Page 21 - 2008 AMA Summer
P. 21
Injury
Incidence Surgery? Physio? Immobilisation?
Treatment time Pulley support
Easy climbing Easy crimping Full climbing Continued taping
Grade 1
-Pulley strain
Grade 2
-Full A4 tear -partial A2 tear -partial A3 tear
Grade 3
-Full A2 tear -Full A3 tear
Grade 4
-full A2/A3 tear -full A2/A3/A4
5%
YES
Until professional assessment
See surgeon
Thermoplastic or soft cast ring
See surgeon
See surgeon
6 months post-op
+12 months post-op
GRADING SYSTEM FOR PULLEY DAMAGE AND TREATMENT
40%
NO
OPTIONAL RECOMMENDED DEFINITELY DEFINITELY
NO
2 weeks tape
1 week
2 weeks
As pain allows 3 months
7 days
3 weeks tape
2 weeks 4 weeks 2 months 3 months
10 days
4 weeks
Thermoplastic or soft cast ring
4 weeks 2 months 3 months 6 months
The i n c i d e n c e refers to the percentage of all pulley injuries that fit into that grade. E a s y c l i m b i n g 1means just that, if you insist on climbing early on you must take it easy Absolutely do not crimp at all in this period. Use jugs or slopers, no crimps, no pockets, no campus board work. Easy means easy. This is a good time to work on either slopers or your footwork. Slopers are useful as they support the pulley and reduce the stress a tendon places on the pulley. Just ask a climbing centre instruc tor for ways to work your feet while either holding ¡ugs or slopers. You should not be in any danger of falling off anything at this stage. This is simply to keep you moving
and stop you getting frustrated.
E a s y c r i m p i n g ' means very easy crimping. There should be no real difficulty in the
movement and it must be introduced very gradually, then progressed as long as it is pain free. At this stage do not ruin the time you have rested by pushing too hard and
re-tearing the pulley. Start with open crimps and towards the end of this period intro duce the closed crimp. Still no pockets or campusing at this stage. Introducing gen tle cnmping will gradually prepare the pulley to take load and slow down the loss of strength.
At f u l l c l i m b i n g ' stage you should be able to do all you could before. You will have lost strength but do not get silly and jump straight onto a hard crimpy route. I would still suggest waiting a little longer before campusing but pockets and monos are fine. If you follow this program the long-term prognosis is pretty good. You must appreci ate that it is still a reasonably long process of recovery and the times suggested are only guidelines for a typical tear of that grade. These times are also the absolute min imum you should wait. Taking more time would allow better healing.
As soon as possible cool the area, either with ice through a tea towel or put your hand in icy cold water. Cooling will help reduce the swelling and after 10 to 15 minutes cause a massive increase in blood flow which helps the healing. This should be done several times a day for about 15 minutes, at least for the first 3 to 4 days after the injury.
Hot & cold therapy is an excel lent way to encourage blood flow and reduce stiffness. Get two bowls of water, one as cold as you can comfortably manage, the other as hot as you can com fortably manage. First place your hand in the cold for 3 minutes, remove, dry, then place in the hot water for 3 minutes repeating as many times as possible but always finishing with the cold. While in the hot water try and gently move your fingers through the pain free range, this can be done whilst still
strapped to the other finger. You must not start this until at least 4 days post-injury as it could cause further swelling.
A good way to keep the fingers mobile is to gently squeeze a soft ball like a squash ball or a pet’s toy. Start this after the fin ger is no longer immobilised. This is excellent for encourag ing movement and optimising scar tissue formation.
press in one direction otherwise you will reduce vital blood flow.
TAPING
This is very important in your safe return to climbing. As the table suggests even if you suf fer a simple pulley strain you should use tape for as long as 3 months afterwards. It may be surprising to hear that tape provides very little support to your pulley, research suggests between 8 and 15% of the actual intact pulley strength. It should not therefore be used to cover an injury but help support a healing one. Think of it more as gentle support than a short-term cure.
ger joint. This helps maintain freedom of movement. Then wrap twice around the A4 pulley (photo 4). Next bring the tape back towards A2, again going on the outside of the PIP joint but on the opposite side (photo 5). This means not only do you support the pulleys but also the other important ligaments we have not mentioned. Use the remaining tape to secure A2 to finish (photo 6). Check finger movement, you should have a reasonable amount of move ment but not be able to com pletely bend the fingers. If at any time the finger tip becomes very warm, numb or you feel pins & needles remove the tape, as it is too tight.
With all injuries your best chance of full recovery is to seek advice from a Physio or doctor as soon as possible. This article is designed to give general advice only, not replace a Physio assessment.
Photo 6
Photo 3
Photo 4 Photo 5
30% NO
25% NO
Massage is the final way to
encourage healing. When a lig
ament, muscle or tendon is
injured it is replaced with scar
tissue. If the scar is laid down
correctly, in good alignment,
only minimal reduction in func
tion is caused. If however it is
allowed to form in any other ori
entation it will cause severe
restriction. Massage helps to
align that scar. Use the thumb
of the opposite hand to mas
sage towards the hand along so that, as far as possible, the the length of the finger. Only tape covers the side of the fin
To support pulleys A2, A3 and A4 use the ‘figure of 8’ approach. Wrap tape firmly twice around the A2 pulley (photo 3). Then take the tape diagonally across the PIP joint
ARMY MOUNTAINEER 19
