Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
Know Thy Enemy: The Top Ten Rock Climbing Injuries Explained
Embark on a deep dive into the rocky terrain of climbing injuries, from overuse to acute, as we dissect a German study that sheds light on these frequent foes. We'll navigate the complexities of annular pulley injuries, examining their anatomy, various injury grades, and treatment options, including when surgery might come into play.
The conversation doesn't stop at our hands; it scales up to address the surge in knee and shoulder problems that blight many climbers, especially as bouldering's popularity peaks. Discover the intricacies of knee sprains and ligament damage, and join us in a fascinating exploration of shoulder injuries like SLAP tears and impingements. With insights from the FIMPACT trial, we unravel the enigma of painless structural shoulder damage and the contentious debate surrounding shoulder surgery. Our guests and I delve into these injuries with the precision of a climber finding the perfect route, aiming to fortify your understanding and help you stay clear of these pitfalls.
The episode wraps up with a focus on the wrist and elbow—key pivot points for any avid climber. Learn about the vulnerable TFCC in your wrist and how to rehabilitate this and the often-misunderstood epicondylitis, which climbers are all too familiar with. We also spotlight a critical issue for young climbers: growth plate injuries. The mission of our podcast is not just to inform, but to safeguard your climbing future, providing you with prevention strategies that are as valuable as a solid grip on a crux move. Share the love for climbing and this episode, hit subscribe, and leave us a review to spread the wisdom to your fellow crag enthusiasts!
Top 10 climbing injuries:
Lutter, C., T. Tischer, T. Hotfield, L. Frank, A. Enz, M. Simon, and V. Schoffl. 2020. “Current Trends in Sport Climbing Injuries after the Inclusion into the Olympic Program. Analysis of 633 Injuries within the Years 2017/18.” Muscle Ligaments and Tendons Journal 10 (02): 201.
FIMPACT Trial:
Paavola M, Malmivaara A, Taimela S, Kanto K, Inkinen J, Kalske J et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860 doi:10.1136/bmj.k2860
Growth plate injury resources:
Bärtschi, N., Scheibler, A., & Schweizer, A. (2019). Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers. Hand Surgery and Rehabilitation, 38(4), 251-256.
Meyers, R. N., Schöffl, V. R., Mei-Dan, O., & Provance, A. J. (2020). Returning to Climb after Epiphyseal Finger Stress Fracture. Current Sports Medicine Reports, 19(11), 457-462. Chicago
If you have listened to this podcast for any length of time you know that strength training is crucial for runners. However a major obstacle for many runners is not know what to do once they get to the weight room. This PDF seeks to change that. It will arm you with the tools you need to effectively strength train to get the most out of your runs.
use code PODCAST for a 20% discount at checkout at artofprevention.org/runners
Hello everyone and welcome to yet another episode of the Art of Prevention podcast, and today I'm going to be experimenting with a slightly different format for the podcast and to set the stage of this format, I'm going to recite a quote from the famous text the Art of War by Sun Tzu, and he said If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for ever victory gained you will also suffer a defeat. And if you know neither the enemy nor yourself, you will succumb in every battle. And this is from his famous text the Art of War, in which he discussed many of the strategies of war. But these many strategies that he used in wartime we also utilize now in our daily lives.
Speaker 1:Today also begins our foray into the world of rock climbing, and today we're going to be talking about rock climbing injuries in a hopes to arm you with data, arm you with knowledge and information about the quote, unquote enemy, which is injury itself. So hopefully you can combine knowledge of yourself and knowledge of your injuries or potential injuries to decrease the prevalence of these injuries from happening. So today I will be diving into the 10 most common climbing injuries and a little bit about those injuries. Then later on, I will be having guests and other individuals on the podcast, as well as doing further solo episodes where we can discuss how we can target these injuries and hopefully prevent these from ever happening. Now, the place in which I'm getting this data as far as the the top 10 injuries is from a German study, and this is data that's extracted from some of the hospitals in Germany that treat a lot of rock climbers, and they have done multiple cohorts and time periods of data extraction, and in this podcast, I'm going to be referencing the most recent cohort of data. Now, one interesting thing is really diving into how injury prevalence has changed over time. But for simplicity's sake, we're going to go with the most recent cohort of data and we're going to pretend that this is going to be the most representative of epidemiology behind the 10 most common climbing injuries. So this data was pulled from 2017 to 2018. And what they found was that about 56% of injuries were overuse injuries, so not associated with a single traumatic incident, and then 44% of injuries were quote unquote acute injuries, and these were injuries that are associated with a single inciting event, such as I heard a pop in my finger and I felt a pop, or I fell and I sprained my knee, or I dislocated my shoulder, etc. So we have about a 50-50 split between overuse or chronic injuries and acute injuries, with a leaning towards overuse injuries. So here are the top 10 injuries and I hope you enjoy this episode Alright.
Speaker 1:Well, let's get into the number one injury in rock climbers, which is an injury to the annular pulley. So you may or may not be familiar with the anatomy of the hand and rock climbing, but every rock climber who's been climbing for an extended period of time knows about the annular pulleys and probably knows someone if they have not sustained one themselves knows someone that has had an annular pulley injury, or at least we've heard about it. So our annular pulleys are dense pieces of connective tissue that actually help tack our flexor tendons to the bones of our fingers. So we have flexors of our fingers where the muscle belly actually resides within our forearm, and once we go from muscle belly we have these long, tendinous expansions of the muscles that extend all the way into our fingers, one of them actually going into the tip of our finger, the flexor digiton profundus. If you're really nerdy like me and you want to know what the name of the muscles are. But when we flex our fingers, the pieces of connective tissue that are keeping those flexor tendons from coming and budding up against the skin would be our annular pulleys. And these are fascinating, really, really small structures that create these almost fibro-osseous tunnels through which these flexor tendons pass. Now, as rock climbers, we put very unique stressors on our annular pulleys and our flexor tendons. So you really don't see a lot of data around injuries to these pulleys except in rock climbers. So this is a very unique injury and we can have various levels of injury to these fibro-osseous tunnels that we can call them.
Speaker 1:The grading is from a one to four scale, beginning with simply a little sprain to the pulleys. So if something like a small sprain to your A2 pulley occurs, then we would call that a grade one. Grade one actually grade one through grade three typically do not need any form of surgical management and actually get away very well with conservative management, typically going off of a little bit of rest followed by maybe a pulley protection splint and then gradual return to activities after a few days or a few weeks, depending on the extent of that injury. Now, if we go all the way up to a grade three, this would be a full rupture of one of these annular pulleys. Now it'd be important for me to backtrack and talk about these annular pulleys themselves a little bit more. We have five annular pulleys. However, the most commonly torn annular pulleys would be well in rock climbers, would be the second annular pulley, which is near the base of the finger, and then the second most common would be the A4 pulley, which is the middle aspect of our digits, and then third most common would be the A3 pulley, and in some instances we can actually have ruptures of multiple pulleys at one time and that would be a very much a high grade pulley injury that might actually require a surgical management. But before you go through surgery, definitely consult with someone who specializes in annular pulley injuries and how to manage these annular pulleys injuries. So these are graded on a one to four scale and these can be due to overuse. However, it's more commonly especially the higher grade versions of these more commonly associated with a single traumatic incident. Oftentimes the fingers will be in a crimped position, more commonly a fully closed crimp, because these crimp positions full and half crimp do place a lot more stress on the annular pulleys and this is oftentimes associated also with pulling down on a pocket or a small ledge, having a foot slip. So a lot more pressure than intended is going through those finger digits and through those flexor tendons and thus being placed upon those annular pulleys. Individuals will very commonly hear a pop emanating from said finger and they may actually feel and hear multiple pops if there are multiple pulle ruptures. So the annular pulley injury is by far the number one climbing injury that will lead to a cessation or a needing to stop climbing, and that's why we started out with the annular pulley injury today.
Speaker 1:The next injury that we'll talk about is tenosynovitis. So tenosynovitis is an inflammation of the peritendinous sheath that that flexor tendon resides in. So this is somewhat different from an annular pulley. The tendon sheath is there to provide a nearly frictionless interface so that that tendon can shorten and elongate and move through those fibro-osseous tunnels without any form of friction or any form of barrier or resistance. As we're shortening and lengthening our flexor tendons and our flexor muscles, now what can happen is through this one is a little bit more of a chronic overuse type syndrome. No one has an acute tenosynovitis. No one hears a pop and goes oh, I think I've got tenosynovitis. No, this is more through overuse. It can be through crimping or pulling on slopers with an open-handed grip.
Speaker 1:This one isn't quite respective of the finger grip type and this one is very much easily to appreciate on ultrasound and what we'll see is what's called a halo phenomenon, ie the flexor tendons will be surrounded by this quote unquote halo of fluid and inflammation as that has gotten into the flexor tendon sheath. So typically this isn't going to be a localized phenomenon, although it may be localized to a single portion of that flexor tendon sheath, but oftentimes the individual will feel that discomfort extending throughout a part of the length of that flexor tendon or through the length of that finger, as opposed to the previous injury that we talked about, the annular pulley, where people typically have pain and tenderness over the location of that specific pulley that was injured, or the multiple pulleys that were injured in a higher grade strain or rupture of multiple tendons. Now the management for tinnocentivitis is usually a couple of days of rest until that acute inflammatory stages calms down, followed by a significant monitoring of load, and by load I mean climbing load, especially the intensity coupled with volume. And this is really important because if we increase both of those factors at the same time, then this is what really predisposes individuals to an increased susceptibility to injury and it's also something that can significantly exacerbate these chronic onset or overuse onset types of injuries. And our next injury type, our next most prevalent injury type, is also a chronic overuse injury, and this is capsillitis. So if you look at your fingers and you look at the joints of your fingers, each one of these articulations, these bendy points in our fingers, if you will, is surrounded by a joint capsule. This joint capsule is somewhat continuous with some of the other connected tissues, such as the collateral ligaments, as well as even portions of that capsule are continuous with the bone itself. And when we overuse these capsules, either through too much crimping or too much volume coupled with intensity, we can have an inflammation infiltrate into that capsule and it can cause things like swelling, redness, pain, loss of range of motion, etc.
Speaker 1:And capsillitis is really a tricky one that one wants to capture early, or one wants to catch early In order to begin monitoring load and intensity, because typically capsillitis will take quite a bit of time to go away. This is typically going to be isolated in one of the joints of the finger, although it can be in multiple joints of the finger. If you have basically tixan fleas, you have multiple sites of capsillitis. So typically again beginning with one or two days of rest and then very slowly increasing activities while monitoring that load in such a way that we don't keep increasing this capsular inflammation that may be present for really months at a time. So this is not going to be a short game where you can just rest for a week or two and then have a decrease in the prevalence of that injury. This is something that you have to slowly work through and slowly increase loads in such a manner that do not significantly increase your predisposition towards aggravating that capsule inflammation.
Speaker 1:One surprising next injury that we'll talk about. So you know, with climbers, obviously the fingers represent the most common sites of injury and prevalence of number one, number two and number three, all to the fingers. But this next injury is kind of a surprising injury and one that we didn't see in the previous cohorts seen as strongly or in such a high prevalence, and that is actually to the knee. So we saw a much higher increase in knee sprains as well as knee ligament injuries and knee strains of musculature in this most common cohort, which the authors of the study attribute mostly to bouldering and the increase in popularity of bouldering, because we take a lot more falls onto the lower extremity while we're bouldering, relative to sport climbing and top roping, etc. So because of these increase in the number of falls and increase in the height of falls, if you look at bouldering gems, we're going quite a bit higher than we used to and we're doing much more acrobatic movements such as dynamic movements, dynamic jumps to holds, and we are also performing more comp style boulders that may require putting the knees in these positions that don't exactly give us a biomechanical advantage for utilization of muscular tissue. So we're putting much more stress on cartilaginous structures such as the menisci and these collateral ligaments that I mentioned previously.
Speaker 1:The next side of injury is the shoulder, and in the top 10, we have two back to back issues that will commonly occur in the shoulder. The number one issue is a slap tear, which is a superior labrum anterior to posterior tear. What that really means is we have this piece of fibrocartilaginous connective tissue in our shoulder called our shoulder labrum. The job of this labrum is to increase surface area of contact between the head of our humerus, which is our arm bone, that's right next to our torso and our scapula, which is where that humerus inserts and creates that nice ball and socket joint that gives us tons of movement. However, there is also another piece of connective tissue that inserts onto that labrum and that is the long head of your biceps tendon. So if you look down at the arm, we have that bicep that we're doing curls in the gym. For that bicep, one of its attachments goes up to the humerus and then actually attaches directly onto the labrum itself, and this is a very common location for an injury to the shoulder.
Speaker 1:However, just because an individual has an injury like a slap tear they put that acronym together and call it a slap tear does not mean that that individual is going to have any pain associated with that structural damage. So up here in Summit County we have some really, really awesome orthopedic offices where they do really, really great research on individuals like rock climbers, and one of the orthopedic surgeons was the lead author or one of the authors on the study. His name was Tom Hackett and what he did was he took 100 rock climbers that had been rock climbing for a while but they had no previous shoulder injury and no pain in their shoulder at the time of the study, and they took MRIs of each of these individuals and what they found was that over 70% of these rock climbers again with no shoulder pain did damage to their either their rotator cuff or to the labrum that I just described. So structural pathology is not a direct correlation to symptoms and dysfunction, especially in rock climbers. They attribute a lot of these injuries to the significant amount of overhead movement that we do, especially when we're doing like overhanging climbs or things that require a lot of work from the shoulder. However, again, even if we do have an injury to the labrum, it is possible to become asymptomatic with this. However, there are some circumstances where someone isn't able to become asymptomatic through treatment and conservative management, and then surgery may be required. The next injury to the shoulder would be a shoulder impingement, and the shoulder impingement diagnosis has really come under a lot of scrutiny recently due to a couple of studies that have examined the efficacy of shoulder surgery for impingement.
Speaker 1:So let's just start with the classic definition. The classic definition of shoulder impingement has two main categories. The first category is a quote unquote primary impingement, which is defined as a decrease in space underneath this bony prominence called the acromion, and this is due to structural deformity and this is also due to a variance in the shape of one's acromion. So an acromion is this arched structure that almost represents this sort of hook that goes over one of our main rotator cuff tendons, our supraspinatus, and it's a piece in projection off of our shoulder blade. And if we have a misshapen arch, basically people can form what's called a hooked acromion or a type III slash, type IV acromion. It can impinge, thus put pressure on that supraspinatus tendon. So this is one of the main etiologies that we previously thought was the driver of pain. In a quote unquote primary shoulder impingement, the secondary impingement, the secondary classification, is more of a functional classification that is not necessarily based on the space that's underneath the acromion but how you actually use that shoulder when you're lifting your arm. So if you are lifting your arm with an improper movement pattern or you don't have quite enough stability within that shoulder to be able to lift up your arm without too much scapular movement, in that scenario that acromion will functionally move forwards and then place too much pressure on that supraspinatus tendon.
Speaker 1:Now those are the classic definitions that are now a little bit under scrutiny because of this very interesting trial that was done in the Scandinavian countries. It might have been Sweden, it might have been Finland, but this trial was called the FIMPACT trial and what they did was they took individuals with shoulder impingement, ones that failed conservative management, ie physical therapy, etc. And they divided these participants into two groups. They did a randomization. So they did a blinded, randomized, controlled trial where some individuals got the actual arthroscopic opening up of that subacromial space, so they shaved down the acromion in order to improve the amount of space underneath that acromion for that supraspinatus tendon. And then the other group just received arthroscopic, basically, evaluation. So they went in, they took a camera and sent it underneath the skin, looked at some of the structures and then took that camera out and didn't actually change any of those structures. And the big surprise, at the end of this trial, after 12 and 24 months follow up and good conservative management after surgery, or placebo surgery, which they called that's what they called that group the placebo control what they found was that the results were largely the same in terms of pain at rest as well as pain during functional activities.
Speaker 1:So this, among other placebo controlled trials, are really turning out the medical field on its head regarding what we need to do with individuals that are experiencing shoulder pain, which we're now more commonly calling subacromial pain syndrome as opposed to an impingement syndrome. So this is not to say that your surgeon is wrong, or this is not to say that one healthcare provider is wrong versus the other. This is just to give everyone a little bit more knowledge about some of the progress that we're making in understanding shoulder pathology as well as shoulder management, whether that be conservative or non conservative, with a more surgical approach. So we're other authors have actually proposed that this impingement may be more due to instead of this actual space underneath the acromion, more due to the amount of thickening that one might have in the supraspinatus. Thus, an enlargement of that supraspinatus may lead to decreasing in space available for that tendon to move underneath that acromion. Either way, we're really changing the game when we're looking at shoulder pain and shoulder pain underneath that acromion that may be related to that supraspinatus tendon. Again, this is not to decry anyone's previous medical experiences or previous experiences with their medical provider or their diagnoses. I'm just trying to give you some of the most up to date and relevant information regarding things like shoulder pain and arm you with the knowledge necessary for you to get the best outcomes and hopefully prevent things like impingement syndrome or subacromial pain syndrome from ever happening to you.
Speaker 1:The next region that we're going to move to is the wrist. The most common region for wrist pain and wrist strain or sprain is actually to the pinky side of the wrist, which medically we would describe as the ulnar side of the wrist. This is to a specific structure called the triangular fibrocartilaginous complex, which is really a mouthful. Oftentimes people would just call this the TFCC. The TFCC is a dense fibrocartilaginous complex of ligaments that connect your ulnar to your carpal bones and then to your metacarpal bones in that region of the wrist. This is the ulnar or the pinky side of the wrist. Oftentimes we will have injury here because we have much more range of motion in this side of our wrist than we do on the other side, the thumb side, or we would call the radial side. We even have an intraarticular disc in this region that can or cannot be injured with an injury to the TFCC. This is often time supported with some taping techniques or a wrist guard, and then slow rehabilitative therapies and slow progressive loading is applied to the TFCC. To return back to rock climbing, nice and slowly, in a nice, great and progressive fashion.
Speaker 1:Now, moving a little bit more proximal to the wrist, we have epicondylitis, which we would call medial or lateral, based on if it was on the inside or the outside of the elbow. These are your typical golfer's elbow and tennis elbow complaints. I really don't like to use the terms golfer's elbow or tennis elbow, largely because tennis players can get golfer's elbow and golfers can get tennis elbow and so can rock climbers. So obviously I don't think that acronym or that name is super accurate when a rock climber comes in and we go oh, you have tennis elbow, now you have elbow pain on the inside of your elbow and there can be stages to this pain, just like how we had stages to that tenosynovitis. So we can have an acute stage in which we actually have quote unquote itis occurring. So if we break down epicondylitis into its word stems, it's epicondyle, which actually stands for abownee prominence on the inside or the outside of your elbow, and then itis, which actually refers to inflammation, so inflammation to the inside or the outside of your elbow, leading to pain and discomfort. So the medial epicondyle is probably an area where we would see a higher or more common place injury to climbers just because we're using the flexors which attach to a conjoint tendon on the medial aspect of the elbow. However, like I mentioned, we also use our extensors when we're climbing, so climbers also will have lateral or outside elbow pain as well.
Speaker 1:The acute stage, where we actually have inflammatory infiltrate into those conjoint tendons, typically lasts a few days typically two or three days and then we can have a chronic overuse of these regions as well, leading to tendinopathy or leading to a slow degenerative process in that tendon. Over time we can have cycles of this occurring, where we have an inflammation to that tendon due to overloading. Again looking at that volume coupled with intensity, then somebody will take a couple days off and then go right back to high volume and intensity. Oh gosh, I just re-flared up my golfers up I'm just kidding re-flared up my elbow pain. So what we have to do is we have to monitor the amount of load and the intensity that we are subjecting those tendons to. We have to slowly increase that over time, but we do need to load those tendons and oftentimes we can load these tendons actually with quite a bit of force, but we would include a high, what we would call time under tension. So the acute stress ratios or the cycles of loading that we experience during our rehabilitation loading would be very different from the number of cycles of loading that one would experience during just regular training and rock climbing. So let's say we're doing a sport climb, we may have 30, 40, 50, or even 100 loading cycles exposed to that tendon, whereas in a progressive loading stage of rehabilitation one might have four or five loading cycles, but those loading cycles just take a really long time because you're holding a contraction for 30, sometimes 40 or 45 seconds. Even so, there we're manipulating variables, specifically the time under tension, the time that tendon is under tension. So we'll dive way more into each of these pathologies and how to prevent them and potentially how to rehabilitate them later on in subsequent episodes.
Speaker 1:But the gist of epicondylitis is that this can be a cyclical overuse injury with an acute stage followed by chronic degenerative processes that can lead to more pain over time. Now that's not to say that that degenerative process would necessarily show up on an image like an MRI or an ultrasound. Nor do we look at that MRI or ultrasound to gauge whether we're progressing. We actually look at pain as our guide when we come back from an injury like this, in order to load appropriately and manage load appropriately, which is the most important thing.
Speaker 1:The next area we're going back to the fingers and we're talking about a very important injury, especially in the adolescent population, and this injury is to the growth plate or the epiphysis of the finger joints. So as we are growing, we have different regions of our bones. We have the shaft of the bone, which is also called the diaphysis. We also have the epiphysis, which is the end of the bone, and as we are growing, it's the end of the bone that's actually elongating the bone. It's the reason why adolescents, people from birth all the way to skeletal maturity, around age 20, depending on which bone you're talking about this is the region.
Speaker 1:The epiphysis is the region where we're experiencing growth and elongation of that bone, and in adolescence this is a very susceptible region to an injury. And the nefarious aspect of this is that this is an injury that, if left untreated or if let progress, can actually lead to permanent deformity and asymmetrical deformity over time, because what can happen is you can have what's called a salter Harris fracture type three is the most common, where you have a crack through the growth plate and typically this crack through the growth plate will be on one side of the epiphysis and that side of the epiphysis will basically stop elongating and will have a difficulty in elongating relative to the other side of that end of the bone, the epiphysis. So this can lead to what we would call permanent angular deformity, or the joint angle of that finger can be significantly affected, as parts of that finger are able to grow and other parts are unable to grow due to that injury. And unfortunately, you know, one of the nefarious aspects of the increase in this sports popularity is that the rates of growth plate injuries in adolescent rock climbers has increased by seven times since the previous data extraction was performed in the 2011 through 2012. A secondary analysis of data found that approximately 50% of finger injuries in adolescents are to the growth plate itself, and survey data indicates that a lot of these adolescents believe that and will attribute their finger injury to an annular pulley injury, which they actually are much less likely to experience than they are to experience a growth plate injury. So this is really a perfect storm where adolescents are more likely to experience an injury to the growth plate. They're very, very psyched individuals that want to perform well and climb with their friends and things like that. However, they do have a very high or very increased susceptibility for an injury to that growth plate.
Speaker 1:Now, once those growth plates fuse around age 18 to 20, we don't necessarily need to worry about growth plate injuries. So if you're someone who's 25, 30, 35, 40, and you're feeling finger pain guess what you don't necessarily need to worry about this. However, if you're between the ages of, like somewhere like 10 to 18 to 20 years old, we have to suspect and we have to rule out a growth plate injury. Remember, 50% of finger injuries to adolescents are to the growth plate and there are multiple means by which we need to evaluate, and that is through diagnostic imaging. And then the first line of imaging would be either an x-ray, a radiograph or an ultrasound. Now that x-ray needs to have three views and it is somewhat commonplace for the finger to just do basically an anterior or a lateral view, looking at the fingers from the front and from the side. However, these types of injuries are very commonly missed, especially if you talk to a very, very knowledgeable individual who I'm going to have in a subsequent episode on this podcast, and we go a little bit into these types of injuries. If you talk to Jared Vegey, he'll tell you that you need to have an oblique view with the x-ray, which is basically a diagonal look at the finger, because these growth plate injuries are so commonly missed on an x-ray. And even if an x-ray shows up as quote unquote negative, showing that there's no sign of growth plate injury, it's oftentimes good medical practice to still perform an MRI magnetic resonance imaging, but to really be sure that there isn't an injury to that growth plate because of the significant downfalls and downsides of if that injury is missed. So it seems this is definitely something that every coach, every parent, every young climber needs to know about and be on the lookout for. When youth and adolescent climbers present with finger pain and that's especially if that finger pain is on what we'd call the dorsal side, which is the back of the finger, because this is where we're going to see those growth plate injuries more commonly is in that dorsum or the back of the finger.
Speaker 1:Last but not least, we have spinal injury. So this is really just an umbrella term for injuries to the neck, upper back, mid back and lower back. Now, luckily, in this data extraction there was no mortality, so no one died during this diet data extraction and no one had terribly significant spinal pathology. There were probably a few fractures, but by and large, the majority of spinal injuries. The authors really didn't get into this one too much, but I'm a chiropractor so I'm going to talk about spinal injury for just one second. The majority of these spinal injuries were likely just strains of muscles, potentially sprains of ligaments or other fibrocart legends connected tissues like the intervertebral discs. So luckily, spinal injuries didn't account for a large proportion of injuries in rock climbers and luckily they don't typically. Again, if we look at all of the data, almost higher than a quarter of these injuries are to the annular pulleys and a very large percentage I think it was somewhere between 40 and 50% of injuries were to the fingers themselves. So that wraps up our top 10 rock climbing injuries in terms of prevalence in this study.
Speaker 1:Now you or someone you know may have experienced a different injury that was not discussed, and that's because we can have multiple other injuries that were not represented in this top 10 list. Now in subsequent episodes I'm going to be bringing on awesome guests with tons of knowledge on how to prevent these injuries and we're going to have deep dives into individual injuries as well. So if you have a specific injury that you would like for us to talk about, send us an email over at artofpreventioninfo at gmailcom, or send me a DM or a direct message on Instagram if there's specific content or specific injuries that you would like to hear on how to prevent. I hope that you enjoyed this wrap up of the top 10 most common climbing injuries and I hope that this gives you the knowledge and tools necessary to prevent these injuries from ever happening to you or any of your climbing buddies.
Speaker 1:I'm Dr Nick and thank you for listening to this episode. I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy and or benefit from some of the information in this podcast, please be sure to like, subscribe and share this podcast, or please give us a five star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No patient is formed and if you are having any difficulty, pain, discomfort, et cetera with any of the movements or ideas described within this podcast, please seek the help of a qualified and board certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, et cetera.