New 'Physio Clinic' Q&A session

[CharlieBoulder1994]

Re: New 'Physio Clinic' Q&A session

For the last 1/2 weeks I've had I have got a constant tingling sensation in my fingers and sounds like it's pops when I pick up something or go to a hold, worse when I've just woken up, some times get a weak hand. Just hoping it's not Carpel Tunnel? Cheers Charlie.

 

[HPclinic]

I've woken up today with a very unhappy right knee. I had a few goes on a problem with quite a powerful throw off a high heel last night. I didn't feel anything pop or go at the time but the go I did the problem I was definitely aware that the knee felt a bit wrong after the move. I finished my session (at least another hour of climbing though no more right heels) without any discomfort and walked around for the rest of the evening with no problems.

I woke up with it very stiff and sore when trying to move it, the head of the fibula is quite tender to the touch. I have full ROM with a just a little pain when the knee is full bent if I am not weighting the leg, bending it far when standing on it feels a bit grim. What seems to be the big problem in terms of movement is if I lie with my knees bent at 90 degrees on the left side, I really struggle to lift the lower right leg from the left. Walking is generally ok so long as I go very slow, feels quite unnatural though. Worst functional thing is going down stairs, bending the bad leg to put the good one the next step down isn't very nice.

I've just been taking it pretty easy today and working from home with a bit of icing. I guess I'm looking for a rough prognosis and how worried I should be? I'm in Sheffield and happy to come and see you guys but wondering if it's worth seeing my GP or if I'm just being paranoid and it'll be ok in a few days. Also, does this sound like something that would benefit from a knee support?

Cheers,

Alistair

Hi Alistair, it is a little difficult to give you an exact diagnosis but the good things are that you have;
-no swelling
-your knee is not locking or giving way
-and at the time you didn't feel anything tear or pop.
If I have understood then the mechanism of the injury may be a muscular strain. Some of the hamstrings attach to the head of fibular and there is a muscle called popliteus that assists in rotation of the lower leg when the knee is in flexion. These should settle with the correct management.
It may be worth calling the clinic and having a chat and we can decide whether it is worth an assessment.
If symptoms are progressing then ease back into the climbing over the next few weeks starting at lower grades and build up. Initially avoid heel hooks.
either call me today or let me know and I will pick up the post next Friday.
regards
Matt

 

[HPclinic]

Re: New 'Physio Clinic' Q&A session

For the last 1/2 weeks I've had I have got a constant tingling sensation in my fingers and sounds like it's pops when I pick up something or go to a hold, worse when I've just woken up, some times get a weak hand. Just hoping it's not Carpel Tunnel? Cheers Charlie.

Hi Charlie, tingling would indicate some nerve compression or irritation as well as the weakness. This could be from your neck or wrist area (as you have mentioned). I would suggest you book in to see a local physio as this needs to be sorted asap.
In the meantime try wearing a splint at night and see if it makes a difference.
regards
Matt

 

[benno]

Hi Matt,

I've started doing some squats in the gym recently. The weight I'm using doesn't seem excessive (80kg, bodyweight is 76kg), in that I'm not particularly sore after each session and I can happily maintain what looks to me like good form throughout. However, for a couple of hours after each session, I've had some numbness/pins and needles in my right arm. This is mainly in the tip of my thumb, the thumb side of my index finger and, to a lesser extent, along my radius and lateral upper arm. I'm guessing this is a nerve issue? It feels quite tight all around the medial side of my elbow when I'm actually lifting, and my shoulder flexibility isn't great...

What should I do? I'm not too worried about this at the moment as the effects seem temporary and have perhaps been decreasing slightly in severity (I've done 4 sessions over 4 weeks so far). If it is flexibility related, will continuing to do the exercise improve things gradually? It certainly feels like a decent non-painful stretch for some things I know should improve.

Thanks,
Ben

 

[Paul B]

What type of squat are you donig?

 

[benno]

Sorry, should have been more specific. Back squats:

I've got my hands quite a bit closer together than the picture, though. Shoulder width plus 6", maybe?

 

[HPclinic]

Hi Matt,

I've started doing some squats in the gym recently. The weight I'm using doesn't seem excessive (80kg, bodyweight is 76kg), in that I'm not particularly sore after each session and I can happily maintain what looks to me like good form throughout. However, for a couple of hours after each session, I've had some numbness/pins and needles in my right arm. This is mainly in the tip of my thumb, the thumb side of my index finger and, to a lesser extent, along my radius and lateral upper arm. I'm guessing this is a nerve issue? It feels quite tight all around the medial side of my elbow when I'm actually lifting, and my shoulder flexibility isn't great...

What should I do? I'm not too worried about this at the moment as the effects seem temporary and have perhaps been decreasing slightly in severity (I've done 4 sessions over 4 weeks so far). If it is flexibility related, will continuing to do the exercise improve things gradually? It certainly feels like a decent non-painful stretch for some things I know should improve.

Thanks,
Ben

Hi Ben, it definitely sounds like a nerve issue particularly as you are getting pretty specific symptoms.
There could be a few reasons why you are getting them. To begin with check that you are not protracting your head/neck too far forward or looking up as you may be impinging or compressing a nerve root at its origin. Secondly you may not have the flexibility at the shoulders ie external rotation when your arms are above your head. What might be occurring if this is the case is that you may be over extending the wrist and tractioning the nerves around the wrist. It definitely sounds like a positioning problem and if it is slowly improving then you may be getting used to the weight and your flexibility may be changing. The exercise is new to you and I would probably have started on a lower weight and higher repetitions for the first month and slowly increase the weight and decrease the reps as you require. Your muscles and soft tissues need time to adapt even if it feels easy.
Hope this helps and contact us at the clinic if symptoms persist.
kind regards
Matt

 

[EDDIES]

Hi Matt,

4 weeks ago I injured my shoulder/triceps, not sure how i did it, nothing felt bad during my usual week of training but my best guess is I strained it doing reverse shoulder fly's with a resistance band as these are the only new excesses Ive been incorporating into my training as a way to warm down after weights.

The week that followed the injury i took off training my shoulders all together as pretty much the most painfull thing I found was to hang from a bar or fingerboard. Climbing outside didn't hurt so Ive continued to do that.
Ive visited my usual physio twice, he has told me that Ive damaged my sub scapularis rotator cuff and i should avoid doing anything painfull but to rehab regularly doing the usual rotator cuff exercises with a band or light weight...
This Ive been doing now for 3 weeks, and Ive started to reintroduce fingerboarding although i find warming up painfull!

What do you think?

Thanks in advance

 

[HPclinic]

Hi Matt,

4 weeks ago I injured my shoulder/triceps, not sure how i did it, nothing felt bad during my usual week of training but my best guess is I strained it doing reverse shoulder fly's with a resistance band as these are the only new excesses Ive been incorporating into my training as a way to warm down after weights.

The week that followed the injury i took off training my shoulders all together as pretty much the most painfull thing I found was to hang from a bar or fingerboard. Climbing outside didn't hurt so Ive continued to do that.
Ive visited my usual physio twice, he has told me that Ive damaged my sub scapularis rotator cuff and i should avoid doing anything painfull but to rehab regularly doing the usual rotator cuff exercises with a band or light weight...
This Ive been doing now for 3 weeks, and Ive started to reintroduce fingerboarding although i find warming up painfull!

What do you think?

Thanks in advance

Hi,
I am trying to work out what you might have strained or injured. The reverse shoulder fly would probably bias the posterior cuff ie infraspinatus or teres minor more than subscapularis as you are rotating your shoulder outwards. Often all of the cuff muscles can be working together so to isolate a specific muscle strain is difficult. The exercises you are doing will be fine. It makes sense that you are getting some discomfort from hanging as all the cuff muscles will be working to keep the shoulder in the right place. I think you are getting more discomfort indoors as it tends to be more intense. Think about graded exercises and putting graded stress through the shoulder, so don't go too quickly on to the finger boards try bigger holds and progress on to more crimps and then finger boarding.
Ultimately make sure that when you move your shoulder (look in the mirror) you are not getting any compensations ie hitching of the shoulder.
Give me or Steve a call if you want to discuss in more detail.
Regards
Matt

 

[EDDIES]

Thanks for that Matt,
yeah, its hard to say what did it but all the discomfort is in the lower rear part of my shoulder... putting my hand behind my back is agony atm but becomes bearable once warmed up a bit!

I will back off the hangs and persevere with the stretches for a couple more weeks.
Thanks again
Eddie

 

[siderunner]

Hi there,

I have picked up a hamstring strain which has now recurred and is in danger of becoming (literally!) a pain in the butt.

Started about 1 month ago, after a hard session threshold bouldering using a poor R heel hook. After the session I noticed a pull in my R hamstring roughly at the buttock crease.

Few days rest and it seemed to have gone, did some medium runs and modest climbing no probs.

BUT about a week ago I did a harder route which needed a high step then aggressively pulling down on that high (and out to the side) right toe. Started hurting again to the extent where I can feel the pull all the time, and even non-heel hook climbing hurts if I step above knee height.

At present I am resting it and have done a bit of gentle foam rolling to try and loosen up the tightness in the general area. Anything else I can do to speed recovery?

I am conscious that I have neglected my usual yoga and stretching over the last 4 months in the quest for more power. Haven't been doing any leg weights recently, and usually do 2 modest runs each week (30-40mins c 6k).

Btw Matt, please do remind us where your practise is, and how to book with you!

 

[cheers big ears]

Hey Matt - amazing resource - ta muchly.

I cant remember how I did it, but I do remember a sort of numb sensation down the back of my hand from between my index and middle knuckles running down about half way to my wrist. The numbness wore off pretty quickly and I assumed I'd just bashed a hold on the way down. Never stopped climbing.

Now about a week later I have a very tender area that extends from what feels like the same area between the knuckles mentioned above down to my wrist. It's a shooting pain if I touch it and similar shooting pain and tightness if I extend my arm and try to fully articulate my fist?

I've asked my GP who reckons its something to do with an extensor tendon (tear?) and has prescribed ibuprofen gel (which seems pretty useless because its sore to apply..). Keen on a second opinion and any advice?

 

[HPclinic]

Hi there,

I have picked up a hamstring strain which has now recurred and is in danger of becoming (literally!) a pain in the butt.

Started about 1 month ago, after a hard session threshold bouldering using a poor R heel hook. After the session I noticed a pull in my R hamstring roughly at the buttock crease.

Few days rest and it seemed to have gone, did some medium runs and modest climbing no probs.

BUT about a week ago I did a harder route which needed a high step then aggressively pulling down on that high (and out to the side) right toe. Started hurting again to the extent where I can feel the pull all the time, and even non-heel hook climbing hurts if I step above knee height.

At present I am resting it and have done a bit of gentle foam rolling to try and loosen up the tightness in the general area. Anything else I can do to speed recovery?

I am conscious that I have neglected my usual yoga and stretching over the last 4 months in the quest for more power. Haven't been doing any leg weights recently, and usually do 2 modest runs each week (30-40mins c 6k).

Btw Matt, please do remind us where your practise is, and how to book with you!

Hi, it could be a hamstring strain and it should be able to be rehabilitated. I would normally like to make sure you haven't irritated your sciatic nerve which can sometimes seem like it is a hamstring strain (particularly if it reoccurs). In theory when you strain a muscle it should heal and during this process if you gradually load it again it should recover. You may have overloaded it too soon. I am based at the Hallamshire Physiotherapy clinic. If is still bothering you then either give me a call next week or book in. Sorry about the delay in responding I have been away for easter.
Regards
Matt

 

[HPclinic]

Hey Matt - amazing resource - ta muchly.

I cant remember how I did it, but I do remember a sort of numb sensation down the back of my hand from between my index and middle knuckles running down about half way to my wrist. The numbness wore off pretty quickly and I assumed I'd just bashed a hold on the way down. Never stopped climbing.

Now about a week later I have a very tender area that extends from what feels like the same area between the knuckles mentioned above down to my wrist. It's a shooting pain if I touch it and similar shooting pain and tightness if I extend my arm and try to fully articulate my fist?

I've asked my GP who reckons its something to do with an extensor tendon (tear?) and has prescribed ibuprofen gel (which seems pretty useless because its sore to apply..). Keen on a second opinion and any advice?

Hi, sorry about the delay in responding, I have been away for easter. Numbness tends to mean nerve irritation. You may have compressed or stretched part of the radial nerve into your hand. It should recover with regular wrist movements. Perhaps give me a call on 0114 2671223 next week if it hasn't settled and we can have a better discussion.
regards
Matt

 

[siderunner]

Thanks Matt, that all sounds sensible and I'm now working on a more gradual loading with gentle weights - so far so good. Appreciate the warning about sciatic nerve, will book in if it flares up.

Much appreciate you advice, Andy

 

[mctrials23]

I injured my A2 about 3.5 months ago and I think I have perhaps been a little harsh on it at times since then but I have been able to climb on it at 90% plus of normal use without really having any issue but it still nags at me and I can feel that there is something wrong with it most of the time. If I hit it against something unexpectedly it hurts but prodding it afterwards doesn't produce the same reaction. It was never a particularly bad injury and there was no pop etc.

I have taken nearly a week of because I am on holiday and its a little better (doesn't really feel like anything is wrong). I type on a computer all day for work usually so I don't know if the lack of climbing or lack of typing is what is helping.

Is this normal? I think that somewhere in dave macleods literature it mentions that sometimes you will feel a pulley injury for months after its healed and then one day it will just disappear but I wanted to hear your opinions on this.

 

[HPclinic]

I injured my A2 about 3.5 months ago and I think I have perhaps been a little harsh on it at times since then but I have been able to climb on it at 90% plus of normal use without really having any issue but it still nags at me and I can feel that there is something wrong with it most of the time. If I hit it against something unexpectedly it hurts but prodding it afterwards doesn't produce the same reaction. It was never a particularly bad injury and there was no pop etc.

I have taken nearly a week of because I am on holiday and its a little better (doesn't really feel like anything is wrong). I type on a computer all day for work usually so I don't know if the lack of climbing or lack of typing is what is helping.

Is this normal? I think that somewhere in dave macleods literature it mentions that sometimes you will feel a pulley injury for months after its healed and then one day it will just disappear but I wanted to hear your opinions on this.

Hi, in my experience the pulley injuries do take months to rehabilitate but this does depend on the degree of strain or in the worst case scenario a complete rupture. The A2 pulley is the most common injured. I would say that if you had completely ruptured the pulley you would have heard a 'pop' and definitely would have had to stop immediately.
If you have had a strain then you would of been able to return to climbing quite quickly. It sounds like you may have overloaded the injury a little too quickly. Normally we recommend staying away from any crimping in the first 2-4 weeks and then slowly add some.
By now the injury should be healed but perhaps back off the harder grades and see how it feels and increase load gradually.
If symptoms are still persisting or not changing then give me a call.
regards
Matt

 

[cheers big ears]

Hey Matt - amazing resource - ta muchly.

I cant remember how I did it, but I do remember a sort of numb sensation down the back of my hand from between my index and middle knuckles running down about half way to my wrist. The numbness wore off pretty quickly and I assumed I'd just bashed a hold on the way down. Never stopped climbing.

Now about a week later I have a very tender area that extends from what feels like the same area between the knuckles mentioned above down to my wrist. It's a shooting pain if I touch it and similar shooting pain and tightness if I extend my arm and try to fully articulate my fist?

I've asked my GP who reckons its something to do with an extensor tendon (tear?) and has prescribed ibuprofen gel (which seems pretty useless because its sore to apply..). Keen on a second opinion and any advice?

Hi, sorry about the delay in responding, I have been away for easter. Numbness tends to mean nerve irritation. You may have compressed or stretched part of the radial nerve into your hand. It should recover with regular wrist movements. Perhaps give me a call on 0114 2671223 next week if it hasn't settled and we can have a better discussion.
regards
Matt

Matt - Thanks a bunch for this - I've been off line for a while but got this through a friends phone so I've been keeping an eye on things for a couple of weeks now and what you mention above seems to be correct - and very useful. Things are slowly getting back to normal - shooting pains are much less intense and much less frequent - numbness is getting pretty rare.

If anything else develops then I'll get back.

Again - many thanks!

 

[becciesarah]

Hi guys,

Firstly thanks, this is a great idea!

Secondly, I've been suggested to post something here as I have finger pain that is currently preventing me climbing at my normal level. This started approx 3 weeks ago after I had completed a series of crimpy problems on the edge of my ability, which I had been working for a few back to back sessions.

The pain/ache is generally at the base of my fingers (base of my proximal phalanges), predominantly my ring fingers. I have noticed this before when I have been over-crimping on problems, have subsequently eased off for a couple of weeks alongside taping below my knuckle joint (which seemed to help with the ache whilst climbing) and things have improved.

This time however feels a bit different, particularly on my right ring finger, the ache is more constant with pain if I squeeze my hand around something. I have also noticed pain in my knuckle joint and if I squeeze my intermediate phalanges it is also tender.

If I massage around my proximal phalanges the ache seems to ease, ibuprofen has also helped. I have continued to climb approx 2-3 times a week restricting myself to easier problems and trying to open-hand or pinch only (I have noticed though a bad tendency to want to crimp most things!) this however still causes some level of discomfort.

I'd be interested to hear any suggestions as to what this might be, whether I should see a physio in person whether it sounds like fatigue or an injury, taping suggestions, exercise suggestions or anything else important!

Thanks,
Beccie

 

[HPclinic]

Hi guys,

Firstly thanks, this is a great idea!

Secondly, I've been suggested to post something here as I have finger pain that is currently preventing me climbing at my normal level. This started approx 3 weeks ago after I had completed a series of crimpy problems on the edge of my ability, which I had been working for a few back to back sessions.

The pain/ache is generally at the base of my fingers (base of my proximal phalanges), predominantly my ring fingers. I have noticed this before when I have been over-crimping on problems, have subsequently eased off for a couple of weeks alongside taping below my knuckle joint (which seemed to help with the ache whilst climbing) and things have improved.

This time however feels a bit different, particularly on my right ring finger, the ache is more constant with pain if I squeeze my hand around something. I have also noticed pain in my knuckle joint and if I squeeze my intermediate phalanges it is also tender.

If I massage around my proximal phalanges the ache seems to ease, ibuprofen has also helped. I have continued to climb approx 2-3 times a week restricting myself to easier problems and trying to open-hand or pinch only (I have noticed though a bad tendency to want to crimp most things!) this however still causes some level of discomfort.

I'd be interested to hear any suggestions as to what this might be, whether I should see a physio in person whether it sounds like fatigue or an injury, taping suggestions, exercise suggestions or anything else important!

Thanks,
Beccie

Hi Beccie,
It sounds like an A2 pulley sprain. It is a common area to strain and the ring finger is often the more common finger to injure. It may also be a finger tendon strain. These type of injuries can vary and respond to gradual loading and management. You sound like you are going in the right direction. I would lay off the amount of crimping and see if symptoms settle and then add the occasional crimp. Perhaps initially try standing and do a crimp hold then decrease the support ie increase the weight through the hand by bending your knees. I think you might just have to be a bit more disciplined with the crimping and increase the amount as symptoms allow. It is important to load the pulleys and tendons to increase strength.
Continue with your massaging the area and I would tape.
I would also be interested in what your shoulder control/strength is like and how mobile your back is (particularly your trunk rotation).
If symptoms are persisting then see a physio or give us a call for further advice.
Kind regards
Matt