these kind of problems checked out.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Also needing ruling out would be
shoulder / wrist / finger injuries or muscular imbalances.</span></span><br />
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Palpation</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">To try and identify the injured structures, you can try and palpate the painful area. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The brachialis tendon must also be
palpated for tenderness during elbow flexion, as both the biceps and
brachialis flex the elbow. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The brachialis muscle and its tendon are
palpated where they insert at the tuberosity of the ulna and the
coronoid process of the ulna. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Like the biceps, the distal end of the
muscle and/or the insertion of the tendon would be tender with
injury. </span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Supination of the hand would not necessarily affect the
brachialis tendon, helping to further differentiate between the two
muscles.</span></span><br />
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Symptoms</span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Deep elbow pain (not superficial like
tennis/golfers elbow generally is)</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain on anterior (front) elbow (note,
this could be due to a biceps brachii injury)</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Swelling around the elbow or above the
elbow (in the cubital fossa)</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Inability to bend elbow comfortably</span></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW5F-gEgUk4MBvU9xbWJHFT3u6GhI2SlQQBGIS1H6-GTWkIKw4I1O-_OorOm_xcoptxrYD6RuNn9jsngpL4ShZRmQtRm3MyWXq6FGmSB21jD2dr1ZlX5MLSLc-zxOIYUNg9LiShGUYFfo/s1600/chin-up1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW5F-gEgUk4MBvU9xbWJHFT3u6GhI2SlQQBGIS1H6-GTWkIKw4I1O-_OorOm_xcoptxrYD6RuNn9jsngpL4ShZRmQtRm3MyWXq6FGmSB21jD2dr1ZlX5MLSLc-zxOIYUNg9LiShGUYFfo/s320/chin-up1.jpg" height="320" width="312" /></a></li>
</ul>
<div style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Cause</span></b></u></span><br />
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Brachialis tears normally occur during a forceful contraction
or a forceful hyperextension while climbing. Complete tears are associated primarily with elbow
dislocation.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tendonitis is normally caused by strain
from sudden increase in training, overuse or repetitive elbow bending
or forced, excessive elbow straightening (hyper-extension).</span></span><br />
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Treatment</span></span></b></u></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Full rupture = surgical intervention would be required.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">For a partial tear:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Control inflammation in the acute phase –
see <a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">POLICE Principles</a></span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Rest</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Dep tissue frictions / Massage</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It has also been suggested that
traversing may irritate the brachialis, so consider limiting this.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If a tendonitis, the research suggests eccentric biceps curls (lowering of a weight in the curl position), however, I've found anecdotally that in the hammer position with your thumb pointing upwards works better.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Exercise progression from isometrics to eccentric to concentric strengthening, ensuring all are pain free, progress from isometrics once
full range of movement around the elbow is achieved</span></span></li>
</ul>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjU0gwOWxG9O31Sme0o-T-TYTEAOMmRBpawDQuwHdx0h2PyWCqjg9c-HJ21GuEYbkJCQmpnxG7bKHIoqDAvih6vawha397WwjRDwnO35u0NHmK40Tz-71Yoje3-FIyU5fR9Z842u7l_0Y/s1600/bicepsecccon.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjU0gwOWxG9O31Sme0o-T-TYTEAOMmRBpawDQuwHdx0h2PyWCqjg9c-HJ21GuEYbkJCQmpnxG7bKHIoqDAvih6vawha397WwjRDwnO35u0NHmK40Tz-71Yoje3-FIyU5fR9Z842u7l_0Y/s1600/bicepsecccon.gif" /></a></span></span></div>
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Prevention</span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As usual, <a href="http://thomasbondphysio.blogspot.co.uk/2013/05/hot-stuff-warming-up.html">warming up</a> is a key
prevention method</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ensure adequate recovery time between climbing days</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">All-round strengthening of rotator
cuff, biceps and brachialis can maintain a good strength all round to
correct any kind of muscle imbalances.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Triceps can also need
stretching/strengthening depending on the imbalance.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Stretching of lattimuss dorsi and
biceps</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Technique when performing pull-ups etc
or when climbing i.e. making sure you lock with your lats by keeping
your elbow close to your body. Try not to chicken-wing (see below)</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi73JfJaEvglcdnSMrJxbKz2PCFPfZ6sJfxmdLAyHiczueUaGYByhh_sKAwNH-RwOK3wrXJ1xybk7Y4pLYsDeUk7AZcvYNg2kPeBGiEe8WUIAQMqyx_7SE34mNDiolld88DX0aClvmktOA/s1600/DSC_0691.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi73JfJaEvglcdnSMrJxbKz2PCFPfZ6sJfxmdLAyHiczueUaGYByhh_sKAwNH-RwOK3wrXJ1xybk7Y4pLYsDeUk7AZcvYNg2kPeBGiEe8WUIAQMqyx_7SE34mNDiolld88DX0aClvmktOA/s320/DSC_0691.JPG" height="114" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEWENmybWDIp0JXEhJ2y66P0aWB-RnMPjQFgBjc_NNfE4LmTMTITnbTljRVKBro4faUZ2MNU1zXUcHvk38N0KUpMqkMxRaEAeh5iedGSmwW8OOBh_Flf_cjC-gAr4JSJ2Vg2wXXCOVb7o/s1600/DSC_0692.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEWENmybWDIp0JXEhJ2y66P0aWB-RnMPjQFgBjc_NNfE4LmTMTITnbTljRVKBro4faUZ2MNU1zXUcHvk38N0KUpMqkMxRaEAeh5iedGSmwW8OOBh_Flf_cjC-gAr4JSJ2Vg2wXXCOVb7o/s320/DSC_0692.JPG" height="118" width="320" /></a></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">In the bottom row of pictures, you can see the correct form for pull-ups, with the elbows tucked in</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">In the top row, the elbows are "winging", which makes you more prone to injury</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Also note, don't snap your elbows straight when lowering from a pull-up, control the movement down.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span></div>
<div style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Avoid: </span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">pull ups with weights – your working
to body strength – why do you need to be able to do pull-ups with
weights?!</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">descending bachar ladder</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">down climbing campus board</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">no snapping back of elbows during
climbing/pull ups</span></span></li>
</ul>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">And if your wondering where I got the lovely t-shirt, go to <a href="http://www.climbersagainstcancer.org/">climberagainstcancer.org</a> </span></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvaTP3cmkGhtQMeaqluEm0LEBaaxOTTeumrEu6WSzvLKOIXd0Izdr2xQvPC6BYxhjUW7vzD4fxA0gAuznGuRRGFQUHtbZTZqVHssW_o6rKZDcwv-JFrHsiqM8cX9jJX6cuIVZl2LLgM04/s1600/DSC_0709.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="http://www.climbersagainstcancer.org/" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvaTP3cmkGhtQMeaqluEm0LEBaaxOTTeumrEu6WSzvLKOIXd0Izdr2xQvPC6BYxhjUW7vzD4fxA0gAuznGuRRGFQUHtbZTZqVHssW_o6rKZDcwv-JFrHsiqM8cX9jJX6cuIVZl2LLgM04/s320/DSC_0709.JPG" height="214" title="" width="320" /></a></div>
<div style="margin-bottom: 0cm;">
</div>
<div style="margin-bottom: 0cm;">
<br /></div>
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References</span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.livestrong.com/article/523045-exercises-for-a-brachialis-injury/#ixzz2RbSWiwiE">Live Strong article</a></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56297">Miller KJ 2013 </a><a href="http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56297">Climber's Elbow: Diagnosis and
Conservative Treatment Protocols. Dynamic Chiropractic Vol. 31, Issue 01 </a></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f={b2574e3d-7051-4e18-b1fe-ebc6e9318aad}&key=26dd85c28d515a89bff6d8625ddf298a"><br /></a></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f={b2574e3d-7051-4e18-b1fe-ebc6e9318aad}&key=26dd85c28d515a89bff6d8625ddf298a">
</a></span>
<br />
<div style="margin-bottom: 0cm;">
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f={b2574e3d-7051-4e18-b1fe-ebc6e9318aad}&key=26dd85c28d515a89bff6d8625ddf298a">
</a><a href="http://www.blogger.com/null">
</a></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f={b2574e3d-7051-4e18-b1fe-ebc6e9318aad}&key=26dd85c28d515a89bff6d8625ddf298a">Memorial healthcare system 2013Brachialis or Anterior Capsular Elbow Strain with Rehab mhs.net </a></span></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Hochholzer T, Schoffl VR 2006 One Move Too Many. Lochner-Verlag, Germany</span></span><br />
<div style="margin-bottom: 0cm;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com9tag:blogger.com,1999:blog-4692690742617863595.post-46080656679105183502013-05-25T09:33:00.000-07:002013-05-25T10:45:46.757-07:00Hot Stuff! Warming Up<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">So,
I've been asked a couple of times to write some more posts about
injury prevention. So, what better</span><span style="font-family: Arial,Helvetica,sans-serif;"> way to prevent injuries than a
proper warm up, which I know many climbers often omit from their
climbing routine. </span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"> </span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: right;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOtvJ45s2WAvVM75f5MIvPs9ZgQrQgQPpcUrfiqdhDl1TbNe0RgiLt3uX7Wwg1oS4cIc18Ocsw4gReKrMW-qaQWL_KZrX0zYj08opfNSclGTWnPyju5ca4rdhfpEkWTPkI5l6liU5VXfw/s1600/football+warm+up.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOtvJ45s2WAvVM75f5MIvPs9ZgQrQgQPpcUrfiqdhDl1TbNe0RgiLt3uX7Wwg1oS4cIc18Ocsw4gReKrMW-qaQWL_KZrX0zYj08opfNSclGTWnPyju5ca4rdhfpEkWTPkI5l6liU5VXfw/s320/football+warm+up.jpg" width="320" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">The professionals do it, why don't we?!</span></span></span></td></tr>
</tbody></table>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">A
warm up is brilliant, both to prepare your body, muscles and joints
physically for the effort you are about to exert, but also for your
brain to be mentally prepared too, to help it remember to “do that
climbing thing again!” (rehearsal effect).</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Unfortunately,
there is no prescribed warm up, everyone has their own routine and
way of doing things. It's about finding your “groove” and the
best way you warm up. Because of this, however, there is little
scientific evidence for warm up routines, due to their variety.</span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX32pVJxRKqVs38su1ybd8Q_e_LnEeGiXzEFz8F_kuoqO_UvtAQXgptsivBixkh18ZoInzK0L1k9WDt-b7JxSevAQZopboPLWaIaG9uep453wAJWFjr6Or_V5XJdMGHxI9aqiDki45hlE/s1600/passive+warming.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX32pVJxRKqVs38su1ybd8Q_e_LnEeGiXzEFz8F_kuoqO_UvtAQXgptsivBixkh18ZoInzK0L1k9WDt-b7JxSevAQZopboPLWaIaG9uep453wAJWFjr6Or_V5XJdMGHxI9aqiDki45hlE/s200/passive+warming.jpg" width="139" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">Passive Warming</span></span></span></td></tr>
</tbody></table>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Passive
warming up (an external source warming you, e.g. a warm shower,
dryer, sun etc) have some short term benefits on an active warm up
(you warming yourself), especially if the active warm up is too
intense or lacks recovery time, however, an active warm up definitely
has better intermediate and long term performance benefits. Passive
warming is useful though to maintain temperature. (Bishop 2003)</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">I
will therefore talk about the principles of warming up, and what you
should achieve from it.</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Rest
between exercises is important, and should usually be kept to a minimum.
Alternating exercises that focus on different body parts (i.e. an arm
exercise followed by a leg exercise) will help to stimulate blood
flow and increase body temperature. </span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The
benefits of warming up are:</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<ul><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGJs3y60A9IM3A6N1LbkrZrZev0ou8ua6BzH-PxG2-qCRzdLFVKoyUWsM3no6iQw3Y0LLkym3lnfYFip03wjv1l6RkloQpe_VGP9z4LA3-8Cn3mbDmPrVVcEtYoUwnJy9sCori5CBwBl8/s1600/blood-flow.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGJs3y60A9IM3A6N1LbkrZrZev0ou8ua6BzH-PxG2-qCRzdLFVKoyUWsM3no6iQw3Y0LLkym3lnfYFip03wjv1l6RkloQpe_VGP9z4LA3-8Cn3mbDmPrVVcEtYoUwnJy9sCori5CBwBl8/s200/blood-flow.jpg" width="200" /></a></span></span>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increasing
blood flow to muscles</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increasing
oxygen delivery</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">decreasing
vascular resistance</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increased
release of oxygen from myoglobin</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">enhanced
cell metabolism</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">reduced
muscular viscosity meaning smoother muscle contraction and efficiancy</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increased
sensitivity to nerve receptors</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increased
speed of nerve impulses</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">decreased
stiffness of connective tissues</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increase synovial fluid (which acts as joint "shock absorbers") </span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">increased
relaxation and concentration</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">all
leading to..........<i><b>decreased likelihood of injuries!</b></i></span></span></li>
</ul>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">(See <a href="http://thomasbondphysio.blogspot.com/2013/04/physiological-response-to-injury-and.html">blog post on "physiological effect of hot and cold for more info)</a></span><i><b> </b></i></span></span><br />
<ul>
</ul>
<div style="font-weight: normal; margin-bottom: 0cm; text-align: right;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> (Brukner
& Khan 2012)</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></b>
</div>
<b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span></b>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>First
part of a warm up should be raising your heart rate</b>.</span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">You
can do this in any way you wish: running, cycling, skipping etc.
Start slow, and build up the intensity. The goal is to be breaking
into a sweat after 5-10mins. </span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This
could even be the walk-in to the crag (unless it's somewhere like Pen
Trywn or Burbage North, which is literally roadside!), or cycling to
your local wall.</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Second
part is flexibility. </span></span></b></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Skm8klI4aaTqPs-wNphHN-YdbusieREW76AZLFKlVpLDNL2LHeDFnIqd1D3tACs64z6S6xigMZKYIWtgLIuVJt9Ct9Gw4oBgG2VKr_m7eUogCqiNOSYDnccfnQPo4CBG2VuJEOSt2-4/s1600/calf+stretch+-+NOT+this.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Skm8klI4aaTqPs-wNphHN-YdbusieREW76AZLFKlVpLDNL2LHeDFnIqd1D3tACs64z6S6xigMZKYIWtgLIuVJt9Ct9Gw4oBgG2VKr_m7eUogCqiNOSYDnccfnQPo4CBG2VuJEOSt2-4/s200/calf+stretch+-+NOT+this.jpg" width="155" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">This is static stretching - <br />NOT this type of stretching!</span></span></span></td></tr>
</tbody></table>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This is <b>NOT </b>static/ballistic stretching which
are designed to “stretch a muscle or muscle group beyond their
normal range of motion”, (as a study published in the Canadian
Journal of Applied Physiology (vol. 26 (3) 2001) showed that static
stretching prior to activity showed force production loses of
decreased Maximal Voluntary Contractions by 12% and increased muscle
inactivation by 20.2% which is not what you want prior to beginning
your sporting activity). <a href="http://thomasbondphysio.blogspot.co.uk/2013/04/stretching.html">More on static stretching here.</a></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This is <b>dynamic stretching</b>, which “systematically
loosens the participant to their current full range of motion”.</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">With
dynamic stretching, you should first off begin with shallow movements
and build up the the full range in stages. This means that, for
instance, you are warming up the shoulders with some “windmills”,
you don't start off and swing your arms round as fast and as far as
you can, but build up with smaller circles.</span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAINoDlfF0kJzytZzMOhRhXx4FYd-0K7WkwQJlOpbfxo1CkW_SkF7mPdGmVgfXCpi6gNlMdIfQWpIitGgzeVfE89iWlo7oUer-sVyW2X_onYOXC00U0QcgHPyU6T6jm0WzF6kjdVCvgLY/s1600/windmills.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAINoDlfF0kJzytZzMOhRhXx4FYd-0K7WkwQJlOpbfxo1CkW_SkF7mPdGmVgfXCpi6gNlMdIfQWpIitGgzeVfE89iWlo7oUer-sVyW2X_onYOXC00U0QcgHPyU6T6jm0WzF6kjdVCvgLY/s200/windmills.jpg" width="123" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">Not these type of windmills!</span></span></span></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2bZGzOtaWQyFUuu1tA3NnYorSkCnAedpzRSqYB9DAdQwKkeEtfl9NZ9QHIA-QmqrDBpDh0shH6Wyashv4oM46WXnbb7VVUDt15lNq6ItWlDKfcO8Uy5RxQ2JnjienMD0xMw9JnfsAA88/s1600/shoulder+windmills.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2bZGzOtaWQyFUuu1tA3NnYorSkCnAedpzRSqYB9DAdQwKkeEtfl9NZ9QHIA-QmqrDBpDh0shH6Wyashv4oM46WXnbb7VVUDt15lNq6ItWlDKfcO8Uy5RxQ2JnjienMD0xMw9JnfsAA88/s1600/shoulder+windmills.jpg" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">These are the windmills I was referring to!<br />Build up the circles gradually until full range is achieved.</span></span></span></td></tr>
</tbody></table>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This
is key for all the warm up – start slow, and build it up gradually
– jump in too fast, too hot, and you'll hurt yourself and it will
defeat the point of the warm up in the first place!</span></span><br />
<br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Don't forget to warm up those fingers and keep them moving too! <a href="http://thomasbondphysio.blogspot.co.uk/2013/01/hand-and-finger-exercises.html">Click for handy warm up exercises!</a></span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbruuBQrAkbSYiRb6IQGa2oW5UgRKCdx88HXVd9DaYZiU9rXA7JwLGvSgTGZGW9LKWQ9Nrbg3jbx653y5o2acwIph-49GE5MBECriNf3mKfD1_D4SwbDwoW5G22eNpUbHPDhSV_SvwpIw/s1600/bouldering.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbruuBQrAkbSYiRb6IQGa2oW5UgRKCdx88HXVd9DaYZiU9rXA7JwLGvSgTGZGW9LKWQ9Nrbg3jbx653y5o2acwIph-49GE5MBECriNf3mKfD1_D4SwbDwoW5G22eNpUbHPDhSV_SvwpIw/s320/bouldering.JPG" width="212" /></a></span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Final
part of the warm up is sport specific activity.</b> </span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<br /></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This is usually in
the form of easy bouldering (bouldering is normally best as you don't
have to bother with ropes, harnesses, belaying etc)</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Then
build up through the grades (i.e. if your max is 6c, don't jump
straight on a 6b+, start on a 5 or 6a and work up to it).</span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Remember,
between routes/problems etc, it is important to stay warm, or you'll
have to go through the process all over again. So it may look nice
and warm out there, but just a t-shirt isn't necessarily going to
keep you warm between boulders at Stanage when that wind starts
blowing! Remember a jumper/belay jacket to throw on between routes to
maintain your core body temperature (an example of passive warming,
as mentioned above)!</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Now
your body is prepared for your competition/project/high end route!</span></span></div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="font-weight: normal; margin-bottom: 0cm;">
<u><b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Sample Warm Ups</span></span></b></u></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqApdMlAxFwUd4mfmvr5IDQqD9fp824eFiJhDaWVydYo6FXgY2K75OeYtmFuNHrFtD7mf2UhavChE7wgIIgDSaCbVCQ-5m1RrVSeR_fAGGARP4KVSdTmYClQ-gsD4bGfMVbNowXSMKE-g/s1600/BMC+warm+up.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="457" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqApdMlAxFwUd4mfmvr5IDQqD9fp824eFiJhDaWVydYo6FXgY2K75OeYtmFuNHrFtD7mf2UhavChE7wgIIgDSaCbVCQ-5m1RrVSeR_fAGGARP4KVSdTmYClQ-gsD4bGfMVbNowXSMKE-g/s640/BMC+warm+up.jpg" width="640" /></a></span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;">Here is the Fifa recommended <a href="http://f-marc.com/11plus/home/">warm up for footballers</a></span></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;"><br /></span></span></span></div>
<div style="text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQrU32d2d0T5p97A1kAhyphenhyphen8ju5bygHsiLvaLm4dDPnsg9CWLrFARpYLfS_tA2YGNOMCxilvOz6uS1_8VzA_UwGj8R5gn0yWyt8BIB3OhKrSh1kZIlfi-F12nkZZa_vULlU7ucMVqgUWPIg/s1600/warm+up+fifa.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQrU32d2d0T5p97A1kAhyphenhyphen8ju5bygHsiLvaLm4dDPnsg9CWLrFARpYLfS_tA2YGNOMCxilvOz6uS1_8VzA_UwGj8R5gn0yWyt8BIB3OhKrSh1kZIlfi-F12nkZZa_vULlU7ucMVqgUWPIg/s400/warm+up+fifa.png" width="283" /></a></span></span></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<b><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Climbing specific warm ups:</span></span></b></div>
<div style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;"><a href="http://www.moonclimbing.com/blog/school/warming-up/">Moonclimbing's warm up, by Rich Simpson</a></span></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;"><a href="http://www.ukclimbing.com/articles/page.php?id=3698">Robbie Phillip's warm up, as shown on UKC</a></span></span></span></div>
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<span style="font-size: large;"><u><b><span style="font-family: Arial,Helvetica,sans-serif;">References</span></b></u></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-weight: normal;"><a href="http://uwf.edu/hles/epp/Dynamicwarmup.html">GreskaE, Ryan S, Dynamic Warm Up </a></span></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Hochholzer
T, Schoffl VR 2006 One Move Too Many. Lochner-Verlag, Germany </span></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Brukner
P, Khan K (eds) 2012 Clinical sports medicine 4th ed. Sydney: McGraw
Hill pg 116</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.thebmc.co.uk/film-warming-up-for-climbing"><br /></a></span>
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<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.thebmc.co.uk/film-warming-up-for-climbing">
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<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.thebmc.co.uk/film-warming-up-for-climbing"><span style="font-size: small;">BMC 2007 Warming up for climbing</span></a></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-weight: normal;"><a href="http://f-marc.com/11plus/home/">FIFA 11+ website</a> </span></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Bishop
D 2003 Warm Up II: Performance Changes Following Active Warm Up and
How to Structure the Warm Up. Sports Medicine 33(7): 483-498</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-weight: normal;"><a href="http://www.moonclimbing.com/blog/school/warming-up/">Moonclimbing's warm up, by Rich Simpson</a></span></span></span></div>
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<span style="font-size: small;"><span style="font-weight: normal;"><a href="http://www.ukclimbing.com/articles/page.php?id=3698">Robbie Phillip's warm up, as shown on UKC</a></span></span></span><br />
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</span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-82333858387256250292013-05-16T14:05:00.000-07:002013-05-16T10:09:57.533-07:00Preventing Rotator Cuff Injuries: Advice and Exercises (Updated)<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I've now updated this post, based on <span style="font-size: large;">some training I attended last week<span style="font-size: large;">:</span></span></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Today's post is based on the rotator cuff, and ways to, hopefully, prevent injuries via regular exercises and advice.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">First off, as always, I will discuss the anatomy involved<span style="font-size: large;">.</span></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmmX21bODNiy72U_PPbikQ4w7nzibfqOE_eeD8N5yWJyySUU6fqTOIB7NkSjhy8TzfFSaJoimjLk1B8nPnfE4_rBDdgqVqOz_64LEBZLBuErMKaLTSuyFBBOlMZUgmG6aEZ9czvTzvgpg/s1600/30207.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmmX21bODNiy72U_PPbikQ4w7nzibfqOE_eeD8N5yWJyySUU6fqTOIB7NkSjhy8TzfFSaJoimjLk1B8nPnfE4_rBDdgqVqOz_64LEBZLBuErMKaLTSuyFBBOlMZUgmG6aEZ9czvTzvgpg/s320/30207.jpg" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_pe6KriZ8P7kAC6i5VpL6OaBHS5BrnBwTzxC5J9gqTWSbBfheFSEJ28j7DNgJKtZm-ZZPtHbHduvWGi_XRmiDLZ_SlHAGUerzM-Ysr1MVOYQV9nF4c1TKcvpvtMBvi6aPjkt99oDMGmc/s1600/rotator+cuff+muscles.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_pe6KriZ8P7kAC6i5VpL6OaBHS5BrnBwTzxC5J9gqTWSbBfheFSEJ28j7DNgJKtZm-ZZPtHbHduvWGi_XRmiDLZ_SlHAGUerzM-Ysr1MVOYQV9nF4c1TKcvpvtMBvi6aPjkt99oDMGmc/s1600/rotator+cuff+muscles.JPG" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The space between the acromion and humeral head is <span style="font-size: large;">where the rotator cuff ten<span style="font-size: large;">dons get impinged<span style="font-size: large;">, especially when performing overhead activities.</span></span></span></span></span><br />
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<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">What does the rotator cuff do?</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The rotator cuff muscles internally and externally rotates the humeral head. These muscles help support and secure the head of the humerus into the glenoid fossa.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This means that the rotator cuff muscles are key to stabilizing the shoulder joint.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7wjCxAI8c90d3zPFupdba6fXMtyMAW0Ajc34AaRXP3sSeX588T-hWgVZSS3XeBd7nTUrgtHV9qb3Qt9uyAF-7epTPK9u1fO0oMkq68MBkdtqXuFBfUpOb6fCG_rNgS3rrkiqTprC6f5s/s1600/1-s2.0-S1531091405000860-gr1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="101" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7wjCxAI8c90d3zPFupdba6fXMtyMAW0Ajc34AaRXP3sSeX588T-hWgVZSS3XeBd7nTUrgtHV9qb3Qt9uyAF-7epTPK9u1fO0oMkq68MBkdtqXuFBfUpOb6fCG_rNgS3rrkiqTprC6f5s/s320/1-s2.0-S1531091405000860-gr1.jpg" width="320" /></a></span></span></div>
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<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Preventative Exercises</span></span></b></u><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Often, rotator cuff strengthening exercises are given as shown below, with internal and external rotation being strengthened in standing or in lying.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBZFJNYtI3avbSxnbqKk4Gwtn1jRHqAfNyzMn0-EFHM1IbPwQVrB3TSXWRYHCi3KMHn1GDhajAz6ZZKNnXjaLa6z3iQqe2NhF26lilCYODAAc58LBG1hAMJEbJvCVt8_kua72YN6VoQ2U/s1600/conrcsci.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBZFJNYtI3avbSxnbqKk4Gwtn1jRHqAfNyzMn0-EFHM1IbPwQVrB3TSXWRYHCi3KMHn1GDhajAz6ZZKNnXjaLa6z3iQqe2NhF26lilCYODAAc58LBG1hAMJEbJvCVt8_kua72YN6VoQ2U/s1600/conrcsci.gif" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqm5F_cYgtrsaJ3rZj69z9HviNNqBfpO1CCIYGwaODnNT96nVowkDPyFhdS3q3_DZu6xhKivjNdTYIXmtuo834XQEcKwvvVobf1ax1a43F1OlXWiDCIHjoOM0WJKTTyqESubKPuWdatxk/s1600/conrcscx.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqm5F_cYgtrsaJ3rZj69z9HviNNqBfpO1CCIYGwaODnNT96nVowkDPyFhdS3q3_DZu6xhKivjNdTYIXmtuo834XQEcKwvvVobf1ax1a43F1OlXWiDCIHjoOM0WJKTTyqESubKPuWdatxk/s1600/conrcscx.gif" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVAUBJKYIjf6WrPNlSHQEm5e4lYebkC7OOWD41EUB_w6Y-b6fVuHQJTIbaby59vcIEA5T5Fs2XGRNfF97gy_NJUsYINRiKYd0p54r8-F6nL135mKHTy-f0kdFnVVxJRNdd_T4IZpUvvpE/s1600/image_0.img.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVAUBJKYIjf6WrPNlSHQEm5e4lYebkC7OOWD41EUB_w6Y-b6fVuHQJTIbaby59vcIEA5T5Fs2XGRNfF97gy_NJUsYINRiKYd0p54r8-F6nL135mKHTy-f0kdFnVVxJRNdd_T4IZpUvvpE/s1600/image_0.img.png" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">These exercises do strengthen the rotator cuff, but not in a functional way applicable to climbing, as the predominant movements involved in climbing are above head actions, therefore the rotator cuff should be strengthened in a similar manner.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It is the same movements as described, but with the arms above the head as shown. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQwMNpx_JaQa0vl0n2qwu8HVmxXvgiR7oU3ON5YokIu89M6G4iQMEcXl1UbiRc6HfGbVABZfRbHkiQD8O7SrOQc8eib9ByDc-dpl5rCuslYtN2HYtWv3hz0-zXFG4gif8tXpjV_4pbrnk/s1600/swimming-exercise-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQwMNpx_JaQa0vl0n2qwu8HVmxXvgiR7oU3ON5YokIu89M6G4iQMEcXl1UbiRc6HfGbVABZfRbHkiQD8O7SrOQc8eib9ByDc-dpl5rCuslYtN2HYtWv3hz0-zXFG4gif8tXpjV_4pbrnk/s1600/swimming-exercise-1.jpg" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjatLbkikzcHNK_NrxCfWphvwWbgsY_1kAxRyBFrVf7guYHqApNm62fzY5JkhyphenhyphenvxxEAPhifjyI2RelNxaco0y2IZSMzGFChcfzXtRMT_j7Hq33RAqAKkdPAuNg3KwCCDE74ONv4tHj1D3o/s1600/rec-rotator-cuff-lifts-11-23-11-md.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjatLbkikzcHNK_NrxCfWphvwWbgsY_1kAxRyBFrVf7guYHqApNm62fzY5JkhyphenhyphenvxxEAPhifjyI2RelNxaco0y2IZSMzGFChcfzXtRMT_j7Hq33RAqAKkdPAuNg3KwCCDE74ONv4tHj1D3o/s1600/rec-rotator-cuff-lifts-11-23-11-md.jpg" /> </a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">These movements can be performed in either standing, as above, or in lying, as below. They can be done using resistance bands, or free weights. The movements should be performed in a slow, controlled manner, ensuring the 90 degree angle at the elbow is maintained throughout. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYRxBt6kM0Me7Ut2Rrp0qyMScMSXqLCkT3Xjta217it4CrfTRJSE5p_RQXOKMa61bkNIWLOfbjtVCs_q2HWWi698f2XSpAivXUlph_rqtuJnQnlpOeEtfXx8UU51FvCzDAumxc4PFU6YE/s1600/image.img.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYRxBt6kM0Me7Ut2Rrp0qyMScMSXqLCkT3Xjta217it4CrfTRJSE5p_RQXOKMa61bkNIWLOfbjtVCs_q2HWWi698f2XSpAivXUlph_rqtuJnQnlpOeEtfXx8UU51FvCzDAumxc4PFU6YE/s1600/image.img.png" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Other exercises that can be performed to work the rotator cuff in a similar, over-head manner are displayed below. Again, these exercises should be performed in a slow, controlled manner, paying particular attention to the positioning of your scapula.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimuOyZURP7ymEr_u1BZWFcqV0iJpvf8X_PCGGE1I5pBhcS8b4w3Z92AkGAYcMYBdoOOv0ku33JW6de2o73It7nL0gzBHOuDxLfh27xYWiBytJqwFY9GsxfmuwxkRBS6ta3xyRf_IRWpng/s1600/1-s2.0-S1531091405000860-gr12.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="152" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimuOyZURP7ymEr_u1BZWFcqV0iJpvf8X_PCGGE1I5pBhcS8b4w3Z92AkGAYcMYBdoOOv0ku33JW6de2o73It7nL0gzBHOuDxLfh27xYWiBytJqwFY9GsxfmuwxkRBS6ta3xyRf_IRWpng/s320/1-s2.0-S1531091405000860-gr12.jpg" width="320" /></a></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6YQdoANngvhCY0H8FDGE0ScR8f0yksTJx66nWUh64K6CumBfwxC6lOz1pd-qEeIVH1oVOJG5gTb3WjN-svGyitVXBfQA7OQRlP-Wlvk3iL6AJtTB-b0VuDW0v3ea-5mSW2vQPQ2VBgq8/s1600/1-s2.0-S1531091405000860-gr14.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="98" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6YQdoANngvhCY0H8FDGE0ScR8f0yksTJx66nWUh64K6CumBfwxC6lOz1pd-qEeIVH1oVOJG5gTb3WjN-svGyitVXBfQA7OQRlP-Wlvk3iL6AJtTB-b0VuDW0v3ea-5mSW2vQPQ2VBgq8/s320/1-s2.0-S1531091405000860-gr14.jpg" width="320" /></a></span></span></div>
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<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</b></u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b>Important note:</b></u> When performing any of these exercises, it is imper<span style="font-size: large;">ative that the shoulder complex as a whole is in the correct posture<span style="font-size: large;">....</span></span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh413esxeVxhaLM7zQGFrAj_32K54i1WtofutMSRzN5SadAtKyQZAlBjj47t-AAYFbdAar0fZiKgwaJSE8wiT2CY9qQgCKxW95LkIJoIhTfxBti5MHggcDBEe7Xn8kukHMdRtAH1IYO4KI/s1600/8416613.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh413esxeVxhaLM7zQGFrAj_32K54i1WtofutMSRzN5SadAtKyQZAlBjj47t-AAYFbdAar0fZiKgwaJSE8wiT2CY9qQgCKxW95LkIJoIhTfxBti5MHggcDBEe7Xn8kukHMdRtAH1IYO4KI/s320/8416613.jpg" width="320" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">...<span style="font-size: large;">a</span>s most climbers adopt the thoracic kyphosis posture, due to overtraining of the forward flexors. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This also applies to when performing the exercises, if the shoulder blades don't stay pulled back and become rounded and forward while performing these exercises, with<span style="font-size: large;"> the head of the humerus bec<span style="font-size: large;">oming more anteriorly located (moves forward),</span></span> either drop the weight, or perform the exercises without the arms above the head, as described at the start of this post.</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b>Advice</b></u></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So other preventative measures for looking after your rotator cuff muscles and shoulder joint in general, are such methods:</span></span><br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">climbing technique - remember to use your feet, don't stretch too far for the next hold, rather work your way up to it, to reduce the load on the upper limbs</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">flexibility - there may be a lack of spinal flexibility, especially around the thoracic area, as this can cause lack of movement around the scapula; tight posterior shoulder capsule or posterior rotator cuff muscles may also do the same (see below for stretch that can be performed on the posterior shoulder capsule)</span></span></li>
</ul>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><img border="0" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX95DprVPsV_vE0tvd9C7yog4oVsbegyHiRz4jaO69RLtSeGz-KEgp0ggUp-N6E4rLlcAu_WSNDbfV1bKdrzR1ylv7whgtP9LpHJULEwA6zyFqPksfoETyI-wg2Q6aKxipAXcVq_5AWEs/s320/1-s2.0-S1531091405000860-gr20.jpg" width="320" /> </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> <img border="0" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJFfqMcOjFI-e4rrpzp7-ACcDB7OBMQP2KIzYq3Smu17dhpdU6kWuqSKNTFpsqjbwh7OqYMh9PBGWxeL8_9e172SpsiVqbri34FVIbGP2jQVEJszCNMjxJKy-8TwcpOUZcqLrNBWzX1yU/s320/doorwaystretch.jpg" width="320" /> </span></span></div>
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<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">posture - this relates to flexibility, as well as the movement relationship between the scapula and humerus, known as the scapulohumeral rhythm, that is a key component in rotator cuff impingement. Also, musculature imbalance is related to posture, which is especially prominent in climbers! In some instances<span style="font-size: large;">, it may be <span style="font-size: large;">necessary</span> to retrain the scapula and perform scapula setting exercises.</span></span></span></li>
</ul>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I hope th<span style="font-size: large;">ese exercises and advice can prevent an injury. These exercises need to be performed often, and with low weight, high reps, as they are stabilizing muscles.</span></span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Any feedback or queries, give me a shout!</span> </span></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Further Reading</span></span></b></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953287/"><span style="font-size: small;">Roseborrough A, Lebec M 2007 Differences in Static Scapular Position Between Rock Climbers and a Non-Rock Climber Population. North American Journal of Sports Physical Therapy 2(1): 44-50</span></a></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">References</span></span></b></u><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div class="publicationHead">
<div class="volIssue">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: small;">JE Budoff 2005 The Etiology of Rotator Cuff Disease and Treatment of Partial-Thickness Pathology. </span><span style="font-size: small;">Journal of the American Society for Surgery of the Hand 5(3): 139-152</span></span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: small;">McCall C Presentation on shoulder conditions in rock climbing. BMC Climbing Injuries Symposium 2012 </span></span></span></div>
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Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com3tag:blogger.com,1999:blog-4692690742617863595.post-79538575432979429262013-05-09T14:24:00.000-07:002013-05-09T14:25:33.634-07:00The Risks of Ibuprofen<div style="margin-bottom: 0cm;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqvHOcYNiDU8nhdcextIZm_PQApgA_KXwcBFm6SJvUy5C4GbAy_CpIwmGJyazjyHmDrya_yA19qkqr-GdgkAsZMhLzjDCPHW_s28SR7c5IeYeC3P7FK72NmJdvEI_CdxMiLLW2ODk8gKs/s1600/ibuprofen.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqvHOcYNiDU8nhdcextIZm_PQApgA_KXwcBFm6SJvUy5C4GbAy_CpIwmGJyazjyHmDrya_yA19qkqr-GdgkAsZMhLzjDCPHW_s28SR7c5IeYeC3P7FK72NmJdvEI_CdxMiLLW2ODk8gKs/s200/ibuprofen.jpg" width="200" /></a><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, you have some swelling, after an
injury, or maybe it's a chronic condition? So you pop some ibuprofen
or two?</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">After a while, you realise the
ibuprofen is no longer having the same effect, so you take some more
to reach the same level of pain relief?
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Before you know it, you've been taking
it for weeks/months/years.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihnk69t3oUAxh5qa4nQ2MMTrsFNGB2lX82YRbczZUppW2ufOfe7gtTDBGUPBhHKrRDxjyUzdM5L_U1XgBntG_myvwTw6HvCqXizpR-9CR_61qDIY2pRibPhFO0JYLZ-NhS0xo_NsbPkX0/s1600/R-ibuprofen-A-2D-skeletal.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="95" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihnk69t3oUAxh5qa4nQ2MMTrsFNGB2lX82YRbczZUppW2ufOfe7gtTDBGUPBhHKrRDxjyUzdM5L_U1XgBntG_myvwTw6HvCqXizpR-9CR_61qDIY2pRibPhFO0JYLZ-NhS0xo_NsbPkX0/s200/R-ibuprofen-A-2D-skeletal.png" width="200" /></a><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Sound familiar?</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I hope not.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Non-steriodal anti-inflammatories drugs
(NSAIDs for short) have there place and can be relevant when taking
appropriately. However, I wanted just to discuss some recent evidence
that was brought to my attention about the dangers of NSAIDs (not to
scare anyone, but just to inform you).</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It has been widely documented that
NSAIDs can cause kidney damage (Murray & Brater 1997) due to all
NSAIDs reduce blood flow to the kidneys. As a result 2 things can
occur: elevation of blood pressure; and, more dangerous, the risk of
acute renal failure/acute tubular necrossis.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">But other studies have now shown the
they may also cause damage to the intestines, and to bone healing.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Bone Healing:</span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<br /></div>
<br />
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A recent systematic analysis of studies
looking at affects on bone healing caused by NSAID's by Pountos et al
(2012), and found that, although there is an absence of robust
clinical trials, that due to the scientific knowledge of the
interference at a cellular level caused by NSAIDs, that they should
be viewed as a risk factor to bone healing.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipxmKg31ESHKY0mwfXboixpeUHDGaMCCjIhWiIkCO974uBzrW8SD-t_NJ1BGCTroETow9-yvOaDXgGRhKqnwJ2ltSRRluEHA7PGxaAmkAmCg6ejYRBIWXbudK4DTt_QZLZp0xvHQZwHTQ/s1600/TSWJ2012-606404.001.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipxmKg31ESHKY0mwfXboixpeUHDGaMCCjIhWiIkCO974uBzrW8SD-t_NJ1BGCTroETow9-yvOaDXgGRhKqnwJ2ltSRRluEHA7PGxaAmkAmCg6ejYRBIWXbudK4DTt_QZLZp0xvHQZwHTQ/s320/TSWJ2012-606404.001.jpg" width="320" /></a><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The idea is, due to the
anti-inflammatory effect of NSAIDs, that it reduces the amount of
certain chemicals in the cells that aid healing, as they are induced
by the inflammation process.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">These chemicals are thought to enlist
osteoblasts which are responsible for bone formation.</span></span><br />
<br />
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCCBOcFgHHpBkO5iODrgmwJgBnMwKZWwgWz69DJPaFLAqDFTfsFfdFh2cpdWTfqoD2LVLiFhfziqnfuJ28IEi7PzAW3tR_xg4SBqoBlmHpJQyBcW2_LB6u2z-HuAZh2n3fjNOiX93zaxc/s1600/2559050.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCCBOcFgHHpBkO5iODrgmwJgBnMwKZWwgWz69DJPaFLAqDFTfsFfdFh2cpdWTfqoD2LVLiFhfziqnfuJ28IEi7PzAW3tR_xg4SBqoBlmHpJQyBcW2_LB6u2z-HuAZh2n3fjNOiX93zaxc/s320/2559050.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Osteoblasts via microscope</td></tr>
</tbody></table>
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<b><u><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Intestinal damage:</span></span></u></b></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It has already been tested that you get
some marginal intestinal damage when exercising (due to functions
such as digestion become a luxury when exercising, as the blood that
normally supplies the small intestine is instead diverted to the
muscles. Due to this lack of blood to the intestines, some of the
cells lining the intestines are traumatized and start to leak.)</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEwRUeyW0t9u9chRs8NsppUXGBcLlsL9_VWRBG-D9bEFqkOsPdH7Yv2BjgU-I_jzBQ3ShWJkZt2gGgHkjLDQMElgHxs2uHu9SJ_ExJhqPvgRo6dWbzXCnDLoA0NSBIg1SNDEfqkfuoeD0/s1600/8940.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEwRUeyW0t9u9chRs8NsppUXGBcLlsL9_VWRBG-D9bEFqkOsPdH7Yv2BjgU-I_jzBQ3ShWJkZt2gGgHkjLDQMElgHxs2uHu9SJ_ExJhqPvgRo6dWbzXCnDLoA0NSBIg1SNDEfqkfuoeD0/s320/8940.jpg" width="320" /></a></div>
<div style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, it has been shown in a recent
study by Van Wijck et al (2012) that NSAIDs, specifically ibuprofen,
can aggravate this phenomena. To what extent, I'm not too sure, but
the result was a significant one.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It is worth noting that this was
performed on healthy males performing an aerobic exercise (cycling),
and only 9 subjects were used, and is only a short term effect. The
long term effects and consequences are not yet clear.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So, there you have it. I'm no
pharmacist or chemist, but I thought I'd share with you what I'd
read. Draw whatever conclusions you wish to from this, but it's worth
bearing in mind.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<div style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<h1 class="western">
<u><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;"><span style="font-weight: normal;">References</span></span></span></u></h1>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<h1 class="western">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;">Murray
MD, Brater DC 1997 Effects of NSAIDs on the kidney. Prog Drug Res.
49:155-71.</span></span></span></h1>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<h1 class="western">
<a href="http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/" target="_blank"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;">ReynoldsG 2012 For Athletes, Risks From Ibuprofen Use. New York Times Blog</span></span></span></a></h1>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<h1 class="western" style="font-weight: normal;">
<a href="http://journals.lww.com/acsm-msse/Abstract/2012/12000/Aggravation_of_Exercise_Induced_Intestinal_Injury.1.aspx" target="_blank"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">VanWijck K, Lenaerts K, Van Bijnen AA, Boonen B, Van Loon LJ, Dejong CH,Buurman WA 2012 Aggravation of exercise-induced intestinal injury byIbuprofen in athletes. Med Sci Sports Exerc 44(12): 2257-2262</span></span></a></h1>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<h1 class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-weight: normal;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259713/">PountosI,GeorgouliT, Calori GM, Giannoudis PV 2102 Do Nonsteroidal Anti-InflammatoryDrugs Affect Bone Healing? A Critical Analysis. Scientific WorldJournal 606404</a></span></span></span></h1>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-37075078423337256772013-04-26T10:30:00.003-07:002013-05-25T09:34:49.747-07:00Stretching<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ok, so in response to this article about stretching from the <a href="http://well.blogs.nytimes.com/2013/04/03/reasons-not-to-stretch/?ref=health&utm_source=buffer&buffer_share=4928b" target="_blank">New York Times blog on reasons not to stretch</a> that is making the rounds at present, I want to explain a little about stretching.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The blog post basically says static stretching during a warm up makes you weaker pre-sporting activity.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Well, of course it does! The idea of stretching is to lengthen muscles. Muscles work optimally in their mid range, so the longer the muscle, the less optimally the muscle is going to work!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This is easily demonstrated when looking at the structure of sarcomeres, the muscle fibres.</span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHD_TcWvKAimB7diGZiLNxNJI99TZSkwSPVFShFq5VwuafYWve75eQ-zn6TajL3U1DoijA1HANnbDvssuDLP2J5A0__aWWn-_WTOnNTsLoxd6KdvxQD8HhtF16HpVyzPOmAhEAJDhtqnY/s1600/775px-Sarcomere.svg.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHD_TcWvKAimB7diGZiLNxNJI99TZSkwSPVFShFq5VwuafYWve75eQ-zn6TajL3U1DoijA1HANnbDvssuDLP2J5A0__aWWn-_WTOnNTsLoxd6KdvxQD8HhtF16HpVyzPOmAhEAJDhtqnY/s1600/775px-Sarcomere.svg.png" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If the "H-zone", the area between the muscle fibres, is longer, then there is less overlap of the muscle fibres to connect to.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This means the muscle is not going to contract as strongly as it would, therefore be weaker.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The idea of stretching is to make muscles longer post activity. These muscles are not going to stretch very well cold, therefore they need to be <a href="http://thomasbondphysio.blogspot.co.uk/2013/05/hot-stuff-warming-up.html">warmed up first</a>. This is why it is best to stretch as part of your cool down routine, to prevent DOMS (delayed onset of muscle soreness) and speed up recovery.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Rant over! :P</span></span><br />
<br />Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-87827719560290094862013-04-19T13:20:00.001-07:002013-04-19T13:20:17.209-07:00Physiological response to injury and hot/cold
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So,
this post originally started off as a post to review the evidence
behind contrast baths, however, I realised it would be best to
explain the physiological effect of hot and cold on the body, and
discuss healing times while I'm at it, due to the overlap.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So,
here it goes, I will begin with healing times and process.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The
healing process consists of 3 different phases, and these are:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><ol>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Inflammation
(0-48 hours)</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Proliferation
(5 days – 4 weeks)</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Maturation
(4 weeks – 2 years +)</span></span></div>
</li>
</ol>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now,
I've put the time frames up here as a guide. A popular misconception is
that these time frames are distinct and seperate, as shown below:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoJhnyrqm_sDy_S_HXnoa7gH8Zjd2K_e-HsHos9tAv4T0DFhZ7Gc19p3l_VaA7bxVgABSWucI5HsvwoyS5yjMIg0WSa0HPksOMyfFwaPETFzHbsPd-EaQ6lBZXlNWML8asQ7M_cjYHkY4/s1600/healing+times+misconception.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoJhnyrqm_sDy_S_HXnoa7gH8Zjd2K_e-HsHos9tAv4T0DFhZ7Gc19p3l_VaA7bxVgABSWucI5HsvwoyS5yjMIg0WSa0HPksOMyfFwaPETFzHbsPd-EaQ6lBZXlNWML8asQ7M_cjYHkY4/s1600/healing+times+misconception.png" height="224" width="320" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">When
actually, each of these areas overlap, as one area is winding down,
the next is building up it's response, as shown below:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijFBraKX3j7q7fI6WaS52_4bBjuYSkO70PNmblCYtgzy1T9OKRKuYrJM_Kr4in-0QbBGY86U_YTzF7AsRLhX05deom_Ra7eSegWGZKNiXclFBMKgM8UlvtGAar3N4qzT1pw0VwvF5YdTY/s1600/healing+times+actual.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijFBraKX3j7q7fI6WaS52_4bBjuYSkO70PNmblCYtgzy1T9OKRKuYrJM_Kr4in-0QbBGY86U_YTzF7AsRLhX05deom_Ra7eSegWGZKNiXclFBMKgM8UlvtGAar3N4qzT1pw0VwvF5YdTY/s1600/healing+times+actual.png" height="227" width="320" /></a></div>
<br /><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now,
here I will discuss what each area does physiologically, in as brief
and simplest way possible:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b></u>
</div>
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span></b></u><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Inflammation</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">We
are all familiar with this process. This is when the injured area,
swells, become red in colour, with associated warmth, pain, and loss
of function. In this stage, the initial bridging of collagen fibres
begins.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The
normal response in this stage is to apply the <a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">POLICE principles</a>. </span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Now,
I must point, at this stage, we all panic about swelling, and try our
best to get rid of it. Swelling is a natural part of the healing
process and we should let it take it's course, as the swelling is
needed to get fresh nutrients to the area, and to remove cellular
debris. </span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Chronic
swelling, so swelling that is still present maybe a week after the
injury is not <span style="font-size: large;">necessarily</span> good, as this will start to impact on the
optimisation of the healing process, and this is where we would want
to remove excess inflammation. </span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Swelling
upon exercise of the injured area, at this stage, would still be
normal.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><b><u><span style="font-size: large;">Proliferation</span></u></b></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This
stage shows the signs of inflammation beginning to decrease, and pain
levels decreasing too.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Collagen
fibres are being laid down at the injured site at the peak rate at
this stage and will progress to orientate themselves in line with
imposed stresses.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b></u>
</div>
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span></b></u><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Maturation</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This
stage should so no signs of inflammation and a huge decrease in pain,
with pain only at end range. This stage should focus on restoring
function and strength, and optimising collagen alignment.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Collagen
fibre deposits peak around 3 months post injury, but will continue to
lay down up to 2 years after an inujry (depending on the severity of
the injury).</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Maturation
is more focussed on return to normal, with excess collagen fibres
removal, optimisation of the collagen matrix to accommodate imposed
stresses, and return to normality of the vascular supply.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/IYL6vg89uds?feature=player_embedded' frameborder='0'></iframe></div>
<div class="western" style="margin-bottom: 0cm; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: small;">This video discusses the three stages of healing in much more <br />detail, if that interests you, and you can stand the accent!</span></span></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b>N.B.
</b></u>Pain is not synonymous with healing. Pain levels will
decrease quicker than structural integrity of the injured site
improves, so the risk of re-injury is still high, even if the pain
has subsided.</span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDggv6y2HbN3VoqkQVYdwxLdN_B2lJrQYwuFuwGSN2AcJowW78yVlyiqxAvBcenu_xiD8e1PB5t8AI5kHtEJd044IHnZp-OHuJqf2Tp2L3XAjudghtCpYfkGkp1WOmQLg4EtFSouEa-IM/s1600/patellar-tendonitis-knee-graph.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDggv6y2HbN3VoqkQVYdwxLdN_B2lJrQYwuFuwGSN2AcJowW78yVlyiqxAvBcenu_xiD8e1PB5t8AI5kHtEJd044IHnZp-OHuJqf2Tp2L3XAjudghtCpYfkGkp1WOmQLg4EtFSouEa-IM/s1600/patellar-tendonitis-knee-graph.gif" height="225" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">This graph shows that after the injury, the pain levels drop <br />below the threshold quicker than the tendon recovery</span></td></tr>
</tbody></table>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It
is also worth mentioning a few stats on the temperature of tissues.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDBVTgaVMsLAeckRuNHgW-m5zya9HGBo3I0M8eaM5sAJmvOvOatgdtAFPYxaWxaKGvjpYH1k8wMOEcJspLy_xUNbqZ2doUm9QQNG7e8vYHq9xVAfkfAYxoV6UuGLl1NMGXmQHk-w0PpA4/s1600/3739600-thermometer-with-temperature-rising--vector.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDBVTgaVMsLAeckRuNHgW-m5zya9HGBo3I0M8eaM5sAJmvOvOatgdtAFPYxaWxaKGvjpYH1k8wMOEcJspLy_xUNbqZ2doUm9QQNG7e8vYHq9xVAfkfAYxoV6UuGLl1NMGXmQHk-w0PpA4/s1600/3739600-thermometer-with-temperature-rising--vector.jpg" height="200" width="155" /></a><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Optimal
tissue temperatures: <br />resting = 36.5ºC – 37.2ºC, <br />aim when
exercising = 38ºC – 40ºC (as tendons exhibit plastic deformation
at 39ºC, collagen at 40ºC)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span></b>
</div>
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span></b><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b><span style="font-family: "Courier New",Courier,monospace;"><u>Hot and <span style="font-size: large;">Cold response</span></u></span></b></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">So,
now I'll move onto the effect of hot and cold physiologically:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Hot
and cold can increase or decrease symptoms of <span style="font-size: large;">inflammation, and
here's how:</span></span></span></div>
<span style="font-size: large;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-size: large;"><br /></span>
</div>
<span style="font-size: large;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Cold</span></b></u></span></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbCnimWK8sW_1KZ_mgBYoHref2wo3xqMKd2Ktr2NKc6ADmd8zsUkGCY5drvv44rpsSZiJfpxTixxjxoJ0p8ZWm0FAg5VSjaF8D48D2ztr_8atzpMU9H8aKCuQhVpz7MaP3dMFfPMvngns/s1600/image.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbCnimWK8sW_1KZ_mgBYoHref2wo3xqMKd2Ktr2NKc6ADmd8zsUkGCY5drvv44rpsSZiJfpxTixxjxoJ0p8ZWm0FAg5VSjaF8D48D2ztr_8atzpMU9H8aKCuQhVpz7MaP3dMFfPMvngns/s1600/image.jpeg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><span style="font-family: Times,"Times New Roman",serif;">Glenn ice climbing in <i><b>cold </b></i>conditions! <br />Copyright Glenn Manifold</span></span></td></tr>
</tbody></table>
</span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<table border="1" cellpadding="4" cellspacing="0" style="page-break-after: avoid; page-break-before: auto; width: 100%px;">
<colgroup><col width="26*"></col>
<col width="23*"></col>
<col width="112*"></col>
<col width="94*"></col>
</colgroup><tbody>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Symptom</span></div>
</td>
<td width="9%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Response</span></div>
</td>
<td width="44%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">How?</span></div>
</td>
<td width="37%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Additional
info:</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Pain</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Reduces nerve conduction velocity and increases the firing
threshold</span></div>
</td>
<td rowspan="7" width="37%">
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Considerations</span></div>
<span style="font-size: x-small;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Rewarming
after icing can take 3-4 hours </span></div>
<span style="font-size: x-small;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">With
a muscle at 4cm depth from skin surface will have a 4ºC fall in
1hr</span></div>
<span style="font-size: x-small;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><br /></span>
</div>
<span style="font-size: x-small;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Contraindications:
Raynauds, Cold hypersensitivity, Open wound, Sensory defect, heart
disease</span></div>
<span style="font-size: x-small;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><br /></span>
</div>
<span style="font-size: x-small;">
</span><div class="western" style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Precautions:
Cardiac disease/hypertension, pelvis/groin area (bone marrow
production/blood cells), left shoulder+neck area (proximity to
heart)</span></div>
<div class="western" style="font-weight: normal;">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Spasm</span></div>
</td>
<td width="9%">
<div style="background: transparent; margin-top: 0.21cm; page-break-before: auto;">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Automatic
protective response, prevents increase demand for O2</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Metabolism</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Reduces
need for O2 in surrounding tissue so less damage via
hypoxia and reduces total debris. Less O2 means less secondary
damage to other tissues</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Blood
flow</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Vasoconstriction
of the blood vessels</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Inflammation</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Oedema</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">By
vasoconstriction of blood vessels and increasing blood viscocity</span></div>
</td>
</tr>
<tr valign="TOP">
<td height="4" width="10%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Tissue
extensibility</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="44%">
<div style="font-weight: normal; margin-top: 0.21cm; page-break-before: auto;">
<br />
</div>
</td>
</tr>
</tbody></table>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;"><br /></span></b></u></span>
</div>
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">
</span></b></u></span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Heat</span></b></u></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijyEtZQiT2WYZ5gAqPEp-Y6VciMdLM2yYrGX_W8VcUJoJwSUzsWwX6Pp1IJiMobKpmX-px-x2ySkYR0UcCG_KWtm99YVRE3zRW3spRKiwW0ixEM9gyxK4yhabgHRAYHn6wcXRrQw5N0xE/s1600/DSC_0734.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijyEtZQiT2WYZ5gAqPEp-Y6VciMdLM2yYrGX_W8VcUJoJwSUzsWwX6Pp1IJiMobKpmX-px-x2ySkYR0UcCG_KWtm99YVRE3zRW3spRKiwW0ixEM9gyxK4yhabgHRAYHn6wcXRrQw5N0xE/s1600/DSC_0734.JPG" height="320" width="214" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">The author bouldering in sunny, <br /><i><b>warm </b></i>Fountainebleau</span></td></tr>
</tbody></table>
<table border="1" cellpadding="4" cellspacing="0" style="page-break-after: avoid; page-break-before: auto; width: 100%px;">
<colgroup><col width="31*"></col>
<col width="23*"></col>
<col width="108*"></col>
<col width="94*"></col>
</colgroup><tbody>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Symptom</span></div>
</td>
<td width="9%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Response</span></div>
</td>
<td width="42%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">How?</span></div>
</td>
<td width="37%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Additional
info:</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Pain</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">By
reducing the nerve conduction velocity and increasing the firing
threshold</span></div>
</td>
<td rowspan="7" width="37%">
<div class="western" style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">Precautions/contraindications:
Diabetes mellitus Multiple sclerosis
Peripheral vascular disease</span></span></div>
<br />
<div class="western" style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">Spinal
cord injuries Rheumatoid disease </span></span>
</div>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;"><br /></span></span>
</div>
<br />
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">Possible
side effects: skin burns</span></span></div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Spasm</span></div>
</td>
<td width="9%">
<div class="western">
↓</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Automatic
protective response, prevents increase demand for O2</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Metabolism</span></div>
</td>
<td width="9%">
<div class="western">
↑</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">More
energy to cells, increasing there productivity, plus increase in
blood flow meaning more oxygen to area</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Blood
flow</span></div>
</td>
<td width="9%">
<div class="western">
↑</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Vasodilation
of the blood vessels</span></div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Inflammation</span></div>
</td>
<td width="9%">
<div class="western">
↑</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Oedema</span></div>
</td>
<td width="9%">
<div class="western">
↑</div>
</td>
<td width="42%">
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">By
vasodilation of blood vessels and decreasing blood viscocity</span></div>
</td>
</tr>
<tr valign="TOP">
<td height="4" width="12%">
<div class="western">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Tissue
extensibility</span></div>
</td>
<td width="9%">
<div style="margin-top: 0.21cm; page-break-before: auto;">
↑</div>
</td>
<td width="42%">
<div style="font-weight: normal; margin-top: 0.21cm; page-break-before: auto;">
<br />
</div>
</td>
</tr>
</tbody></table>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: large;"><br /></span>
</div>
<span style="font-size: large;">
</span><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial, sans-serif; font-size: large;">I
hope this post has given you a little more understanding around the
healing process and the physiological effects of hot and cold, and
hopefully this will aid understanding for future posts, such as the
evidence behind contrast baths, that I'm currently working on.</span></div>
Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com0tag:blogger.com,1999:blog-4692690742617863595.post-27908056166765281682013-04-15T14:16:00.001-07:002013-04-19T13:23:43.929-07:00Wrist Injuries Part 2<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">For basic anatomy and stats, as well as info on <span style="font-size: large;">wrist injuri<span style="font-size: large;">es: </span></span></span></span><br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Carpal Tunnel syndrome</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Stress fracture to the
hook of hamate</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">see <a href="http://thomasbondphysio.blogspot.com/2013/04/wrist-injuries-part-1.html">Wrist Injuries Part 1</a></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This part will discuss Triangular
Fibro-Cartilage Complex (TFCC) injuries, and scapholunate ligament injuries, as well as some preventative measures.</span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">TFCC Anatomy</span></b></u></span></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The Triangular
Fibro-Cartilage Complex (TFCC) connects ulnar and radius, that is
involved in stabilizing the ulnar-radial joint.</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirhz2LXMcW00p3vg4WahtC-Zx9sWx3qRkh1-a2F7hWms8IFu8l53ism-PCaTzgkBETsljG7VFCBsIFtl4U5jHE4fQpg3jWZgxDA2vkjnTflm8-eggoVXv-Izph_NEn-SvSCDsYQeQQK8c/s1600/wrist.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirhz2LXMcW00p3vg4WahtC-Zx9sWx3qRkh1-a2F7hWms8IFu8l53ism-PCaTzgkBETsljG7VFCBsIFtl4U5jHE4fQpg3jWZgxDA2vkjnTflm8-eggoVXv-Izph_NEn-SvSCDsYQeQQK8c/s1600/wrist.jpg" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMY1MQg1uIgF5Q6aJdfKEOCPRoW-PVYQ9H-JxsSsAv9rs1RLuRtRS6dVFzMHofbE7iQjO3BQMDuW727lpiU-71Oz4ETYEbGn_EoUA1wSkOKODo-5lbXuJoDxNnrEBBbwTvL42qUmvaEQ0/s1600/wrist+injuries.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMY1MQg1uIgF5Q6aJdfKEOCPRoW-PVYQ9H-JxsSsAv9rs1RLuRtRS6dVFzMHofbE7iQjO3BQMDuW727lpiU-71Oz4ETYEbGn_EoUA1wSkOKODo-5lbXuJoDxNnrEBBbwTvL42qUmvaEQ0/s1600/wrist+injuries.jpg" height="286" width="320" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">It is also sometimes
referred to as the “wrist meniscus” as it acts like the meniscus
in the knee by forming a congruent surface for the carpal bones to
move more easily on the ulnar and radius</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Symptoms</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Clicking</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Popping</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain on the little
finger side</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Weakness</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Swelling</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tenderness</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Diagnosis is normally
based on the area of tenderness and special provocation tests, as
well as other investigations such as x-rays.
</span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Causes</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Falls onto
pronated hyperextended wrist</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Power-drill
injuries in which the drill binds and rotates the wrist instead of
the bit (obviously not climbing related!)</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Distraction force
applied to the palm side of the forearm or wrist (for instance, when
open-handing big slopers)</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Distal radius fractures</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvXpbv5hyuLBhO5s8FAynHEMDNLLRggr74PSrX0xrAD7WWRqida3NQGmNLxvvmMMR7WAzYi-_Ukam_JVNBe6ELS0H8I9RaJfv9M362dmqRbD4rVsYE-hQ4oFjMtRvMdoOvn_R3o-I7-Tg/s1600/sloper.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvXpbv5hyuLBhO5s8FAynHEMDNLLRggr74PSrX0xrAD7WWRqida3NQGmNLxvvmMMR7WAzYi-_Ukam_JVNBe6ELS0H8I9RaJfv9M362dmqRbD4rVsYE-hQ4oFjMtRvMdoOvn_R3o-I7-Tg/s1600/sloper.jpg" /></a></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjoukxHNHPxXRKa7kuMtfGUWe6000pCnYfSIzkqbzNUxf-TFkE965hAfgZZPMSKRuKJJsopEvotdfHSqo4fHim8teP3tcFHRbFEAAc_icHxBv7OZ3jhgefzTK4DXApKb7FUrBCdMJ7jdU/s1600/Fall+on+outstretched+hand+2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjoukxHNHPxXRKa7kuMtfGUWe6000pCnYfSIzkqbzNUxf-TFkE965hAfgZZPMSKRuKJJsopEvotdfHSqo4fHim8teP3tcFHRbFEAAc_icHxBv7OZ3jhgefzTK4DXApKb7FUrBCdMJ7jdU/s1600/Fall+on+outstretched+hand+2.png" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm6MI2BlJwFuyquZ9XW5uUJZH8W-kqbYEWwJJGNfLgU3VuAc8NgzDCcH-dbdKlv6xUl2ngHoZSc4hXvYZ0y0HH-XWnxqjdgNptWa8U4xhrGReYNfs4uEOs_xhpBP1-DKzPOi1u0Xap5CQ/s1600/Fall+on+outstretched+hand.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Treatment</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Treatments obviously
depend on the extent of the injury. </span></span></div>
<ul>
<li><a href="http://thomasbondphysio.blogspot.com/2012/11/management-of-acute-injuries.html"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">POLICE principles</span></span></a></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;">A</span>voiding aggravating factors</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">NSAIDs</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Immobilization in a cast for up to 6 weeks
</span></span></li>
</ul>
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This is because, like other ligaments, the TFCC
has quite a poor blood supply and so this means that the healing
process is slow.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If a cast is required,
then remember to keep finger and thumb movements within the limits of
the cast</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Then, once out of the
cast, normal rehab resumes, beginning with passive movements, then
active assisted range of movements (ROM), active ROM (including
stretches of the flexor and extensors), isometric strengthening,
resistive strengthening (this includes eccentric movements)</span></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyvx4Eds44yUkmnZAKLZu0x5ISKgAhy9hCmMtLY6pRNuehyY2lvSPj25D5GmdFkBRoj2LcgajQD3LDri93G-awAJ4qDgoYyT3Bcf4cBLNmp4EbNU5jSXAqSjMd4GeePJuDXF34H_2L88/s1600/ForearmSupination.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyvx4Eds44yUkmnZAKLZu0x5ISKgAhy9hCmMtLY6pRNuehyY2lvSPj25D5GmdFkBRoj2LcgajQD3LDri93G-awAJ4qDgoYyT3Bcf4cBLNmp4EbNU5jSXAqSjMd4GeePJuDXF34H_2L88/s1600/ForearmSupination.gif" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Eccentric wrist strengthening</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Wrist extension strengthening</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Wrist flexion strengthening</td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQG5PL5MThR2jiOkyTbN6vEw8BQ2Onf2Z1b8cvF5uHpbj1Sr5Xzs-QvnprfWYgva9oTOxAaIIAUfTgoK6hr7IlIsNO2hWrikXfbQ9R2-SvZIKqaJs04Cgrcc5Bm1l_WRoVySjSyZJhg/s1600/Elbow-tendonitis-exercises.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQG5PL5MThR2jiOkyTbN6vEw8BQ2Onf2Z1b8cvF5uHpbj1Sr5Xzs-QvnprfWYgva9oTOxAaIIAUfTgoK6hr7IlIsNO2hWrikXfbQ9R2-SvZIKqaJs04Cgrcc5Bm1l_WRoVySjSyZJhg/s1600/Elbow-tendonitis-exercises.jpg" height="210" width="320" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b>N.B. </b></u><span style="text-decoration: none;"><span style="font-weight: normal;">It
can take up to 12 weeks before progressing to strengthening work, so
don't rush your rehab!</span></span></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If a cast is not
required, then the normal rehab described above can be implemented
straight away, if deemed necessary by a professional.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDEfXDTNLh7jP_pETsQPAWzP-2lDRG0TsRQT9e_Z7_MUnNopqym8gfDk158IQkAAxeDqfDEkeyuZzexDSmhrhnPQRF5NEPOLK6ljFnG2t3uFD4dqyUdwonIizlk2g2LXh7NaDFzhUYs_c/s1600/TFCC+rehab+exercises.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDEfXDTNLh7jP_pETsQPAWzP-2lDRG0TsRQT9e_Z7_MUnNopqym8gfDk158IQkAAxeDqfDEkeyuZzexDSmhrhnPQRF5NEPOLK6ljFnG2t3uFD4dqyUdwonIizlk2g2LXh7NaDFzhUYs_c/s1600/TFCC+rehab+exercises.jpg" height="320" width="320" /></a></div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A TFCC injury could mean up to 3-4 months off climbing
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Surgery may be
required, such as an arthroscopic repair, depending on the extent of
the injury.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A lot more on TFCC can
be read here: <a href="http://triangularfibrocartilagecomplextear.blogspot.com/">http://triangularfibrocartilagecomplextear.blogspot.com</a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Scapho-lunate ligament
tear</span></span></b></u></div>
<div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Anatomy</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The scapholunate ligament connects the scaphoid to
the lunate. It's an important stabiliser of the wrist to control the
movements between the bones. If this ligament is torn there is a loss
of the balance of the wrist, and causes abnormal wrist movements.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Symptoms</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">pain in the center
or on the thumb side of the wrist, worsened with activities such as
push-ups, or other activities that load the wrist</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">grip weakness,</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">snapping, or
popping of the wrist</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">swelling</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">tender and specific swelling over the gap
between the scaphoid and lunate
</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Causes</span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Large stress on
extension and ulnar deviation, normally a fall on an outstretched
hand – e.g. falling off when bouldering, and spraining your wrist</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoRG3YE8Uu6pJcEqn0OnDB6PoYQAl_vX4f2JJDVSN_0mRmX7xU_RfD8rUrgT1buo0Z7Tz75QKcRv1A2m-_MoDd4hln3tZ9fRBGJCpXHE2Af0DD63V1ZyCScBm-JRh6rzO4pdmgMNxy1_A/s1600/Fall+on+outstretched+hand.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoRG3YE8Uu6pJcEqn0OnDB6PoYQAl_vX4f2JJDVSN_0mRmX7xU_RfD8rUrgT1buo0Z7Tz75QKcRv1A2m-_MoDd4hln3tZ9fRBGJCpXHE2Af0DD63V1ZyCScBm-JRh6rzO4pdmgMNxy1_A/s1600/Fall+on+outstretched+hand.jpg" height="320" width="189" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Treatment</span></b></u></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzyzofaE4CI1YMxQRtq-1zxmS7PXiPiMJU-phSvNjUAp4zlj0igsipTEivsO6DuyTxugFp542YXChgnbb6ZxIUBrfFBIFOS2XaZPXuiqsHMNJMKjEsCX3SpTgZqFb60xDEjCQbMSlVOx8/s1600/wrist+splint.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzyzofaE4CI1YMxQRtq-1zxmS7PXiPiMJU-phSvNjUAp4zlj0igsipTEivsO6DuyTxugFp542YXChgnbb6ZxIUBrfFBIFOS2XaZPXuiqsHMNJMKjEsCX3SpTgZqFb60xDEjCQbMSlVOx8/s1600/wrist+splint.jpg" height="208" width="320" /></a></span></div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Initially,
immobilization up to 8 weeks or more</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Then progress to
increasing the range of movement and gentle strengthening/loading
activities</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Timing and progression
of the exercises depend on many factors, such as the type of injury,
and the healing process.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A surgical option may
be required.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Avoidance/prevention</span></span></b></u></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The obvious prevention is to avoid movements that
cause the issues, however, this is always not easy to do. Therefore, if a wrist injury does occur, take notice in the early stages and do something about it, rather than continue to climb on it and make it worse. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Safer bouldering:
</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Learning how to
properly fall sideways or backwards with fingers pointing safely
towards the body (thumbs to the bum) would be a beneficial technique
to learn, especially for the boulderer, to try and reduce wrist
injuries. It is worth emphasizing that these techniques are not
instinctive and need to be learned in a safe environment
</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2LJfg8_Ez1M2vAgvNZWbavJOSWaq9iDsqtTQTUOy3_5ti0_K1_mh0fsoLvGj6nbodBqLjwwqhreHg85OeytG95NowxR46M4bdGaoRL48-tgYg_oggw-FSwVqbC_dYna49L7SaXybwL_A/s1600/falling+technique.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2LJfg8_Ez1M2vAgvNZWbavJOSWaq9iDsqtTQTUOy3_5ti0_K1_mh0fsoLvGj6nbodBqLjwwqhreHg85OeytG95NowxR46M4bdGaoRL48-tgYg_oggw-FSwVqbC_dYna49L7SaXybwL_A/s1600/falling+technique.gif" /></a></span></div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">References
</span></span></b></u><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Bourdon M, Thompson J
2013 Safer Bouldering
<a href="http://www.mec.ca/AST/ContentPrimary/Learn/Climbing/IntroToClimbing/SaferBouldering.jsp">http://www.mec.ca/AST/ContentPrimary/Learn/Climbing/IntroToClimbing/SaferBouldering.jsp</a></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-weight: normal;">Bissell
B, Bedi A 2011 Scapholunate Ligament Tear
<a href="http://www.sportsmd.com/Articles/id/14/n/scapholunate_ligament_tear_.aspx">http://www.sportsmd.com/Articles/id/14/n/scapholunate_ligament_tear_.aspx</a></span></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Palmer AK, Werner FW
1981 The triangular fibrocartilage complex of the wrist--anatomy and
function. J Hand Surg Am 6(2):153-62.
</span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">McNamara MG, Carino BB,
Thomas R 2012 Diagnosis: TFCC Tear <a href="http://www.akhanddoc.com/TFCC.htm">http://www.akhanddoc.com/TFCC.htm</a></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.shoulderelbowhand.co.uk/wrist_ligament_injuries.html">http://www.shoulderelbowhand.co.uk/wrist_ligament_injuries.html</a></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"></span></span><br />
<div class="western">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Verheyden JR 2012
Triangular Fibrocartilage Complex Injuries
<a href="http://emedicine.medscape.com/article/1240789-overview">http://emedicine.medscape.com/article/1240789-overview</a></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://triangularfibrocartilagecomplextear.blogspot.com/2010/04/how-can-physiotherapy-help.html"><span style="font-weight: normal;">http://triangularfibrocartilagecomplextear.blogspot.com/2010/04/how-can-physiotherapy-help.html</span></a></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div align="LEFT" class="western" style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://ih-voc.eznetpublish.ihealthspot.com/tabid/14407/mid/24836/ContentPubID/113/ContentClassificationGroupID/-1/Default.aspx"><span style="font-weight: normal;">http://ih-voc.eznetpublish.ihealthspot.com/tabid/14407/mid/24836/ContentPubID/113/ContentClassificationGroupID/-1/Default.aspx</span></a></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div align="LEFT" class="western" style="font-weight: normal; margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
</div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.blogger.com/null" name="ctl01_cphContent_PagedEditorialViewer1_articleDates_lblSubHead"></a>
Roux A 2010 Scaphoid and Scapholunate Ligament Injuries: The
Achilles' heel of the wrist
<a href="http://occupational-therapy.advanceweb.com/Archives/Article-Archives/Scaphoid-and-Scapholunate-Ligament-Injuries.aspx">http://occupational-therapy.advanceweb.com/Archives/Article-Archives/Scaphoid-and-</a><a href="http://occupational-therapy.advanceweb.com/Archives/Article-Archives/Scaphoid-and-Scapholunate-Ligament-Injuries.aspx">Scapholunate-Ligament-Injuries.aspx</a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com1tag:blogger.com,1999:blog-4692690742617863595.post-82544370235984107082013-04-08T13:36:00.002-07:002013-05-25T09:41:37.799-07:00Wrist Injuries Part 1<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Wrist injuries aren't
as common as finger injuries (from what I've seen), but can be just
as serious, if not more serious, especially as climbers often focus
on fingers, elbows and shoulders and seem to forget that wrist bit in
between!</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I've been trying to
find statistics on wrist injuries, and the most common wrist
injuries, however, most articles lump wrist/finger/hand injuries all
together, so after much digging, I decided to focus on 4 main wrist
injuries, and these are:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Carpal Tunnel syndrome</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Stress fracture to the
hook of hamate</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">TFCC (Triangular
Fibrocartilage Complex) injuries</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Scapho-lunate ligament
tear</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The latter two will come in a <a href="http://thomasbondphysio.blogspot.com/2013/04/wrist-injuries-part-2.html">follow up post, Wrist Injuries P<span style="font-size: large;">a</span>rt 2</a></span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Statistics I did manage
to find:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">11% of 39 rock climbers
had carpal tunnel (Rooks et al 1995)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">50% had hand or wrist
injuries (Rooks et al 1995)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> 7.1% of 42 climbers
had undercling wrist injury and carpal tunnel (Rohrborough et al
2000)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">9 out of 115 injuries =
wrist (7.8%)(Bollen 1988)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">12% wrist #, 5% wrist
sprain (out of 545) (Logan et al 2004)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"></span><br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Schwiezer (2012) has said that these injuries are
frequently seen only several months after the initial trauma.
A ligamentous injury is quite difficult to treat at such a late
stage and the prognosis is much worse. It is recommended that you get
your wrist thoroughly investigated if it has been painful for more
than three weeks, to exclude such an injuries.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Anatomy of wrist </span></span></b></u></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Bones</span></span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
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<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ligaments</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
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<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Carpal Tunnel anatomy</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0HDvaY9V4r5LJAybM77biSCWqXBEdVeTIInPs_hbYz2FU3heD9-B2Q8efdG04ej2HKMISwX3ZbWWbdY4fxSkoiA07pP_NF2ewtOkajgIwa0BxXQjZdyCjbrYFtpLj-4KAEVtoyaUDGPg/s1600/carpal-tendon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0HDvaY9V4r5LJAybM77biSCWqXBEdVeTIInPs_hbYz2FU3heD9-B2Q8efdG04ej2HKMISwX3ZbWWbdY4fxSkoiA07pP_NF2ewtOkajgIwa0BxXQjZdyCjbrYFtpLj-4KAEVtoyaUDGPg/s1600/carpal-tendon.jpg" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;"><br /></span></b></u></span>
</div>
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">
</span></b></u></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Carpal Tunnel </span></b></u></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Cause</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b><span style="font-weight: normal;">Carpal
tunnel symptoms arise from compression of the median nerve as enters
through the carpal tunnel and into the hand.</span></b></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The median nerve
controls the movement of the thumb, as well as sensation in the thumb
and the next two-and-a-half fingers.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This compression can
be caused by swelling within the carpal tunnel, or changing the
orientation of the structures around the carpal tunnel, that could be
caused from:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Damage to the
flexor tendons usually occurs due to overuse of the forearm flexors.
</span></span></div>
</li>
<li><div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Injury to wrist –
sprain, fractures, crush injuries</span></span></div>
</li>
<li><div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">RSI -from
strenuous grip, repetitive wrist flexion</span></span></div>
</li>
<li><div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Sudden increase
in activities leading to strenuous grip</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Symptoms</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The main symptoms of
carpal tunnel are:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Numbness</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Tingling</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Pain</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">...within the affected
hand</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Normally in a specific
pattern of the thumb and first two and a half fingers (as this is
where the median nerve supplies within the hand)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv5nCI2zwUfUyps4rhZJbMuN6Lm7A1DC2w4avKxfMvl1wWtRXLezZyzMCTGi0J8nbNak0tKdob00b7Ahfal1yhjI5AgoKr273etUtDnzL9WG3s5-CI05n6c7x-VCSqr15BBybosi3XQyM/s1600/Carpal-Tunnel.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv5nCI2zwUfUyps4rhZJbMuN6Lm7A1DC2w4avKxfMvl1wWtRXLezZyzMCTGi0J8nbNak0tKdob00b7Ahfal1yhjI5AgoKr273etUtDnzL9WG3s5-CI05n6c7x-VCSqr15BBybosi3XQyM/s1600/Carpal-Tunnel.jpg" width="320" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">However, other symptoms
can include:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">a dull ache and
discomfort in the hand, forearm or upper arm
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">a burning,
prickling sensation
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">dry skin, swelling
or changes in the skin colour of the hand
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">becoming much less
sensitive to touch (hypoaesthesia)
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">weakness in the
thumb when trying to bend it at a right angle, away from the palm
(abduction)
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">weakness and wasting away (atrophy) of the
muscles in the thumb
</span></span></div>
</li>
<li><div class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">weakness
to the hand and fingers, meaning it becomes difficult to perform
dexterous tasks, such as typing or fastening buttons.</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The symptoms of carpal tunnel are often worse after using
the affected hand. Any repetitive actions of the hand or wrist can
aggravate the symptoms, as can keeping your arm or hand in the same
position for a prolonged period of time.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The symptoms of carpal tunnel tend to develop gradually
and usually start off being worse at night or early in the
morning.</span></span></div>
<div class="western">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Treatment</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Initial treatment of
carpal tunnel should consist of the <a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">POLICE principles</a>. This will mean
resting the wrist, ceasing all aggravating activities (yes, this
means climbing), avoid ports that requires a large amount of stress
on the forearm flexors (yes, this <i>also</i> means climbing!), as
well as racquet sports, gripping activities, opening jars, cans or
doors, carrying or lifting.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This rest is to ensure that the body can begin the
healing process and prevent causing any further damage.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Only once these activities can be performed pain
free, can you gradually build up the stresses applied to the wrist
and return to activities.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">“No pain, no gain” attitude will cause the
problem to become chronic, which then becomes a lot harder to treat
and will take much longer to resolve.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">If your carpal tunnel syndrome is caused by an
underlying health condition such as rheumatoid arthritis,
treating the condition should improve your symptoms.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Wrist splints</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Physiotherapy</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Corticosteroid injections</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Carpal Tunnel Release surgery</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<h4 class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I will discuss the
first two</span></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<h4 class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Wrist splints</span></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A wrist splint can be worn at night to keep it in
the same position and aid the rest required. A wrist splint prevents
the bending of the wrist and further compression of the carpal
tunnel.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Wrist splints are widely available, but you must
follow the other advice to ensure the problem resolves. If there is
no change within your symptoms after 4 weeks, definitely seek
professional help.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPUfZNN8B1LBky3AKGk-jhL_mr9GyptAcsXkkxDfIVjgM8fxgTy5q_uOqypE5TYmndS7Tp7CP7wCwJ70-GDMt7AjDdhKOYSSNmyNlHi2raOovxyV7vNj1s0OprTA6eZB_6elRNLuT-azI/s1600/wrist+splint.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPUfZNN8B1LBky3AKGk-jhL_mr9GyptAcsXkkxDfIVjgM8fxgTy5q_uOqypE5TYmndS7Tp7CP7wCwJ70-GDMt7AjDdhKOYSSNmyNlHi2raOovxyV7vNj1s0OprTA6eZB_6elRNLuT-azI/s1600/wrist+splint.jpg" width="320" /></a></div>
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Physiotherapy</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The cause for your carpal tunnel could be due to:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">excessive training
or activity
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">muscle weakness
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">muscle tightness
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">joint tightness
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">poor sporting
technique or equipment
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">inadequate warm-up
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Injury to the neck, upper back and nerves</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Exercises to target muscle tightness and weakness
would be extensor and flexor stretches, and extensor/flexor
stengthening (see <a href="http://thomasbondphysio.blogspot.co.uk/2013/02/medial-and-lateral-epicondylitis.html">medial epicondylitis post</a> and the images below). </span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQG5PL5MThR2jiOkyTbN6vEw8BQ2Onf2Z1b8cvF5uHpbj1Sr5Xzs-QvnprfWYgva9oTOxAaIIAUfTgoK6hr7IlIsNO2hWrikXfbQ9R2-SvZIKqaJs04Cgrcc5Bm1l_WRoVySjSyZJhg/s1600/Elbow-tendonitis-exercises.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQG5PL5MThR2jiOkyTbN6vEw8BQ2Onf2Z1b8cvF5uHpbj1Sr5Xzs-QvnprfWYgva9oTOxAaIIAUfTgoK6hr7IlIsNO2hWrikXfbQ9R2-SvZIKqaJs04Cgrcc5Bm1l_WRoVySjSyZJhg/s1600/Elbow-tendonitis-exercises.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" /></a></div>
<div class="western">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">As with all exercises, these should be performed
pain-free. They are generic wrist flexibility and strengthening
exercises for the wrist.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A physiotherapist may use other modalities and
treatment techniques to resolve your carpal tunnel</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> Prognosis can be more than 6 months for a carpal
tunnel problem to resolve</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<h2 class="western" style="font-weight: normal;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Climbing
technique and carpal tunnel</b></span></span></h2>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Changes in climbing pattern may reduce the
recurrence of carpal tunnel, especially if it was climbing that
caused the carpal tunnel in the first place.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">This may involve:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">training planning with <a href="http://thomasbondphysio.blogspot.co.uk/2013/05/hot-stuff-warming-up.html">warming up</a> and cooling
down
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">stretching exercises,
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">longer rest periods,
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">use of different hand positions,
</span></span></div>
</li>
<li><div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">appropriate climbing shoes
</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">(Peters 2001)</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>Differential Diagnosis</b></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Please bear in mind
that although your symptoms are portrayed as carpal tunnel syndrome,
there may be a different cause to your symptoms, such as
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">radial nerve at
the elbow and proximal forearm may be an origin of pain (supinator
tunnel syndrome). Since this is purely a motor nerve, only weakness
of the wrist and finger extensors and a dull pain are perceived.
Stretching exercises and deep friction massage of the supinator
muscle are usually helpful and surgery is rarely necessary.
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">median nerve at
its passage through the pronator teres and the ulnar nerve at the
elbow (cubital tunnel syndrome) and at the hypothenar, but this is
rare.
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Digital nerves may
also be compressed but rather acutely (neuropraxia) when squeezed
into cracks or holes, activating a sharp electrifying pain directly
over the nerve with a hyposensitivity and numbness below the injury.
These symptoms usually disappear after a few weeks.
(Schwiezer 2012)</span></span></div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;"><br /></span></b></u></span>
</div>
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">
</span></b></u></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Hook of hamate stress
fracture</span></b></u></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Cause</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">A hook of hamate
fracture is quite rare, but is quite a climbing-specific injury (can
occur in golfers too) that has been observed during a repeated
attempt of an under-cling-grip on a difficult boulder.
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The fracture was caused
by the climber holding his wrist in an ulnar-abduction where the
FDP-tendons of the small and ring-finger are deflected by the hamate
hook. The high forces at the hamulus finally led to a basal-fracture
of the hamate (indirect fracture type).
</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Similar to the
scaphoid, hamate fractures cannot be picked up on normal x-rays. This
means this type of injury is rarely diagnosed</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8kOGyvFsOoXPS4KDvpdP1ORzgdF94CdAmJ32BbmcAoPbtRKGrwHky_92ymJncNQ62Rn676cIpfO3exzb_ko4AuYUEF-w_jLaWGFo_UmcbgHShuAnd3KuqEHPT64hM7H6NHANysdksl3Q/s1600/hook+hamate+fracture+CT.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8kOGyvFsOoXPS4KDvpdP1ORzgdF94CdAmJ32BbmcAoPbtRKGrwHky_92ymJncNQ62Rn676cIpfO3exzb_ko4AuYUEF-w_jLaWGFo_UmcbgHShuAnd3KuqEHPT64hM7H6NHANysdksl3Q/s1600/hook+hamate+fracture+CT.jpg" width="464" /></a></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Symptoms</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<ul>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Ulnar nerve
symptoms such as:</span></span></div>
</li>
</ul>
<ol>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Numbness or
tingling (‘pins and needles’) in the little and ring fingers
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Numbness or
tingling in the heel of the hand
</span></span></div>
</li>
<li><div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Weakness in the
hand when performing fine motor movements, straightening the ring
and little fingers, and spreading the fingers
</span></span></div>
</li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Muscle atrophy
</span></span></li>
</ol>
<ul>
<li><div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">localisation
of tenderness over the hook of hamate</span></span></div>
</li>
<li><div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">pain
on movement of the ring and/or little finger due to the proximity of
the flexor tendons to the hook</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"> (</span>Barton )</span></span><span style="font-family: Arial,Helvetica,sans-serif;"></span>
</div>
</li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"></span></span><br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<b><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Treatment</span></span></b></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">The fracture can be
treated successfully with a special splint in ulnar and radial
deviation of the wrist if picked up early enough. (Schwiezer 2012 and
Barton )</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">Otherwise, an excision
of the fragment, but this is quite a delicate operation, with mixed
results.</span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><u><b><span style="font-family: "Courier New", Courier, monospace;">References</span></b></u></span></span></div>
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"> </span></span></div>
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="https://www.blogger.com/null"> </a>Bayer T,
Schweizer A. 2009 Stress fracture of the hook of the hamate as a result of
intensive climbing. J Hand Surg Eur Vol. 34:276–7.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Peters P. 2001 Nerve compression syndromes in sport
climbers. Int J Sports Med 22:611–7.</span></span></div>
<div class="western">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Rooks
MD, Johnston
RB , Ensor
CD, McIntosh
B, James
S. 1995 Injury patterns in recreational rock climbers. <cite><abbr class="slug-jnl-abbrev" title="The American Journal of Sports Medicine">Am J Sports Med</abbr><span class="slug-pub-date" itemprop="datePublished"> </span><span class="slug-vol"> 23(</span><span class="slug-issue">6):
</span><span class="slug-pages">
683-685</span></cite></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<div class="western">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Barton N 1997</span><span style="font-size: small;">
</span><span style="font-size: small;">Sports
injuries of the hand and wrist.</span><span style="font-size: small;">
</span><span style="font-size: small;"><i>Br
J Sports Med </i></span><span style="font-size: small;">
31: 191-196</span><span style="font-size: small;"> </span></span></div>
<br />
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.smw.ch/content/smw-2012-13688/">Schwiezer
A 2012 Sport climbing from a medical point of view. Swiss Medical
Weekly</a></span><span style="font-size: small;"> </span></span></div>
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<br /></div>
<div align="LEFT" class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Rohrbough, J. T., M. K. Mudge, R. C. Schilling 2000 Overuse injuries in the elite rock climber. Med. Sci. Sports Exerc., 32(8):1369–1372.</span></span></div>
<br />
<div class="cit">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span role="menubar"></span></span></span></div>
<div class="auths">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Logan AJ, Makwana N, Mason G, Dias J. 2004 Acute hand and wrist injuries in experienced rock climbers.<span role="menubar">Br J Sports Med.</span> 38(5):545-8.</span></span></div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Bollen 1988 Soft tissue injury in extreme rock climbers. British Journal of Sports Medicine 22(4): </span></span>145-147<br />
<br />
<div class="western" style="margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"> Next post: Wrist injuries part 2: Scapholunate injuries and instability and TFCC Injuries</span><span style="font-size: large;"><span style="font-size: large;"></span><br /></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">
</span></span>Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com1tag:blogger.com,1999:blog-4692690742617863595.post-36760981013315091112013-02-14T03:33:00.001-08:002013-05-25T09:38:00.073-07:00Medial and Lateral Epicondylitis (Golfers and Tennis elbow!)<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Sorry this one has taken a while - but here is goes: lateral and medial epicondylitis.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Lateral epicondylitis = tennis elbow</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Medial epicondylitis = golfers elbow</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">I will use the different terms <span style="font-size: large;">synonymously throughout this post.</span> </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This is a problem that seems to plague more climbers than I originally first thought. Apparently, medial epicondylitis affects climbers more than lateral does, but I haven't found any statistics on this. However, it makes sense that it should as climbing requires a lot of use of the flexors to maintain grip. </span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">I did find that tennis elbow affects 1-3% of the population, and peak incidence is between 40 and 50 years of age. It affects men and women equally and the prognosis is between 6 months and 2 years. </span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Anatomy</span></span></b></u><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Causes</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The causes of epicondylitis in general is generally one or a combination of:</span></span><br />
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<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Over gripping or over use of flexors</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Muscular imbalance between flexors and extensors</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Not enough rest</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Climbing too hard</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Climbing too often</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Repetitive movements </span></span></li>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">This is because epicondylitis is inflammation that is caused by repetitive microtrauma to the insertion points of the flexor and extensor muscles<span style="font-size: large;"> at the medial and lateral epicondyles respectively.</span></span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">It is important to note the anatomy of the biceps and pronator teres, as the biceps turns the palm inwards (supination), whereas for climbing we want the hand to be palm outwards (pronation), and so pronator teres will battle with the biceps to maintain pronation, and can also cause microtrauma to this usually undertrained muscle of pronator<span style="font-size: large;"> teres</span>, and cause medial epicondylitis. </span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Symptoms</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Symptoms of medial and lateral epicondylitis are usually pain in the region of the forearm muscle attachments (the epicondyles) which is exacerbated by active and resisted movements of wrist extension for lateral and wrist flexion for medial. </span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Do remember though, that the pain could be caused from a neck issue, from the shoulder, arthritis, or carpal tunnel. If you are concerned, see a professional.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Treatment</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Unlike previous posts where I've directed you to my <a href="http://thomasbondphysio.blogspot.co.uk/2012/11/management-of-acute-injuries.html">"Management of Acute Injuries" post</a>, this time, I will not, as the most important initial treatment is <i>REST</i>, as the cause is from repetitive use of those muscles without adequate time for them to rest. and recover. Therefore:</span></span><br />
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<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Eliminate all pain-causing movements, including activities such as climbing</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Ice and ice massage over the area</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Non-steroidal anti-inflammatories if required, but only short term (Green 200<span style="font-size: large;">1</span>)</span></span></li>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> If no swelling is evident and pain is reduced, mild stretching and deep tissue friction massage can be implemented (stretches described below).</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Then, gentle strengthening exercises and gentle return to climbing. If in doubt, a delayed return to climbing is preferred due to epicondylitis <span style="font-size: large;">recurrence</span> rates being quite high.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">If you go to see a physiotherapist, they may also use techniques such as ultrasound (Dingemanse 2012) of which the evidence is good. Physiotherapy exercises have been shown to have a faster and greater regression of pain compared to a wait-and-see approach (Peterson et al 2011).</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Corticosteroid injections are a common approach sought, and studies have found that they are successful in the short term, but physiotherapy exercises have a better intermediate and long term outcome for lateral epicondylitis (Barr et al 2009) </span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">And seeing as I reviewed some <a href="http://thomasbondphysio.blogspot.co.uk/2013/01/kinesio-taping-sceptics-view.html">kinesio taping studies</a> recently, Chang et al (2012) found that kinesio tape may improve pain, but has no significant results for baseball<span style="font-size: large;"> pitchers with medial epicondylitis (baseball pitchers chosen due to the overhead activities performed)</span>.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Please note</b>: Do not return to climbing activities too soon, as epicondylitis has a high recurrence rate.</span></span><br />
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<span style="font-family: "Courier New",Courier,monospace;"><u><b><span style="font-size: large;">Exercises</span></b></u></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Flexor stretch (for golfers) and extensor stretch (for tennis)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Remember to hold any stretch for at least 30-45 seconds, and always warm up first.</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Pronator strengthening (for golfers)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Extensor strengthening (for golfers)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcJ-GWbtf-qXoFi5uewvOYiQD0ZS0uAWgz1f5s1u5sLzldBDkTjhY8ASqHdpUe-iMlB9GbyejIPZkoGu1FMhJOpJDKrTUS8ylofdb-ZGFi_HGQV9BjbS6Dn40iP1T1qThzOI445zugySM/s1600/wrist+extensor+strengthening.jpg" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">For a unorthodox stretch that may aleviate your golfers elbow, click <a href="http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/">here</a></span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Flexor strengthening (for tennis)</span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ7kd9navwML2EDCE0kmJEht4zIemmEciKBMV7zjOJ7istm9_dx7kFMesGarzk3blS0K03mHwd3BA5vrK8ZnXsY94vDixSjdUrOWEcjMKLnj4UUc99bVX8D6nJDcZyVNS2Do5Grk9qgKs/s1600/wrist+flexor+strengthening.jpg" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Eccentric exercises for lateral epicondylitis (Tyler 2010) </span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRTyKOWFfoLp8YZHcwoRFS7SXtJMbdy4Ln_ch-gcY6I6E3QVaTss-tIyCMm4BHlC58Ws3NmnrVva16eB4b__28KNAz8qf0yHDDBg7C30WIZSjzaq0G3FEw2y_rDot_e-4U1S6NmkBViWI/s1600/eccentric+exercisesfor+tennis+elbow.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="284" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRTyKOWFfoLp8YZHcwoRFS7SXtJMbdy4Ln_ch-gcY6I6E3QVaTss-tIyCMm4BHlC58Ws3NmnrVva16eB4b__28KNAz8qf0yHDDBg7C30WIZSjzaq0G3FEw2y_rDot_e-4U1S6NmkBViWI/s320/eccentric+exercisesfor+tennis+elbow.png" width="320" /></a></span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Or eccentric supination as suggested in the <a href="http://www.ukclimbing.com/articles/page.php?id=3614">UKC article about medial epicondylitis</a></span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Tape/Brace</span></span></b></u><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The idea of these braces or clasps is to change the insertion point the muscles are pulling from, to try and reduce the strain on the epicondyles. You can also tape around this area if required to try and perform the same function, but you will probably find that it will hinder your climbing more than help it, so I wouldn't recommend it.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The evidence for elbow clasps for tennis elbow has weak evidence, especially after 6 months and a year (Callaghan 2007). This doesn't mean that it won't help for short term alleviation and the anecdotal evidence using the clasp in conjunction with exercises is positive, but <span style="font-size: large;">it's your choice</span>.</span></span><br />
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<u><b><span style="font-family: "Courier New",Courier,monospace;"><span style="font-size: large;">Prevention</span></span></b></u><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">To prevent epicondylitis from <span style="font-size: large;">reoccurring</span>, or from occurring in the first instance, there are several courses of action. starting with the ever recurring advice of:</span></span><br />
<ul>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Ensure <a href="http://thomasbondphysio.blogspot.co.uk/2013/05/hot-stuff-warming-up.html">adequate warm up</a></span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Stretch regularly (perform both the stretches<span style="font-size: large;"> </span>demonstrated above after each climbing session)</span></span></li>
</ul>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Along with:</span></span><br />
<ul><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
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<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Ensure adequate rest between climbing sessions - listen to your body</span></span></li>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"> Any new activities should be performed gently and controlled, such as starting fingerboarding</span></span></li>
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</span></span>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Any deadhangs should be performed with elbows slightly bent</span></span></li>
<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Correct any muscular imbalances (this can be done by performing the <span style="font-size: large;">muscle stren<span style="font-size: large;">gthening exercises above, generally I'd do the extensor and pronator ones, as <span style="font-size: large;">predominantly</span> <span style="font-size: large;">climbers will ha<span style="font-size: large;">ve strong flexor muscles</span></span>)</span></span></span></span> </li>
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<li><span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Climbing technique - lateral epicondylitis can be caused by poor technique, as your grip strength is strongest when your hand is extended - hence why your arms "chicken wing" from the rock when you're trying to crimp a small hold, and the extensor muscles facilitate this, and this constant extensor muscle strain can lead to lateral epicondylitis - again, an old message - vary the grip you use, don't crimp everything!</span></span></li>
</ul>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Good luck! </span></span><br />
<ul>
</ul>
<a href="http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/"></a><br />
<span style="font-size: large;"><u><b><span style="font-family: "Courier New",Courier,monospace;">Coming soon.......</span></b></u></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">You decide!
Comment below on the next topic you would like me to write about<span style="font-size: large;">, email <span style="font-size: large;">or tweet me!</span></span></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">I have
ideas, such as healing times of tissues, epiphyseal plate injuries,
elbow compartment syndrome, or maybe another shoulder pathology? Let me
know what you want!</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">And if you want updates of when I write a new post, use to "<span style="font-weight: normal;">Follow this blog by Email" function, or subscribe to RSS feeds using the options on the right-hand side. </span></span></span><br />
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<span style="font-size: large;"><u><b><span style="font-family: "Courier New",Courier,monospace;">References</span></b></u></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.ukclimbing.com/articles/page.php?id=3614">UKC article about medial epicondylitis</a></span></span><br />
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<div class="western" style="margin-bottom: 0cm;">
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<div class="western">
<a href="http://www.nicros.com/training/articles/overview-of-elbow-tendon-injuries/"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Hörst</span></span></a><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.nicros.com/training/articles/overview-of-elbow-tendon-injuries/"> 2007 Elbow Injuries</a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="http://www.cks.nhs.uk/tennis_elbow">NHS Clinical Knowledge Summaries</a> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
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<div class="western" style="margin-bottom: 0.5cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span lang="zxx">Chang
HY</span></span><span style="font-size: small;">,
</span><span style="font-size: small;"><span lang="zxx">Wang
CH</span></span><span style="font-size: small;">,
</span><span style="font-size: small;"><span lang="zxx">Chou
KY</span></span><span style="font-size: small;">,
</span><span style="font-size: small;"><span lang="zxx">Cheng
SC </span></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
2012 Could
forearm Kinesio Taping improve strength, force sense, and pain in
baseball pitchers with medial epicondylitis? </span><span style="font-size: small;"><span lang="zxx"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Cheng%20SC%5BAuthor%5D&cauthor=true&cauthor_uid=22584958"></a></span></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span lang="zxx">Clin
J Sport Med<span style="font-size: small;"> </span></span></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">22(4):327-33<span style="font-size: small;"> </span></span></span><br />
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<br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: navy; font-size: small;"><span lang="zxx"><u><a href="http://rockclimbinguk.co.uk/category/performance-improvement/injury-prevention-and-treatment/">http://rockclimbinguk.co.uk/category/performance-improvement/injury-prevention-and-treatment/</a></u></span></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br />Barr S, Cerisola <span style="font-size: small;">F</span>, Blanchard V <span style="font-size: small;">2009 </span></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Effectiveness of <span style="font-size: small;">c</span>orticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review. </span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Physiotherapy 95<span style="font-size: small;">: </span>251–265</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"> </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Dingemanse<span style="font-size: small;"> R,</span> Randsdorp M,<span style="font-size: small;"> </span>Koes BW,<span style="font-size: small;"> </span>Huisstede<span style="font-size: small;"> BMA 2012 </span></span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Evidence for the effectiveness of electrophysical modalities for treatment of medial and <span style="font-size: small;"></span>lateral epicondylitis: a systematic review. Br J Sports Med</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br />Peterson M, Butler S, Erik<span style="font-size: small;">sson M, Svardsudd K </span>2011 A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis)</span></span>. <span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Upsala Journal of Medical Sciences; 116 269–279</span></span><span style="font-family: Arial,Helvetica,sans-serif;"></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Callaghan M<span style="font-size: small;">, </span>Holloway J 2007 Tennis elbow and epicondyle clasp<span style="font-size: small;">: </span>Best Evidence Tpoic Report</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-size: small;">. </span>Emerg Med J 24: 296-297</span></span><br />
<div class="western" style="margin-bottom: 0cm; margin-left: 1.25cm; text-indent: -0.5cm;">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Green S, Buchbinder
R, Barnsely L 2001 </span><span style="font-size: small;">Non-steroidal
anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in
adults (Cochrane Review).</span><span style="font-size: small;">
The Cochrane Library. Issue 4. John Wiley & Sons, Ltd</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"> </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Tyler TF, Thomas<span style="font-size: small;"> GC, </span>Nicholas<span style="font-size: small;"> SJ</span>, McHugh MP </span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">2010 Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial</span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">. J Shoulder Elbow Surg 19<span style="font-size: small;">: </span>917-922</span></span><br />
<br />Anonymoushttp://www.blogger.com/profile/10557031250263580961noreply@blogger.com1tag:blogger.com,1999:blog-4692690742617863595.post-17416201311902355352013-01-15T12:43:00.002-08:002013-01-15T12:43:58.904-08:00Kinesio Taping: A Sceptic's View<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">So I'm beginning this post as a sceptic towards the use of kinesio tape. I aim to look at the research behind kinesio taping, review some of the papers, and we'll see <span style="font-size: large;">if</span> my stance changes.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Even as I begin to type this, I'm getting reports of success stories from the use of kinesio taping, however, there seems to be a lack of understanding of how kinesio taping works anatomically, and of robust studies testing it's use.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE2bk0YD4HW3W97dNQVIfJTHbMBq5pG7KvzIER_xqg47tr6v9Q7LzTDUiI1QQSnIiYYXbAbjpqlksr6gzkA2B-OS_l8M1hcFfJ0GjxDr4146VEQ4Sevgon-LYMh8rnuzRJ-t31WTq-UMk/s1600/kinesio+tape.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE2bk0YD4HW3W97dNQVIfJTHbMBq5pG7KvzIER_xqg47tr6v9Q7LzTDUiI1QQSnIiYYXbAbjpqlksr6gzkA2B-OS_l8M1hcFfJ0GjxDr4146VEQ4Sevgon-LYMh8rnuzRJ-t31WTq-UMk/s1600/kinesio+tape.jpg" /></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Firstly, let me explain about kinesio taping. Kinesio tape has many brand names (such as Rock Tape, KT Tape etc) and is different from the traditional use of taping.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Traditional taping is using zinc oxide tape and is what is commonly used with climbers to tape fingers etc, and is generally used to prevent a certain movement, for stabilization and support.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Kinesio taping, according the the <a href="http://www.kinesiotaping.com/global/corporation.html">Kinesio Taping Website</a>, "is applied over muscles to reduce pain and inflammation, relax overused
or tired muscles, and support muscles in movement on a 24-hour-a-day
basis. The taping is non-restrictive and allows for full range of motion"</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHuV6OSj0vZRlwSE2oS8wZigFemYgdubLyDpGFYJ6KVDvKGfVxD3-YUbFXUvgI7ez486VpDErKVj7GzBbpJ7z_FmOiLIslVhNwnJNeLgyKAyE7T-HjkK6YLWjX278AT3pDE84u87zKtJw/s1600/Dr_+Kase+-+Japnese+Kinesio+Tape+developer.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">The tape is basically an elasticated therapeautic tape.</span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">More information on Kinesio taping and how it is supposed to "lift the skin microscopically" is widely available on the web, but I'm going to now look more at the evidence published.</span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">I will stick to kinesio tape applied to the shoulders, as I feel this is an area appropriate to climbers, rather than the lower limbs. I have also tried to look at the most recent papers I have access to<span style="font-size: large;">, and a variety of outcome measures tested</span>.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEl5U-aUQ1eTGif_Rql5yjeenALvdGL-qtIn5V_-noHl3I0ICT1rQjtCRtFNNk0PCA84-U7NigsbTwM03UrfI1S5W_U8VFI0VIhQiNfHgaSsYA0feKK53DC4O3NPYPTdeqs-dYybGuXCY/s1600/kerriwalsh.jpg" imageanchor="1"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEl5U-aUQ1eTGif_Rql5yjeenALvdGL-qtIn5V_-noHl3I0ICT1rQjtCRtFNNk0PCA84-U7NigsbTwM03UrfI1S5W_U8VFI0VIhQiNfHgaSsYA0feKK53DC4O3NPYPTdeqs-dYybGuXCY/s320/kerriwalsh.jpg" width="214" /></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">First paper I will look at </span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">compares kinesio taping to a programme of physiotherapy modalities for the treatment of <span style="font-size: large;">shoulder impingement. This study <span style="font-size: large;">compared 30 patients in the kin<span style="font-size: large;">esio taping (KT) group to 25 patients</span> in the physiotherapy (PT) group (5 dropped out in the PT group and were not included in the final data analysis) b<span style="font-size: large;">etween the ages of 18-70 years old</span>. </span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Both groups <span style="font-size: large;">had a home exercise programme. </span>The PT group had </span>daily intervention of TENS, exercise, <span style="font-size: large;">ultrasound and hot pack. The KT group had just the home exerc<span style="font-size: large;">ise programme and the taping<span style="font-size: large;">, for a 2 week period.</span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">There <span style="font-size: large;">were</span> no significant differences between groups at baseline. </span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">DASH scores (Disability of Arm, Shoulder and Hand) and pain scores decreased significantly in both group<span style="font-size: large;">s compared to baseline. </span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">The pain scores for <span style="font-size: large;">the KT group were significantly lower than the PT group at 1 week, but no<span style="font-size: large;"> signifi<span style="font-size: large;">cant d<span style="font-size: large;">ifferences were found at 2 weeks.</span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Therefore, this study found that <span style="font-size: large;">kinesio taping is <span style="font-size: large;">comparable to physiotherapy treatment for the treatment of shoulder impingement<span style="font-size: large;">, but has a more immediate affect on pain scores. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">From a cost implication point of view, the kinesio taping was only applied 3 times in the 2 week period, compared to daily treatment of the PT group, therefore the kinesio taping could be seen as a more cost effective method to rea<span style="font-size: large;">ch the same end-point.</span> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span> <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUmks7CGahUhxZCAOWOzwzbZLMeJjsBRn-KoSVeMLi9D6sEZy0mmjSJhEYmr_Y-7LLFq-0km4LltoVo19IL320YLzlndOSdjbB7ODliNsa7Z8IejnLzjdNg_52b9sBlAdZPzGbkiRpqnU/s1600/Kinesio+tape+shoulder.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUmks7CGahUhxZCAOWOzwzbZLMeJjsBRn-KoSVeMLi9D6sEZy0mmjSJhEYmr_Y-7LLFq-0km4LltoVo19IL320YLzlndOSdjbB7ODliNsa7Z8IejnLzjdNg_52b9sBlAdZPzGbkiRpqnU/s320/Kinesio+tape+shoulder.jpg" width="213" /></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">The second study I have <span style="font-size: large;">read consists of 42 18-24 year olds complaining of shoulder pain. This study compared kinesio taping to a sham application of kinesio tape<span style="font-size: large;"> over a 6 day period with 2 applications of the tape.</span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">This study was more robust that the previous study, with the participants randomly assigned to the groups and<span style="font-size: large;"> the study procedure being double-blinded.</span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">They found that <span style="font-size: large;">there was only a slight increase in shoulder abduction range of movement on initial application of the <span style="font-size: large;">tape, but no </span></span>significant differences were found after 6 days for range of movement, pain intensity or disability score compared to sham tape.</span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Th<span style="font-size: large;">ere was also no control gro<span style="font-size: large;">up for comparison<span style="font-size: large;">, and it must <span style="font-size: large;">be noted t<span style="font-size: large;">hat</span></span></span></span></span></span></span></span></span></span></span></span> it has been widely published that tap<span style="font-size: large;">ing</span> has a high placebo affect (in the case of taping for patellofemoral pain).</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwgKjGPrKtp3d6tODazxjxjgmCSxeWj7sIMwVtQK1FPkqx5i1XV2rn0yh1YUH5tfi_zxmiBPbuIiZE2g1HZQwOQ2EWlBfccaQiB6JyTqYSQaFWymbT6AM7TAF4ej2_Bwb1kfl6_7_3hQ4/s1600/kt3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwgKjGPrKtp3d6tODazxjxjgmCSxeWj7sIMwVtQK1FPkqx5i1XV2rn0yh1YUH5tfi_zxmiBPbuIiZE2g1HZQwOQ2EWlBfccaQiB6JyTqYSQaFWymbT6AM7TAF4ej2_Bwb1kfl6_7_3hQ4/s320/kt3.jpg" width="320" /></a></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">The third study <span style="font-size: large;">looked at kinesio tape vs placebo taping again, in 17 baseball players with subacromial impingem<span style="font-size: large;">ent. There were randomly assigned to the kinesio tape or placebo group first, and performed both interventions. </span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Outcome measures consisted <span style="font-size: large;">of muscle activation, st<span style="font-size: large;">rength<span style="font-size: large;"> and</span></span> <span style="font-size: large;">scapula range of movement<span style="font-size: large;">. </span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">The study found that kinesio tape increased lower trapezius muscle <span style="font-size: large;">activat<span style="font-size: large;">ion and strength <span style="font-size: large;">but it is unclear whether this was significant change, and wh<span style="font-size: large;">ether this is a beneficial change to the participant.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span> <br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Finally, I also read a meta-analysis<span style="font-size: large;"> on kinesio tapin<span style="font-size: large;">g in treatme<span style="font-size: large;">nt and prevention of sports injuries, and they foun<span style="font-size: large;">d similar results to me (regarding <span style="font-size: large;">slight increase in range of move<span style="font-size: large;">ment), just in a much more scientific manner!</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">So, in conclusion, I still think that the evidence is weak for kinesio taping, but it has been sh<span style="font-size: large;">own to have a short term effect on range of movement of the shoulder abduction.</span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">This doesn't mean <span style="font-size: large;">I don't think it works, but it is d<span style="font-size: large;">ifficult to measure the effect placebo taping has. </span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;">Please feel free to share any an<span style="font-size: large;">e</span>cdotal stories of succe<span style="font-size: large;">ss with kinesio taping.</span> </span></span> </span></span></span></span></span></span></span></span></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">For further reading on how Kinesio tape works, see the following links:</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://science.howstuffworks.com/kinesiology-tape.htm">How Stuff Works.com</a></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><a href="http://www.kinesiotaping.com/global/corporation/about.html">Kinesio website</a></span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;">Paper<span style="font-size: large;">'<span style="font-size: large;">s Revie<span style="font-size: large;">wed: </span></span></span></span></span></span><br />
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<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"><span style="font-size: large;"> <span style="font-size: small;">Kaya E, Zinnuroglu M, Tugcu I 2011 Kinesio taping compared to physical modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology 30:201-207</span></span></span></span></span></span></span></li>
<li><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> Thelen M, Dauber JA, Stoneman PD 2008 The clinical efficacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. Journal of Orthopaedic and Sports Physical Therapy 38(7):389-395 (9 /10)</span></span></li>
<li><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> Hsu YH, Chen WY, Lin HC, Wang WTJ, Shih YF 2008 The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. Journal of Electromyography and Kinesiology 19: 1092-1099 (4 /10)</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><span style="font-size: small;">Williams S, Whatman C, Hume PA, Sheerin K 2012 Kinesio taping in treatment and prevention of sports injuries: A meta-analysis of the evidence for its effectiveness. Sports Medicine 42(2): 154-164 (<span style="font-size: small;">Level of evidence not applicable due to being a meta-analysis)<br /><br /><span style="font-size: small;">(The number in brackets equates to how <span style="font-size: small;">high the level of e<span style="font-size: small;">vidence scores)</span></span></span> </span></span></span></span> </li>
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