Tuesday, 26 August 2014

Goth on a Rock

Me climbing.
   I really like rock climbers. I’d have to say, I have never treated a rock climber I didn’t envy to some degree. Their sport is graceful, but inherently dangerous. It demands strength, but also flexibility. For my son’s birthday recently, we spent the day at an indoor climbing gym. The kids went up and down the walls like rats up drainpipes. I was more like a turtle on a wheelchair access ramp. 
    If I wasn’t climbing, I was watching. One climber in particular caught my attention. She was a big woman with Goth style makeup and purple hair. There is no way that if I’d seen her on the street that I would have credited her with any athletic ability whatsoever. I don’t think I’ve ever been more wrong. Watching her focussed repetition and her rehearsed moves as she made her way up a ridiculous wall was hypnotising. And then, like I always do, I started to look at her hands. Every finger was taped.

Ruptured A2 pulley.
Note how the tendon (black line) no longer conforms to the bone.
    When rock climbers come to see me, it is usually for treatment of a finger pulley injury. Pulleys are thin bands of tissues that force the flexor tendons in the finger to glide as closely as possible to the bone, ensuring the most efficient transfer of power. When they tear, the tendon is freed, and will take a more direct path to its’ insertion. This is known as bowstringing. Depending on how bad the tear is, they do respond well to conservative management. 

Tape pre application
    In 2007, Dr Isabelle Schoffl published an article that examined the ability of several taping methods to replicate the role of a finger pulley. She was able, using ultrasound imaging, to determine that one particular method was significantly better at this than others. She called this the “H method” of taping, and I’ll try to explain it below.

  • Get an 8- 10cm piece of rigid sports tape
  • Split it down the middle longways, leaving a 1cm “bridge” in the middle. The tape should resemble an H now with legs of about 4cm.
  • Place the “bridge”, ie the not split bit, over the palm side of the PIP joint (the middle joint of your finger.
  • Wrap the ends of the tape closest to your palm around the finger below the PIP joint.
  • This bit is important. Bend the finger at that PIP joint to about 30 degrees. Then wrap the remaining two legs around the finger above the PIP joint.
  • This is also important. The tape needs to be firm, but not so tight that it makes your finger turn blue or go numb. If that happens, please loosen it off asap.

Finished tape
   When completed, the tape doesn't look significantly different from a circumferential tape, or a figure eight tape. Where it does differ however, is in its’ ability to provide support directly where it is required instead of simply redistributing forces. 

There are several clips on YouTube that demonstrate the technique nicely. I like the fact that the finger still bends easily with the tape on. I really like the fact that Dr Schoffl has quantified finger strength and the tendon / bone relationship with the tape on. I have now even started to adapt this method for taping PIP volar plate strains, as I find it easier than figure eight taping, whilst also being less bulky. The athletes also report that it still gives them the support they need.

Goth on a Rock

I never spoke to the Goth climber. She didn’t get my business card, nor did she get a lesson on H taping. It’s more than likely she didn’t need my help. But if she ever does need that lesson, I’ll be able to show her how to protect her pulleys, confident that science has my back. I’ll even find some purple tape to match her hair!

Look after those fingers,


        Refs: Schoffl, I et al. Impact of Taping After Flexor Tendon Pulley Ruptures in Rock Climbers. Journal of Applied Biomechanics 23:52-62, 2007.

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