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Specific knuckle stiffness (Read 8482 times)

spidermonkey09

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Specific knuckle stiffness
March 28, 2018, 10:33:20 am
Thought it worth picking the collective UKB brain about this.

The backstory: August 2017 I went and tried Tales of Yankee Power at High Tor. I spent a long time hanging off a shallow pocket (left middle two, one pad) while I tried to place a shit C3. I fell off anyway (and the piece ripped). Didn't notice anything at the time but over the next few weeks, particularly while bouldering on the Barrel, I noticed quite a lot of stiffness and mild pain in my middle knuckle (PIP joint), on my left hand. I didn't have pain or stiffness anywhere else.

Through googling I diagnosed this as capsulitis and followed a painful regime of aggressively stretching the joint as per Julian Saunders blog and video. Can provide a link later. I also taped either side of the joint when climbing.The stiffness was particularly acute the day after an indoor session, but wasnt noticeable after an outdoor session. Any ideas why? Then it sort of just went away over the winter, so gradually that I didn't really notice it.

A few weeks ago, it came back; still just the one knuckle, on the one hand. I can't think of a particular incident that provoked it, and its not a huge issue as I'm reasonably confident it will go away again in time. However, its bloody stiff this morning after a session last night, to the extent I could only make a fist with discomfort this morning. It does wear off though.

Any thoughts on this? Anyone have anything similar? Does it sound like capsulitis? The weird thing for me is that its limited to just the one knuckle, on one finger, on one hand, whereas a lot of people seem to have more chronic issues with knuckles across multiple fingers. Cheers for any thoughts.

sheavi

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#1 Re: Specific knuckle stiffness
March 28, 2018, 12:03:25 pm
It is perfectly normal for just one joint to be problematic after the incident you mentioned.  It is not possible to accurately diagnose capsulitis from the information you provided.   It may be perhaps a ligament strain or volar plate injury. As to why it was worse indoor climbing - nature of plastic holds, higher volume of climbing indoors to out, trying harder moves indoors??

Stiffness in the morning would probably indicate inflammation - i.e you've overloading the joint again. Are you warming the joint up before climbing and warming down afterwards?  Which finger is it btw? Range of motion/mobility exercises are probably a better bet than stretching.  If it is a ligament/capsule issue these tissues are not keen on being stretched! 

I'd keep it simple - warm up the joint ( and body) sufficiently, ease back on climbing or certain types of holds/climbing if you are getting marked morning stiffness and don't progress your climbing until this eases up.
« Last Edit: March 28, 2018, 12:14:56 pm by sheavi »

spidermonkey09

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#2 Re: Specific knuckle stiffness
March 28, 2018, 12:13:27 pm
It is perfectly normal for just one joint to be problematic after the incident you mentioned.  Capsule/ligament injuries take a very long time to heal.  Are you warming the joint up before climbing and warming down afterwards?

Beyond warming up and warming down as I would normally (basically doing some circuits and light crimping to start and some aerocap to warm down) I'm not doing anything specific for the joint, no. Are you thinking of stretching it or something else? Apologies for being dense!

sheavi

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#3 Re: Specific knuckle stiffness
March 28, 2018, 12:15:32 pm
I've just amended my reply - sorry!

sheavi

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#4 Re: Specific knuckle stiffness
March 28, 2018, 12:22:02 pm

spidermonkey09

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#5 Re: Specific knuckle stiffness
March 28, 2018, 12:28:29 pm
It is perfectly normal for just one joint to be problematic after the incident you mentioned.  It is not possible to accurately diagnose capsulitis from the information you provided.   It may be perhaps a ligament strain or volar plate injury. As to why it was worse indoor climbing - nature of plastic holds, higher volume of climbing indoors to out, trying harder moves indoors??

Stiffness in the morning would probably indicate inflammation - i.e you've overloading the joint again. Are you warming the joint up before climbing and warming down afterwards?  Which finger is it btw? Range of motion/mobility exercises are probably a better bet than stretching.  If it is a ligament/capsule issue these tissues are not keen on being stretched! 

I'd keep it simple - warm up the joint ( and body) sufficiently, ease back on climbing or certain types of holds/climbing if you are getting marked morning stiffness and don't progress your climbing until this eases up.

Interesting, thanks! Yeah I'm no professional so was just punting around on the interweb looking for hints. This was the article I used and did seem to help...if you can get past JS's overly wordy writing style. http://drjuliansaunders.com/ask-dr-j-issue-173/

Its my middle finger, left hand. Will give some exercises a crack though, cheers! Any recommendations or shall I get googling? (Edit: Just saw your post, thanks). I'm notoriously bad at easing up (!) with lime season approaching but if it gets any worse I'll have to consider it!

sheavi

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#6 Re: Specific knuckle stiffness
March 28, 2018, 12:51:29 pm
Good luck!  I always thought this would make a good whole upper limb warm-up and down for climbing. 


sheavi

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#7 Re: Specific knuckle stiffness
March 28, 2018, 12:55:51 pm
Or to give him his correct title Mr Julian Saunders ;)

spidermonkey09

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#8 Re: Specific knuckle stiffness
March 28, 2018, 01:04:22 pm
Thanks! I'll give it a crack.

Hahah here we go...I'm tapping out as the osteopathy/physiotherapy differences escape me a lot of the time! Keen for an expose though  :popcorn:

sheavi

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#9 Re: Specific knuckle stiffness
March 28, 2018, 01:11:08 pm
Ha ha - not having a go at him personally, just the 'unfortunate' use of the title Dr for non-medical professionals or Phd's I think simply misleads the public.  I'm a physio who goes to see an osteo when I need treatment btw. But chiro's and osteo's are not doctors.

Tails

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#10 Re: Specific knuckle stiffness
March 29, 2018, 06:19:22 pm
I had a very similar thing years ago, it was especially bad after climbing indoors. Got to a point that I thought climbing was over, a few medical professionals tried but only got as far as the capsule was inflamed.
I was at a yoga class and the instructor noticed my fingers were not straight in downward facing dog and that the area post knuckle wasn't getting any blood flow. After permission she straightened them. Finger felt much better after and after several practices of getting my finger straight in downward dog the inflammation went.

My 2 cents but I'm not qualified in anything related.

spidermonkey09

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#11 Re: Specific knuckle stiffness
April 08, 2018, 08:28:26 pm
I had a very similar thing years ago, it was especially bad after climbing indoors. Got to a point that I thought climbing was over, a few medical professionals tried but only got as far as the capsule was inflamed.
I was at a yoga class and the instructor noticed my fingers were not straight in downward facing dog and that the area post knuckle wasn't getting any blood flow. After permission she straightened them. Finger felt much better after and after several practices of getting my finger straight in downward dog the inflammation went.

My 2 cents but I'm not qualified in anything related.

Reading this thread as its hurting again and I'm pissed off!

That's interesting Tails, although I'm not quite sure what you mean. What does straightening refer to? I presume some sort of painful wrenching?

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#12 Re: Specific knuckle stiffness
April 09, 2018, 08:27:07 am
I have this on one knuckle on each hand. I've been resting, stretching and icing and it is easing.

Since it became really bad I've become a lot more aware of what I'm doing and realised that my hands are often cold so I've started doing a warm up before climbing to get the blood flowing.

I've got a really sore knee and my back is a bit stiff at the moment too, I had started to wonder if there was something bigger going on but it's probably just general overuse/abuse.

Cheers for the stretches and warm up links, will give them a go.

spidermonkey09

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#13 Re: Specific knuckle stiffness
April 09, 2018, 09:15:40 am
I masochistically iced the whole hand yesterday evening out of sheer grumpiness and I have to say it feels a lot less sore this morning, although still swollen. I think you're right battery; being very aware of how the hand feels and warming the fingers up properly is the way forward.

On that note, anyone got any good methods of warming the fingers up at the crag that mimics the stresses and strains of climbing? Hypothesising with my housemate last night and we thought a combination of a squeeze ball, some deadhangs and maybe one of those gripmaster things should get the blood flowing. Suggestions welcome.

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#14 Re: Specific knuckle stiffness
April 09, 2018, 03:11:45 pm
Ibuprofen will help with swelling. You can get the gel and apply directly to the joint - not sure whether this is actually better than oral use. Make sure you eat when using it and don't use gel and pills together.

I use a Theraband to warm-up at the crag. Doesn't directly target the fingers but being warm everywhere will help warm-up fingers.

sheavi

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#15 Re: Specific knuckle stiffness
April 10, 2018, 01:24:43 pm
Ibuprofen could also hinder full tissue healing and lead to ongoing problems.  Is this finger issue really being properly managed? The same thing keeps happening - are you really expecting a different result?

Tails

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#16 Re: Specific knuckle stiffness
April 10, 2018, 01:32:49 pm
Ha, it does read like a torture technique but it was the opposite.

The instructor gently pulled the end of the finger. It was like I'd forgotten how to fully straighten it as I was used to having the claw. I've just straightened out on the desk next to me and it feels a little uncomfortable like when you stretch properly, but then a release of tension immediately. Got to remember to keep doing it!

spidermonkey09

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#17 Re: Specific knuckle stiffness
April 11, 2018, 11:41:24 am
Thats really interesting. Sort of like cracking your knuckles? Just tried to replicate it but can't so perhaps I have straight fingers!

I've been icing the finger every evening for about 6 minutes by immersing it in cold water. I had a climbing session last night, nothing outrageous, and the joint was stiff but not unreasonably so this morning. Its definitely easier to make a fist than it was, so hopefully its easing.

I am definitely not going to make a habit of using ibuprofen as I gather this is bad karma all round. Basically I'm just looking to manage it as realistically I'm not going to stop climbing; there's lots I want to do this summer and I'm going to Ceuse in July! Hopefully being fairly disciplined with icing, warming up, warming down and stretching will do the job. It went away last time...

 :o :o :o

Tails

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#18 Re: Specific knuckle stiffness
April 11, 2018, 07:29:15 pm
All my joints constantly crack and click but it's not like that. If You've ever had your posture looked at and you learn to straighten up by reaching up with the crown of your head, it's more like that. A little uncomfortable due to habit but it feels like the right position. If you haven't, try a yoga class and have someone point out all the ways you are doing tadasana wrong.

Starting to think the finger thing is peculiar to me.

spidermonkey09

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#19 Re: Specific knuckle stiffness
April 12, 2018, 09:15:47 am
Yeah it would be nice to find the time for yoga but I struggle to feed myself adequately after work and climbing so might be a stretch too far...(sorry)!


duncan

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#20 Re: Specific knuckle stiffness
April 12, 2018, 12:45:25 pm
The stiffness was particularly acute the day after an indoor session, but wasnt noticeable after an outdoor session. Any ideas why? Then it sort of just went away over the winter, so gradually that I didn't really notice it.

A few weeks ago, it came back; still just the one knuckle, on the one hand. I can't think of a particular incident that provoked it, and its not a huge issue as I'm reasonably confident it will go away again in time. However, its bloody stiff this morning after a session last night, to the extent I could only make a fist with discomfort this morning. It does wear off though.

Any thoughts on this? Anyone have anything similar? Does it sound like capsulitis? The weird thing for me is that its limited to just the one knuckle, on one finger, on one hand, whereas a lot of people seem to have more chronic issues with knuckles across multiple fingers. Cheers for any thoughts.

Most people find indoors tweakier than outdoors. Possible reasons might include: higher proportion of dynamic moves, steeper, more powerful moves, greater intensity of sessions (less resting compared to a day/afternoon outdoors), different hold types, inadequate warm-up if a rushed (before/after work) session, and probably many more.

Could be capsulitis though not really enough information to know. <Usual internet diagnositic get-out clause here>. Many joints, symmetrically distributed or a family history of arthritisare some warning signs of a more serious condition. Usual soft tissue injury management techiques apply: try to work out the exacerbating factor(s), change these (relative rest), ice, keep mobile as it heals, avoid ibuprofen and other NSAIs routinely.

The longditudinal stretching of the joint sounds like a fairly common physio. technique. Worth a try.

(from about 2'15")

Some people have one painful finger, others have many. Who knows why. Variable relative finger length? Different stresses will be applied depending on whether you have a short or long ring finger for example. Different rock-types and climbing styles? We should expect variety.

Warming-up outside? Get generally warm (and make an effort to stay that way). The portable fingerboards seem like a neat idea, probably better than a gripmaster if you want to use a device. I'm not a great advert as I mainly tend to warm up on easier routes (and get injured).


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#21 Re: Specific knuckle stiffness
April 12, 2018, 03:02:27 pm
hi Duncan/spidermonkey
My middle finger pip joint is often very stiff especially after indoor session.
I have a pretty significant tender spot/trigger point in the extensor muscle up near the elbow. When I massage/try to release this, the finger pain gets better. Is this 'a thing' which can be explained physiologically or is it psychological. (I also suffer with 'tennis elbow' on the same side , symptoms of which are improved with massage of this point)

Spidermonkey. Try following your extensors up into your forearms to see if you've any tender lumps/gristle which you can go to town on.

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#22 Re: Specific knuckle stiffness
April 12, 2018, 03:51:41 pm
Like Scouse I had tender middle finger PIPs, I found the trigger points for mine are pressure on the palms or vibration from zips.
Used to get intermittent problems with elbows as well.

After asking a masseuse to give my forearms a quick look and him advising they were very tight and full of trigger points, I started self massage on them and actually bought an Armaid in the end (which is great, btw).

They really are full of points from elbow to wrist, inside and out and have benefited daily massage and stretching, haven't had a squeak from either PIP or elbow since becoming diligent about out it 6-8 weeks ago.

I suspect a lot of climbers golfers and tennis diagnoses are down to tightness and trigger points rather than actual injuries which is why many folk find 'alternative' methods work when the usual remedies haven't.

spidermonkey09

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#23 Re: Specific knuckle stiffness
April 13, 2018, 01:06:49 pm
That is really interesting. How are you massaging your forearms?

sheavi

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#24 Re: Specific knuckle stiffness
April 13, 2018, 01:34:55 pm
It is highly unlikely that trigger points in muscles are causing a joint to swell.  The joint is injured and is continually being loaded beyond its current capacity.  Solution is simple but requires self-discipline.

As a side note the Armaid looks like a good self-management tool. 

spidermonkey09

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#25 Re: Specific knuckle stiffness
April 13, 2018, 01:47:56 pm
This occurred to me just after I got interested! The logic doesn't really follow for me sadly.

Scouse D

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#26 Re: Specific knuckle stiffness
April 13, 2018, 02:46:14 pm
No worries. But whether the logic follows or not I'd still have a feel up the top side of your forearm for trigger points as the extensor muscles do refer to the fingers and the joints of the fingers. In your op you said they were stiff, not swollen so it could be referred from forearm? I'm just saying don't rule it out. From mine and nais experience, forearm massage makes the pips less hurty.


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#28 Re: Specific knuckle stiffness
April 17, 2018, 01:28:31 pm

After asking a masseuse to give my forearms a quick look and him advising they were very tight and full of trigger points, I started self massage on them and actually bought an Armaid in the end (which is great, btw).

They really are full of points from elbow to wrist, inside and out and have benefited daily massage and stretching, haven't had a squeak from either PIP or elbow since becoming diligent about out it 6-8 weeks ago.

I suspect a lot of climbers golfers and tennis diagnoses are down to tightness and trigger points rather than actual injuries which is why many folk find 'alternative' methods work when the usual remedies haven't.

+1 to all of the above. After months of trying to sort out tennis elbow with Julian Saunders' exercises etc, i went to a sports masseuse and he utterly beasted my forearms, saying they were ridiculously tight. Within about a week, all pain was gone and (touch wood) hasn't come back. I'm too cheap to buy an armaid, but have had great success with religious stretching
and a standard foam roller up against a wall or somewhere where i pull in and bring full strength against the roller and really work the trigger points. Painful (but not as bad as an Armaid!) but it works.

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#29 Re: Specific knuckle stiffness
May 01, 2018, 11:06:24 am
I'm interested in this thread.

I have a number of finger joints on both hands that are permanently painful to press. Some are a bit swollen and the worst one on my right middle finger DIP is always a bit red/pink compared to a healthy finger. Quite a few of my fingers actually have this red/pink bit going towards the nail actually.

I saw a specialist some time ago who diagnosed it as early onset arthritis (and essentially said, manage it but keep climbing) but reading the above I wonder if I have capsulitis/volar plate injuries and should seek a second diagnosis.

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#30 Re: Specific knuckle stiffness
May 01, 2018, 09:44:49 pm
I'm suffering with middle finger DIP pain just now, right along the back edge of the knuckle (i.e. nail side, not pad side).It mainly hurts when clenching a fist but also certain lifting movements.

 It's been a long onset...."manageable" type of pain. Bit stiff and sore after climbing and the next day. However, last week I was away for a week ski touring and thought "great, a week rest and cold treatment" but it just got worse and worse. It's now quite sharpand the knuckle is starting to look like my dad's when he had rheumatoid arthritis!!!  (i.e. there's a noticeable firm lump on the back outside of the joint line)

Anyway, standard doc appointment tomorrow but we'll see what they say. Wondering if it could be a stress fracture?

Tails

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#31 Re: Specific knuckle stiffness
May 03, 2018, 09:23:13 am
I'm interested in this thread.

I have a number of finger joints on both hands that are permanently painful to press. Some are a bit swollen and the worst one on my right middle finger DIP is always a bit red/pink compared to a healthy finger. Quite a few of my fingers actually have this red/pink bit going towards the nail actually.

I saw a specialist some time ago who diagnosed it as early onset arthritis (and essentially said, manage it but keep climbing) but reading the above I wonder if I have capsulitis/volar plate injuries and should seek a second diagnosis.

I was initially diagnosed with arthritis but as it was affecting my work as an outdoor instructor I was sent to a specialist. He was well regarded and his conclusion was that even though the blood tests and physical signs seemed to be arthritis that it was just inflammation as this can also look like mild arthritis. He was right.

spidermonkey09

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#32 Re: Specific knuckle stiffness
May 03, 2018, 10:30:02 am
What did the doc say Fultonius? I've been managing mine through a bit of stretching, a bit of forearm extensor massage and generally trying to be smart. Hasn't gone away, but hasn't got worse either!

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#33 Re: Specific knuckle stiffness
May 03, 2018, 12:25:42 pm
If you go and see a gp you will get referred on as they are not specialists. This is in no way a criticism as my wife is a GP, they are generally not specialists in musculoskeletasl stuff. If you present with general achey joints and stiffness then there is a very good chance you will be 'diagnosed' with arthritis.
Being told you have 'arthritis' is never helpful. 'Early onset arthritis' sounds terrible. You feel like you are falling apart. It makes you stop using your body how it way designed. I was told I had arthritis in my ankle after I broke it ('OH that's bad arthritis you've got' - guess how that made me feel... guess how that made me walk, 'I've got to be careful, I've got arthritis'). I was subsequently told it wasn't arthritis by a more enlightened healthcare practitioner and I needed to start walking normally and using my ankle. It's loads better now, as is my mental health.
I would stop chasing a diagnosis. A diagnosis of a condition makes you feel shite and will only be a guess based on the fact you have inflammation and stiffness. You are far more likely to have overused some muscles in your forearm than have developed a degenerative condition to worry about.  Have you been climbing loads? Have you done much forearm care? Have a good feel up the extensors on the back of your forearm. Healthy muscle shouldn't have tender points, I reckon you'll find some up near the elbow on the top of the forearm- have a good dig about. Try pressing into these spots firmly for about 30 seconds or so until the tenderness diminishes then wiggle your fingers to see if they feel a bit less stiff. If hey do then it's probably worth getting a sports massage/trigger point/dry needle/whatever massage technique you prefer.

Fultonius

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#34 Re: Specific knuckle stiffness
May 03, 2018, 01:12:41 pm
GP was great, said it could be a Heberden's node (arthritis) but more likely a ligament inflammation or potentially a stress fracture.

Sent straight for an xray, which, praise to our local NHS was done in about ten minutes from entering the hospital!

Strong anti inflamatories and rest, wait for results.
« Last Edit: May 03, 2018, 01:28:56 pm by Fultonius »

pat69

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#35 Re: Specific knuckle stiffness
May 09, 2018, 11:18:04 am
I've been using the wave tool to work on adhesions and also to increase blood flow after hard sessions and general maintenance on my  fingers and arms with some real success.

[https://youtu.be/X4V1Qs41dHE]

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#36 Re: Specific knuckle stiffness
May 23, 2018, 07:24:24 pm
X-Rays all clear, so no bone injuries or arthritis. Not much help or advice either...
Quote
It'll get better with rest.
  Good news I guess, but I'm a bit lost now.

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#37 Re: Specific knuckle stiffness
July 04, 2018, 02:49:09 pm
Unsurprisingly, I didn't get lucky with a super-knowledgeable GP this time...  6 weeks later, no improvement.

Speaking to a climbing mate I got a recommendation to see Phil Mack in Edinburgh as he's apparently pretty experienced with climbers hands. I'm glad I did, but wish I had ages ago!

After 10 minutes of questions and a through examination he showed me on a diagram where the flexor extensor!! tendon bifurcates just past the back side of the DIP joint and where it inserts. Precisely where I've had pain. It was very much an "aha" moment as it explains why it was rarely directly sore from individual moves, but more of a nagging niggly building type pain.

I then said "oh, by the way, I've also had lateral (tennis) tendinitis/tendinosis in both elbows in the last year" - he thought this was linked and it'll be down to a change in my movement patterns.

Either way, deep cross friction, dry needling and some laser for the a few session plus an immediate and careful return to climbing to restore function.

Obviously it's early days but I'm glad to have a diagnosis that makes sense and I can treat. I think Dave Macleod said it right when he said something akin to "keep searching until you find the correct expert". Amen.
« Last Edit: July 04, 2018, 03:14:11 pm by Fultonius »

 

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