A2 Pulley Injury Recovery - Learnings from Misuse, Nutrition, and Stress

Hi folks,

I wanted to write up the story of my A2 pulley injury and recovery in hopes that it can be helpful to others. It went from a simple injury, to multiple injuries, to chronic injuries spanning what will be 2 years or more.

I've read numerous articles, seen two PTs, and a surgeon. I’ve learned about how to better take care of and listen to my body. I’ve also learned about the effects of sleep, stress, and diet including being vegetarian and the importance of eating sufficient food. I’m just now on what I hope is a path to recovery. Some of the information I’ve written here I haven't seen anywhere else (specifically around stress, sleep, eating sufficient food, and red meat).

Dec 2017 : Climbing a boulder problem in 30deg F temperature without warming up, injured a tendon in my left hand middle finger knuckle
→ Culprit : Not warming up and bouldering in cold weather

Jan 2018 : Took a few weeks off from climbing but continued doing pull-ups; middle finger did not improve. Went back to climbing at max grades hoping injury would go away; instead it got worse. I began climbing without middle finger (would just hold it back) which led to me injuring my A2 pulley on ring finger left hand (at this point I had two finger injuries).
→ Culprit : Impatience and overloading fingers

Feb 2018 : Went to see PT and she told me to rest, climb gently, and work on massaging out tight forearm especially on left side because tendon and ligament injuries in hand can’t heal under constant tension from tight muscles
→ Culprit : Tight forearms

Mar-May 2018 : Followed plan of gentle climbing and slowly incrementing up. Fingers were getting better very slowly; but inevitably I would get excited and climb too hard one day, re-injure them, and set myself back to the beginning. At this point even lifting free weights or holding ski poles aggravated my fingers.
→ Culprit : Impatience to climb harder grades

May 2018 : My PT observed that I wasn’t healing at the rate I should be. Something was preventing me from healing properly but she didn’t know what it was. I suspected that it was stress and sleep. I was in a stressful job, had recently ended a long relationship, and wasn’t sleeping well (as little as 3-4 hours per night)
→ Culprit : Can’t heal with high stress and not enough sleep

Jun 2018 : Saw hand surgeon and he told me I should take 3mo off without climbing at all. Then go back to climbing. This didn’t not line up with what I’d learned from articles and PTs so I ignored his advice
→ Culprit : Surgeons shouldn’t be looked to for recovery protocol

Jul-Apr 2019 : I found Esther Smith’s article that provided the first comprehensive, high confidence guide I’d seen for chronic pulley injury recovery. This kicked off the first period since my injury that I was actually responsible and conservative in following a long-term recovery protocol. I was incrementing up slowly - even more slowly than Esther’s article suggested). Nevertheless, I was continually getting re-injured and having to start the program over from the beginning. Meanwhile, I watched a number of friends and acquaintances injure pulleys and return to full climbing while I barely progressed.
→ Culprit : Unknown; suspected not enough sleep and high stress

Apr 2019 : I was climbing easier routes in Indian Creek, generally protecting my injured fingers, and ended up getting a minor injury in a finger on my right (*other*) hand. This was a sign to me that it wasn’t just sleep or stress preventing me from recovering - I had some sort of chronic internal tendon/ligament weakness. I suspected diet so I started researching.
→ Culprit : Diet and nutrition

May-Jun 2019 : The changes I made to my diet happened at the same time as I reduced stress and started sleeping better. This brought me into what I'll call the "golden period" in which my fingers were suddenly healing. It felt incredible. I completely stopped my PT, and just climbed. I started trad leading again and was even approaching the grades I was at when I had gotten injured. The positive changes I made were:
   - Started eating steak and beef tendon upon recommendation from my Chinese Medicine doctor who is also a pro climber (I had been vegetarian up until this point)
   - Started taking herbs that my Chinese Medicine doctor prescribed me for sleep and tendon/ligament health
   - Started taking Vitamin C, Fish Oil, Magnesium, and Collagen for tendon/ligament health based on articles I read online
   - Stopped stressing about my job (just stopped caring and have since quit) and met a woman that I’m now dating; both of these things meant I was sleeping better (7-8 hours per night)
   - Was getting routine dry needling in my forearms to release knots and muscle tension
→ Keys : Low stress, sufficient sleep, red meat and tendons, collagen, vitamins, Chinese herbs, loose forearms

Jul 2019 : I went home to the Midwest for two weeks. During this time I wasn’t climbing and was sleeping a lot, so I figured I’d return back to Colorado with a well rested and healthy finger, ready to take my climbing to the next level. Instead, the opposite happened. By the time I left the Midwest my finger had degraded to the point of being sensitive all the time and acutely painful even while playing the guitar. What happened? Upon reflecting the following things had changed:
   - I was eating a small amount of red meat but not steak or beef tendon
   - I was eating a lot or carbs, sugar, and dairy
   - I wasn’t eating enough because I wasn’t enjoying the food (it wasn’t healthy or fresh). I lost almost two inches on my belt in 2 weeks (I have high metabolism). I think this was the main culprit. I listened to a podcast with ultra runner Clare Gallagher and she mentions that when runners don’t eat enough they get injured.
→ Culprit : Not eating enough food

Now I’m back in Colorado and am doing all the things I did during the “golden period” plus making it a priority to eat lots of food. I’ve also made a decision to come to peace with the things that are stressing me out so I can sleep better, and I’m leaning into my relationship with my girlfriend for the same reason. It’s only been a few weeks but results are great so far. I climbed near my hardest trad grade yesterday and have no finger sensitivity today.

Other learnings:
   - H-taping method is the most effective at reducing stress on A2 pulley (16% reduction) using Leukotape which is stiffer than regular sports tape
   - Break up scar tissue in your fingers with the wave tool for chronic injuries

The takeaway is that there was no one thing that was the silver bullet. It has required patience, consistency, changing my relationship with my body, dealing with stress, and changing my diet. I hope this can be helpful to others on a similar journey. Feedback and insights are welcome.

Ted

Ted, first of all, thank you for a fantastic post. This sort of content is the antidote to the bickering and competitiveness we see too often on MP forums - you represent what is great about the real climbing community.

I'm on month 6 of a similarly cryptic finger injury recovery although without the visits to the PTs or doctors. One thing I have learned in my limited interactions with medical professionals is that hand injuries are like a black box and very hard to properly diagnose; and recovery protocol is a similar unknown. I don't know if you experienced this, but often I do a hangboard session and it makes my finger feel better - not worse. This of course doesn't correlate with healing, and then I'll find my next session makes it worse again. You are smart to note all the other lifestyle factors that may be affecting your healing and I will start doing the same. Good luck with the recovery, keep us updated! 

Thanks Andy. I've had the same experience with a seeming mismatch between the stress I put on my finger and the resulting pain/sensitivity. For me I think it has a lot to do with sleep and diet (per the above). I'm not out of the woods yet but am staying optimistic. 

I'm a believer in the diet component, at least for myself.  I was very injury prone for a while and eventually found out I was diabetic.  My blood sugars were chronically high which caused all sorts of systemic inflammation.  I also wasn't absorbing any of the nutrients I was eating.  There are a lot of people that can get away with high stress via work, diet, lack of sleep, etc but I imagine they'd be even better off if they did things in a more healthy manner.  It can be a big lifestyle change though and some people aren't willing to put in the effort.