Continuing to train without using injured finger? (Tenosynovitis)

I recently developed what I think is tenosynovitis in my right pinky. Everything I've read says to rest completely to avoid this becoming a chronic issue, but I'm in the middle of a super important training cycle and have basically structured my entire school term around climbing and training. Since only my pinky is affected, I was wondering if climbing in a three-finger-drag and hangboarding front 3 only would make the issue worse? My biggest concern is the inflammation isn't confined to the finger and does extend to my forearm. However, I don't see why immobilizing my pinky while training with my front 3 fingers wouldn't allow for healing without having to stop climbing. (Also, 3f open hand/drag is my strongest grip position and I tend not to climb with my pinkies very much anyways.) If anyone has any experience or thoughts on continuing to climb without the affected finger let me know!

Hey Olivia,

I feel for you. I had a similar thing happen last summer (popped my pinky A4 pulley) and tried to climb three fingered because I too always drop my pinky. I almost immediately injured my ring finger because when you hold your pinky out, it loads the ring finger tendon system differently and that tendon system is tied to the pinky. I'd really recommend buddy tapping the ring and pinky rather than holding your pinky out or just pausing. Or at bare minimum, certainly don't limit boulder on side pulls that really load the ring finger if you are holding your pinky out. I think it's less of a big deal on down pulling holds but it seems sketchy either way because of the way the finger is loaded differently. For what it's worth, I got Tyler Nelson to help me out with rehab and found it really helpful. I have friends dealing with tenosynovitis who have talked with him and have been happy with the rehab results. Good luck! ~ Anne Mariah

Hi Olivia!

I'm sorry to hear you're dealing with pinky pain that's affecting your climbing, that can be so frustrating. I am a physical therapist and complete rest is not the answer here. If you rest an injury you get weaker and deconditioned, making you more prone to injury once you return and the same issue will likely come back because those tissues have not been strengthened to adapt to the load you're placing on them. I will give you some general tips that help reduce inflammation and facilitate recovery in the body which is helpful 100% of the time but especially when dealing with an injury. I will also give you some guidance from The Climbing Doctor blog that is overseen by Dr. Jared Vagy, a physical therapist in Southern California who specializes in the treatment and research of climbers. They are just guidelines and the best option is always to find a doctor of physical therapy or an occupational therapist who works with hands (and climbing would be huge) to find the root cause of your issue and to create a plan that is specifically tailored to you. If you need help finding someone in your area I'd be happy to help you out!

You're right that offloading the affected finger in the short term can help with symptom management but I would try to not do this for too long. You're also right that inflammation is typically not limited to one local body region but it spreads and can be influenced by inflammation throughout the entire body system. Here are some of the best ways to manage inflammation:

1. Hydration!!! This one is huge as it will help flush out any inflammation and byproducts of healing and will keep blood moving well to bring nutrients to calm the tissues. Avoiding alcohol while healing is also huge as alcohol increases systemic inflammation in the whole body and slows recovery time.
2. Hitting protein targets is necessary for daily recovery from training and is even more important with injury. General guidelines (not specifically tailored for you, but a goal for most athletic populations) is 1.4-2g/kg body weight - A great goal is to shoot for 1 gram per pound of body weight, which is a lot but it is essential. If you have other medical conditions, medications or special diet needs this would be a better topic to discuss with a registered dietician. 
3. Increasing anti-inflammatory foods such as vegetables, fiber, nuts/seeds, etc and limiting inflammatory foods such as processed carbs/sugars, red meats, deli meats, fried foods can be helpful as well. The same goes here as for protein in terms of your dietary needs, if you need any extra help at all, definitely reach out to a dietician for the most accurate and safest information.
4. Optimizing sleep - there is the obvious shooting for 8-9 hours but what is more impactful is your quality of sleep. If you aren't waking feeling well rested then there are likely things you can try to improve sleep quality. If you're doing most of these already it can be helpful to seek the help of a sleep therapist. I'll list several ideas but I would pick 2-3 to incorporate so you don't get too overwhelmed: sunlight directly on your eyes first thing in the morning for 10 min (not through a window), waking at the same time every day, room between 60-65 degrees F, black out the room w/curtains and even the little lights on alarm clocks, fans, etc try to block those as well with some tape (I put a washcloth over mine since it's easy), avoiding exercise within 4 hours of bedtime, avoid caffeine after 12pm (half-life of caffeine is 7 hours), avoiding alcohol/spicy foods within 3 hours of bedtime, reserve bedroom for sleep and sex, warm bath/shower within 30 in of bedtime, limiting blue light before bed (either reading/no screens or using the night settings on your devices w/blue light glasses)
5. Reducing stress - this can have a huge impact on inflammation levels, sleep quality, pain experience, and recovery time. There are so many ways to work on this and it is a personal decision to try a few and stick with the ones that you like best. For that reason I'll list off some ideas but if you have some that work for you stick with those for sure! Breathwork (physiological sigh is worth a google, it's a breath strategy proven to reduce stress and it takes less than a minute, meditation/mindfulness (Calm, headspace, YouTube videos are helpful with this), yoga (yoga nidra is a type that doesn't include any movement but it focuses on full body relaxation).
6. Just throwing in a note here that while you're managing inflammation, NSAIDs (like Advil, Aleve, etc.) are not highly recommended for soft tissue injuries as they have been found to reduce healing time. If you need help in the medication realm as a last resort, I would reach out to your primary care provider or pharmacist and ask about options that are not NSAIDs. 

Now for your finger-specific help! I'm going to link an article below that discusses finger joint swelling. Read through and see if it applies to you, if not, there are additional articles on the blog that review several common finger issues that climbers experience.

Finger Joint Swelling - The Climbing Doctor Blog

Finally, I'm going to include some soft-tissue injury guidelines for you to know how much pain is okay to work through, and how much is too much:

EXERCISE GUIDELINES

• RED is 5+/10 pain = STOP

• YELLOW is 3-4 = monitor 24 hour response to see if loading was appropriate or too much

• GREEN = 0-2 SEND IT

I hope some of this information is helpful and that you're able to continue trying hard and having fun! Let me know if you have any questions!