Helmet or not to helmet?

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!

The author climbing "Looning the Tube" E1 5b in the Dinorwic slate quarries, helmet in situ.

Now, there are plenty of sports that wear helmets, horse riding and cycling are the immediate sports that spring to mind.

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.
I understand that there are no rules and regulations that require 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.

Below is the BMC video from last year that canvassed opinions from climbers out on the Eastern Grit about helmet wearing.

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!
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.

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).

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 could have resulted in him being killed outright instead of resulting in a recoverable (albeit long!) head injury.

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%!

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!
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. 
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.

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).

Paul Pritchard's craniotomy in 2012
Copyright Paul Pritchard

So next time you go to the crag, will your helmet be packed? Personally, I know mine will. 


References/Further Reading

Paul Pritchard 1999 Totem Pole

BMC articles: 
Head Case 
Keeping a head; a head injury case study 
Tech skills; why wear a helmet 

Personal experience!

Long QT Syndrome and Sudden Cardiac Deaths

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.

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.

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.

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.

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.

 

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. 

It affects roughly 1 in 2000 people, and causes roughly 1-2 deaths per 100,000 athletes per year.

Those who are thought to have Long QT can be diagnosed via ECG, genetic testing or stress test.

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.

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). 

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.

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.

ICD 

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.

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. 



Post ICD Insertion

Normal post-surgical precautions
No contact sports incase of dislodging wires or implant
Take care around other devices/objects that omit electrical pulses which may confuse the device

Living with Long QT Syndrome

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.

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.

Read more here

If anyone has any experiences of this condition, I'd love to hear about it, via email (thomasbond.physio@gmail.com), Twitter (@Tombondphysio) or just comment below!

References

O'Connor A 2012 Overcoming a heart condition to win Olympic gold. New York Times Blog

Pugh, Andrew, John P. Bourke, and Vijay Kunadian. Sudden cardiac death among competitive adult athletes: a review. Postgraduate medical journal 88.1041 (2012): 382-390.

National Heart, Lung and Blood Institute 2011 What is Long QT Syndrome?

Heart and Stroke Foundation 2011 What is Long QT Syndrome?

Khan 2014 Introduction to Long QT Syndrome: A Cause of Sudden Cardiac Death in Athletes. BMJ Group

 British Heart Foundation Implantable Cardiac Defibrillator Patient Leaflet

Injures in Indoor Rock Climbing: New Research

Now the winter is fast approaching, all but the most tenacious of climbers will scurry indoors. But just how "safe" is indoor climbing?

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.


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.


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.


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.


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.
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.

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.


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)).

Of the injuries that occurred, the authors report that many of them were preventable, such as belaying or knot tying mistakes.


However, this study did have some flaws, of which are discussed below:

1. 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
   
2. 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?!
   
3. 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.

But there you are, relative to other sports, indoor rock climbing has a much lower risk of injury. 

This article is also available on the BMC website, along with information on preventing becoming an indoor wall injury statistic yourself!

References


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


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.


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