Climbing Medicine A Practical Guide Volker Schöffl Isabelle Schöffl Christoph Lutter Thomas Hochholzer Editors 123 Climbing Medicine Volker Schöffl Isabelle Schöffl • Christoph Lutter Thomas Hochholzer Editors Climbing Medicine A Practical Guide Editors Volker Schöffl Isabelle Schöffl Center of Sports Medicine, Department Department of Pediatric Cardiology of Orthopedic and Trauma Surgery Friedrich-Alexander Universität Sozialstiftung Bamberg Erlangen-Nürnberg Bamberg, Bayern, Germany Erlangen, Bayern, Germany Christoph Lutter Thomas Hochholzer Department of Orthopedic Surgery Orthopädie und orthopädische Chirurgie University of Rostock Privatklinik Hochrum Rostock, Germany Innsbruck, Tirol, Austria Translation from the German language edition: Klettermedizin by Isabelle Schöffl, et al., © Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2020 2020. Published by Springer Berlin Heidelberg. All Rights Reserved. ISBN 978-3-030-72183-1 ISBN 978-3-030-72184-8 (eBook) https://doi.org/10.1007/978-3-030-72184-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020, 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Rock and sport climbing is currently evolving from an individual sport into a mainstream sport. The worldwide boom of bouldering has especially contrib- uted to this increase in popularity, and the number of indoor climbing centers is constantly growing. Unfortunately, climbing’s 2020 Olympic debut in Tokyo had to be postponed but the whole climbing community is eagerly awaited the event in 2021. We, as editors and contributors of this book, are all avid climbers our- selves and have been practicing climbing medicine for many years (some of us approximately 30 years or more). In this capacity, we have not only been treating patients with injuries in climbing clinics but have also been monitor- ing national teams and supervising competitions. The climbing sport pro- vides many professional challenges, as its pathologies are very sport specific and unique to the sport. Since climbing has only been a professional sport for the last 30 years, many questions about long-term developments and conse- quences remain unanswered. Based on our clinical knowledge as well as our scientific research of climbing pathologies, we are proud to present the cur- rent standards of research in this book. The English edition of “Climbing Medicine” aims to demonstrate ana- tomical and biomechanical characteristics of the sport and to analyze the spe- cific injuries and overstrains. Furthermore, we will present the medical, gynecological, and pediatric aspects of the sport. While our book “One Move Too Many” (Schöffl V, Hochholzer T, Lightner S Jr) is in its third edition and is addressed to trainers, athletes, and laypeople, this book targets medical professionals and scientists with a focus on evidence-based knowledge in v vi Preface climbing medicine, covering a wide range of topics and current research. We are privileged to have received the support of the famous physiologist Professor Phil Watts for Chap. 4, “Physiology.” Phil Watts is a remarkable researcher and his work on climbing physiology has set the standard in climb- ing. In addition to Prof. Watts, Y. El-Sheikh, the Canadian team doctor, con- tributed to the chapter on finger injuries, and Thomas Bayer presents diagnostic imaging and all of the newest research from the field of radiology. Our British friends Gareth Jones and Ugo Ehiogu present data and recom- mendations on rehabilitation and prevention. The very important topic of medical issues in climbing medicine is covered by Thomas Küpper. Michael Simon and Jens Liße contributed valuable insight to various chapters. Our special thanks go to all of the contributors for this great joint effort as well as to Rosamunde Pare for the English language support. Michael Simon, Enrico Haase, and Kilian Reil contributed with numerous photos to illustrate this work, as well as Tiffany Fung did provide illustrations. Finally, we want to thank all of our patients for their trust and support in allowing us to carry out our research with and on them, as well as the teams from our clinics and institutes, research staff, and chiefs of staff for making it possible for us to conduct all of this research. Photographs by Enrico Haase: Instagram: rico.haase.photo Kilian Reil: www.kilianreil.com, Instagram: kilioreilly Michael Simon: www.michaelsimon.org, Instagram: Michael_simon_ photography Bamberg, Germany Volker Schöffl Erlangen, Germany Isabelle Schöffl Innsbruck, Austria Thomas Hochholzer Rostock, Germany Christoph Lutter Disclaimer WARNING!! THIS BOOK DESCRIBES TRAINING TECHNIQUES FOR DANGEROUS ACTIVITIES.  BOTH THE ACTIVITIES AND THE TRAINING TECHNIQUES DESCRIBED CAN CAUSE SERIOUS INJURY AND/OR DEATH. By your use of this book, you agree to the following: USE THE INFORMATION CONTAINED IN THIS BOOK AT YOUR OWN RISK. The techniques, ideas, and suggestions presented in this book should not be considered medical advice, and they are not intended to replace consulta- tion with a qualified medical professional. Any application or use of the tech- niques, ideas, and suggestions contained herein is at the reader’s sole discretion and risk. THE AUTHORS, PUBLISHER, DISTRIBUTOR, and/or anyone else connected with the creation, marketing, and distribution of this book (col- lectively referred to as the “Authors”) MAKE NO WARRANTIES, EXPRESS OR IMPLIED, OF ANY KIND IN CONNECTION WITH THIS BOOK, INCLUDING WARRANTIES OF SAFETY OR FITNESS FOR ANY PARTICULAR PURPOSE, AND EXPRESSLY DISCLAIM ANY WARRANTY REGARDING THE ACCURACY OR RELIABILITY OF THE INFORMATION CONTAINED HEREIN. The authors assume no liability or responsibility of any type to any person or entity for errors contained herein, or for any special, incidental, or conse- quential damage caused or alleged to be caused, directly or indirectly, by the information presented herein. WARNING! The activities described in this book carry a significant risk of personal injury or death. DO NOT participate in these activities unless you are an expert, have sought and obtained qualified professional instruction or guidance, are knowledgeable about the risks. involved, or are willing to assume personal responsibility for all risks associated with these activities. The learning and/or practice of suitable tech- niques and safety measures is your sole responsibility, and you assume any and all risks associated with the practice of techniques discussed herein. If you are unwilling to assume these risks, do not use this book or under- take the activities or the training techniques described herein. vii Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Volker Schöffl Part I Basics 2 Injury Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Volker Schöffl, Christoph Lutter, and G. Jones 3 Anatomy and Biomechanics of the Hand . . . . . . . . . . . . . . . . . . . 27 Volker Schöffl and Isabelle Schöffl 4 Historical Development of a Physiological Model for Rock Climbing Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 P. B. Watts 5 Imaging of Climbing Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 T. Bayer Part II O rthopedics of the Upper Extremity 6 Hand and Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Volker Schöffl, Thomas Hochholzer, Y. El-Sheikh, and Christoph Lutter 7 Wrist Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Christoph Lutter and Volker Schöffl 8 Elbow and Forearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 M. Simon, Christoph Lutter, and Volker Schöffl 9 Shoulder Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 M. Simon and Volker Schöffl Part III O rthopedics of the Lower Extremity 10 Foot and Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Volker Schöffl and M. Simon 11 Hip and Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Christoph Lutter and Volker Schöffl ix x Contents Part IV O rthopedics of the Trunk 12 The Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 J. Liße and Volker Schöffl Part V C limbing and Age 13 Long-Term Effects of Intensive Rock Climbing to the Hand and Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Thomas Hochholzer and Volker Schöffl 14 Pediatric Aspects in Young Rock Climbers. . . . . . . . . . . . . . . . . . 201 Isabelle Schöffl and Volker Schöffl 15 Climbing in Older Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Christoph Lutter and Volker Schöffl Part VI G eneral Medical Considerations 16 Anorexia Athletica and Relative Energy Deficiency . . . . . . . . . . 215 Isabelle Schöffl and Volker Schöffl 17 Sport Climbing with Pre-existing Medical Conditions . . . . . . . . 221 T. Küpper and A. Morrison 18 Sport Climbing During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 239 T. Küpper and A. Morrison 19 Sports-Medical Supervision of Competition Climbers and Climbing Competitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Volker Schöffl and Isabelle Schöffl Part VII Rehabilitation and Prevention 20 Climbing Injury Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Uzo Dimma Ehiogu, G. Jones, and M. I. Johnson 21 Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 G. Jones, Uzo Dimma Ehiogu, and M. I. Johnson 22 Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Volker Schöffl and Christoph Lutter Part VIII Future Perspectives 23 Future Aspects: Climbing in the Olympics . . . . . . . . . . . . . . . . . . 325 Christoph Lutter and Volker Schöffl Contributors Thomas Bayer, MD, PhD Department of Radiology and Neuroradiology, Klinikum Fürth, Fürth, Germany Uzo Dimma Ehiogu, MSc, BSc, BSc, MMACP Research and Training Department, Birmingham Royal Orthopaedic Hospital, Birmingham, UK Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK Y. El-Sheikh, BSc (Kin), MD, FRCSC Department of Surgery, North York General Hospital, Toronto, ON, Canada Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada Climbing Escalade Canada, Ottawa, ON, Canada Thomas Hochholzer, MD Private Clinic Hochrum, Innsbruck, Austria M. I. Johnson, PhD School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK G. Jones, PhD, MSc School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK T. Küpper, MD, PhD Institute of Occupational, Social and Environmental Medicine, RWTH Aachen Technical University, Aachen, Germany Jens Liße, MD Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany Christoph Lutter, MD, PhD, MHBA, MSc Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany A. Morrison, BSc, RNutr Royal Free London NHS Foundation Trust, London, UK Isabelle Schöffl, MD, PhD, MSc Department of Pediatric Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany xi