[cofe]

Not about the road in Kent.

Wondered if there was any up-to-date thinking on diagnosis and treatment of A2 injuries? I appear to have done my RH ring finger, which I think I did years (15+) ago. Didn't hear or feel it go; it just became sore about 10 days ago and clearly isn't up to climbing at the moment. Happy Christmas etc.

Have read this and other similar things, which reference Volker Schoffl. Also, understand these things are almost impossible to diagnose properly without ultrasound.

Any new links/science/treatment options much appreciated.

[Ru]

The following is my own take on pulley injuries formed after talking to and climbing with Volker a lot and talking to other orthopaedic surgeons and physios over the years. Unless you have completely ruptured 3 pulleys on the same finger, surgery is not recommended. You generally know if you've done that - audible cracks, swelling with visible bruising and a clearly bowstringing tendon. Anything less that that and the recovery protocol is basically initial rest, followed by gradual progressive loading to regain strength. Some think taping works, I know Volker is generally an advocate, but in my experience getting the tape tight enough to support the tendon cuts off the blood supply. It's useful to give you feedback or stop you crimping up whilst in recovery.

If yours has just become sore and it's an old injury site you may have torn some scar tissue or a some pulley fibres or something. I doubt actual diagnosis will change what you do to recover.

Distilling all this down even further into practical advice that is easy to follow, go easy on it for a bit and it will probably get better. If it hurts, stop or do something that doesn't hurt. Pain that gets better as you warm up but comes back afterwards is better than than pain that hurts as you climb. Avoid that. Science still hasn't bettered the normal healing process. Last time I mentioned an injury like yours to Volker he just said, "me too," and set off on his redpoint.

Apart from a few very expensive treatments with inconclusive or low efficacy (like plasma rich platelet injections), almost all sports injuries seem to fall into three categories - it's either completely broken and you're best having it surgically stuck back together, or it's not and you either leave it alone and it basically gets better by its self helped by gradual loading exercise, or it's somewhere in the middle and no-one can decide whether surgery will improve the outcome. There are a few exceptions like tendonosis where eccentric exercises seem to be very effective and some chronic inflammation seems to respond well to a cortisone injection.

[tomtom]

Since re-starting climbing in c.2008/9 I've had two A2 strains - and both have healed fairly fast with just rest for a week or two of rest then open handing things for a few weeks. What I noticed from being older (and having climbed longer) is that they healed faster than ones when I was younger.. just me and n=4 etc...

[SA Chris]

Ru, any mention of friction massage to break down scar tissue or is that BS?

[Ru]

Ru, any mention of friction massage to break down scar tissue or is that BS?

Don't think anyone really knows. Probably won't make it worse.

[cofe]

Thanks Ru. My last one was middle A2, same hand, in early 2016. I made it worse two weeks later by not resting properly initially and then it took a while to recover (followed by secondary injuries; joy), mainly through building up climbing. This injury doesn't feel as bad. I did wrap the finger in tape when I climbed back then, but only so it wasn't possible to crimp: I think DMC recommends this in his book. I'm not convinced you can get tape tight enough to help without affecting blood flow, and therefore recovery. I've read this elsewhere too. Volker recommends the H taping.

I have been doing the cold water (20mins) stuff to encourage blood flow. Feels good.

[Ru]

H taping is supposed to be better at taking load off the pulley, but I'm skeptical about its efficacy. Isa Schoeffl did some cadaver studies that showed it works, but cadavers don't have to pump blood through their fingers at the same time. There are also a few underground treatments with good anecdotal reports of efficacy in injury healing but with no human studies to back them up like BPC-157 injections. I've not read enough about them to comment and clearly cannot recommend.

[Ged]

Alright Cofe. I seem to get an annual dose of a pulley sprain. Usually from unleashing emergency crimp on something in bad conditions, or just generally overdoing it a bit. I often don't notice anything major at the time, but it's stiff the next day. After lots of mucking around with different things, here's what seems to work for me...

Total rest from climbing for 2.weeks to let it calm down a bit. Icing feels nice at this stage, but don't overdo it. Likewise with ibuprofen. Just be patient and go running. Keep moving it through full range lots, but carefully.

Then start doing the pen rolls (look at the Esther Smith article, rubber band stuff, and very steady climbing with absolutely no crimping whatsoever. I tape up here, purely so that my finger can't bend. No support for tendon, just to stop it crimping. Gradually build up the rubber band work and open hand climbing over 2 or 3 weeks, but mainly, keep being patient and go running. This is the key here. They often start to feel better around this time, so I'll get over excited, climb something too hard, and then quickly make my way back to square 1. Or worse. Be patient. It's only a few weeks.

After 6 weeks, start finger boarding. Really gently at first. Aim is to fix your injury, not get stronger (although there's loads you can do around it, like one arm stuff on big holds etc). I do three finger open, then half crimp. At first this hurts the injury a bit. And it feels weak as hell. Like can't actually hang bodyweight off half crimp. Every other day, a good warm up and then gentle half crimp sets (maybe 5 hangs), and every session it will feel stronger and less painful. I think at this stage you're probably OK to carefully ramp up the bouldering too. Stay open handed until its feeling lots stronger.

Usually 3 weeks of this and I start to feel condmfident using a crimp whilst climbing again. I find 9 or 10 weeks from first doing it to pretty much fully recovered. In the past it's taken months and months due to a combination of overdoing it early on, and then not doing the progressive loading.

Article...

https://eu.blackdiamondequipment.com/en_GB/experience-story?cid=esther-smith-nagging-finger-injuries

[cofe]

Cheers Ged. Sounds like I’m already doing a bit too much. Will back off a bit more and the build it back up next year.

[Coops_13]

One thing I found really helpful for my latest finger injury that got me back to near full strength, before the latest wrist injury... was progressive loading over sessions.

After various non-climbing rest and rehab, I started with 2-handed hangs with weight taken off by a pulley. I was on a 20mm edge with -45lb to start and every session I'd slowly decrease the weight taken off (increase once bodyweight is passed). Was really good to be able to track progress and was so psyched when I was back to bodyweight hangs. Half-crimp throughout.

I think the starting point will depend on severity of injury

[hstmoore]

After 6 weeks, start finger boarding.

I'd like to give a shout-out to finger boarding as a rehab method for finger injuries. I seem to have a couple of finger injuries a year. With my most recent injury it had pretty much healed, 90% of the way there, but I still found it really difficult to warm up enough to be able to crimp properly and I had to be very careful with it. It was frustrating because I always had to climb conservatively, especially coming back to the wall after a summer of climbing outdoors.

After two sessions of 5 x 10 second half crimp hangs with no added weight I could suddenly climb on all my subsequent sessions without being cautious. I suppose the fingerboarding brought my injured finger up to a similar level as my other fingers. I'm not totally sure how it worked but it has made a massive different to my recent climbing and the healing of my finger. Totally recommend it when your finger is nearly healed but not 100% there.

[Nigel]

Not about the road in Kent.

Wondered if there was any up-to-date thinking on diagnosis and treatment of A2 injuries? I appear to have done my RH ring finger, which I think I did years (15+) ago. Didn't hear or feel it go; it just became sore about 10 days ago and clearly isn't up to climbing at the moment. Happy Christmas etc.

Have read this and other similar things, which reference Volker Schoffl. Also, understand these things are almost impossible to diagnose properly without ultrasound.

Any new links/science/treatment options much appreciated.

Ay up cofe! If you didn't feel or hear it go then its not that bad, probably. I don't know any science but whenever I do this (usually with a bang to be honest) it's:

1 or 2 weeks off, occasionally rubbing / mobilising / straigtening finger as appropriate..

Easy climbing for a couple of weeks / a month (severity dependant) with mummifyingly cross taped finger. So a couple of tight turns round a2 base of finger, cross knuckle, across a4, then back down to a2. Tight enough that finger feels numb. Finger should feel locked straight, open hand. Stay in this position. Probably mainly big holds by default.

A couple of weeks / a month of same taping but allowing yourself to half crimp if needed i.e. Try to use smaller holds. Borderline impossible with tape on, especially at start if session as its tight, but it will loosen. Probably still can't do it but just try and hold on. Stop when it aches. Gradual giving in tape as you warm up gives you a natural progression of loading if you stop early.

After that then open hand fingerboarding for a week or two. Then half crimp fingerboarding for a week or two. Tape on or off, or tight or slack, depending on feeling. If you haven't gone mad by this stage then you should be nearly healed, just needing to get some load on to remind it what to do / break down scar tissue.

After that avoid full boning down for another month or two to avoid reinjury, should be healed then.

Basically doing nothing is the worst thing you can do. As is ignoring it. Take the middle way grasshopper. I've taken some fucked ring fingers to font and cone back a happy man. I can't say the same for raven tor.

[tomtom]

One of these massagers might help... I’ve one for sore / stiff post climbing fingers.

Can’t go too far wrong for £1.66 inc postage...

Finger Roller Massager Hand Handheld Blood Circulation Tool Joint Relaxing Massage Tool https://www.amazon.co.uk/dp/B07K427R6J/ref=cm_sw_r_cp_api_i_Ru.-Db6AHV2KP

[Moo]

I'll totally reiterate all the posts on here about progressive loading and trying to keep as active as possible. Something I found really useful to help with this is using progressively more difficult squeeze balls. I've got the set that metolious make.

https://www.metoliusclimbing.com/grip_saver_plus.html

I'm no advocating these ones particularly, in fact I sacked off the stretchy rubber band bits because I thought they felt a bit pointless. Something like this is good for really high volume of very light loading which can help align and strengthen scar tissue moving the finger through its full range of motion and helping increase blood flow. I found them particularly useful to have sitting on the desk at work so you can exercise with them a little and often. The main downside of the these is that they're quite expensive so I don't know if anyone knows of a cheaper alternative?

I've tried the squeeze putty in the past as well but I that didn't seem to work for me.

[duncan]

For soft tissue injuries in general...

Effective:
Relative rest immediately after injury followed by progressive loading during healing
(more aggressive loading if a long-term problem).

Fingerboarding could be good way to reintroduce loading to your healing pulley: it’s easy to control the grip type (crucial, start open-hand obviously) and the load. I’ve found bathroom scales easy to use if you want to apply a low load.

Ice may promote local blood flow in very superficial tissues, eg fingers, certainly gives pain relief, is relatively harmless and cheap.

Shockwave Therapy (low quality evidence, may turn out to be a placebo).

Placebo:
Acupuncture rings and other massage devices (use your fingers).
Acupuncture.
Ultrasound.
PRP (profit-related placebo).


Unknown:
Deep friction massage.

Avoid
NSAIDs. Likely interfere with soft-tissue healing a little, probably a small effect only.
Steroid injections, unless very clear indication.

There are likely to be exceptions to all these suggestions, discuss with the person treating you.
 

[cofe]

Cheers for the extra feedback. While it's disappointing no one has found a magic cure for pulley injuries since I last did one, I'll keep chipping away.

[tomtom]

Cheers for the extra feedback. While it's disappointing no one has found a magic cure for pulley injuries since I last did one, I'll keep chipping away.

Don’t chip it!

[cofe]

Coming up to 10 weeks and I can climb OK-ish (can't bone/bear down on that hand, certainly can't crimp). Still tender, not painful, but always the same. Have been taking it steady. Disciplined light/controlled fingerboarding, no hard climbing. But there is a fairly pronounced ridge/lump around the palmar side of the finger roughly at the bottom (palm) end of the A2. Starting to think it might be something else. Tenosynovitis or some other strain/thing. Any ideas? 

[SA Chris]

is it not scar tissue? Cross friction massage to break it down?

[Bradders]

Coming up to 10 weeks and I can But there is a fairly pronounced ridge/lump around the palmar side of the finger roughly at the bottom (palm) end of the A2. Starting to think it might be something else. Tenosynovitis or some other strain/thing. Any ideas?

I have the exact same thing on my LH middle A2. It appeared one day alongside a minor pulley issue and the two seemed like they must be linked.

Have speculated that it might be various things but never gone to get it actually diagnosed. Main theory was either some sort of synovitis or a ganglion cyst which might be a direct result of the tissue damage in the pulley.

I got the injury in late Spring 2018 and did what you're doing over summer, lots of gradual fingerboarding, building up adding weight and open handing stuff. Back to full crimping by October and set a new max hangs PB in November. Whilst the lump is very much still there it causes no issues.

[cofe]

Sounds similar. Doesn't feel like a usual pulley thing or what I've experienced with scar tissue in the past. Might just take a while to settle down and I'm being impatient. Not a lot of people you can see about this kind of thing. Given it felt a minor tweak at the time I'd expected to be building it back up again soon.

[spidermonkey09]

Thread refresh:

My RH ring A2 is sometimes sore, not constant but occasionally gives me a bit of gyp. I have been prophylactically taping it for at least the last few years, can't remember when I started. This seems to help and its never stopped me climbing.

Over the summer I was consistently doing three finger drag, openhanded hangs on the RH, on the middle slot of the BM2K with a few kg of assist. I can't do that anymore and the position feels tweaky and painful. There is no pain in the finger at all when half crimping, I can fingerboard fine in that position, and I have been carefully fingerboarding in 3FD with both hands on. This is sometimes with some reasonable weight added - up to 15kg in Anderson hang sessions.

Today after climbing at the weekend it is a bit sore but suspect it won't be so painful I can't fingerboard. I have no discernible pain in palm or forearm which would seem to make a flexor strain less likely. Whats going on here, and is my current plan of just carry on doing what I'm doing carefully the right one?

[mrjonathanr]

In terms of re/prehab, this may be worth your time.
https://useful.coach/articles/nutrition-for-soft-tissue-training-recovery-and-injury-prevention/

[SA Chris]

I either strained or partially tore A2 on 22 October (sore on sides right at base of finger, and swollen after climbing wall session).

Followed most of the above, and am now climbing lightly on it once a week (big holds, no crimps)  using some squeezy putty or a hand exerciser dialled right down and taping as a precaution.

There is no pain in general use, and a bit sore after climbing, but it still looks pretty swollen, is this common?

Managed to avoid any finger injuries for quite while (15 years?) so wondering if it changes as you get older.

[highrepute]

I had a probable full rupture of A2 just over a year ago.

Was swollen for quite a few weeks.

I rested for 5 weeks the started easy climbing. It was still swollen at this time. Built up very slowly. Back to hard climbing in 3 months and very hard climbing with nasty crimps in 6 months.

H-taping is the recommended taping.

I saw a physio called James at Sheffield Climbing Clinic who was very good. Saw him twice. Worth the Dosh to know I was doing the right things.