Disruption of finger flexor pulleys in rock climbers: prevalence, diagnosis and strategies for rehabilitation - page 1 Background The sport of rock climbing has developed into a mainstream, competitive sport with considerable popularity. This growth is likely to be partly attributable to the virtual elimination of the significant danger aspect in rock climbing, within the disciplines of sport climbing (routes protected by pre-placed anchor bolts) and indoor climbing. In addition, the explosion in numbers of indoor climbing centres and organised competitions in most cities in Europe and the U.S. have prompted a significant rise in participation. The focus of these new disciplines is the gymnastic, athletic and competitive aspects of movement on rock (Jones 1991). The history of structured and specific training patterns in rock climbing spans only the past few decades (Morstad 2000). Today, considerable sport specific literature together with increased availability of climbing facilities has fuelled a dramatic rise in standards throughout the sport, such that its basic biomechanical demands have changed and continue to change. Today’s hardest rock climbs feature angles up to and beyond 45 degrees beyond vertical (Goddard & Neumann 1993). On such overhanging terrain, the legs cannot support much of the body mass in the vertical direction; they can only push the body along the plane of the surface (Fig 1). As the angle increases, the forces exerted shift increasingly to the smaller muscles of the upper limbs. This area is also the focus of rock climber’s training regimes with exercises such as ‘deadhanging’ (isometric hangs from fingertip edges) and ‘campus boarding’ (a form of training based on plyometrics which involves jumping between fingertip sized rungs on a wall) (Goddard & Neumann 1993; Morstad 2000). The forearm, specifically the finger flexors have been identified by several studies as the most significant centre of muscular fatigue during rock climbing (Watts 1998).
In climbing movements, the fingers produce tension on a hold to support a proportion of the body mass while the elbow and shoulder joints flex to pull the body upward. The isometric contraction of the finger flexors is interrupted when reaching towards the next hold. Finger flexor strength has been shown to be a determinant of performance in rock climbing (Bollen & Cutts 1993; Grant et al 1996). Holds used by climbers, even at a recreational level are remarkably small (often less than 10mm deep) and can often accommodate only 1-4 digits (Bollen 1990). Several different grip styles can be used to maximise the force produced on holds (Goddard & Neumann 1993). Bollen identified one style in particular, known as “crimping” which is of particular relevance to injury patterns among climbers. It is thought that over 90% of climbers use this grip style regularly (Bollen 1988). Crimping involves placing the fingertips on the hold with the distal interphalangeal joint (DIP) held extended while the proximal interphalangeal joint (PIP) and the metacarpophalangeal joint are held flexed.
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