H-Tape for Injured Finger Pulleys

I came across an article entitled "Impact of Taping After Finger Flexor Tendon Pulley Ruptures in Rock Climbers" a couple of months ago and decided to write up a review. The article proposes a new taping method for torn pulleys called the H-Tape and compares it to the Ring and Figure-8 methods. The authors' goal was to "evaluate whether this new taping method [could] effectively change the course of the flexor tend and therefore reduce the tendon-bone distance." Through their study they found that "[t]he new taping method decreased the tendon-bone distance in the injured finger significantly by 16%" resulting in a closer imitation of a real pulley ligament during a crimping position.

The article states "[t]he method for the application of the H-tape is as follows: A tape of length of 10cm and a width of 1.5 cm is cut in half longitudinally from both ends, leaving a bridge of 1 cm standing in the middle. After adjusting the proximal straps at the distal end of the proximal phalanx, the PIP joint is flexed and the remaining two distal straps are wrapped tightly around the proximal part of the middle phalanx."

These instructions aren't very clear unless you have taken anatomy or a medical terminology class, so here are my instructions:

The article calls for 1.5 cm wide tape, which isn't a standard size of tape, so 1" or 1.5 " (split in half) can be used.  

 Unless you plan on having a ruler with you every time you tape take the time to find a reference for 10 cm on your body. The tip of my thumb down to my palm is about 10 cm.

Isolate the injured finger as much as possible to help with tape application.

Lay the piece of tape across your finger, so your finger divides the tape 1/4 and 3/4.

Cut the tape towards your finger.

Starting with the pieces closest to your body, wrap the tape around your finger.

Slightly flex the injured finger.
Wrap the rest of the tape around your finger.

**If you squeeze the end of your finger and it doesn't fill back up with blood the tape is too tight and you will need to redo the tape job**

The authors mentioned that they "did not test the effect of a prolonged use of the tape as would occur during climbing a route or a larger boulder. Although tape is made of a rather stiff material, it will nevertheless stretch during a prolonged use and thus have less effect than what [they] measured immediately after having applied the tape. [They] therefore recommend renewing the tape after every route in order to have an optimal support of pulley system during the climb."  

I haven't suffered any finger injuries lately, so I haven't used the H-Tape for a prolonged duration. If you try out this tape method please leave a comment so we can all learn how well and for how long the H-tape works.

GlucoChondro, A No Show?

Here is a copy of a paper I wrote for my Sports Nutrition class last semester regarding Glucosamine and Chondroitin supplementation. A week or so after I turned in the paper I came across this web page, which provides the research that the NCCAM has found on the effectiveness of GlucoChondro.

Non-steroidal anti-inflammatory drugs (NSAIDs) have been a popular choice for athletes to relieve their joint pain and other symptoms of osteoarthritis. These drugs are great for providing relief for short periods of time, but have some negative effects that can delay injury recovery if taken long-term. (4) One alternative to NSAIDs that has been suggested in the last decade is glucosamine/chondroitin supplementation. It is believed that glucosamine helps in the formation of cartilage as well as its repair.  Chondroitin has a similar function and helps with the elasticity of cartilage. Glucosamine and chondroitin sulfate are chemicals that are naturally produced by the body.  Because their production isn’t dependent on the individual’s diet, it is suggested that supplementation will either increase cartilage growth or decrease its breakdown. (5)  Rock climbers are known for the strain they put on their bodies, especially their joints.  Taking a glucosamine and chondroitin sulfate supplement is strongly encouraged within the climbing community (6,7) to prevent osteoarthritis though the research regarding the effectiveness of such supplementation is conflicting to say the least.

The usual dose for glucosamine and chondroitin is 1500 mg/d and 1200 mg/d respectively. (1,5) The larger doses are due to the fact that the supplement’s bioavailability is only 12 to 21%.  Glucosamine/chondroitin supplementation is relatively safe due to a small number of adverse effects. As a supplement, glucosamine is derived from the exoskeleton of shellfish like shrimp, lobsters, and crabs and can causes allergic reactions in individuals who have seafood allergies. Chondroitin can have a blood-thinning effect and should be avoided by individuals taking blood-thinning medication. Other adverse effects that have been reported are nausea, abdominal pain, headaches, and back pain. (1)

Most of the positive evidence regarding glucosamine/chondroitin supplementation has been obtained from experiments involving animals. Though these studies do not directly related to human patients they do provide information that would be difficult or unethical to obtain from human subjects. One study involving cows used the cartilage and ligament cells surrounding the metacarpals joints as cultures and concluded that glucosamine/chondroitin not only stimulates cartilage growth but ligament growth as well. (4) Another study conducted on rabbits suggests that glucosamine/chondroitin supplementation cannot improve already healthy joints. (2)

A study comparing a mineral supplement, Aquamin, a glucosamine/chondroitin supplement, and a combination of the two in their ability to relieve osteoarthritis pain happened upon some shocking results. This study tested the functional capacity of subjects with moderate to severe osteoarthritis in their knees. Aquamin is a supplement derived from seaweed that contains minerals such as calcium, magnesium, salt, and other trace minerals. The subjects were tested by walking as far as they could until their pain was too much. The distance they could walk was measured several times during the 12 week study.  The study found that Aquamin provided the greatest amount of relief and allowed for the greatest distance of walking, followed by glucosamine and chondroitin, the placebo, and the combination of the two supplements. (8) The performance of the combination treatment suggests the ingredients of the two supplements must be counteractive in one-way or another. This topic would be very interesting to study.  The results of the study should be viewed with caution because Marigot Ltd, the manufacturer of Aquamin, paid for the study.

The clinical practice guideline approved by the American Academy of Orthopedic Surgeons is based on a review of published studies regarding osteoarthritis in the knee. The purpose of the review is to compile a list of recommendations of non-invasive treatments for osteoarthritis. One of these recommendations is to refrain from prescribing glucosamine and chondroitin to patients. This recommendation is based on another review of studies that concludes that glucosamine/chondroitin supplementation doesn’t provide any clinical benefits to the patient but is superior compared to a placebo. Unfortunately, the guidelines do not define clinical importance or specify what clinical benefits are. Though the guidelines do not suggest glucosamine/chondroitin supplementation they do suggest the prescribing on NSAIDs as well as acetaminophen despite the long-term implications. (3)

With this review of the research literature it would be suggested that glucosamine/chondroitin supplementation should only be recommended as a last resort treatment for osteoarthritis.  Supplementation hasn’t been shown to prevent joint injuries or the onset of osteoarthritis so it should only be tried by those that have already suffered injury. Also supplementation should be considered if the duration of injury recovery is longer than the suggested duration of NSAID use to avoid longer delays in recovery. Because research suggests that improvements due to glucosamine/chondroitin supplementation take 6 to 8 weeks to show (1); supplementation should stop after 8 weeks if improvements aren’t noticed.

References
1.     Leburn, CM. GLUCOSAMINE (and Chondroitin). American Journal of Medicine and Sports. 2004 May/June

2.     Bradley-Popovich, G. Sports Injury Management: Do Diet and Supplementation Play a Role?. Strength and Conditioning Journal. 2004 October

3.     Richmond, J; Hunter, D; Irrgang, J; Jones, M; et al. Treatment of Osteoarthritis of the Knee (Nonarthroplasty). Journal of American Orthopedic Surgeons. 2009 September

4.     Lippiello, L. Collagen Synthesis in Tenocytes, Ligament Cells and Chondrocytes Exposed to a Combination of Glucosamine HCl and Chondroitin Sulfate. Advance Access Publication. 2006 December

5.     Dunford, M. Sports Nutrition. American Dietetic Association. 2006

6.     Horst, E. Training for Climbing. Falcon Guide Publishing. 2008

7.     Rosenberg, Thomas. To Supplement or Not To Supplement? Climbing.com

8.     Frestedt, J; Walsh, M; Kuskowski, M; Zenk, J. A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial. Nutrition Journal. 2008 February

Antagonistic Muscle Training: Part 2

We'll finish off this series of posts by going over exercises that minimize the imbalances between our quads/hamstrings and the finger flexors/extensors.

Quads/Hamstrings
Our quads do a couple of things, but they mainly straighten our knees when we stand up, which we do a lot in climbing. In contrast, our hamstrings mainly help bend our knees, which we do on occasion when high stepping or heel hooking. Exercising the hamstrings is kind of tricky because most specific sport specific movements initiated by the hamstrings are closed chain movements (our legs aren't usually moving, think about pulling off of a heel hook. The heel stays in place while the rest of the body moves). There is only one closed chained exercise for the hamstrings that I know, the Romanian Deadlift. This lift is great because it utilizes a barbell so the weight can increased until there just isn't anymore room. On the downside it doesn't look like anything that would be done in climbing. My favorite way to target the hamstrings is the Stability Ball Hamstring Curl. This exercise isn't closed chained but probably the closest thing to actually heel hooking and because it is performed on a stability ball it engages the core muscles as well.

Finger Flexors/Extensors
The finger flexors and extensors reside in our forearms and they do exactly what the say they do. So when we are climbing we're flexing our fingers in order to grab on to the rock but we don't really extend our fingers forcefully. If our fingers are always flexing we're putting a lot of strain on the extensor muscles and tendons. It used to be that the main way to exercise the finger extensors was by doing Reverse Wrist Curls. I'm not a big fan of this method because in order to grip on to the dumbbell the flexors muscles would have to be engaged too (this is kinda like taking 2 steps forward and 1 step back, you're still headed towards the goal but very slowly). Luckily Metolius Climbing has developed the Grip Saver Plus.** The Grip Saver Plus is nice because the fingers can be extended fully as well as the wrist. If you don't want to fork out the money to buy a Grip Saver, you can always use a rubber band in the same fashion.

I feel that taking the time to train our antagonistic muscles is worthwhile, not only do these exercises help prevent injury, they give us something to do on our active rest days. Like always, if you have a question about anything discuss in this post or any of the others just let me know.

**I was not paid to mention the Grip Saver Plus**

Antagonistic Muscle Training: Part 1

This might be an assumption but I think most climbers would like to only have the muscles necessary to climb and throw away all the others in order to cut down on their weight. If this was possible it would actually cause a lot of problems especially with our joints. By using our main climbing muscles i.e the lats, biceps, finger flexors, quads most of the time and their anatagonists i.e the external rotators, pectorals, finger extensors, triceps, and  hamstrings very little of the time we can cause stress to our tendons (tendinitis anyone?) or strain/pull muscles. In this post I'll present various agonist, their antagonists (as they relate to climbing), and some exercises to help strengthen the anatagonists.

Lats -- Pecs/External Rotators
The lats originate on the lower back and insert on the front of the arms, underneath the biceps, by going through the arm pit. As we mentioned in some previous posts, the lats are the pulling muscles. On the opposite side of the coin the pecs are the pushing muscles (think of the bench press). Climbers rarely perform pushing movement except for maybe mantling or the occasional opposing side pull or press move.
The pecs can be strengthen by doing bench presses, push ups or the pec fly. I prefer the pec fly to the other two exercises because it targets the pecs better and provides a more sport specific movement.

Because the lats attach to the front of the arms and through the armpit they can cause internal rotation of the arm especially if the lats are very big. This is one reason why climber's shoulders roll forward and we look a little hunch backed. Not only does it make us look weird it can cause an impingement of the biceps tendons. An impingement is when a tendon becomes inflamed and irritated by rubbing on bony structures. By exercising the external rotators of the rotator cuffs we can prevent impingement.
There are several exercises that target the external rotators. If you have dumbbells handy, then you can do the reverse butterfly or kneel parallel to a weight bench (or couch) with one knee on and one elbow one. Use the other leg to stabilize yourself and with the dumbbell in the free hand. Bend the arm so the elbow joint is at a 90 degree angle bring the dumbbell from the bench twist out from your body.
 
If you have access to resistance cords, attach one end to a door knob or another elbow height object. Grab the other end of the cord and turn your body so the hand that isn't holding the cord is facing the door knob. Again bend the elbow so the joint is at a 90 degree angle. Take the hand with the cord from your body twisting out away from the body.

Biceps -- Triceps
The biceps help assist the lats in the pull up motion as well as pulling in after grabbing an under-cling. Opposite of the arms are the triceps and they help with extending the arm and forearm. The triceps are contracted when performing a mantle move mid-route or the top out of a boulder problem. Push ups are a good exercise if you want to work your pecs and triceps but if you would like target the triceps more specifically you can perform tricep curls or bar dips. My favorite are dips because they are the closest thing to topping out and they can be done when suffering a shoulder impingement.

In the next post, we'll discuss exercises to minimize the imbalances between the quads/hamstrings and the finger flexors/extensors. I will also try to post some pics of the exercises described above.