Gold Standards, Chopsticks and Individuality
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Behind every great climber, there’s a great physio. Klaus Isele, physiotherapist and Master of Osteopathy, is the hand-and-elbow man behind Adam Ondra, the Austrian Climbing Team and dozens of other competitors on the World Cup circuit. Isele, who maintains a practice in Schwarzach, Vorarlberg, Austria, has been helping climbers in need since 2009. He recently released a study that will help even more people with one of the most ubiquitous injuries—pulley tears. Until Isele’s work, there was no great way to treat these vexing problems.
A pulley injury is a complete or partial tear of the connective tissue that wraps around the tendon and bone—sometimes likened to breaking one of the hoops that hold a fishing line to the rod. Pulleys tear when too great a force is placed on them. The more weight applied (relative to what a person has built up to) and the more dynamic the move, the greater the force the pulley must bear. The force also depends on the angle of pull. Increased flexion, or bending your finger more, increases the burden. Crimps are more dangerous than slopers. Full-crimp grip positions, or crimping with your thumb next to or on top of the index finger, are the most dangerous. The most common cause of injury is from hanging on when a foot slips.
There are four grades of pulley injuries, based on site and severity of tear. Treatment protocols depend on the grade incurred. The best prognosis, Grade I, is a partial pulley tear. The worst, Grade IV, occurs when multiple pulleys are completely ruptured or ligaments are also damaged. The common thread in all treatment protocols is also the most unsatisfactory—rest, and lots of it.
Most athletes will need what is commonly called “conservative treatment,” which does not involve surgery, but rest, ice and rehabilitation. That takes time.
“None of the conservative therapeutic approaches can be considered gold standard,” said Isele. In other words, they’re not very effective. Isele saw his opportunity to contribute both to the lives of athletes and the world of physiotherapy. With Isele’s approach, athletes may have results and be back to to climbing faster than ever.
Isele’s study, titled Treatment of finger problems in climbers with the local-osteopathic Isele-method: a Pilot study published by Donau University of Krems, Austria in 2016, involved 62 climbers with finger injuries. Subjects answered three questionnaires, used to assess intensity of pain before and after treatment. After just one treatment, the average subject’s “restriction of training intensity” dropped from seven to two.
Isele’s treatment focused on three techniques. The first is “Mädchenthrust,” which in itself has three levels of intensity. In the first level a therapist stretches the affected finger by pulling the distal end out in a quick extension. For the second level, the therapist pushes the distal end towards the proximal part of the finger. The third level uses a “Fingerhülsen,” or net attached to the tip of the finger that gives the therapist a larger lever to extend the distal end of the finger (a painful but effective action). These stretches serve to correct alignment of the bones, joints and ligaments.
The second technique is the “Chopstick Technique,” using a chopstick to probe the most sensitive point within the finger. The therapist increases the force until the patient reaches nearly a “10” in reported pain level, at which point the PT continues to apply it until the pain level subsides (or until, we are afraid, “pain exceeds the tolerance of the subject”).
According to Isele, this technique works because it increases inflammation: “To increase inflammation is something very new, especially in the American market … [E]verybody thinks to take Ibuprofen to keep inflammation down. I for myself say that this is the wrong way because inflammation is in the [body’s] repair mechanism, and if we can … speed [the mechanism] up at the right spot, this is much better than every cortisone injection which will do the total opposite and not help your body.”
Climbers who receive this treatment are required to take 48 hours off afterwards to allow inflammation to decrease.
The third technique is “Flexor-lifting,” in which the therapist pinches and lifts the most painful region of the affected finger while the athlete extends and flexes the finger. Like the other techniques, it is painful, but it increases blood flow to the affected area.
“The Isele-method was reported to be painful, so further investigations should aim at improving patients’ comfort,” Isele observed in the discussion section of the study. Still, unlike most other therapeutic techniques, Isele’s method was time effective and easily applied to all the subjects. Perhaps most important, subjects needed less rest for recovery than with conventional treatment.
What also distinguishes Isele’s method is his attitude. When asked by Gym Climber about differences between his protocol and that of other physicians, Isele said, “Well I don’t have a protocol, and I don’t like protocols at all.
“You have to treat people individually. I mean, there are guidelines—let’s say guidelines but not protocols. That’s the biggest difference.”
He explained his approach in terms of what he calls individual norms. “You and I are different, and every human being is different from the next human being,” he said. “I’m going to ask the patient: ‘When did the problem occur? How long have you felt pain? What happened? Show me the exact move? Age? How many times do you train? Pro climber or beginner? What are your biggest fears? What are you afraid of? What happened in the past? What treatment are you used to? What helped and what didn’t?’
“And there are differences. After a pulley rupture somebody with a swollen finger [can be] totally different than someone with a pulley rupture and half the swelling. There are so many differences I cannot really explain all of them.”
For now, Isele has no other studies planned and has turned his attention to gaining field experience with top athletes in preparation for the 2020 Olympics. Isele hopes that other physios will pick up where he left off in the lab, and that his protocols may eventually be used worldwide.
Be proactive! Here are five tips to help prevent a pulley injury:
- Warm up properly. Your tendons are like rubber bands. If you stretch them when they’re cold, they’re more likely to tear.
- Avoid full-crimping as possible. Especially in the gym, where you can choose what you do more easily, climb with an open-hand position. Certainly, try to train that way.
- Drink water—and lots of it! Water acts a protective layer to your muscles and connective tissue. Dehydration means stiffer tendons, which increases the likelihood of pulley injuries.
- Be consistent with your training, but don’t overdo any single move. A slow, steady build-up in your training is key. Have a training regimen that is appropriate for your experience and doesn’t overtax your body, especially your fingers.
- Be self-aware. If you feel any tenderness in your fingers, cool it with the training. Avoid holds and moves that cause pain. As an extra precaution, tape the trouble finger.
Feature Image by Boone Speed