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Ring finger Pulley injury?
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By AndyMac
From Center, CO
Nov 29, 2011

I know there are a million posts about this stuff on mp, but I didn't find an answer in my brief search, so hopefully one of you wise folks will have an answer. A month ago I was crimping a terrible small hold when I heard the dreaded "POP", but it more sounded to me like a knuckle popping and bones scraping than a gunshot like I've heard others say. The most obvious deficiency is the tip won't curl in tight, so when I try to touch my fingertips to my palm or base of my fingers, it sticks out and I can't close that finger down. I've been resting it, doing cold water treatments, and limiting pull-ups and other exercises that require holding on to a bar.
I know that this is just the internet, but I'm looking for insight from anyone who's experienced a similar injury. Thanks!


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By hotlum
From Roseburg, OR
Nov 29, 2011
East face of the Monkey with Mt. Jefferson to the west.

Yep, been there, same finger right after getting over the middle finger being hurt. All I can say is I hope you like to ski because the best thing to do is stay off that thing for a few months until completely healed. When it is better tape it up and take it easy for a few pitches.


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By Dr. Ellis D. Funnythoughts
From Evergreen, Co
Nov 29, 2011
You can tell Lenny any of your sport climbing problems. He's a great listener.

this article helped me a lot, it comes from Dave Macleod's climbing coach website:


THURSDAY, 18 NOVEMBER 2010
AVOIDING PULLEY INJURIES - THE HARD AND EASY WAYS
In the comments of my last post, John asked about how to avoid crimping all the time and hence reduce the build up of stress and microscopic damage that leads to pulley tears.
Of course there is the short answer of ‘just openhand everything’ and you’ll get better at it. When it comes down to it, that’s what you have to do. It’s not easy to take the temporary drop in climbing grade while you gain openhanded strength. Most climbers who’ve not had pulley injuries yet are miserably weak at openhanding and really have to take a hit. But it’s your choice - it’s only your ego you have to beat.
I’ll make a very detailed case in Rock ‘til you drop not only for why you must do it, but all the ways you can make it easier on yourself. However, since you’ll have to wait a little longer for that, here are a few headlines for now:
- ‘It’s just training’. The biggest enemy of changing habits like crimping is that climbers are always trying to compete, even in training. When you go to the climbing wall, you cannot bear to do something differently to normal because you’ll have to take a grade hit for a while. And maybe your training isn’t going perfect anyway so you are trying extra hard to the standard you’ve become accustomed to. There is only one way around it; stand back and realise that you are just training. You are just pulling on plastic blobs. Who cares what the number is? If you think other people do, you’re kidding yourself. Sure it’s ok to compete once in a while. Climb openhanded most of the time, and allow yourself to crimp when it really matters. If you don’t, you’ll only have to later when your broken pulleys won’t let you do anything else.
- Get off the starting blocks. If your openhanded strength really is that spectacularly rubbish in comparison to your crimp strength, you could get yourself off the starting blocks by a little supplementary fingerboard work with a 4 finger and 3 finger openhanded grip. Use the protocol I described in 9 out of 10. After 10 or 20 sessions you shouldn’t have to take such an ego hammering blow when you climb for real with an openhanded grip. But don’t forget that the subtleties of the movement are realy quite different than when crimping; getting comfortable with openhanded needs both the strength part as well as actually learning how to climb with it on real moves.
- Know the score. A lot of people I’ve coached reckon they just aren’t cut out for climbing openhanded. They usually invent a reason like the shape of their hands or the length of their fingers. Rubbish. If it feels weak, it’s only because you’re weak. And the only reason you’re weak on this grip is because you don’t do it. I challenge anyone to climb solely openhanded for 20 sessions or more and still tell me it doesn’t work for them.
- Do it on easy routes first. Very experienced or expert climbers have a disadvantage in that their habits are very set and egos expect very consistent performance. But the advantage they have is that a lot of the movement decisions are quite automatic. Someone who climbs 8a+ can probably do a 7c while having conversation. So there is room on easier routes during warm-up or mileage climbs to concentrate on learning a new technique like openhanding.
Crimp everything and you will suffer for it down the line. Don’t worry about it too much - most people have to learn to openhand the hard way (post-injury). But injury is arguably the most wonderful motivator for changing the way you climb. That’s what happened to me. At 17 I scoffed at openhanded climbing. 5 years of constant pulley injuries later I couldn’t believe how much better it is than crimping on the vast majority of holds.
POSTED BY DAVE MACLEOD AT 11:20 PM 14 COMMENTS

CATEGORIES: FINGER PULLIES, INJURIES, ROCK 'TIL YOU DROP


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By AndyMac
From Center, CO
Nov 29, 2011

Thanks, guys. I wish i could have open-handed that hold, but it was low and the width of a tortilla chip. A doctor friend told me 6 weeks, and I'm getting close to that but am still feeling uninspired by the progress. If it takes 3 months to be better than so be it. Any opinions of ice climbing to ease my mental pain, I realize it's the same clamp down hand position that is bothering me now.


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By Brototype
From Albuquerque, NM
Nov 29, 2011

That 6-week figure you were told sounds pretty bogus to me. In my (limited) experience with pully injuries it depends on the severity. For a serious strain then sure, 6-weeks is probably accurate for a full recovery. I recently tore a pully in my ring finger and I'm going on 5 months and it's still not 100%.


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By Ryan Williams
Administrator
From London (sort of)
Nov 29, 2011
El Chorro

So your ring finger has three sections divided by two joints. The first joint is closest to your palm and the second joint is closest to your finger tip. Hold your injured hand up, palm facing you. Hold your ring finger with the other hand, hold it on the middle section. Don't let the first joint bend, but try to bend the finger tip toward you, try to bend the second joint.

If you can't you've torn the Tendons connected to the Flexor digitorum profundus. Hopefully someone with more experience will give a Better explanation and correct anything that I've said that is wrong.

Oh yea, if you really tore something you're in for much longer than 6 months. I strained mine and it took months of light to no climbing and it's still tender.


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By criccia
Nov 29, 2011

Is diet related to pully/tendon injuries in any way? Are their foods that are good for increasing finger strength and decreasing pully/tendon injuries?


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By Christopher Barlow
Nov 29, 2011

I would also question whether this is a classic pulley strain/tear. I'll qualify this by saying that I have no formal medical training, but in my 20 years of climbing have had many injuries and done pretty extensive research on climbing related injuries.

The symptom of not being able to fully flex the finger is, as best I know, not one associated with pulley strains. Pulley strains usually present with tenderness in the area and pain on resistance. Extreme strains show bowstringing when the finger in flexed. Any limited range of motion is usually associated with swelling, which should have gone down a few days post injury. The inability to fully flex the finger suggests the possibility that the injury might be to the tendon itself. The worse case scenario would be that the tendon has torn at the insertion in the tip of the finger. This would mean surgical treatment.

The pulley strains I've had have involved something like 2-4 weeks of no climbing/gripping at all (use wrist straps for pull ups) and then another 3-4 weeks of slowly progressing back to climbing at my limit. If you're still suffering from basic range of motion problems at 6 weeks, I'd encourage seeing an orthopedic and/or an occupational therapist.

If it is only a strain that doesn't need a more involved treatment, I'd first recommend avoiding any kind of real gripping until it is nearly pain free and full range of motion. I've heard that any load over 15 lbs. can tear tissue, especially tissue that's already injured. A treatment I've used with good success recently has two parts. The first part is immersing your hand for 15 seconds in ice water then 45 seconds in hot-as-you-can-stand-it water for 5-10 sets (1 set = ice + heat). This gets great blood flow. I do it twice a day. The second part is eccentric finger extensions. Basically, hold your finger straight and use your other hand to force it to curl into the palm of the hand. Do 3 sets of 10 reps daily. Make sure to isolate the injured finger and to put force on the length of the finger. I also do a lot of self massage on the muscles on the outside of the forearm (finger extensors). Best of luck.


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By Evan S
From Erie, CO
Nov 29, 2011
Me, of course

I had a similar injury on my right hand. I used hydrotherapy like you already are, and bought a set of ring splints. They are little plastic splints that hold your finger straight. Wearing one of those and not climbing, it took about 8 weeks before I felt comfortable using my hand again, but everything healed just fine.

www.scriphessco.com/products/oval-8-splint-sizing-set/?sourc>>>


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By Nathan Scherneck
From Portland, OR
Nov 29, 2011
He took the whipper while trying to place his #1 Stopper.  So sad.

I've heard the dreaded pop too. It's hard to do, but the best thing to do is stay away from climbing and pull-ups for a few months. I had my initial injury and stayed off it for approx three weeks. Figured maybe I could follow a pitch on ascenders and severely worsened the injury. I now have an irreparable bend in my finger due to a volar plate avulsion. I was out for four and a half months which could have probably been two or three had I listened to the advise and let the tendon heal.

Best,
Nathan


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By Christopher Barlow
Nov 29, 2011

In regard to diet, I've heard nothing about diet and its relationship to tendon strength and/or tendonopathy. Rock and Ice published an article a while back about the anti-inflammatory diet, but that's only tangentially related. Not to be smug, but I think the diet that most influences tendon health is the diet that makes you weigh less. Less force on tendons makes them less likely to break.


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By Brent Apgar
From Out of the Loop
Nov 30, 2011
Me and Spearhead

In reference to Ryan, Christopher and Evan's thoughts I'd say it would be worth talking to an occupational therapist, specifically a hand therapist.
Being in the medical field, it definitely sounds like it's more tendon related than a simple pulley injury and certainly worth getting it looked at. You don't want to deal w/ a chronic profundus tear or avulsion, get it looked at sooner than later and it will save you a lot of time and trouble down the road.
Good luck healing up,
BA


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By Chris treggE
Administrator
From Madison, WI
Nov 30, 2011
This problem haunted my dreams for 6 years after failing to send in 2008.  Finally got to try it again -- now I can sleep.  Photo Darin Limvere.

Andy you didn't say exactly where it hurts on your finger. Is there still pain?

I had a complete A2 pulley rupture on my ring finger of left hand in August 2005 from crimping. It took about 3-4 months of light climbing before I could really crimp again, and the pulley area hurt while climbing for probably close to a year. I never stopped climbing, I just readjusted my goals. Six years later my fingertip still doesn't go all the way down to my palm when I make a fist (just like you describe). I also had to have my wedding ring resized because my finger swelled and never went back to it's original size. I think A2 rupture is the most common pulley to rupture. I did a lot of research on this when it happened, but probably have forgotten more than I remember. A thread on another forum.


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By fortmental
Nov 30, 2011

What CB said, above. I was sure I had a pulley rupture years ago when my feet had popped off unexpectedly during a serious crimp. I went to an orthopedic surgeon that specialized in hands/wrists and he showed me pictures of real pulley ruptures and I clearly didn't have it.

A pulley rupture is very specific (and obvious) and can only be repaired with surgery (imagine a directional placement ripping during a fall). My guess is that your knuckle popped and you strained the pulleys and tendons in your hand, maybe even your inside elbow. Lay off it for a while, and tape up weakened pulleys in the future.

Diet doesn't help. Rebuild smart, know your limits; you're only meat, after all.


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By AndyMac
From Center, CO
Nov 30, 2011

It hurts just above the first joint. It is basically pain free until I use it the wrong way and apply pressure on the tip. Ryan - if I hold the first joint I can wiggle the tip back and forth fine.


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By Ryan Williams
Administrator
From London (sort of)
Nov 30, 2011
El Chorro

There is a lot of stuff going on in our fingers, and it's impossible to get any more specific than people already have. It is good that you can wiggle the tip normally. That means the tendon that connects to the tip of your finger is intact. And it sounds like you can also bend the first (largest) knuckle normally as well which means that the other tendons and muscles responsible for bending your finger are working properly.


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By Evan S
From Erie, CO
Nov 30, 2011
Me, of course

Brent Apgar wrote:
In reference to Ryan, Christopher and Evan's thoughts I'd say it would be worth talking to an occupational therapist, specifically a hand therapist. BA


I did that, went to a hand specialist in Boulder who was supposedly a climber. She just told me I might benefit from surgery, or not, or maybe, then gave me literally worthless splints and charged me a bunch of money. I had to go find the ring splints (which a hand specialist had somehow never heard of) myself and just keep it from moving while it healed. The pain your describing Andy is exactly what happened to me, NOT bending you finger for a while will let the connective tissue heal, then you have to rehabilitate it, but better than your finger never working right again.


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By Chris treggE
Administrator
From Madison, WI
Nov 30, 2011
This problem haunted my dreams for 6 years after failing to send in 2008.  Finally got to try it again -- now I can sleep.  Photo Darin Limvere.

Hey Rich wrote:
A pulley rupture is very specific (and obvious) and can only be repaired with surgery.


True, but not all pulley ruptures NEED to be repaired. I had an MRI which showed complete A2 rupture. The ortho I saw said he could fix it, but after reading more about it, I decided it wasn't really necessary.

Andy, sounds like the pain you are having is exactly what I had. Only way to know for sure is get evaluated, MRI or ultrasound, or possibly a competent hand surgeon can diagnose it on clinical exam alone. I got a ring splint too, but really didn't use it.


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By LeeAB
Administrator
From ABQ, NM
Nov 30, 2011
Once we landed we headed to Font to find a place to stay for the night before doing a day of wine tasting and heading to Buoux.

Christopher Barlow wrote:
In regard to diet, I've heard nothing about diet and its relationship to tendon strength and/or tendonopathy. Rock and Ice published an article a while back about the anti-inflammatory diet, but that's only tangentially related. Not to be smug, but I think the diet that most influences tendon health is the diet that makes you weigh less. Less force on tendons makes them less likely to break.


Damn, and I always wanted to think that the grease and fat in donuts and bacon helped to lubricate the tendons...


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By Christopher Barlow
Nov 30, 2011

LeeAB wrote:
Damn, and I always wanted to think that the grease and fat in donuts and bacon helped to lubricate the tendons...


Only if the donuts are frozen and you stick your finger in the hole to ice it, then immerse it in hot bacon grease as you're eating the donut. The combined benefits of reduction of swelling, increased blood flow, and lubricated tendons will instantly heal any tendon injury. That's science.


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By Christopher Barlow
Nov 30, 2011

Evan S wrote:
I did that, went to a hand specialist in Boulder who was supposedly a climber. She just told me I might benefit from surgery, or not, or maybe, then gave me literally worthless splints and charged me a bunch of money. I had to go find the ring splints (which a hand specialist had somehow never heard of) myself and just keep it from moving while it healed. The pain your describing Andy is exactly what happened to me, NOT bending you finger for a while will let the connective tissue heal, then you have to rehabilitate it, but better than your finger never working right again.


My experience with medical folks and climbing injuries has also been fraught with frustration. That said, one ineffective specialist doesn't make them all worthless. Many of these injuries seem to heal well with rest, inflammation and scar tissue management, and increased blood flow. Severe tears in tendons and ligaments often do require surgical intervention, but most surgeons are hesitant - as they should be - to go down the road of major procedures like MRIs and cutting you open.

The kinds of PT I've had that have actually gotten better results than what I can do for myself have involved ultrasound (for locating damage/inflammation), laser therapy, ASTYM, and deep tissue massage. I've had this stuff for shoulder problems, elbow tendonitis, and tendon problems in the fingers.


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By AndyMac
From Center, CO
Nov 30, 2011

Thanks everyone for the help and input. This is my first time with a finger injury and felt this was a great place to ask people who have been there. I've had a lot of experiences with doctors who do very little if anything for injuries I've been concerned about and then I still have to pay their lofty prices. I'll have to check out the ring splint and keep taking my time. Thanks again, climb hard for me!


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By Brent Apgar
From Out of the Loop
Nov 30, 2011
Me and Spearhead

Christopher Barlow wrote:
My experience with medical folks and climbing injuries has also been fraught with frustration. That said, one ineffective specialist doesn't make them all worthless. Many of these injuries seem to heal well with rest, inflammation and scar tissue management, and increase blood flow. Severe tears in tendons and ligaments often do require surgical intervention, but most surgeons are hesitant - as they should be - to go down the road of major procedures like MRIs and cutting you open. The kinds of PT I've had that have actually gotten better results than what I can do for myself have involved ultrasound (for locating damage/inflammation), laser therapy, ASTYM, and deep tissue massage. I've had this stuff for shoulder problems, elbow tendonitis, and tendon problems in the fingers.


Evan and Chris I completely understand the frustration w/ the medical community. By in large if you can walk around, feed yourself and do some kind of work most medical professionals say that you're fine and don't need any treatment. So when you start talking human performance and then god forbid detour down the road of climbing specifically you're going to find very few folks that are all that helpful when it comes to injury management and sound training advice.

A lot of times I'm at a loss when I get asked about what to do for climbing related hand injuries. That's because there really isn't too much you can do for them other than take it easy on the injury, let it heal and then slowly start putting stress on it so that it becomes stronger.
In general, dealing w/ hand injuries is a nightmare. Hand surgery doesn't have the greatest outcomes because the hand is just so damned complicated. Self massage, drugs, supplements and home therapy can all be helpful but the real key to healing an injured hand as quickly as possible is to not keep re-injuring it.
I think a lot of people are coming around to the belief that it's best to climb through mild to moderate hand injuries, provided the climber can practice enough self control to only stimulate the soft tissue to heal and not go overboard.
Anyhow, that's my two cents. Sorry for the longer post, the topic of health care (the whole thing, patients, providers and the standard of care) can just frustrate the shit out of me... guess that's true of any job.
Hope everyone's hands survive the winter plastic pulling and come out stronger in the spring,
BA


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By abc
Nov 30, 2011

Here is an article I wrote for the climbing gym here in town that might be of some interest. Also, curious to hear any dissenting views, so I can learn more myself.

Finger Injuries:
Diagnosis, Treatment, and Prevention
Written by Brett Pierce for CityRock

Tendon and ligament injuries in the upper body (hands, wrists, elbows, and shoulders) occur frequently in climbers who are pushing their limits through increasing the total volume and/or intensity of the workout. Since muscles respond more quickly to a stimulus (significant muscle strength gains can happen within a few week period) than connective tissues (which takes years), it is common for climbers to push beyond what the body can handle and thus experience frustrating, nagging injuries that don’t seem to heal no matter how much time is spent away from climbing. This is especially true for the ubiquitous hand injuries that climbers in training encounter sooner than later.

The most common hand injury is the straining or tearing of a finger pulley, which is a tiny structure that surrounds the flexor tendon like a sheath or a wide rubber band. These pulleys or sheaths absorb significant amount of force while climbing, especially while crimping, which is the most commonly used hand position for climbers who experience finger injuries. If the force is high enough or prolonged enough without proper recovery, the pulleys will become damaged – ranging from a slight strain or overstretching to a complete tear.

Diagnosis
Only an experienced hand doctor who regularly works with climbers will be able to give an accurate diagnosis, and if you have affordable health insurance, this should be your first line of recourse.

Dr. Steven Topper with The Colorado Hand Center here in Colorado Springs comes highly recommended from his peers and has experience working with and treating climbing related injuries.

If access to a specialist isn’t an option, here are some considerations to keep in mind for a self-diagnosis:

1. If you heard an audible popping sound or if you have a visible bowstringing of your finger between the joints or if you have significant swelling, you may have completely ruptured your pulley, which might require surgery. An experienced hand physician will only suggest surgery after she has first tried several Platelet Rich Plasma (PRP) injections, - orthopedics.about.com/od/injectio2/p/prp.htm.

Pulleys are very small structures that are not easily surgically repaired and research suggests that most people who choose the surgical route don’t return back to previous levels of strength. It should, thus, be considered a last resort.

2. Most pulley injuries respond very well to treatment. Typically, if the climber experiences pain or discomfort in a crimping position, this is a telling sign that a pulley has been injured. Most climbers in this situation are still able pull on holds with little to no pain if they grab the hold with a fully open-hand position.

3. If there is pain in a fully open-hand position, then the flexor tendon (the tendon that runs from the tip of your finger down into your wrist) has been damaged, but this is much less common and will respond to the same treatments discussed below.

Treatments:
1. Rest – At the onset of injury, the climber is wise to use the PRICE method (Protection, Rest, Ice, Compression, and Elevation) until the initial swelling has subsided in one to three weeks or until an accurate diagnosis can be obtained. Counter-intuitively, after this initial phase, complete time of from these types of injuries is counter-productive. Instead, once the finger has complete range of motion with minimal pain, the pulley will best respond and heal to gentle, pain-free use, which encourages a growth response in the tissue. During this stage, the climber must exclusively use an open hand and only jump on safe and easy climbs so as not to be tempted or forced to pull too hard and reinjure the affected area. Each climbing session, additionally, should end before pain or discomfort is felt.

2. “Lewis Reaction” – Otherwise known as cool (not cold) water therapy, has a different goal than traditional icing, which is performed to decrease swelling/inflammation. Rather, this therapy increases blood flow, if done properly, to the affected area, which is critical for the healing process anywhere but even more so for tendons and ligaments.

Soaking your affected area in significantly cold water causes the blood vessels to constrict in an effort by the body to protect the vital organs. While moderately cool water has the same initial effect, the secondary response is for the body to dilate the blood vessels and flush the affected area with blood flows reportedly greater than 500 % of normal.

To perform this treatment, soak the injured area in water that is tap-water cool for thirty minutes. The first five minutes of the treatment will constrict the blood vessels, and your hand will feel cold. But for the next twenty-five minutes the body will realize that the vital organs are safe and will begin pushing blood into the injured area. Finding the correct temperature is critical, and it may take a couple of sessions to figure it out – too cold and the blood vessels never dilate; too warm and the blood vessels don’t have to dilate. It often takes a few sessions for the body to learn to adapt, but the process can be sped-up by wearing a winter jacket and hat while you execute the therapy, which should be performed two to three times a day until the injury is pain-free.

Some argue that contrasting three to five minutes of very cold water with three to five minutes of hot water gives the same effect. There is very little research to support the effectiveness of this method while the “Lewis Reaction” has been proven a potent agent of healing by various studies.

3. Supplements and Diets – Climbers who recognize that there is a direct correlation between body weight and performance often take being lean too far and minimally sustain themselves on diets that contain no fat intake. Essential fatty acids from nuts and seeds, avocados, quality olive oil, salmon and other fatty fish are necessary in the maintenance and repair of the body’s connective tissues. Climbers should also consider if they are keeping their muscles properly hydrated before, during, and after each workout because a dehydrated muscle is not able to fully relax, which causes considerable tension on the connective tissues.

While there is active debate on the efficacy of dietary supplements, many climbers report anecdotal evidence to support the use of turmeric and Tissue Rejuvenator by Hammer Nutrition (CityRock has no connection with this company). Turmeric, a spice used in Indian food, has many medicinal qualities, most of which are beyond the scope of this article, that promote healing and increased blood flow without negative side effects. Turmeric can be found on the Internet through various sources, but this seems to be a quality product at a fair price -- www.vitacost.com/Himalaya-Herbal-Healthcare-Turmeric-Antioxi>>>. A suggested dosage while trying to heal from injury would be four capsules in the morning after your breakfast and another four after your evening meal. Once the affected area has returned to normal, a maintenance dose of a couple per day may prove beneficial.

Tissue Rejuvenator by Hammer Nutrition (www.hammernutrition.com/products/tissue-rejuvenator.tr.html) contains low to moderate levels of turmeric, but more importantly employs glucosamine and chondroitin as main ingredients. While not as affordable as turmeric, the extra cost is probably worth a shot for those who are suffering from finger injuries. The dosage recommendations are the same as turmeric, and the two can be combined together without ill side effects.

Think-Twice Treatments: Current science and effective medicinal treatments morph over time as more researchers look into the efficacy of “accepted practice”. It often seems that there is as much placebo effect as real results in many therapies, which is probably just fine. However, some common treatments also come with caution because of potentially damaging side effects.

1. Ice – Undoubtly ice is effective at the onset of injury to reduce inflammation, but once this initial swelling has subsided, ice reduces blood flood, which is the opposite reaction that is need to promote healing. Instead, use the cool water therapy that is outline above in the article.

2. Ibuprofen and other NSAIDS – While anti-inflammatory drugs might have a place in your toolbox of therapies at the onset of injury to reduce swelling and pain, their continued use is risky on two levels. The dangerous side effects of these drugs have been outlined in many articles (www.acg.gi.org/patients/women/asprin.asp), and these warnings should not be taken lightly. But ever more alarmingly from a climber’s perspective, these drugs should NOT be used to mask pain in an attempt to climb before the injury has fully healed. This will only result in a prolonged recovery period, and potentially, could greatly exacerbate the injury or even result in a complete rupture.


3. Tape – The tensile strength of tape is insufficient to provide any real support to your finger pulleys, which are absorbing tremendous forces. All research on the subject depicts this therapy to beof little value for the fingers, past the initial recovery stage. So why not just use it for placebo effect then? Much for the same reason climbers should not climb under the influence of aspirin and other similar drugs – climbers who test their limits before the injured area has fully recovered risk a prolonged recovery period, exacerbation of the injury, or even a complete rupture.

4. Deep Friction Message (DFM) – The idea behind this therapy is to realign the scar tissue at the end of the healing process once most, if not all, of the pain has subsided. While there is much research to back the effectiveness of this, many climbers, until trained by a professional massage therapist who has experience with this technique, seem to apply too much pressure, and this causes more harm than benefit.

5. Stretching – There is conflicting research on the effectiveness of stretching as means to injury prevention, but stretching as a means of increasing the range of motion of a healing injury area can be effective if accomplished after “cool water” therapy when the injury has been warmed from the flushing of blood or after a long, slow warm-up of open-handed jugs. Keep in mind that stretching “cold” connective tissue will likely cause increased micro-trauma to the injury.

6. Recovery Aids – Many companies produce various putties, foam balls, and donuts, which are designed for increasing hand strength. Each commercial product has limitations, and no one product seems to stand out from the rest. Possibly, a simple, cheap foam ball that springs back slowly at the correct resistance (which is different for each person) and allows for the eccentric resistive motion of the injury is effective, but there is no apparent research to support this. And all too often, climbers use these tools as training, not therapy, which again will prolong the recovery period if the injured area is not allowed to heal.

Prevention:

1. Warm-up – Climbers should warm-up slowly and gently beginning on large, friendly jugs and gradually moving through the grades making sure to provide significant rest in-between climbs. Climbers should concentrate on varying the gripping position of the hand and moving with fluid motions.

2. Technique – During the warm-up, climbers should focus on moving efficiently and utilizing the strength of the lower body. Climbers who always climb with their hips square to the wall and jump from hold-to-hold risk shock-loading the fingers. By no means is this to suggest that “static” climbing is preferable over “dynamic” climbing, but rather it is a case of knowing when and how to use both styles, since both have a time and a place.

Any climber looking to improve in this area should consider taking one of the Advanced-Movement Classes offered at CityRock.

3. Open-handed Climbing – Almost without fail, the climber who is suffering from finger injuries exclusively uses a closed-crimp hand position, which causes even greater force on already fragile pulleys. The vast majority of climbers would benefit from learning to climb open-handed, both in terms of performance and injury prevention. However, this will result in the temporary drop in climbing grade as the body adapts to this new stimulus, and most climbers are simply not patient enough to undertake this process until they have suffered multiple finger injuries.

There is no easy way to make the transition into this new holding position, so climbers are best just jumping into it – open hand everything. Yes, the climbing grade must be lowered. Yes, it will feel unnatural. But the person who crimps everything will eventually pay the price of complete time off soon than later. Instead, the climber should embrace being a beginner again and learning a new skill that could ultimately support moving him/her to another level of climbing – the vast majority of world-class climbers exclusively use the open-handed method.

4. Recovery – Everyone seems to grasp the idea that have a training plan is an important tool for improvement, but how many of those same people put equal, if not greater, importance on having a recovery plan – training tears down muscle, but the recovery from the training creates strength. An effective recovery plan will incorporate these essentials:
-Quality sleep
-Nutritious diet based on whole foods
-Finishing each climbing session early: “Training to failure is failure to train.”
-Hydration
-Protein calories immediately after the workout
-Supplements that promote healthy connective tissue

As with anything worthwhile in life, true progress takes time and real, consistent effort, which requires a healthy dose of patience. Like training, recovery requires work to see results. Those who do the work, listen to their body, and allow pain to be the guide will slowly improve over time.



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By Monomaniac
Administrator
From Morrison, CO
Nov 30, 2011
Insurrection, 5.14c.  Photo Adam Sanders.

Outstanding work Brett! There is a ton of great stuff in here. The big nugget that I think is worth emphasizing is this:

abc wrote:
...At the onset of injury, the climber is wise to use the PRICE method ... after this initial phase, complete time of from these types of injuries is counter-productive. Instead, once the finger has complete range of motion with minimal pain, the pulley will best respond and heal to gentle, pain-free use, which encourages a growth response in the tissue.


I think this is the big mistake that most folks make. They just keep 'resting' for months and months (either on the couch, or climbing easy routes, etc), and so the injured tissue never really recovers.


I do, however, question this statement:

abc wrote:
... the vast majority of world-class climbers exclusively use the open-handed method...


Is this a matter of semantics regarding the definition of "oepn-handed"? It seems The Highlander has had a hard time forming a consensus on what is a crimp and what is open-hand.


FLAG
By abc
Nov 30, 2011

Thanks for the feedback Mark.

If I say, "most world-class climbers avoid exclusively using a closed crimp position," would this feel more accurate? Any other possible suggestions?


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