When the days are dark and gloomy and you still want to get your nature kick in, what better way than to hit the local mountains to get some snow…although a slow start so far.
With this may come a variety of different aches and pains from simply not using certain muscles in the same way for a whole season…to falls…to compensation patterns (i.e always having your left leg forward whilst snow boarding).
Whether a beginner or expert, it is likely that you will have a fall at some point and even if you get up and bounce back right away your body (nervous system, ligaments, muscles, tendons, bones) may still have a residual affect even a long time after. You might even be going into the season with aches and pains already and don’t want these to prevent you from hitting the slopes or getting worse after going.
A common mechanism of injury on the mountain, while skiing and snowboarding, is falling onto your outstretched hand (or FOOSH); which may result in/affect a number of different regions, particularly in the upper extremity.
Brief anatomy
There are a number of different joints in the upper extremity so we will start with the shoulder. First we have the sterno-clavicular joint where the clavicle meets the sternum (the only joint that attaches the arm to the axial skeleton). Then there is the acromio-clavicular joint at the other end of the clavicle, where it attaches to the highest point of the scapula.
When people usually refer to the shoulder joint they are referring to the gleno-humeral joint, which is a ball and socket joint consisting of the humerus (arm bone) articulating with the glenoid cavity of the scapula. This is one of the most mobile joints in the body – meaning it has compromised its stability in order to be more mobile. The increase in range in this shoulder joint makes it more susceptible to injury, which is why there are a lot of muscles surrounding it (i.e the rotator cuff muscles which help try to keep the humerus in its place).
The humerus also connects to the two forearm bones the ulna and radius (the latter being on the outside with the the thumb) to form the elbow. The radius and ulna then articulate with the carpal bones (there are 8) and subsequently, each other to form the wrist (the ulnar bone doesn’t directly articulate with the carpal bones but instead with a fibrocartilagenous ligament called an articular disc). The carpals then articulate with the metacarpals or bones of the hand, which then articulate with the phalanges to form the fingers.
There are over 30 muscles in each hand/forearm and the brachial plexus (consisting of nerves, arteries and veins) which originates in the neck – meaning there are multiple areas neck, shoulder, elbow, wrist where these vessels may be compromised.
From the brief anatomy above you can see how important it is to make sure your whole body is addressed after any injury, not only a fall on an outstretched hand.
Injuries which can happen after a FOOSH
Scaphoid fracture (carpal bone on side of thumb) – Most common wrist fracture, where you feel pain/ swelling at base of your thumb. It is important to get this looked at as this fracture can compromise the blood flow to the scaphoid bone potentially resulting in death of the bone, which may over the long term lead to other complaints such as arthritis.
Colles / Smiths fracture – Both are fractures of the radius, with the former being more common, as it it happens when you fall onto your wrist while it’s extension and the latter when the wrist is in flexion.
A FOOSH mechanism can result in a dislocation/fracture of any of the bones in the hand, wrist elbow and shoulder, including the collar bone. Even if not fractured or dislocated, the surrounding muscles and joints and subsequently the other arm will over compensate as a consequence. Muscle, ligament, tendon tears and or tightness are also possible and sometimes you may feel whiplash like symptoms afterward – although you may not think you’ve injured yourself if there is no pain afterwards.
It is also likely after a fall that you may experience a concussion or feel neck tightness/stiffness and experience headaches – even if your shoulder, elbow and wrist feel fine.
This is why as Osteopathic Practitioners we always take a thorough case history of any accidents and falls which you may not think are related to your current present complaint. It is possible for a fall onto your right arm may cause lower back pain on your left side even many years later. No matter how you fall or how little the injury may seem, it may affect the whole body due to the inflammatory processes that happen afterwards and the internal mechanisms that happen to bring your whole body back to its normal function (including your nervous system, endocrine system, musculoskeletal system).
If you suspect a fracture/ dislocation and have been experiencing your fingers going pale, numbness in your wrist, arm or hand and/or are in a lot of pain do not wait to get urgent medical attention as the blood flow/nerve supply to your upper extremity may be severely compromised.
How Osteopathic Manual Therapy can help
Osteopathic Manual Therapy may be helpful in treating your FOOSH injury by increasing blood flow and lymphatic drainage to the local/surrounding areas of your injury. Your Osteopathic Practitioner may be able to help reduce muscle tension, joint restrictions, pain and swelling which may be happening as a result of you fall. When appropriate they will go through how to strengthen/activate the surrounding and correct muscles and/or refer you to a rehabilitation specialist in your community.
The compensation patterns that may occur don’t necessarily have to directly relate to the fall, it could be that you noticed some tension in your forearms after going to the mountain, then had a busy week working in front of the computer and then started to notice wrist and/or elbow pain for example “tennis elbow”.
Osteopathic Manual Practitioners will examine your whole body as maybe a previous ankle/foot injury may be contributing to your current complaint. Sometimes, for example, you may have started to sleep on your left side after experiencing right shoulder pain which may lead to tightening of your left neck muscles and your shoulders moving forward. This position may affect your ability to breathe efficiently into your diaphragm, consequently, impacting your thoracic and rib mobility.
Manual Osteopathic treatment may help to mobilize your joints, reduce soft tissue tension, encourage blood flow and lymphatic drainage to the necessary areas, thus, addressing compensation patterns/fascial chains.
When we have joint restrictions this may also affects the nervous system and lymphatic drainage – ultimately making the healing process slower, allowing pain and swelling to be present for longer. For example when the joints in the upper spine are compromised (lets say after a fall), the part of the nervous system which controls the diameter of the arteries and lymph vessels may also be affected, causing them to narrow. This contributes to less drainage – which promotes stagnancy of the swelling that has occurred in the wrist – which can then compress, for example, the median nerve – causing carpal tunnel systems, like numbness and burning sensations in the hands.
This blog is only a small glimpse on some injuries that can happen from falling on an outstretched hand and how Osteopathic Manual Therapy can help. If you have had any recent injuries or muscle pain from going up the mountain or in general, get in touch to see how we can help you. Our Osteopathic Practitioners do not diagnose or practice medicine, nor do we attempt to treat disease. If you are concerned about any medical pathology and /or a fracture/dislocation, always consult your physician prior to exploring Osteopathic Manual Therapy.