This blog post concerns a widely known but less well understood condition which affects the hands and feet – Raynaud’s syndrome. Named after Auguste Raynaud, who described it in 1862, the syndrome is painful and for climbers and those who work at height, it is potentially dangerous.

This article will be of help to any Raynaud’s sufferer and it is part two of my climbing series of blogs.

 

Raynauds

Raynaud's syndrome

(https://upload.wikimedia.org/wikipedia/commons/thumb/4/43/Raynaud-Syndrom.JPG/320px-Raynaud-Syndrom.JPG)


What is Raynaud’s

The first thing to say is that Raynaud’s is not only an issue of cold hands/fingers. That’s just the endpoint of the condition and obviously the most troubling thing about it. But to treat it effectively we have to understand what it is – a vascular disorder featuring recurrent attacks of cold fingers and/or toes resulting from exposure to the cold or emotional stress. It classically features three phases:

  1. An initial phase characterised by painless, pale digits.
  2. A blue (cyanotic) phase as blood travels neither in nor out of the digits.
  3. A painful throbbing phase as the blood returns and the digits warm up.

Raynaud’s can be well understood as a slight malfunctioning of an ingenious system designed to protect your body. Blood vessel constriction in response to cold, known as vasoconstriction, is a normal function; it decreases blood flow to the skin which helps to reduce heat loss from the blood and therefore keep your core temperature warm. This is part of homeostasis – the way your body keeps you alive and well and it’s controlled by a part of your nervous system called the sympathetic nervous system (SNS). More on this later as it’s a critical piece in solving the Raynaud’s puzzle.

If you want more detail on the pathophysiology of the condition, here’s an excellent article.


Primary and secondary Raynaud’s

The most common form is the primary form. This form affects around 10% of the population in a 4:1 female:male ratio. This is the version you have if you don’t have any of the conditions which cause secondary Raynaud’s. Those conditions are either autoimmune or connective tissue diseases and they all have in common an effect on the blood supply to the hands and feet. As a rule of thumb (literally), it’s more likely that you have primary Raynaud’s if your thumbs aren’t involved in attacks (see the image above), and if you don’t have pain in the pallor phase of attacks. The exact cause of primary Raynaud’s is not well understood, but it’s likely that the vascular system, the nervous system and chemical messengers called cytokines are responsible for it. There is more detailed information on the causes in this article.

 

Raynaud's pathophysiology

Vasoconstriction in Raynaud's syndrome

(https://upload.wikimedia.org/wikipedia/commons/4/4f/Raynaud%27s_Disease.jpg)


What can I do about my Raynaud’s?

This is the crux of this post, and here I will offer some hope if you’re a sufferer. Numerous studies have shown that a combination of measures drastically improves the situation. The key thing is that Raynaud’s seems to be cumulative, meaning that repeated attacks make it more likely that you will experience further attacks. Prevention is therefore as important as cure.

We need to try to trick the SNS into not initiating the vasoconstriction I described earlier. Remember what it’s trying to do: keep the rest of you warm. So keep the rest of you warmer than you’d ideally like to be and there’s less chance that it’ll be activated. Wear a hat. Wear thermals even if you don’t need them if you think there’s a chance that you’ll get a Raynaud’s attack. A great solution is to wear wristbands of the tennis variety. There are some specifically designed Raynaud’s bands which are made of plastic but the effect is the same – to trick the SNS into not switching on the vasoconstriction response. If you can get into the habit of doing this you will prevent attacks and over time this will downregulate the SNS response (and make the system less sensitive to cold), potentially preventing future attacks.

Other ideas:

  • Keep your hands dry as well as warm – cold wet hands experience more attacks than cold dry ones.
  • Use hand, foot and body warmers, which are available now as chargeable devices and can even be wearable.
  • Limit caffeine consumption.
  • The most common association is with smoking, so if you do smoke you should bear that in mind.
  • If these measures aren’t successful and you notice the skin on your hands or feet changing in any way, see your GP or a vascular specialist as there are some medications which can help.


Specific advice for climbers with Raynaud’s

Things get interesting when you consider that climbing is an exciting but also a stressful activity. We know now that the SNS triggers vasoconstriction in Raynaud’s which cuts off the blood supply to your fingers, and this system gets activated when we are stressed or excited. This is why climbers with an underlying predisposition are especially prone to Raynaud’s.

So if you’re a climber it’s critical to pre-warm your hands and your body before you climb, and do some meditation. So try to stay as calm as you can while you climb if you feel like an attack might be coming on. Take a break, warm up fully, and then get going again.

Thank you for reading. If you have questions or comments please email me via The Practice at 322. As well as running a general osteopathic practice, I am a climber and I also specialise in treating climbing injuries. I’m always happy to help with anything that might be troubling you.