手指受伤与保养(转贴) by Dave Macleod

逛山

这个贴子对于手指受伤的分析和治疗建议非常值得一读. 原文很长, 我选了一些重点翻译了一下. 凑合看吧.

Pulley injuries articleNB: This article used to live in the articles section of my old site. I've reposted it here since it was really popular.

Finger pulley tears are now more common than any other in rock climbing, yet few climbers know much about how to treat or even avoid pulley tears. After trawling the scientific and climbing literature on the issue (not to mention treating my own injuries!), I realised there was plenty of knowledge out there…


Definitions and Diagnoses


The first problem is deciding what your injury is! Most of us can’t afford to pay for specialist sports injury consultations or therapy and it’s safe to say that your GP alone is unlikely to provide an accurate diagnosis or strategies for repair of this extremely sport specific injury.


There are two tendons which flex your fingers and are tensioned while you pull on holds. The tendons are held in place by the flexor pulley system; a series of ligamentous bands stretching over the tendons, along the length of the fingers. The pulleys withstand astonishing forces, especially during crimping. If these forces are high enough or if there is a sudden additional loading, they can and do tear. The severity of the tears can range from partial tears of isolated pulleys to complete rupture of several pulleys!

当你用力拉手点时, 手指有两处肌腱受力最大. 这些肌腱由手部的Pulley系统支撑, 一系列的韧带沿着手指伸入到肌腱各个部位. Pulley系统承受极大的压力, 特别是在Crimping的时候. 如果这些压力已经到达足够高的程度, 再来一个突然的更多的压力, 它们就可能拉伤.



Often there is an audible popping noise if a pulley ruptures, (remember you might not hear this if you are concentrating on the job in hand!). Later there may be visible bowstringing, where the tendons can be seen to bulge in the finger when you flex it against resistance. This might not be obvious if the finger is too swollen and painful to examine. If you suspect a rupture, you MUST try to see a specialist to have a scan (ultrasound, MRI or CT) and receive expert advice. Complete rupture may require splinting and/or surgery to repair and ignoring the problem can lead to further tears, permanent loss of ability to bend the finger and arthritis.

当手指拉伤是通常你会听到手指关节发出奇怪的响声(你可能当时因为全神贯注在岩石上而没有听见).  如果你反压住受伤的手指, 你可能会看见明显的一道象弓炫似的东西, 那是受伤的肌腱. 可能你的手指已经肿的很大很痛了, 那么你必须要去看专科医生了.



Partial tears of isolated pulleys are much more common and heal remarkably well compared to certain other ligament injuries. You might feel a sudden twinge of pain in the affected finger (and possibly a small pop). However, it is possible not to notice the injury at all during the climb or session. There might be localised pain and tenderness over the area the next morning or the next time you climb. The most commonly injured pulley is A2, which is near the base of your finger. A1 or A5 tears almost never occur. If you have a pulley injury, and the acute inflammation is not too bad, it should still be possible to pull on holds with a fully open-handed grip without pain. If the pain becomes much worse during or after crimping, this indicates a pulley injury.


Another common finger injury is flexor unit strain. These are tendon strains which often occur in the ring finger when using two or three finger, open handed holds. Unpleasant twinges of pain are felt along the length of the tendon through the finger and palm. For this injury, follow the treatments below and avoid gripping positions which irritate it.


Preventing pulley tears - 预防手指拉伤



If you have a history of repeated finger injuries, or even if you just want to protect against ever getting one, you must look at your climbing and lifestyle. Tears are most often caused when you are pulling hard on a crimp and your feet slip off, placing a sudden additional load on the pulleys. To avoid injuries in general, you must try to be in control of your movement as much as possible. This is a difficult and multifaceted skill to learn! An important thing to understand is that it is possible to stretch your abilities to the absolute limit, pull with 110% and climb explosively, yet still be ‘in control’. The goal is to be more aware of what your body is doing and how it moves. In this way you can predict what it will do before it happens. If you can improve this skill you will not only prevent injury but climb better too! Try to feel how your feet are positioned on each foothold, feel the traction. If you can do this then you will be ready if they slip.
不管是你有多次的手指受伤的历史, 还是想预防拉伤, 攀岩技巧和生活方式是关键. 拉伤最常出现在当你用尽全力拉一个手点的时候, 脚突然滑掉了, 这样一来全部的多出来的压力全部都集中到了手指上. 总的来说, 为了防止手指受伤, 你必须尽可能的控制你攀岩时的每一步移动. 这是一个困难并多层次的学习过程. 关键是要记住- 挑战自身的极限, 110% 的全力爆发, 并且不受伤, 是完全有可能的. 目标是了解你自己身体在做什么, 应该怎么移动. ..... 试着体会如何将你的脚放在每一个脚点上, 感觉它的摩擦力. 如果你能这么做, 那么在你的脚滑开的时候, 你已经做好准备了.


Climbers who don’t get injured often tend to have a good balance of gripping styles. Before my first pulley injury, I was one of the many climbers who crimped everything, even pockets. Once I was forced (by injury) to train using open handed, I realised that this grip is much stronger and less tiring on certain holds. You don’t have to learn the hard way!

不受伤的Climber通常掌握多种gripping的技巧. 在我的第一次手指受伤之前, 我也是众多任何手点都用crimping(甚至包括口袋洞)的climber 之一. 我是在被迫的情况下开始练习用Open Handed, 才意识到Open Handed 在一些岩点上比Crimping 要更有效并更省力.



Some climbers use finger tape on healthy fingers or old injuries to try and prevent pulley tears. The consensus of a few scientific studies is that tape is not strong enough to absorb injury causing forces. Tape appears to be useful only in the early stages of repair when the pulley is weak and you are not climbing hard. It’s also important to consider your general health, diet and lifestyle. Good sleep is essential for tissue repair during training and if you are tired, your sloppy technique will predispose you to tweaking your fingers. Don’t underestimate the importance off gentle and progressive warm up during a session.
一些Climber 使用胶带缠在健康或是受过伤的手指上来试图预防受伤, 科学研究的结果证明胶带的强度不够吸收造成伤害的压力. 胶带对于当手指Pulley系统较弱并且你爬的不是很难的时候有一定的帮助. 还有就是要重视身体健康, 饮食和生活习惯. 良好的睡眠是修复损伤组织的关键, 如果你很累, 你的草率的技术预示你将会折磨你的手指.


Treating pulley tears - 治疗篇



In this article I have focused on the self administered treatment/prevention of minor pulley injuries (where hand function is not severely limited). If you suspect a pulley rupture you should see your doctor/specialist straight away. For less serious tears, long lay-offs and surgery are thankfully not necessary and with prudent care, the injury should heal very well. It is crucial to understand that the extent and speed of your healing is down to what YOU do during the recovery. The outcome is dependent largely on the effort and diligence you contribute to the process.


Rest
休息

Contrary to popular belief, months of complete lay-off from climbing is not required and is likely to stunt the healing process! All injuries follow a well defined and staged healing process. The first stage is inflammation and this usually lasts a few days to a week. Inflammation is a good thing as it triggers the later stages of tissue repair. However, chronic inflammation (from climbing too hard, too soon) can cause further tissue damage. It’s important to stop climbing completely until the inflammatory phase is past. It’s hard to know exactly how long the lay-off should be, but in general it should be 1-3 weeks. Too short and you risk chronic inflammation and too long and the tissues become naturally weaker and scarred. Once you can move the finger through its normal range of movement without pain, its time to start using it again gently. Using the injured part encourages healing in the same way that training makes your body stronger.
与一般的理解相反, 多个月的完全休息是不需要的, 它反而有可能对愈合过程产生反作用! 所有的损伤跟随的是一个有计划有步骤的愈合过程. 第一个阶段是发炎, 通常持续几天到一个星期. 发炎其实是件好事, 它触发接下来的愈合过程. 但是, 慢性炎疹(来自爬的太难, 太快)可能造成更多的组织损伤. 在发炎阶段完全停止攀岩是非常重要的. 很难预测到底修伤期该多长, 一般是一到三个星期. 太短了可能造成慢性炎疹, 太长了手指组织又会恢复到自然的弱状态. 一旦你能够自由的没有疼痛的移动手指, 就是时候开始渐渐使用它了. 适当使用受伤的部可以帮助恢复愈合, 这和训练使你的身体强健是一个道理.


Build up carefully over weeks and back off if the pain and tenderness increases. Climbing with a completely open handed grip produces little strain on the pulleys and thus you may be able to climb harder by using strictly only this grip until you can crimp again. Such discipline and change to your climbing style is extremely hard to maintain and it might only take one lapse of concentration to crimp again and risk further injury! It follows that this approach may be best confined to careful use of a fingerboard and certainly not where any dangerous climbing is involved.

小心的渐渐的重新开始, 如果疼痛又回来就休息一下. 完全使用Opne handed来攀岩可以将对手指Pulley系统的压力减到最低, 这样你有可能继续爬有难度的线路直到你又可以用Crimp. 如此的纪律和改变攀岩方式是非常难持续的, 有可能只用一个来回的重新使用Crimp就会带来更多的损伤. 最好是避免使用指力板, 并且远离有危险系数高的攀岩.



Ice therapy - 冰疗



Increasing the blood flow to the area helps to speed healing greatly. Gentle climbing or exercise is an obvious way of achieving this. A little used, but massively effective method of increasing blood flow is ice therapy. If significant cold is applied to the skin, the blood vessels in the nearby area (in this case the hand) constrict to reduce blood flow and prevent cooling of the blood. However, when moderate cold is applied there is an initial reduction in blood flow followed by significant dilation of the blood vessels and subsequent increase in blood flow of up to 500%. This is called the ‘Lewis reaction’. The cycle of blood vessel constriction and dilation takes around 30 minutes and thus the cold application should last this long. Place your injured hand in a pot or small bucket of cold water with a few (roughly 5) ice cubes added. Leave your hand in the water for the length of the treatment. If your hand hasn’t gone pink and feels flushed with blood after ten minutes, the water is too icy. Try to use the ice at least once or twice a day. Don’t use this treatment on a freshly injured finger where there is significant inflammation!

增加血液流量可以帮助加速愈合过程. 一个有效的方法就是冰敷. 如果皮肤遇到非常冷的温度, 附近的血管就会收缩来减少血液的流量以防止血液变凉. 但是, 适当程度的冷敷是先降低血液流量然后接着显著的血管扩张从而促使血液流量增加到最高500%. 这叫做"Lewis 反应". 这种血管的收缩与扩张的循环过程大致需要30分钟, 因此冷疗也应该要这么长的时间. 将受伤的手放在一个装着冷水的桶里, 桶里放上几块冰块. 如果你的手在5分钟之内还没有开始变粉红, 那么水就是太冷了. 尽量做到每天至少一到两次冰疗. 不要在手指刚刚受伤发炎的时候使用该法.



Deep friction massage (DFM)


DFM helps to break up the loose network of scar tissue which forms in an injury, promoting its realignment and strength. Rub the pulley with your thumb, applying firm pressure (moderate pressures dont produce the desired effects). The thumb motions should run lengthwise along the affected part of the finger. Only use DFM when your injury is already well past the initial inflammatory stage and stop if you feel the massage is irritating the pulley or causing excessive pain. Use DFM for a few minutes at a time and begin with very brief applications.


Stretching


Stretching the injured finger is another vital treatment you must apply to ensure adequate healing. Stretching promotes blood flow and tissue growth.  You should stretch the finger until it feels tight and hold this position for 10 seconds. After holding it may be possible to stretch a little more, held for up to 30 seconds. Never stretch the finger aggressively; it shouldn’t be painful. You can stretch the injured finger as often as you like but particularly important before and after a climbing session.


Drugs


Some climbers use anti-inflammatory drugs such as Aspirin or Ibuprofen (from a class of drugs called NSAIDS). NSAIDS have been used to reduce ongoing inflammation and allow continued training. NSAIDS can be useful where there is chronic inflammation, in conjunction with lay-off. However, in general the inflammatory process should be seen as vital and upsetting its progress will prevent normal progression to the tissue building stages of healing, and ultimately result in permanent dysfunction. If a pulley injury is persistently painful and tender, you need rest or reduction in your climbing level and perhaps a change in climbing style until the injury has a chance to progress.


Taping


Taping allows you to climb while taking up to 10% of the strain off the affected pulley. Recent scientific studies have confirmed its effectiveness in supporting the injured pulley in the early stages of healing. It was suggested that the greatest support came from taping nearer the middle finger joint where A2 was injured. Tape has poor tensile qualities compared with healthy pulleys. Therefore, there is no advantage in continuing to use tape once the injury is nearly recovered.


The single most important aspect of any rehabilitation is that you are in control of the recovery and you recognise that hard work and patience brings good results. Work hard at the treatments outlined above and be positive! Seeing results of rehab treatments can be just as rewarding as seeing results from hardcore training. Recovery from pulley tears will still take time, so be patient and don’t overdo it. It can be very disheartening when the pulley is still painful after three months despite all the effort. However, if you just stick with it you will be cranking it out again a few weeks later. Finally, it’s also my experience that my best ever periods in climbing have always been just after recovery from finger injuries!

逛山

一些Climber 使用胶带缠在健康或是受过伤的手指上来试图预防受伤, 科学研究的结果证明胶带的强度不够吸收造成伤害的压力. 胶带对于当手指Pulley系统较弱并且你爬的不是很难的时候有一定的帮助. 还有就是要重视身体健康, 饮食和生活习惯. 良好的睡眠是修复损伤组织的关键, 如果你很累, 你的草率的技术预示你将会折磨你的手指.


看来还是要技术细腻才能少受伤！

左左

这经典，就是看着累，求高手通译