[jooonas]

Hi!

I managed to injure my left hand ring finger while bouldering on a two finger pocket where alot of load was put on the ring finger. Initially i didn't think it was so bad. I experienced some pain in my palm but i still finished the session with some easy traverse (no pain). Now after 4 days of complete rest i can hardly load the finger at all in open hand before there's pain. The pain is located from about the middle of the palm to  the first knuckle. Loading the finger in a crimp position is much less painful.

Any advice?   

[cjsheps]

Please help!

I was doing some front-3 half crimping on the fingerboard two days ago, when I felt a sudden twinge in my left ring finger. I moved on, and had a decent session. However, the next day, it hurt (and still hurts) to extend my middle and ring fingers to the limit of their range of motion.

There's no inflammation or pain with pressure on the finger, and it doesn't feel like it would hurt when crimping again or using four fingers open handed. The only thing that seems to hurt is this extension, but it's quite noticeable (hurts when I catch it on something, not climbing).

I'm not quit sure what I've done, so any diagnosis and/or advice would be very much appreciated!

[Luke Owens]

Back in January when I was climbing, using an open handing pinch at an awkward angle my wrist cracked. It was a bit painful afterwards. Since then it's never got any better but never got any worse until now. It seems to play up more when i'm draging holds and I can feel it really pulling on my wrist like it's going to pop! When I also hit a hold in a certain way and I feel the pain my grip goes very weak.

Any ideas? Not sure what i've done and how to sort it...

Cheers

[roddersm]

ok played 9 holes of golf there on Tuesday for the first time in my life. Mid way through I started getting a pain in the outside of my elbow. It eased off after a day or so and have done a couple of short sessions in the wall with only a little discomfort since.

Today I am getting a sharp pain in the outside of my elbow when I rotate my forearm outwards and, to a lesser extent, straighten my arm.

Is it possible to get acute tennis elbow from golf??     

[webbo]

Only if you play with a Racquet instead of a club.

[roddersm]

The way I was swinging those clubs I may as well have been...

[HPclinic]

Boom!

I've injured what feels like the longhead of bicep tendon in my shoulder: a dull ache at the front of the shoulder near where where the bicep joins. I did it on a high gaston move (annoyingly on my first proper route following a six month layoff following spine surgery). It's been 19 days now and I haven't climbed on it.  It doesn't hurt too badly with light resistance - more just what feels like hard to shift inflammation.  I've started light therabanding and some scapular press-up+ and normal press-ups. My question is about deep friction massage.
I had a similar injury from mixed climbing in Canada about 8 years ago - then it was quite a bad strain of 3 of the 4 rotator cuff muscles from falling onto one arm and twisting. My left shoulder has since then been way tighter than the right one, presumably from scar tissue shortening. Back then I saw a Canadian physio for 6 weeks who did some sickeningly painful deep massage during the rehab phase, using these little blunt metal 'blades' called graston tools: http://www.grastontechnique.com/. It seemed to work well then and I'm wondering if I should try to aggressively massage this one during the healing phase and if there's much evidence to show it improves healing time? Also any general tips for rehabbing a minor bicep longhead strain which is starting to feel stubbornly inflammatory.

Hi, sorry about the delayed response I have been away. I know you are now a few weeks further on. I am presuming you have not ruptured the head as you would notice a large lump when you bend your elbow and it would feel extremely weak.
In theory there shouldn't be any inflammation now and I am sceptical on whether frictions will help (evidence on frictions is poor). They certainly will not harm you but the tissue will be more mature now. The best way to recover is to increase tissue strength and to put a graduated load through it ie lower grades/ low intensity and slowly increase as symptoms allow.
The things to be careful of are any compensations at the shoulder i.e. is it more forward when you are loading the arm and if there is a chronic tightness are you again compensating. Let me know how it is now as this mail is 2 weeks old.
regards Matt

[petejh]

Thanks for the reply Matt. I restarted climbing at low intensity about a week ago. It feels fine with anything apart from gastons (which was how I tweaked it). Now it's feeling good enough for my trad proj's!
I haven't done much frictioning, just a couple of times around the time I posted. Have been doing lots of pressup + in an attempt to wake up the serratus, therabanding in various configurations to try to target rotator cuff. I've also been doing a lot of other core/kinetic chain exercises from a personal trainer I've been seeing for rehab following back surgery last year, and this work targets the shoulders too. Especially useful are some thoracic mobility exercises.
I'm aware of it being much tighter than the uninjured shoulder - it always has been since the previous rotator cuff tears - so I'm trying to stretch it a few times per week: scarf stretch, pecs stretch against doorframe, kneeling 'bowed forward' yoga type stretch with arms out in front on ground. Any other stretches I can find on the web.

Great thread you've got going here.

[HPclinic]

Hi!

I managed to injure my left hand ring finger while bouldering on a two finger pocket where alot of load was put on the ring finger. Initially i didn't think it was so bad. I experienced some pain in my palm but i still finished the session with some easy traverse (no pain). Now after 4 days of complete rest i can hardly load the finger at all in open hand before there's pain. The pain is located from about the middle of the palm to  the first knuckle. Loading the finger in a crimp position is much less painful.

Any advice?

Hi, sorry about the delayed response I have been away. It sounds more like a tendon strain rather than a classic pulley injury. The tendons for your ring finger are attached to the same muscle belly as all of the other finger tendons.They are separate tendons in the palms so I think you may have strained it near to the A1 pulley. That would make sense regarding crimping as I would expect a pulley injury to not tolerate this type of hold.
I would imagine you have tried to climb again as it is now a few weeks on from the initial strain. Basically gradually load the hand on a variety of holds and increase as symptoms allow. You need to load the tendon but in a graduated way. Please let me know how things are going as this is a delayed response.
regards Matt

[HPclinic]

Please help!

I was doing some front-3 half crimping on the fingerboard two days ago, when I felt a sudden twinge in my left ring finger. I moved on, and had a decent session. However, the next day, it hurt (and still hurts) to extend my middle and ring fingers to the limit of their range of motion.

There's no inflammation or pain with pressure on the finger, and it doesn't feel like it would hurt when crimping again or using four fingers open handed. The only thing that seems to hurt is this extension, but it's quite noticeable (hurts when I catch it on something, not climbing).

I'm not quit sure what I've done, so any diagnosis and/or advice would be very much appreciated!

Hi, it could be that you have overloaded or irritated the joint. Inflammation will not always be present or easily seen. Pain with extension could indicate a mild pulley or cruciate ligament strain. The best thing would be to back off the intensity of the climbing and start stretching the finger. Try to regain full extension. You may have already started back climbing so just ease in to the increased loading manoeuvres and crimping. If it is not going in the right direction send me another post.
regards
Matt

[as646]

I have an issue with the end joint of my left middle finger (near C3, I guess?). The pain seems to be localised around the outside side of the finger.

With the finger fully extended, if I push upwards against the tip and resist it (like an isometric hold), I can feel a pain in the joint. Doing the same thing with a bent finger is fine. Climbing pretty much mirrors this; crimping is okay, open handed not so much.

It happened about 10 days ago and has gotten a bit better since then, but I've not noticed any improvement over the last 4 or 5 days specifically. Should I just give it another week of no climbing? I find it quite difficult to limit myself to only easy things...

[mrjonathanr]

Hi HP clinic,

I have a right elbow FCU tendinopathy on the epiciondyle itself ie right where the tendon joins the bone.   I've been receiving treatment from a physio whose advice I respect, but progress is currently poor.

I'm doing neg eccentrics with an 8kg dumbell, 2 sets of 15, 5 secs duration per rep, once a day.

My climbing is limited to 2-3 hrs a week spread over 2-3 indoor sessions , avoiding extending my arm ie only using the arm in a limited range.  This is manageable,  but still causes soreness.

Have you used any different protocols for similar tendinopathies with a measure of success? Any suggestions about a different approach? My climbing has really hit the buffers:  I'm not really enjoying being a 95% ex-climber.

thanks!

Jon

[HPclinic]

Back in January when I was climbing, using an open handing pinch at an awkward angle my wrist cracked. It was a bit painful afterwards. Since then it's never got any better but never got any worse until now. It seems to play up more when i'm draging holds and I can feel it really pulling on my wrist like it's going to pop! When I also hit a hold in a certain way and I feel the pain my grip goes very weak.

Any ideas? Not sure what i've done and how to sort it...

Cheers

Hi sorry about the delay in responding. We have had holidays and a backlog of responses.
It doesn't sound like a tendon issue as I think you would not have been able to continue climbing. When a joint cracks it is difficult to say what the sound is from. Sometimes it is a release of pressure or tendons flicking over a boney prominence. The fact that your wrist feels weak may indicate a mild subluxation of one of your small carpal bones and the pain is inhibiting the movement or there is a mechanical disadvantage. Depending on where you feel the pain there is also a cartilage disc between one of the joints that occasional moves and again causes discomfort. It may be worth visiting a physio or you may now have found that the problem is resolving as your message is 2 weeks old. if you wish call me for further advice on 0114 2671223.
Let me know how you are going.
regards
Matt

[HPclinic]

ok played 9 holes of golf there on Tuesday for the first time in my life. Mid way through I started getting a pain in the outside of my elbow. It eased off after a day or so and have done a couple of short sessions in the wall with only a little discomfort since.

Today I am getting a sharp pain in the outside of my elbow when I rotate my forearm outwards and, to a lesser extent, straighten my arm.

Is it possible to get acute tennis elbow from golf??   

Hi, if you are trying any activity or sport that is new to you regardless of strength and fitness then you can be prone to injuries. Basically we adapt to an activity over time, and stresses to muscles, bones, ligaments and tendons are necessary to get stronger and hopefully improve. For example a climbers finger tendons will be a lot stronger than an average person and usually there are boney changes at the finger joints due to putting stresses through them and jamming them into small holes. To cut a long story short you can irritate the common muscle/tendon attachment at the elbow. It may also be that the joint is grumbling from twisting and over extending during the golf stroke. Hopefully this has settled now but let me know if you are experiencing further problems.
regards
Matt

[HPclinic]

I have an issue with the end joint of my left middle finger (near C3, I guess?). The pain seems to be localised around the outside side of the finger.

With the finger fully extended, if I push upwards against the tip and resist it (like an isometric hold), I can feel a pain in the joint. Doing the same thing with a bent finger is fine. Climbing pretty much mirrors this; crimping is okay, open handed not so much.

It happened about 10 days ago and has gotten a bit better since then, but I've not noticed any improvement over the last 4 or 5 days specifically. Should I just give it another week of no climbing? I find it quite difficult to limit myself to only easy things...

Hi, The fact you can crimp but open handed is more uncomfortable may be related to a tendon issue or pulley. Basically you have two flexor tendons running up the fingers with 5 pulleys (A1-5) and cruciate type ligaments keeping them in place. One of the tendons finishes below the last joint so it may be that the crimp is using the longer of the two tendons and hence you are ok. If it is a pulley strain then you do need to back off and SLOWLY increase the grades and volume as symptoms allow. As long as you grade the progression things should settle. Total rest at this stage isn't really indicated.
let me know how you are going.
Regards
Matt

[HPclinic]

Hi HP clinic,

I have a right elbow FCU tendinopathy on the epiciondyle itself ie right where the tendon joins the bone.   I've been receiving treatment from a physio whose advice I respect, but progress is currently poor.

I'm doing neg eccentrics with an 8kg dumbell, 2 sets of 15, 5 secs duration per rep, once a day.

My climbing is limited to 2-3 hrs a week spread over 2-3 indoor sessions , avoiding extending my arm ie only using the arm in a limited range.  This is manageable,  but still causes soreness.

Have you used any different protocols for similar tendinopathies with a measure of success? Any suggestions about a different approach? My climbing has really hit the buffers:  I'm not really enjoying being a 95% ex-climber.

thanks!

Jon

Hi Jon, the exercises you have been given are certainly ones that are commonly given although the evidence on the use of them is still debateable. It is all too easy to think that just doing eccentric exercises will be the cure. The weight you are using is quiet a lot, I would be tempted to reduce the weight, do higher reps ie 20+ and twice a day. The evidence for eccentric exercises is more to do with Achilles tendonopathies.
The other structures that can give similar type symptoms around the elbow are nerves and the joint itself. The cervical spine can also refer in to the elbow.
I would also consider what you do in the day ie are you doing a lot of typing or mouse work. If so look at posture and where you arm is ie are you reaching forward too much or slumping when you sit. Climbers tend to be stiff in the thoracic spine and will tend to favour slumped positions, so every now and then reach to the ceiling and lift your chest X10.
I would also consider what you are doing with you arm and trunk when you are climbing as you may be compensating and overusing your forearm for a more proximal weakness.
Taping the elbow or muscle belly may reduce symptoms during climbing.
Climb at a level that is relatively comfortable and start with 20-30mins (may be less). If this is ok during, after and the next day then slowly add routes or time as symptoms allow. Basically graded progression is best rather than climbing and it being too sore.
Hope this helps and I would subtley ask the physio about some of the things I have mentioned.
regards
Matt

[mrjonathanr]

Brilliant Matt,
Thanks for taking the time to reply. I'll think about those other things and see if we can tweak the exercises. I'd be happier if I were making some better progress.
Regards
Jon

[205Chris]

Hello HPclinic,

Back in January I felt a slight twinge in my left hand middle finger when climbing. I didn't really notice any pain at the time so finished my session. The following morning it felt sore at the base of the finger. Being an idiot I carried on climbing on it for another few weeks and it wasn't until March that I started trying to manage the situation.

The current status is that climbing open handed on my finger feels OK, but any holds in the full crimp position make it hurt. It is also slightly swollen towards the base and when I massage it there is what feels like a small lump on the left hand side of the proximal phalanx.

I don't think it is a pulley injury as I've had these before. Just wondered if you had any advice on what it could be and suggestions for managing it.

Thanks.

[roddersm]

ok played 9 holes of golf there on Tuesday for the first time in my life. Mid way through I started getting a pain in the outside of my elbow. It eased off after a day or so and have done a couple of short sessions in the wall with only a little discomfort since.

Today I am getting a sharp pain in the outside of my elbow when I rotate my forearm outwards and, to a lesser extent, straighten my arm.

Is it possible to get acute tennis elbow from golf??   

Hi, if you are trying any activity or sport that is new to you regardless of strength and fitness then you can be prone to injuries. Basically we adapt to an activity over time, and stresses to muscles, bones, ligaments and tendons are necessary to get stronger and hopefully improve. For example a climbers finger tendons will be a lot stronger than an average person and usually there are boney changes at the finger joints due to putting stresses through them and jamming them into small holes. To cut a long story short you can irritate the common muscle/tendon attachment at the elbow. It may also be that the joint is grumbling from twisting and over extending during the golf stroke. Hopefully this has settled now but let me know if you are experiencing further problems.
regards
Matt

Thanks for the reply, thankfully its since settled down but for sure no more golf for me! bouldering is much safer,..

[HPclinic]

Hello HPclinic,

Back in January I felt a slight twinge in my left hand middle finger when climbing. I didn't really notice any pain at the time so finished my session. The following morning it felt sore at the base of the finger. Being an idiot I carried on climbing on it for another few weeks and it wasn't until March that I started trying to manage the situation.

The current status is that climbing open handed on my finger feels OK, but any holds in the full crimp position make it hurt. It is also slightly swollen towards the base and when I massage it there is what feels like a small lump on the left hand side of the proximal phalanx.

I don't think it is a pulley injury as I've had these before. Just wondered if you had any advice on what it could be and suggestions for managing it.

Thanks.

Hi, as you probably know crimping will put more stresses through the tendons and in particular the distal pulleys. It is difficult to say whether it started off as a small pulley strain and you may have continued to overload it. It is ok to climb but there will be a period where you have to back off the intensity and the grades. You need to climb as symptoms allow and increase gradually to allow the tissue to adapt to stresses ie add in more crimps.
It could also be that the joint is irritated. Check that you have full extension and flexion. Also check that the control at all your finger joints is equal. What I mean by this is apply some resistance to the tip of the middle finger from a clenched fist position. You should be able to uncurl you finger without any joint "snapping" backwards. Once the finger is straight curl it back to the palm, again with control. Apply as much resistance as you can control.
let me know if things are changing, otherwise visit a local physio for a more detailed look.
regards Matt

[sidewinder]

While moving above a small pinch/crimp something felt wrong in my RH middle finger (yesterday) I stopped and abandoned my holiday  .  I now have noticeable swelling between the knuckles of my third (middle) and fourth (ring) finger, along with pain in the base of the third finger when I fully straighten the finger, resist on a very open crimp positions and some pain if I make the third and fourth finger move contrary to each other (always at base of finger rather than standard ring pulley pain I have experienced before).
This is outside my normal finger injury/rehab experience, I am guessing I have done something around where the tendons of the third and fourth finger meet/are shared?  Any advice other than rest/ice/cold water (how long icing before switching to cold water)? Any taping strategies that may help on returning to climbing?
Thanks in advance.

[abarro81]

I have an ongoing collateral ligament injury in a middle finger. Since pushing it too hard again last weekend it now clicks and crunches like nothing else when stretched, and sometimes clicks quite a lot just opening and closing it. Any thoughts/advice on how concerning that should be?

[HPclinic]

While moving above a small pinch/crimp something felt wrong in my RH middle finger (yesterday) I stopped and abandoned my holiday  .  I now have noticeable swelling between the knuckles of my third (middle) and fourth (ring) finger, along with pain in the base of the third finger when I fully straighten the finger, resist on a very open crimp positions and some pain if I make the third and fourth finger move contrary to each other (always at base of finger rather than standard ring pulley pain I have experienced before).
This is outside my normal finger injury/rehab experience, I am guessing I have done something around where the tendons of the third and fourth finger meet/are shared?  Any advice other than rest/ice/cold water (how long icing before switching to cold water)? Any taping strategies that may help on returning to climbing?
Thanks in advance.

Hi, the tendons for your third and forth fingers are separate although from the same muscle belly further up your arm (deep and superficial tendons come from flexor digitorum longus and flexor profundus muscles). As you may know you have 5 ligaments known as your A1-5 pulleys and there is one at the base of your fingers (A1) although less commonly strained. You seem to have either strained this or the tendon/tendon sheath as you are getting pain with increased tension or load. Either way the management would be similar. For the first three days (and longer if you like) ice is a good idea to minimise the amount of swelling. Ultimately swelling is normal and is part of tissue repair. After this period regular finger flexion and extension is necessary and then add graded resistance by curling and uncurling individual fingers using the other hand ie start with fingers into the palm then add resistance to the tip of the finger and slowly uncurl making sure that the movement is smooth without joints snapping backwards. When the finger is straight then curl back to the palm smoothly. Discomfort is acceptable. Increase resistance as symptoms allow.
Start climbing on lower grades with bigger holds and add occasionally add crimps. Gradually increase the loads to put a controlled stress through the fingers and progress as symptoms allow.
Hope this helps and let me know how you are going.
Regards
Matt

[HPclinic]

I have an ongoing collateral ligament injury in a middle finger. Since pushing it too hard again last weekend it now clicks and crunches like nothing else when stretched, and sometimes clicks quite a lot just opening and closing it. Any thoughts/advice on how concerning that should be?

Hi, might need a little more info. on how you injured it? The collateral ligs will be strained when the fingers are moved excessively lateral ie sideways, or repetitively laterally. If you feel it is one of the collaterals then try taping specifically around the joint and back off any finger jams or any sideway strains for 2-3 weeks as symptoms allow.
The only other thing is that the noise/clicking could be coming from the joint itself or the tendon sheath. The same advice would apply ie back of the grades and loading and make sure you have full flexion and extension at all the joints of that finger. Let me know how you are going. Regards Matt

[psychomansam]

Hi,

Controversially for this site, I have a running injury. Right knee, when slightly bent and loaded with any lateral movement outwards. Hurts, feels weak. Only noticeable when loaded in that way. Feels like a tendon on the inside of the knee. Medial collateral ligament perhaps? Been bugging me for a couple of weeks. Now becoming a problem for running.
Don't know how I did it. Most likely running as I've been increasing mileage recently while doing less bouldering, though obv can't rule out a bouldering fall (but I'd be more likely to notice an acute injury while bouldering I presume).

Can you recommend any exercises to help? Should I brace it for running? Is an exercise bike / rowing an appropriate way to reduce the load on it from running?