Page 10 - 2009 AMA Summer

COMMON CLIMBING INJURIES:
THE ANKLE
By Andy Lewis(MHPC) and Rob McAfee(MHPC)
£150
ARTICLE
of treatment and rest! As with all soft tissue injuries, the acronym RICE should be applied. REST, ICE, COMPRESSION and ELEVATION will all help to reduce the swelling and encourage a good start to healing. This should last about 48 to 72 hours and advice on how best to use ice can be found in previous articles.
Deep Frictional Massage
This is a good way to encourage healing in damaged tendons, ligaments and muscles as well as reducing pain. Try to put the lig- aments on a gentle stretch; this can be done simply by bending the ankle over the edge of a bed, sofa, the other foot etc. The first picture shows the ligament positions in black. As described in previous articles
The ankle is a very commonly injured site in climbing, particularly boulder- ing. As the damage is often relatively minor, the injury can be one of the most frustrating and is rarely given enough time to heal.
ANATOMY
The ankle is made up of four bones which come together to allow all the movements. Of these four the largest is the shin bone or Tibia (green in all pictures) which carries the weight of the body and forms the bottom surface of the knee (see left – a front view of right leg). The second largest bone is the Fibula (blue) which sits on the outer side of the Tibia. Both Tibia and Fibula end at
your ankle and form the bony parts that stick out of the sides called your Malleolus. The Tibia forms the inner one (medial) and the Fibula the outer one (lateral). These two connect to form
the upper part of the ankle joint.
The next bone is the Talus (red) which sits
between the Tibia and Fibula (see right), here the only movements possible are from up on
tip toes down to a calf stretch in a straight line. The Talus sits on the Calcaneus (yellow) which is the heel bone. The Calcaneus can move sideways under the Talus, together allowing a circular movement at the ankle. If you turn your feet and ankles so that the soles of you feet face each other that is called inversion, if you turn so they face away that is eversion.
Ligaments hold these joints together but the ones we are most interested in are the ones from each Malleolus to the Talus and Calcaneus. These exist on both sides. The ones on the
medial side are so strong that ankle twists into eversion are more likely to break off bone than snap the ligaments. The other side is very dif- ferent. Here three ligaments (black) stop your ankle from going into inversion (see left) and these are the ones most commonly injured.
Also related is your foot arch. A low arch or flat foot means that when you are standing still almost all of the sole of your foot is touching the floor. A high arch means the opposite, only the balls of your feet and your heels are touching and a thin bit on the outer side of your foot (called your Lateral Border). The higher your arch the more weight you put on your Lateral Border and biome- chanically the more likely you are to
twist into inversion.
The main reason climbers are so
vulnerable is that when you crank on tight climbing shoes your toes are bunched up pushing you into an unstable high arch. Try it and see for your- self, you’ll probably feel as if most of the weight is on the Lateral Border (outside) of the foot. When you fall in stickys your foot is fixed in a high arch and so you are much more vulnerable to spraining your ankle by inversion. Add to this the force of falling from a boulder problem and it’s no wonder inversion injuries happen so often to climbers. The other common cause is a fall when inside edging, this twists the ankle into a vulnerable position to start with so inversion injury is even more likely. In the photo you can see how the foot with the sticky is already very inverted compared to
the other foot.
REHAB
The good news is that inversion type ankle injuries respond very well to the right kind
8 ARMY MOUNTAINEER