Rock Climbing: Treating Common Wrist and Finger Injuries and Integrating Medical Philosophies, Part Two
By Ronda Wimmer, PhD, MS, LAc, ATC, CSCS, CSMS, SPS
In the first part of this series, we examined the treatment of injuries associated with rock climbing from the perspective of Western healing. In part two, we will look at rock climbing and related injuries from the Eastern perspective.
In traditional Chinese medicine, factors that contribute to sprains include qi and blood stagnation (eventually leading to liver/kidney yin deficiency), spleen qi deficiency (creating accumulation of dampness), and invasion of external pathogens (wind, cold and damp) into the channels/meridian/vessels.
To differentiate between acute and chronic injuries, we must determine external versus internal origins of the mechanism of injury. Acute injuries reflect external direct or indirect trauma, whereas chronic injuries represent internal pre-existing problems that allow the external pathogens to invade more easily, disrupting the circulation of qi and blood in that specific location.
Because the injury mechanism tends to be chronic, the focus of the following primary treatment is as follows. One can add in point combinations that support this primary treatment of the underlying condition(s). There are three components to examine: the local points (for the affected area); the distal points (for pre-existing/underlying conditions); and the back shu (transporting) points (for treating deficiency conditions and other factors). Reiterating the point, depending upon the individual climber, any specific injuries and underlying conditions, there are many point combination possibilities that can be used in addition to the local, distal and back shu points.
SI 3 - stream point
SI 6 - accumulation point, harmonizes collaterals, promotes circulation in SI
HT 3 - sea point, harmonizes collaterals, promotes circulation in HT
HT 5 - connecting point, harmonizes collaterals, promotes circulation in HT
HT6 - accumulation point, harmonizes collaterals, promotes circulation in HT
HT 7 - stream point, harmonizes collaterals, promotes circulation in HT
LG 5 - sea point, harmonizes collaterals, promotes circulation in LG
LG 6 - accumulation point, harmonizes collaterals, promotes circulation in LG
LG 7 - connecting point, harmonizes collaterals, promotes circulation in LG
LG 9 - stream point, harmonizes collaterals, promotes circulation in LG
Ah shi and ba xie (extra) points
Constant pain (+) LI 1 & SJ 1 - well points, remove obstructions in channels and open collaterals
Painful arm (+) SJ 14 & LI 15 - promote circulation of blood and qi
With heavy sensation (+) SP 9 sea point & ST 40 connecting point - promotes circulation of qi and eliminate damp
Stabbing pain worse at night (+) SP 6 - promote circulation of blood
An example of a typical formula that can be used is as follows:
Xiao huo luo dan ( minor invigorate the collaterals special pills) - blood/qi stagnation;
Gui pi tang ( tonifying the spleen pill) - spleen qi deficiency and blood deficiency
I also will apply Tiger Balm and white flower oil (or any other heating liniment) along the affected channels, then apply tui na to the affected muscled to stimulate movement of qi.
A few of the following points can be added in order to support this current treatment.
The treatment principle is to maintain the flow of qi and blood circulation. By maintaining the flow of qi/blood, the physiological manifestation of injuries and pain are non-existent. However, if this qi/blood become stagnant, the flow within the channels/meridians/vessels around the affected joint becomes obstructed, creating pain in the affected area(s). The main physiological manifestation includes pain that is stabbing and fixed for blood stagnation, and wandering and distended for qi stagnation.
Ah shi points - regulates circulation of qi and blood in channels
SP 10 - disperses blood stagnation
LI 4 - source point, dispels blood stagnation, promotes circulation of qi in the channels
LV 3 - source point, dispels blood stagnation, promotes circulation of qi in the channels
GB 34 - sea point, harmonizes movement of affected joints and strengthens tendons
SP 6 - crossing point of the three yin channels of the foot
UB 17 - gathering point of the blood
Sedating method should be used on all points. Use xiao huo luo dan or jin gu die shang wan (muscle and bone traumatic injury pill).
The treatment principle is to support the tendons by nourishing them through liver blood, and the kidneys nourish the bones. Over years of climbing, training long hours, environmental conditions and stress, the qi and blood get depleted or consumed; specifically, the qi and blood involving the zang/fu organs of the liver and kidneys. In either case, the lack of nourishment of both the tendons and bones gives rise to finger joint injuries. Age is a factor because, as we get older, the liver/kidney functions decline and the kidney jing and liver blood are unable to nourish the tendons and bones as efficiently as previously noticed in recovery after a climb.
K 3 - source point, strengthens bones and tonifies kidney; tonify method
LV 3 - source point, strengthens tendons and tonifies liver; even method
GB 34 - gathering point for marrow; even method
GB 39 - gathering point for tendons, reinforces tendons and bones; tonify method
ST 36 - sea point of ST channel, promotes production of blood and tonifies SP/ST; tonify method
SP 6 - crossing point of the three yin channels of the foot, tonifies blood and strengthens SP/LV and K; even method
Wind, Cold, Damp Invasion of the Joints
Wind, cold and damp pathogens can invade through the joints because that is where qi enters and exits. Wind presents with pain moving from joint to joint. Cold can create qi and blood stagnation because it constricts the flow of qi and blood within the channels/meridians/vessels and tendons, so the climber presents with severe finger pain. Dampness can create obstructions within the channels/meridians/vessels, due to the accumulation from spleen qi deficiency. The climber feels heaviness due to the damp accumulation, leading to stagnation, when the climber will feel fixed pain, swelling with a heavy sensation, and possible numbness in the phalanges and wrist joint.
LI 4, SJ 5, UB 12 - relieves external wind and symptoms
SP 6 - crossing point LV/SP/K channels, eliminates wind by regulating qi/blood
SP10 - improves circulation of blood and is able to eliminate wind through increasing blood circulation
Ah shi, GB 40, GB 41 - regulating local circulation of qi/blood
L I4, SJ 5, UB 12 - relieves external wind and symptoms
SP 6 - crossing point LV/SP/K channels, eliminates wind by regulating qi/blood; sedate
ST 36 - sea point, dispels cold, warms channels, and tonifies qi; tonify
UB 60, UB 63, GB 40 - local point, regulates qi/blood circulation; sedate
Ah shi - local point, regulates qi/blood circulation
SP 6 - crossing point of the three yin channels, eliminates damp, activates SP/ST
SP 9 - sea point, eliminates damp, activates SP/ST
ST 40 - connecting point, eliminates damp, activates SP/ST
GB 40, UB 64 - source point, local point, regulates circulation of qi/blood, eliminates damp
UB 63 - accumulation point, local point, regulates circulation of qi/blood, eliminates damp; sedating method
In summary, in order to treat injuries specific to rock climbing, the clinical management should not only include the symptoms of both mechanical and functional instabilities, but also address the integration of TCM, emphasizing the prevention and reducing the risk of chronic rock climbing injuries. To truly integrate both diagnostic methodologies, one must be well-versed in the philosophy behind TCM and understand and appreciate the biomechanical components, anatomy and kinesiology of the wrist, hand and finger joints. Implementing TCM perspectives into the treatment strategy for these climbers proves beneficial and ultimately essential in treating as truly preventing injuries from occurring.
Treating with TCM is extremely effective when applied in conjunction with TCM philosophy. Protocol treatments, which are unfortunately greatly represented both academically and clinically, seem to be more predominant as a typical symptom/sign-based treatment. That is not what Oriental medicine espouses. Acupuncture is like geometry - there are many different diagnostic methodologies that can be implemented in developing an acupuncture prescription - the key is understanding and having the ability to modify treatments accordingly to the individual.
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