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Ideas for training while pulley is injured?
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By Jon H
From Boulder
Nov 19, 2012
At the matching crux

I sustained a partial rupture in my A2 pulley a couple weeks ago. I'm having the hand seen by a hand specialist so all my rehab is covered, but I'm going crazy sitting here with nothing to do besides run, hike, and do squats.

I want to keep on training (particularly for ice/winter alpine) but a lot of my usual exercises are off limits for the next 4-6 weeks. The Ouray Ice Fest (early Jan) will be the start of my ice season and I've got a bunch of pretty packed weekends planned after that. I don't want to be atrophy into weaksauce between now and then.

Does anyone have suggestions of upper body exercises that would be beneficial for alpine climbing that wouldn't force me to hang on my hand? My cardio and legs will be rock solid, but I'm afraid I won't be able to hang on to my tools worth a damn.


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By csproul
From Rancho Cordova, CA
Nov 19, 2012
Summit of Wolf's Head with Pingora in the background

Does grabbing a tool really hurt your pulley? I wouldn't think that it would affect grasping a tool too much?


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By Ryan Williams
Administrator
From London (sort of)
Nov 19, 2012
El Chorro

Use the time to really strengthen your core. You'd be amazed at how much of a pounding your core can take. You can do like 3 workouts a day, 6 days a week. Work on your lower back just as much as you work on your abs. Do loads of different stuff.

Throw in some pushing exercises and make a circuit workout. Keep up the running and other stuff and you'll be in great shape.

PS, you can always hang on the good hand and get it super strong - and practice placing screws with the other ;-)


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By Jon H
From Boulder
Nov 19, 2012
At the matching crux

Ryan Williams wrote:
PS, you can always hang on the good hand and get it super strong - and practice placing screws with the other ;-)


Brilliant in its simplicity. My left hand is the injured one and I've always been crappy at placing screws lefty anyhow.


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By Jon H
From Boulder
Nov 19, 2012
At the matching crux

csproul wrote:
Does grabbing a tool really hurt your pulley? I wouldn't think that it would affect grasping a tool too much?


The pressure on the pad of the finger is the worst cause of pain. I can hang, but only with an open-hand grip which is crappy on an ice tool. Swinging with an open hand grip is even worse - there's a 50-50 chance the tool will go flying right out of your hand.


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By csproul
From Rancho Cordova, CA
Nov 19, 2012
Summit of Wolf's Head with Pingora in the background

Jon H wrote:
The pressure on the pad of the finger is the worst cause of pain. I can hang, but only with an open-hand grip which is crappy on an ice tool. Swinging with an open hand grip is even worse - there's a 50-50 chance the tool will go flying right out of your hand.

That sucks. I guess I was think about the crimping motion causing the pain and not direct pressure on the pad itself.


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By gearwhore
From Orange, CA
Nov 19, 2012

hmm...had a similar finger problem this past summer - While not being able to climb I went right to work on my weakness; visiting with my family. It was great as we all enjoyed it. Now that I've done my time - I'm back to climbing guilt free : )


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By Rob Fielding
From Las Vegas, NV
Nov 19, 2012
Third pillar of dana descent.

Jon i'm in the same boat, a2 pulley in my left middle finger...

Cardio/Gym is what i'll be doing for the next month or two. I'm hoping i'll still be able to do pull ups/etc, but we'll see.

Did a 18 mile hike/run yesterday to 11,900 feet and it felt really good. In the next few weeks i'm going to do Mt. Russells East Arete, all 3rd/4th class. Might do some snowboarding/skiiing as well.

Anything to keep my mind off of climbing

Cheers buddy.


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By Eric Coffman
Nov 19, 2012
mountainlion

Step 1 to getting back on the rock is to not re-injure yourself. Make sure you understand this correctly. Take things slowly in progression back to full strength or you risk re-injuring yourself. Avoid any activity that causes your injury to be painful.

Get good sleep.

Eat very healthy.

Drink lots of water.


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By Jon H
From Boulder
Nov 19, 2012
At the matching crux

Thanks all for the additional suggestions. I got a PM asking some more specifics so I might as well post my answer here.

The full story:

I had a distinct pop in my left ring finger (in the pad closest to my palm) while in a full crimp.

I've been climbing about 12 years. This July I turned my training volume WAY up and went from flashing V6 to flashing V8 by mid September, then got hurt at the end of the month. Interestingly, I started having intermittent discomfort in the same pad in other fingers once I started this training regimen. I have no recollection of any acute injuries in those other fingers, just occasional discomfort. Once I started feeling the discomfort, I would maybe take an extra rest day and occasionally stick my hand in an ice bath, but not much else - not that there is necessarily anything else to do.

Post injury, I immediately took a week off and iced, stretched, massaged the finger daily. That seemed to help. I resumed climbing after that week off and interestingly, I had no reduction in power. I was still doing the exact same climbs and moves I was doing pre-injury. My finger was very aggressively taped (tightly around the pad for compression and then another "X" wrap around the knuckle to limit ROM/prevent crimping) which seemed to help with the pain. After a week of climbing injured, I decided it was probably not a smart move and have been on full climbing break since.

What's alarming is that the pressure-induced discomfort in my pad has gotten worse. I got on a pullup bar just 2 days ago and couldn't even really hang on without gritting my teeth and wincing, but in the 7-14 days post injury period I was still climbing V7/V8. I should note that there was/is absolutely no pain at all during the course of a normal day. It is only painful under pressure.

I'm off to the hand specialist on Wednesday so I'll see what she says. She's been a big help to my (very strong) brother over the years. He's prone to tendonitis and climbs V10ish when he's in shape, so he's always tweaking something.

Based on everything I've read (and I've read plenty), I've self diagnosed an A2 pulley injury - probably a partial rupture. The one other possibility is actually a broken phalange and I suspect the doc will take an X-ray to be safe.

I'll update the thread with actual diagnosis and rehab suggestions.


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By dancesatmoonrise
Nov 27, 2012
avatar

A balance between rest and atrophy... How to resolve this dilemma?

IF it's truly an A2 pulley tear, get a metal ring. Tape deforms. Think about it. The pulley holds the flexor tendon to the underside of the phalanx (finger bone) when you crimp. It sees a phenomenal amount of pressure in this situation, and can tear. By taping the volar side of the finger (palm side) one is attempting to "splint" the pulley. But crimping results in the circumferencial tape splint deforming along the axis of force - in other words, the pulley still sees stresses during a crimp.

A metal ring, well-fitted, will essentially "hold" the tendon against the phalanx - it does this by transferring forces to the dorsal side of the phalanx. Tape cannot do this, as it simply bulges into the stress.

With a correctly fitting ring, you can actually continue to climb, both protecting the pulley (and allowing it to heal) as well as continuing to keep everything fit.

Many years ago I went to a hand surgeon after pushing hard numbers in the early days of Shelf Road (sport climbing.) His first take was "ganglion cyst." "We can operate." Then, me: "Wait, dude, listen to what I've been doing with this hand!" After spending some time together, we figured it out. I went to the local hardware store and tried on every brass fitting they had, till I found one that fit the finger really well (it was also my 4th.) It was wide, so it fit basically from the crease at the palm to the crease at the PIP (first knuckle.) I had to do a little work on it in the garage to fine-tune the fit. I also taped under it (taped first, then put it on) to give it a solid fit. I climbed with the ring on for three months. During this time the mofo healed, and I didn't loose any fitness.

Nowadays I think physical therapists have some type of manufactured ring for the purpose. It's a much better known injury since climbing is a lot more popular now.

See the hand surgeon, for sure, but make sure she knows exactly how it happened and what you've been doing with it. Don't assume she knows what a crimp is (though she probably does.) Show her. If it turns out this is the problem, ask her about this solution.

Then post back in a few weeks/months and let us know how you're doing.

Good luck!

PS - I'm not much of an ice or tools guy; my experience with this injury is mostly on rock, so take that FWIW. Thx!


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By Lanky
From Portland, ME
Nov 27, 2012

If you do wear a ring, look up ring avulsion injuries. Maybe don't do the image search first.


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By jeff lebowski
Nov 30, 2012

You can train the uninjured fingers on a hang or system board. If it's the ring finger then you can do 2 finger pockets with the pointer/middle finger. You will actually experience strength gains in the unexercised fingers due to irradiation (a nervous system phenomenon). As you recover you may find that you can add pinches and open hand exercises without pain. Pulley injuries take a while to heal (6 wks - 6 months). Do some research here and on other climbing sites and try some of the suggested rehab. One suggestion is to buy all of the power putty resistances and squeeze it all day long starting with the easiest resistance. You need to encourage a steady blood supply to your finger and apply slow, steady, increasing stress to the area to encourage proper remodeling. This is assuming you're past the acute inflammation stage of healing. It might be difficult to find a dr or pt who has experience with pulley injuries.


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By dancesatmoonrise
Dec 3, 2012
avatar

Lanky wrote:
If you do wear a ring, look up ring avulsion injuries.


Good point, but for another reason.

In my experience, the ring was well-fitting enough (with tape under it) that it wasn't going to result in an avulsion injury. However, one must be extremely vigilant not to get it caught in cracks.

The one I used was brass, which I liked. However, just like RPs, brass loves to wedge into rock. Getting the ring caught and wedged into a crack would be almost as bad as wedging a body part in the rock (it happens) and probably more likely.

The one I used was a sloppy (large) fit on the bare finger. You tape the finger, then install the ring. This has several advantages. You can get the fit perfect by varying the amount of tape. And when it comes time to take the ring off, even if the finger swells, pulling the tape out from under it will always release the ring.

In sharing this experience, I think Lanky's point was very helpful so that it is pointed out that, at least for me, oversizing the ring and wearing tape under it worked very well. The tape takes up the gap in the oversize, and allows the ring to function just as well, constraining the soft tissues (pulley mechanism) yet allows additional safety for a metal circumferencial device.

I wouldn't recommend anyone try this without a discussion with, understanding of, and recommendation by their hand surgeon. But I will say that with a clearly evident pulley injury, it allowed me to continue climbing whatever I wanted. And three months later the ring came off, and the finger kept climbing without a hitch.


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By Tony Hawk
Dec 3, 2012

I didn't have an acute injury, but woke up one morning with a sore middle finger - A2 region. My finger didn't want to close until after a warm shower and some stretching. After that it has been more or less totally fine, including climbing. Hurts if you specifically press on it hard, but no pain climbing (I was lightly taping it). In fact I never really had any pain or swelling, just noticed it not bending in the AM. I climbed for a week or so also, but the finger has always been sore the morning after. Rather risk a full blown rupture I've also stopped climbing on it to let it heal. Maybe until the new year? I'm going to try the ring thing perhaps...but only after I wake up and can bend it properly do I want to climb on it. Each morning it is a bit better.

I would be interested in any tips on rehab anyone has: diet, supplements that have worked, how long to wait - especially for partial tears, massage, hot/cold therapies, etc.

I'm sure you could do some weight type work with a splint on the finger. Pushups, pulldowns, core work, etc.


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By Jonathan Metzman
From Blacksburg, VA
Jul 22, 2013
Morning Dew 12a, NRG

Tony Hawk wrote:
I would be interested in any tips on rehab anyone has: diet, supplements that have worked, how long to wait - especially for partial tears, massage, hot/cold therapies, etc.


I am by no means an expert, but after having over 10 tweaks/tears, my bombproof finger healing diet includes a lot of:

->Fish, chicken, salad (heavy on vegetables with vitamin C, avocados, fruits, rosemary/oregano/thyme - all anti-inflam's)
->Vitamin C (preferably containing alpha lipoic acid or the New Chapter version to actually digest)
->Proteolytic enzymes - these somehow work friggin amazing as natural anti-inflams and supposedly help break down the amino acids needed to heal tendons - Bromelain seems to work the best (I'll take 500 - 1000 mg when injured) and Papaya enzymes
->Tumeric - more natural anti-inflams
->Fish oil - a good kind, like New chapter

I never take any kind of anti-inflams before climbing, only after. I also stop taking the enzymes once the injury is healed (Bromelain is not supposed to be taken for a long time) and stick to mult-vitamin, fish oil, vitamin C

Do a lot of dead hangs on jugs and climb boulder problems 3-4 grades below limit for a while.


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