Part Three of this three-part series on Hangboarding for Climbers focuses on Finger Injury Management. Click Here for Part One – Getting Started, and Part Two – Injury Prevention.
For a climber, the devastating pop and pain in your finger can be soul crushing. If you plan your week around training and projecting, then a finger injury can set you back for weeks or will side line your goals. Often the response is rest, taping, a bit of rubbing then attempting to get back to full training which can lead to chronic finger pain. Climbers might avoid treatment for fear of being told to not climb and pick up hiking instead. Never fear, there are ways to rehabilitate the injured finger and it includes climbing! But let’s first look at what it is, why it happens and how it can be treated.
Finger injuries are one of the most common experienced by climbers and the majority of these injuries are to the pulley system. This photo shows the bones of the hand called phalynx and the two flexor tendons that run to the tip of your finger and middle bone. These two flexors allow us to flex and extend the joints in our fingers independently at the interphalangeal joints. The connective tissue holding our tendons close to the bone are called annular pulleys and we have five in each finger.
In climbing we often need to load a large portion of our body weight on our fingers while holding small edges only a few millimetres wide. As we load our fingers, significant force goes through the pulleys, repetitive loading in the area or sudden increase in weight can load the area too much leading to a partial or total tear. The most common cause of pulley injury is an increase in weight through the hold, such as when a foot slips off or excessively loading with a reduced angle of the fingers such as a big move off a crimp.
There are four grades of pulley injury depending on severity of injury to pulleys:
Grade 1: The partial tear of single pulley
Grade 2: Complete A4 or partial A2/3 rupture
Grade 3: Complete A2 or A3 tear/rupture
Grade 4: Annular Pulley Ruptures, single or multiple rupture to pulleys with possible lumbrical or collateral ligament trauma
Symptoms of a pulley injury include:
- Tenderness to the base of the finger
- Swelling or bruising around base of finger
- Difficulty flexing the finger
- Pain with gripping or resisting finger flexion
To get a clear diagnosis on the severity of your injury it is best to undergo a full assessment from your Physiotherapist. In some cases an ultrasound might be required. The severity of your injury will affect your rehab and recovery time.
Lower level pulleys recovery will include a reduction in training but generally do not require splints. Climbers start by regaining full pain free range of motion through exercises like tendon glides or towel squeezes. This is followed by progressive loading and functional training on easy climbs or a hangboard.
It is ok to return to open hand climbing as long as it is pain free but you will generally being climbing multiple grades lower than your normal red point grade. It can take six weeks to work back to full climb strength but is advised to tape over finger while climbing for up to 3 months following the injury.
For higher grade pulley injury it is recommended for finger to be immobilized for 10-14 days in a splint to unload the tissue and allow it to heal. Then climbers can begin range of motion exercises and gentle loading through fingers until pain free. Climbing can be re-introduced around four weeks at reduced levels with recommended taping to be used during this time for 3-6 months. With these injuries it can take 3 months to return to full climbing activities.
Unfortunately for the grade four pulley injuries, surgery is necessary followed by two weeks of immobilization in a splint. This rehabilitation takes more time starting with range of motion exercise, progressive loading and a gradual return to climbing over 6 months to a year.
Regardless of you level of injury it is important to be patient and diligent with rehab exercises. Coming back too quickly can lead to chronic injury. However, completely avoiding any movement that isn’t comfortable will prolong healing and make return to climbing more difficult. It is best to get assessed and guided on your rehab journey. Although reducing climbing is never fun, backing off finger intensive training makes room for cross training. Climbers can focus on core, shoulder strength and hip mobility so they come back stronger after injury.
Resources
Schöffl V, Hochholzer T. Pulley injuries in rock climbers. Wild Environ Med. 2003;14(2):94–100. doi: 10.1580/1080-6032(2003)014[0094:PIIRC]2.0.CO;2. [PubMed] [CrossRef] [Google Scholar]
https://www.climbing.com/skills/how-to-prevent-and-treat-finger-flexor-pulley-injuries/
SIMPLE TREATMENTS AND EXERCISES TO KEEP YOU ON THE ROCK AND OFF THE COUCH Mike Gable DBT
Crowley, T. P. (2012). The flexor tendon pulley system and rock climbing. Journal of hand and microsurgery, 4(01), 25-29
ROHRBOUGH, J. T., MUDGE, M. K., & SCHILLING, R. C. (2000). Overuse injuries in the elite rock climber. Medicine & science in sports & exercise, 32(8), 1369-1372.
