Four months after partial pulley rupture....

So it has been about four months since I partially ruptured what appears to be my A2 pulley in the left ring finger. I saw a hand specialist a couple months ago and he said "I could charge you a bunch of money for an MRI to tell you you partially tore it or you can take my word for it. " So after four months total of rest I am back climbing and am relatively pain free.

However, if I really put weight on it in closed crimp, or put moderate force on it in open crimp, the position which screwed me in the first place, I do notice discomfort. I have avoided anything that I would describe as pain because I assume this would be very bad.

I have been doing laps on easy 5.9 terrain in the gym in an effort to slowly rehab and wanted input on if this is okay. The doc initially said "As long as you avoid positions causing pain you are good" and even went on to suggest easy trad and to stay below 5.10. Thoughts on whether or not I am going about this right or am just going to do more damage?

I did the same thing back in early November except it was A2 and A4 on my right hand. Two weeks ago the Doc said I should start climbing again and try to re-strengthen it. So I have begun to climb again and just like you, I don't climb on it if it causes me pain. I do still take the crap out of it as I think it is entirely too weak. (I feel this my be the norm for the rest of my climbing career)

To answer your question best, it sounds like we have both been given the same diagnosis and instructions for returning to climbing. See where easy climbing gets you for a while and as you rebuild strength hopefully you will be able to crimp again.

On a separate note, do you have issues with getting your finger straight after the injury? I can only extend it to about 160 degrees. I doesn't really affect climbing but just wondering.

It took about a year for me to be completely pain free with climbing after a complete A2 rupture. I had the MRI so I knew exactly what I did.

Four months of complete rest for a partial rupture of a single pulley is excessive. But, erring on the conservative side isn't a bad thing.

Climb with the open handed grip ONLY. Do not crimp or half crimp. You shouldn't need to crimp on 5.9-5.10 territory even if the climb has small holds. If you are, it's out of habit not necessity.

Check Dave MacLeod's site for more detail. The book "One Move Too Many" details the various protocols for varying degrees of pulley ruptures.

I also think that 4 months sounds like a long time of no use unless it was a nearly full tear. Still, there a lot you can do to increase the healing, decrease the risk of re-injury, and actually make your finger stronger in the long term.

First, all the most recent research and medical advice I've seen/heard is that after the initial recovery phase (<1 week), specific activity for the injury is good. It needs to be very controlled and specific to activating muscles fibers and moving tendon structures without further damaging them. The soft forearm rings or silly putty (I bought a tub of Playdough) work great for this. Just gently squeeze them for 10 minutes a few times a day. Once the injury has become pain-free with a normal load, begin climbing in positions that do not aggravate it. it sounds like you're on the right track with this, but I'd be cautious because you've taken so long off from climbing - there's likely to be a lot of scar tissue that is poorly developed. Climb light at first; give your finger several days between sessions; warm-up and cool-down with the ring/putty and use it on the days you don't climb. Over a few weeks, you can gradually increase the load on your finger.

The basic idea is that without use, the scar tissue will not properly develop into true tendon tissue and will remain weak. The right amount of load with realign the fibers and continue to stimulate tissue growth. Dave Macleod gives a bunch more info on how to actively heal an injury. Listening to how he deals with finger problems, it's clear that one can almost take no time off from climbing if done properly.

Here are some other things that work:

Cool water therapy: Soak your hand in cool water (chilly tap water or water that's been in the fridge for a while) for 30 minutes. Your hand should start out cold but in about 5 minutes get pretty red and filled with blood.

Ice water/hot water baths: 15 seconds of ice water then 45 seconds of hot-as-you-can-stand-it water for 10 minutes.

Extensor muscle strengthening: These are the muscles on the outside of your forearm. There are several ways to do these; they all involve putting force on the top of your finger and pushing it closed while trying to resist with your finger. You can do them in different groupings of fingers. The goal is to feel a deep burn, even muscle soreness, on the muscles on the outside of your forearm.

Light stretching: Only do this when the tendons are warm and only go at about 80%.

ASTYM: Look it up. If you're willing to find a PT who does it and pay them for it (not cheap), it will help with healing a lot.

What doesn't work:

Taping: It does nothing to protect or strengthen the tendon. If you insist on taping, tape very lightly simply so that you're reminded not to pull too hard and not to crimp.

Massage: A trained manual therapist could help with this, but most of us too aggro climbers push way too hard.

I hope it goes well for you.

I'd argue that taping does have benefits in the recovery stage. x taping can help keep your finger straight and avoid crimp grips.

Dsands wrote:On a separate note, do you have issues with getting your finger straight after the injury? I can only extend it to about 160 degrees. I doesn't really affect climbing but just wondering.

Dsands, the bend in your finger is probably due to some sort of injury to the volar plate. I had a pulley rupture in May of last year. Instead of taking it easy I tried to follow a pitch on ascenders and caused further damage including a volar plate injury. My finger was locked at about 45 degrees at the PIP joint for a month (no health insurance at the time). With months of splinting and physical therapy I only now have a slight bend in the finger, but I'm sure it will never be completely straight again. Better to address the issue with a physical therapist sooner than later.

Christopher Barlow wrote:there's likely to be a lot of scar tissue that is poorly developed

I had exactly the same injury in the same finger with the same sensation after months of rest. Abnormal scar tissue was the problem and I solved it in a couple of sessions of what's called Graston technique.

Dsans,

I do have an issue getting the finger to full extension, but I think it is a result of some improper care in the beginning (i.e. sleeping with tape on) that created a slight contracture. I have been actively stretching it past the point where it likes to stop and have once again returned to full range of motion as far as extension goes.

I know four months sounds excessive but I tried to climb after two months and couldn't climb pain free, so I decided to wait and really let that tissue heal.

Thanks for the advice from everyone else, I have a lot of hours of research into this (typically with my climbing shoes on, in bed, with The Sharp End on) and am glad I seem to be going about it right.

Just gonna keep at it slow, squeeze some putty, and stop looking at photos of friends tearing it up in the prime of the AZ season

Giuseppe Cavallo wrote: I had exactly the same injury in the same finger with the same sensation after months of rest. Abnormal scar tissue was the problem and I solved it in a couple of sessions of what's called Graston technique.

ASTYM is a brand name that is based on the same, or similar, technique. It is rather uncomfortable to have done, but it works incredibly well for all kinds of soft tissue injuries.

As to the taping issue, I've seen no rigorous research that shows benefits of taping beyond placebo. I've heard/experimented with the splinting to avoid the crimp position, although I'd say being aware of your hand position and cautious is far more effective than limiting motion with a "brace" that restricts blood flow. Ultimately for me, no finger tape job is a true medical practice; it's climber mythology. That doesn't mean it hasn't worked for a few folks, but medically speaking, it has no benefit. Buddy taping, on the other hand, does have medical backing, but it's for a different kind of injury.

Power Putty, plain and simple. Get the stiffest one they sell (Green I think) and carry it with you everywhere. The whole idea is to stimulate blood flow to an area with traditionally poor blood flow. Best way to increase blood flow is to use those muscles enough to get blood flowing to that region without overdoing it and causing more damage. I tend to avoid climbing entirely when I have a pulley injury just because it's too easy to get ahead of yourself and "test" the finger. Even though I climb .12, if I'm running laps and pumped, there are times I'm tempted to crimp down n a 5.9, so I just don't do it. Carry the putty with you everywhere and focus less on squeezing hard and more on squeezing often. Think volume instead of power. Squeeze it rapidly to get a semi-pump going on. Do this for a week or two and with 4 months already off, you should be pain free pretty quickly. Oftentimes, the residual pain is from scar tissue and redeveloping weakened tendons, not the actual injury. It sounds like the injury has healed and is now in the rehabilitation/strengthening phase.

TheBirdman wrote:Get the stiffest one they sell

If you haven't yet been working with therapy putty you should work up through the different resistances in a structured approach (i.e. 1-2 weeks with each color, using it on a consistent schedule each day).

PTs have a device that can measure your grip strength. I recommend you get it measured to gauge the status of your recovery and continue to take it easy until you're grip strength is back to normal (i.e. almost as strong as the uninjured hand - but consider that your dominant hand will naturally have a stronger grip).

Nathan Scherneck wrote: If you haven't yet been working with therapy putty you should work up through the different resistances in a structured approach (i.e. 1-2 weeks with each color, using it on a consistent schedule each day). PTs have a device that can measure your grip strength. I recommend you get it measured to gauge the status of your recovery and continue to take it easy until you're grip strength is back to normal (i.e. almost as strong as the uninjured hand - but consider that your dominant hand will naturally have a stronger grip).

Nathan,

Normally, I'd agree with you but since the OP is 4 months out of the initial injury, it doesn't make much sense for him to start at the bottom and buy the entire set of putty. If he's already climbing in the gym, he's putting way more strain on those tendons than even the stiffest putty will.