Doctors are a waste of time for finger injuries

A general observation: The last few years on the climbing internet, there has been a trend that whenever someone asks a question about a finger injury, there is a chorus of "just go see a doctor".

This doesn't match well with my experience though. I've visited doctors at various times for typical climbing finger/hand/wrist injuries over the past 20 years. Not once has this been productive. Your typical physician doesn't know the slightest thing about how to treat climbing finger injuries, and more often than not will give bad advice.

So I've stopped visiting physicians for finger injuries. Instead, the general protocol is to rest 7-10 days for initial swelling reaction to subside, then begin gradual, careful, progression loading on a Tension Block, then hangboard, then easy climbing, and eventually building to full climbing. You proceed by feel, identifying what the problematic grips/positions are, how to work around them in climbing, and how to gradual re-train those grips to full strength. This can take anywhere from 3 weeks to 4 months, depending on injury and severity.  But the sort of differential diagnosis a doctor/MRI provides is generally irrelevant. The course of treatment is essentially the same in the end.

If you can visit a climbing specific physical therapist, that's a different story - that would be worthwhile. But those types of practitioners are not available/accessible for many people. If your choice is seeing your general practitioner, or self treating from internet advice, honestly I've gotten much better results (at a better price) from the internet. An online consult with someone like Jason Hooper or Esther Smith would be another good option for a complicated or persistent injury, but these folks give so much good information away for free on the internet that for basic finger injuries you can generally just read their articles and go from there.

Note that this is specific to fingers. For shoulder and knee injuries, etc, those are much more in the mainstream of what your typical doctor is used to, and I've gotten good advice on shoulder injuries through the regular medical system. 

100% agree with you. I’ve been to a few and as long as you can move the injured digit they just want you to leave and tell you to to never climb again. Total waste of time and money. 

As a retired ER Doc, I'd basically agree that most doctors have no idea how to treat climbing related finger injuries.

I'm not sure they're so good with climbers' elbows either.

I don't know if your average PT is going to be much better, although I'm guessing they tend to be less convinced of their own knowledge and more likely to actually look things up.

Tyler Nelson does online consults for a reasonable price (certainly less than the cost of seeing an Orthopod for most of us.)

I can't comment on Hooper or Smith, but have been very impressed with what I've seen of them online.

All that said, there are times when you need an X-ray and that might require an office visit with somebody. 

In LA we have a “climbing doctor”, Jared Vagey, that is definitely not a waste of money.

I think there’s 4-5 of these doctorate of some kind folks, that specialized in climbing, across the states. Nelson, Hooper, Smith, as mentioned.

Seems like you wanna see someone with a climbing speciality, and climbing background, so they don’t give you shit advice on something they know nothing about 

I might recommend a therapist with a CHT (certified hand therapist) credential. You are correct general practitioners won’t know climbing specific injuries but they can be a resource for a referral to imaging, a hand specialist (orthopedic), or therapy.

You are correct in that therapist will most likely look something up if they are unsure.

Hand injuries are so hard since it involves a lot of soft tissue which takes time to heal unfortunately. You are correct in that there is a lot of free information on the internet, but sometimes a hand therapist can offer a little more than the internet. 

Fortunately in my city there is a physiotherapy clinic moveclinic.com.au/ that was started by climbers and even has an office attached to a bouldering gym. The guy I saw through them, was not a climbing specialist (his bio had more traditional sports work with football and rowing) but clearly he had studied up on it and had access to a lot of knowledge and tools from the others at the clinic. His diagnosis was fantastic and I learned a lot.

I think that overall, a specialist climbing doctor or physiotherapist, will be much better than self-diagnosing from climbing literature and tidbits from online forums and other climbers, which in turn is yes still arguably better than going to a local family doctor.

My doctor was pretty rad. Attached my interior pinky nerve and both flexors. She knew I climbed and worked with me and my PT to get back to climbing a lot quicker than I thought.

So I had a climbing partner once who had a finger that was swollen looking, weak on use and hurt all the time when climbing. He had waited a many months to go see a hand surgeon after the injury, and whatever it was, was told if he had come in soon after injury, something could have been done, but at that poibt it was too late.

By the time I got my first finger injury, I already was established as a patient with a great local Sports Medicine group. I got in to see a hand/arm surgeon within a week and he knew exactly what is was and gave exact guidance on recovery time, rehab procedure, etc.   He had already had experience with climbers.  more reassuring than self-diagnosing on the internet at the time, although I agree with you, there are a lot of good resources available online now.

There is no motivation for a doctor to offer the kind of specific advice and expertise that you want. The 60 minutes I would spend being thoughtful about your finger I could have treated and discharged 2-3 other patients. If you’re not aware, I keep my job based on how much revenue I generate (patients I see) not how good my care is or satisfied you are.

The problem isn’t the doctors per se, it’s that the system isn’t actually designed to fix your, or anyone else’s problem. It’s designed to keep doctors busy and billing, so long as those two are happening (regardless of health outcomes) the machine will churn on.

I mean…there’s a good example of a disease that’s killed a million Americans in the past 2 years alone and about half the population won’t even consent to us caring for them.

edit: this is why people like to gravitate towards surgeons. They can “fix things.”  They reconstructed your pulley complex but don’t give AF if you used to climb 5.13 and now flail on 5.8. They still “fixed it,” billed you for a successful surgery, and can now punt you to PT or someone else. 

JCM wrote:

If you can visit a climbing specific physical therapist, that's a different story 

IMO you don't need to visit a "climbing specific" PT. there are plenty PTs that specialize in hand therapy and don't know anything about climbing. oh, and most are also DPTs ;)

Cole Darby wrote:

In LA we have a “climbing doctor”, Jared Vagey, that is definitely not a waste of money.

Vagy isn't an MD though (which is a compliment).  He's a Doctor of Phys Therapy.  As you said, there are a few of these who know about climbing.  Evan Ingerson here in Boulder was a comp climber.  ( mendcolorado.com/dr-evan-in…)

Heck, we have a Doctor of Phys Therapy whose office is in my gym, Kevin Cowell, who just did his first 13d, so he knows something about climbing.

Also you can do self-guided care with materials like books (Make or Break), or videos (Ester Smith).

I would never got to a family doc for a finger injury (or any sports/overuse injury).

Hooper is great! I’m currently seeing him right now for a finger injury. We are lucky to have him in San Diego. 

Had a finger injury last year, and my doctor told me to either quit climbing or go watch YouTube videos made by climbers about how to rehab. 

Arthur W wrote:

There is no motivation for a doctor to offer the kind of specific advice and expertise that you want. The 60 minutes I would spend being thoughtful about your finger I could have treated and discharged 2-3 other patients. If you’re not aware, I keep my job based on how much revenue I generate (patients I see) not how good my care is or satisfied you are.

The problem isn’t the doctors per se, it’s that the system isn’t actually designed to fix your, or anyone else’s problem. It’s designed to keep doctors busy and billing, so long as those two are happening (regardless of health outcomes) the machine will churn on.

I mean…there’s a good example of a disease that’s killed a million Americans in the past 2 years alone and about half the population won’t even consent to us caring for them.

edit: this is why people like to gravitate towards surgeons. They can “fix things.”  They reconstructed your pulley complex but don’t give AF if you used to climb 5.13 and now flail on 5.8. They still “fixed it,” billed you for a successful surgery, and can now punt you to PT or someone else. 

Finally, there is someone who truly understands.

Arthur W wrote:

edit: this is why people like to gravitate towards surgeons. They can “fix things.”  They reconstructed your pulley complex but don’t give AF if you used to climb 5.13 and now flail on 5.8. They still “fixed it,” billed you for a successful surgery, and can now punt you to PT or someone else. 

My orthopedic told me this strait up when discussing trying to fix my injuries, i appreciated his honesty.

I would never look to an orthopedic surgeon for help. Anyone who does so is a fool.

I've seen good results from Ortho hand specialists when indicated.  As well as getting a reduction from the ER at the outset, possibly saving the need for surgical intervention. 

Identifying and correcting an avulsion fracture or reducing a disarticulation can be worth the money in the cases I've seen. Although I see snowmachine and atv mechanism rather than climbing or skiing. I have seen a return to function with Ortho and PT services in any case. Saying the whole process is a waste of time and money in every case is a bit of a stretch to me.

I'm a nurse, and would generally agree,  that for your run of the mill climbing finger injury a typical doctor is basically worthless...but not completely.  Assuming you don't have a major injury that requires a hand surgeon.  Most  doctor's aren't going to have much to offer you.  If you live somewhere with a ton of climbers in the area, and can find a doctor that's also a climber, that's different.  If that's not the case though, what you need is an Occupational Therapist.  Basically, they are like a Physical Therapist that works from the elbow to the finger tips.

Whether you need that Occupational Therapist or that Hand Surgeon, you're going to need a referral from your doctor (or NP / PA) first.  So when you see the doctor, ASK them for a referral to OT!  They might not think to offer the referral to you if you don't ask.  Also, to get the OT referral, you may need to see a PT too, depending on insurance. 

Yes and no...  I feel the same way about toes.  I took a whip and broke a couple of toes.  Nothing was out of place, I knew there was nothing they would do, so I skipped the doc.  A bit later I went to see a PT (I had PTO so I could self refer) and she (been seeing her for ages) told me I had to see a doc before she could do anything.  The doc (sports medicine that deals with NCAA and pro athletes) confirmed I broke 3 toes, said they were healing, and said the only think they would have done is give me a walking boot.

But, if something were out of alignment, crooked or otherwise really really painful, I am going to the doc.