[mctrials23]

I know that there are plenty of questions about how to treat A2 pulleys but they are mostly related to how to rest, for how long and how to treat them (hot/cold baths, massage and rest).

There doesn't seem to be a lot of information about how to ease back into loading the injured finger from people that have had these injuries though.

I tweaked my A2 about 2 weeks ago and had minor swelling, a fair bit of pain when crimping and it was stiff first thing in the morning. I rested it till the swelling went down, religiously iced it and stretched it until it didn't hurt any more and there was no pain through its full range of movement. I then went an climbed on it relatively gently and injured it straight away.

After getting pissed off at myself I started from square one again with the rehab but did things slightly differently.

To avoid the stiffness and aching in the morning I took an ibuprofen before bed. My reasoning was that during the day most people are reasonably active in so far as moving their hands and fingers if nothing else. This keeps the area well supplied with blood and coupled with movement, prevents the stiffness and handles the swelling. At night when you don't move and the blood supply lessens, any swelling would adversely affect the supply of nutrients to the finger that it requires to heal. Since I have been doing this I have found the aching and stiffness in the morning to be much less severe.

I bought some theraputty to keep kneading while I work and this seems to have helped a bit as well.

I have also stopped prodding and massaging it until it hurt which seems like common sense really but I couldn't resist seeing how it reacted when there was no pain before.

The main thing that I didn't do on my first session back (when I re-injured it) was climb with only 3 fingers. I was "open" handing things with 4 fingers which is why I didn't think it would give me any problems. All the articles just say "open hand everything as it won't strain the injured A2". Well I don't know if I have an abnormally short pinky but if my little finger is on a hold, I can't properly open hand it. I'm much closer to a crimp than an open hand.

I went for a session yesterday and ignored my pinky entirely and open handed everything with 3 fingers and magically I had 0 issues. I made sure I wasn't jumping about obviously but I was probably only climbing about 2-3 grades lower than when I am completely fit.

I guess the next stage of the rehab is starting to load my injured ring finger in the crimp position but I am very very keen to avoid tweaking it or injuring it again. How have those of you that have successfully recovered from this sort of thing eased the finger back into crimping? Fingerboarding with weight taken off? Feet on a box fingerboarding? Very gentle climbing in the crimped position?

Any thoughts are very welcome. I think I have got the first part of the recovery sussed but I really don't want to be a knob and end up back at square one or with another injury 3 months down the line because I haven't stressed the finger back into action in the right way.

[Fultonius]

Not specifically about A2s, but here's some "light reading" about using a fingerboard for recovery... http://ukbouldering.com/board/index.php/topic,8245.25.html

[GCW]

That thread was just daft.  Where is Houd nowadays?

This may be of some use.  Personally, I would tape carefully and avoid anything that feels tweaky.  Vague but you need to use a bit of common.

[tomtom]

Whenever I've injured A2's I've avoided crimping for ages - as in 6 months to a year... I try and open hand everything, and only really bring my crimp out when its a very small edge that you just can't open hand - or if I really need that extra little bit... I think there were probably less than 10 problems I used a crimp on last year.

Maybe use this as an excuse/reason to re-educate your hands not to crimp?

[cha1n]

If you injured an A2 bad enough to cause localised swelling, then going back to crimping whilst climbing after a couple of weeks is very optimistic, even at a low intensity.

You have to use your common sense when choosing a grip position, anything that creates a bend at the PIP or MCP joints is going to load the injured pulley, which surprisingly puts jugs out of the question too in many cases (plus the jugs can really press against the pulley which can be uncomfortable). If I have an A2 pulley I will use a 3-finger drag, where my palm and fingers are in-line from a side view. You can pull surprisingly hard like this with an injured A2.

As Tom has said, you're looking at months of recovery, it usually takes me between 6 and 9 months to fully bone down hard again but for the most part I've also moved away from crimping and will often walk away from a problem if I can't do it half-crimped.

In terms of recovery, I had a brief conversation with Dave Macleod about this on one of his posts and we agreed that it's not a good idea to stop loading the pulley altogether during recovery. Every time I've completely stopped loading an injured pulley for an extended period of time (months, yes I can be that disciplined!), I've re-injured the pulley very quickly after re-introducing the crimp. Dave was quoting 'tendons don't like rest or change'.  I'd say that you should start reintroducing the half-crimp grip at a very low intensity after a 2-3 weeks (from my own experience, I have no scientific evidence to back it up), but I don't mean climbing loads, more gentle pressure applied by the other fingers or a gripmaster or something.

I injured one of my A2's 2 months ago and I've only just started using the injured finger with slight bends in the PIP joint (4 finger drags instead of 3). I plan to build the half-crimp strength up slowly with a fingerboard as it's a more controlled environment.

[mctrials23]

I used to open hand pretty much everything back in the day but there are so many problems that are much easier / require a crimp to get the correct angle on the hold that its hard to remove it from your climbing unless forced to by injury. Once I started half crimping it made quite a big difference to how hard I could pull on a lot of holds.

I guess like a lot of people I don't think about hand position enough to swap between open handed and half crimp when one or the other is batter / more sensible.

I used to open hand and my crimp strength was pants so I worked on that when I realised it was required for some stuff. Then I just half crimped everything because it became my stronger grip.

When I talk about swelling, I don't mean that it was a little balloon, it was simply a little larger than the other ring finger. Barely noticeable and in terms of circumference it was about 3-4mm larger which is very little. In all the articles about this they mention swelling but without any real explanation of what sort of swelling you would see.

[slackline]

Check the blog-pile around 18:00 today when it sucks in the next round of blog posts for a useful one on a forth coming book on injuries from a prominent professional climber.

[andy_e]

Or click here for a less cryptic and more instant solution about that book.

[mctrials23]

Cheers guys. Ordered that because I seem to be tweaking more and more parts of my body as I increase my training load.

[tomtom]

Cheers guys. Ordered that because I seem to be tweaking more and more parts of my body as I increase my training load.

The cause is in your sentence..... slowly slowly...

[mctrials23]

When I rub my finger across the area of the a2 pulley if feel kinda crunchy (across the finger not up and down the length). Is this normal or symptomatic of anything. It doesn't hurt, it just feels a little like when you rub a hacky sack.

[krymson]

that is not fucking normal.

Btw a good way to get an idea of what actually is normal is to compare it to non-injured fingers.

[tomtom]

that is not fucking normal.

Btw a good way to get an idea of what actually is normal is to compare it to non-injured fingers.

I've had that (a little) sounds like scar tissue...

[andy_e]

If it is scar tissue, get a spiky to break it up.

[krymson]

that is not fucking normal.

Btw a good way to get an idea of what actually is normal is to compare it to non-injured fingers.

I've had that (a little) sounds like scar tissue...

Ah, that makes sense. I guess I was just coming off the perspective of - none of my(presumably healthy) fingers make that noise!

[mctrials23]

Right, so I've been resting it more since my last post and its feeling generally better. That crunching feeling on the tendon has 95% gone so I assume it was scar tissue that needed a little help to break up.

I don't find that it hurts or aches in the morning anymore either which can't be a bad thing.

If I just pull on four fingers in a half crimp the area is a little sore but not painful and the pain doesn't persist after I stop. Is this fine or should I be avoiding any load on the finger in the crimp position until there is no pain when I put weight through a crimp.

This isn't hanging on the finger, just putting force through it.

[SA Chris]

If it hurts when you press on the injured spot then either it's not fully heled or there is still some scar tissue. Friction massaging it heals the scar tissue.

http://onlineclimbingcoach.blogspot.co.uk/2010/05/pulley-injuries-article.html

Deep friction massage (DFM)
DFM helps to break up the loose network of scar tissue which forms in an injury, promoting its realignment and strength. Rub the pulley with your thumb, applying firm pressure (moderate pressures dont produce the desired effects). The thumb motions should run lengthwise along the affected part of the finger. Only use DFM when your injury is already well past the initial inflammatory stage and stop if you feel the massage is irritating the pulley or causing excessive pain. Use DFM for a few minutes at a time and begin with very brief applications.

[tomtom]

If it hurts when you press on the injured spot then either it's not fully heled or there is still some scar tissue. Friction massaging it heals the scar tissue.

http://onlineclimbingcoach.blogspot.co.uk/2010/05/pulley-injuries-article.html

Deep friction massage (DFM)
DFM helps to break up the loose network of scar tissue which forms in an injury, promoting its realignment and strength. Rub the pulley with your thumb, applying firm pressure (moderate pressures dont produce the desired effects). The thumb motions should run lengthwise along the affected part of the finger. Only use DFM when your injury is already well past the initial inflammatory stage and stop if you feel the massage is irritating the pulley or causing excessive pain. Use DFM for a few minutes at a time and begin with very brief applications.

Yup - you can be quite brutal with scar tissue massage too.. former student of mine had his cruciates done (he was an american football player) and he used to roll the scar tissue out (replete with popping noises) with glass bottle pressed hard on the knee parts... euch!

[fried]

  Nice tips

I've had exactly the same 'crunchy' A2 since about last October, I'd stopped giving it any thought. 5 mins of brutal massaging and it's almost gone.

[tomtom]

Right, so I've been resting it more since my last post and its feeling generally better. That crunching feeling on the tendon has 95% gone so I assume it was scar tissue that needed a little help to break up.

I don't find that it hurts or aches in the morning anymore either which can't be a bad thing.

If I just pull on four fingers in a half crimp the area is a little sore but not painful and the pain doesn't persist after I stop. Is this fine or should I be avoiding any load on the finger in the crimp position until there is no pain when I put weight through a crimp.

This isn't hanging on the finger, just putting force through it.

When I've had A2's go (always ring finger) I've let the swelling/pain subside, then climbed GENTLY on it all open handed - with the joint heavily taped.. at first this is also taped to restrict bend/movement - so I can't crimp. It then enters a kind of 'recovery' phase where for a couple of months you can feel it, but it doesnt really hurt as such, and as this progresses I increase the movement/load on the finger - and they've got better. Last one (the pop when I make the final move on this vid at 1:43) only took 2-3 months to heal up (surprisingly..)