Online Hallamshire Physio Clinic

[Simon Lee]

Thought I would start a new thread for this.

Our Sponsors Hallamshire Physiotherapy based in Sheffield who have a wealth of knowledge of climbing injuries will answer any questions that you may have.

If you post questions during the week a member of the HP team will log in on friday lunchtime to answer.

For reference the old thread is here

 

[nai]

Excellent, glad this thread is back.

I currently have a niggle which manifests mostly in my neck which feels tight and stiff, get a bit of discomfort in the back left when turning my head, can't turn it as far to the left as I can the right. Feel the discomfort turning it either way.
The discomfort manifests in trapezius, deltoid and inside of the elbow on the left too.
Symptoms feel better once warmed up and engaged in activity than when cold or inactive.
Feel a bit weaker than normal on my left-hand side, not just in climbing related activities, e.g. struggled to lift my bike over a stile with my left arm whereas it's straightforward with my right.

 

[Schnell]

Thanks for reopening this.

I've picked up an odd finger tweak on my left hand middle finger. The background is that I have felt very slight discomfort in the PIP joint on that finger and on my ring finger of my right hand for a few weeks, which only appears in some circumstances mainly when pulling on slopers and (though I'm not totally certain about this) when there is some sideways torque on the joint. For that reason I had more or less dismissed it as a twinge from old collateral ligament injuries, which I had suffered on the affected fingers.

The current flare up just affects the left hand middle finger as I said. I was doing easy bouldering four days ago and towards the end of the session I noticed that there was some discomfort straightening the finger. I don't have a recollection of a particular 'pop' moment. The discomfort got worse later in the evening and the next day the PIP joint was quite swollen and tender on the palm side, right at the joint rather than near or towards the A2 and not around the sides of the joint. Also the main discomfort was if the joint gets flexed sideways at all, ie if I knocked it off something and also trying to straighten the finger, the last few mm of going from slight bend to fully extended are what seems to cause the problem. I've been keeping it more or less immobilised since and a few days later the swelling is mostly gone though it's still fairly tender.

Based on Dave McL's injury book I suspected 'tenosynovitis', mostly because I've had a few pulley injuries in the past and it doesn't feel like that at all (more a diffuse tenderness rather than a particular sore spot and not in the right place) and it's not around the side of the joint like a collateral ligament injury.

It'd be great if you had any suggestions about diagnosis and treatment, one thing is whether I should keep it immobilised til it feels normal, there seems to be conflicting advise on this.

 

[mrjonathanr]

Hi,

I would appreciate any thoughts about my left shoulder if you have a minute. It has suffered a bit over the years with supraspinatus strains and an AC separation (over 7 years ago) but is generally strong. I do a few TRX/theraband exercises to maintain it.

Several weeks ago I felt a strain across the front of the shoulder warming up on a coldish day, but afterwards fine. Two weeks ago it felt fine out bouldering but then felt very sore afterwards, a generalised ache within the joint, not specific to any point/muscle/tendon.

A week off exercise, a week of yoga to mobilise the joint (impingement?) and then some light bouldering and it's sore again... I have taken 50mg diclofenac every other day to reduce inflammation.

Daily activity -it is not acutely painful. Arm raised straight up and back (palm either prone/supinated) slightly stiff, not too bad. Reaching behind back, extending fingers up back- stiff, some reduced ROM, aches in front of shoulder afterwards. No pain when touched manually, just ache in the joint.

I have been climbing >30 years, bit baffled.

A really big thank you for any reply.

Jonathan

 

[ashtond6]

Any help would be greatly appreciated

Finger (just above knuckle, maybe A4)
Injured in may, back up to speed by August.
Did 5 days on, re-injured!
Took two weeks off, yet still hurts when I climb again, seems to get better then still as bad when I try to climb again? Are there cases where the recommended 1-3 weeks initial rest isn't enough? Why after lots of rest can I not climb on even jugs??

Also, any pull ups or steep climbing leaves up shoulder super 'crunchy'. Can't get rid of it! In 2012 I had a disc rupture in my neck, since then I've had constant right hand side injuries (neck, shoulder, palm, fingers)

Any help would be appreciated - would also pay for an appointment reference the finger as I have a big trip come March

Seems stupidly susceptible to injury - now ongoing for 5 months!

 

[mctrials23]

Thanks for opening this up again

I have had a reasonably long term niggle in my left arm that was at one point super painful but over time has just become an occasional background niggle/pain. If I pull hard on wide moves with my arms just above shoulder height it is a sharp pain sometimes and if I do pullups and don't pay a lot of attention to being really controlled it hurts at about 2/3rds of the way down (of the pullup negative phase)

The pain is in the outer arm roughly half way along the humerus. Its at the very tip of the deltoid as far as I can tell. Most of the time when I am climbing it doesn't even register but when I put my arm in just the right place its quite a sharp pain. It doesn't hurt for long and doesn't seem to persist after I stop climbing.

As this was at one point a more serious injury I assume that it just hasn't properly/fully healed but any advice or information that might help me finally put it to bed would be really appreciated.

 

[Ross.Cooper]

Hi,

I have two niggles, one with the right elbow, one with the left.

Right - The muscle at the top of my forearm (by the elbow) when my palm is flat on the table (brachioradialis muscle?) as been aching for a few weeks. It started after a an old uni climbing trip where I did a fair amount of sock wrestling (try to get opponents sock off their foot) after a big day climbing. The next day I tried climbing but after 2 climbs, both elbows (the muscle mentioned) were hurting too much I couldn't do anything. The left has settled down but the right still occasionally aches, especially if my elbow is bent under pressure (carrying shopping etc.). Once I'm warm, it doesn't hurt at all while climbing. What would you recommend in terms of icing/stretching?

Left - I fell off at Curbar on Sunday from about half a metre up and missed the pad, landing on a rock on my back. I got a graze to my back and smacked my elbow hard. Didn't climb for rest of day (was at the end anyway). The elbow bursa seems to have swollen up (only a little bit) and there is pain if I knock it or apply pressure. I went climbing indoors yesterday (Tuesday) and the whole left arm seemed really weak with the elbow hurting slightly. Is the climbing aggravating the injury? I left after only an hour and went home. Plan is to rest until the weekend. What would you recommend I do to aid recovery, also any idea how long I can expect to be better/climbing without this weird pain/weakness?

Thanks

 

[HPclinic]

Excellent, glad this thread is back.

I currently have a niggle which manifests mostly in my neck which feels tight and stiff, get a bit of discomfort in the back left when turning my head, can't turn it as far to the left as I can the right. Feel the discomfort turning it either way.
The discomfort manifests in trapezius, deltoid and inside of the elbow on the left too.
Symptoms feel better once warmed up and engaged in activity than when cold or inactive.
Feel a bit weaker than normal on my left-hand side, not just in climbing related activities, e.g. struggled to lift my bike over a stile with my left arm whereas it's straightforward with my right.

Hi Nai
This sounds like you are irritating a nerve on the left hand side of your neck. The pain into your deltoid, traps etc are probably referred pain as is the problem with your elbow. I assume you sit at work so correct your sitting position and stretch your thoracic spine (lost of upper back rotation). Stand regularly and reach up to the ceiling. If this does not improve over the next few weeks you might need to see a physio. If the weakness in your left arm deteriorated see your GP.
Steve

 

[HPclinic]

Hi,

I would appreciate any thoughts about my left shoulder if you have a minute. It has suffered a bit over the years with supraspinatus strains and an AC separation (over 7 years ago) but is generally strong. I do a few TRX/theraband exercises to maintain it.

Several weeks ago I felt a strain across the front of the shoulder warming up on a coldish day, but afterwards fine. Two weeks ago it felt fine out bouldering but then felt very sore afterwards, a generalised ache within the joint, not specific to any point/muscle/tendon.

A week off exercise, a week of yoga to mobilise the joint (impingement?) and then some light bouldering and it's sore again... I have taken 50mg diclofenac every other day to reduce inflammation.

Daily activity -it is not acutely painful. Arm raised straight up and back (palm either prone/supinated) slightly stiff, not too bad. Reaching behind back, extending fingers up back- stiff, some reduced ROM, aches in front of shoulder afterwards. No pain when touched manually, just ache in the joint.

I have been climbing >30 years, bit baffled.

A really big thank you for any reply.

Jonathan

Jonathan.
Thanks for your question. It sounds like you are losing some control around the shoulder joint and the previous trauma is exacerbating the situation. A few thoughts: Stop stretching the joint and start strengthening with something stronger than theraband (ok for some people but the strength needed for the average climber I would use higher weight/resistance). Careful with yoga and don't overstretch the shoulder and I agree you could be getting a degree of 'impingement' or loss of control. As you are finding, the shoulder gets easier with climbing so it doesn't appear to be a serious pathology. The problem occurs after load as the tissue is being over stressed. I would reduce your climbing few a couple of week but concentrate on strengthening the shoulder and not stretching. I see more climbers with hypermobile shoulders but tight lats and thorax, usually as a result of sitting at a computer or the nature of pulling all the time (or both). If you have climbed for 30 years the shoulder joint will be work hardened and just need to change your loading pattern. I would think this problem will respond to conservative management.
Thanks
Steve H

 

[HPclinic]

Any help would be greatly appreciated

Finger (just above knuckle, maybe A4)
Injured in may, back up to speed by August.
Did 5 days on, re-injured!
Took two weeks off, yet still hurts when I climb again, seems to get better then still as bad when I try to climb again? Are there cases where the recommended 1-3 weeks initial rest isn't enough? Why after lots of rest can I not climb on even jugs??

Also, any pull ups or steep climbing leaves up shoulder super 'crunchy'. Can't get rid of it! In 2012 I had a disc rupture in my neck, since then I've had constant right hand side injuries (neck, shoulder, palm, fingers)

Any help would be appreciated - would also pay for an appointment reference the finger as I have a big trip come March

Seems stupidly susceptible to injury - now ongoing for 5 months!

Hi

Thanks for the question. This sounds complicated! I suspect the previous neck injury is causing some of your ongoing problems. Its not uncommon for previous injuries to continue being a problem as you compensate by changing muscle recruitment in the upper limb. You might be overusing your hand/forearm as a result of the neck injury. The 'crunchy' shoulder is not helping but once again this is all part of the same problem. You need to find out why you are getting these repeat injuries and see a recommended physiotherapist. You can try stretching your neck, but be careful not to exacerbate the right arm symptoms.

Thanks
Steve H

 

[HPclinic]

Thanks for opening this up again

I have had a reasonably long term niggle in my left arm that was at one point super painful but over time has just become an occasional background niggle/pain. If I pull hard on wide moves with my arms just above shoulder height it is a sharp pain sometimes and if I do pullups and don't pay a lot of attention to being really controlled it hurts at about 2/3rds of the way down (of the pullup negative phase)

The pain is in the outer arm roughly half way along the humerus. Its at the very tip of the deltoid as far as I can tell. Most of the time when I am climbing it doesn't even register but when I put my arm in just the right place its quite a sharp pain. It doesn't hurt for long and doesn't seem to persist after I stop climbing.

As this was at one point a more serious injury I assume that it just hasn't properly/fully healed but any advice or information that might help me finally put it to bed would be really appreciated.

Hi
This is referred from your shoulder or neck. I assume it is a shoulder control problem that is an issue with certain wide holds as it is fine normally. A muscle injury would be more consistent. If its was 'super painful' you might have had a neck/nerve irritation that slowly improved but only caused problems with certain positions. Stretch you neck and strengthen your shoulder but continue climbing. Strengthen the shoulder in positions that reproduce your symptoms i.e. wide moves above head hight but do both pulling and pushing type exercise.

Thanks
Steve H

 

[HPclinic]

Hi,

I have two niggles, one with the right elbow, one with the left.

Right - The muscle at the top of my forearm (by the elbow) when my palm is flat on the table (brachioradialis muscle?) as been aching for a few weeks. It started after a an old uni climbing trip where I did a fair amount of sock wrestling (try to get opponents sock off their foot) after a big day climbing. The next day I tried climbing but after 2 climbs, both elbows (the muscle mentioned) were hurting too much I couldn't do anything. The left has settled down but the right still occasionally aches, especially if my elbow is bent under pressure (carrying shopping etc.). Once I'm warm, it doesn't hurt at all while climbing. What would you recommend in terms of icing/stretching?

Left - I fell off at Curbar on Sunday from about half a metre up and missed the pad, landing on a rock on my back. I got a graze to my back and smacked my elbow hard. Didn't climb for rest of day (was at the end anyway). The elbow bursa seems to have swollen up (only a little bit) and there is pain if I knock it or apply pressure. I went climbing indoors yesterday (Tuesday) and the whole left arm seemed really weak with the elbow hurting slightly. Is the climbing aggravating the injury? I left after only an hour and went home. Plan is to rest until the weekend. What would you recommend I do to aid recovery, also any idea how long I can expect to be better/climbing without this weird pain/weakness?

Thanks

Coops
The dangers of sock wrestling! Stick to climbing its safer. Anyway, the forearm problem is not a local problem from what you are saying. If you pull a muscle you would expect if to repair within a few weeks. If both arms are a problem I would suspect this is referred from your neck. Don't ice/stretch your forearms bit concentrate on your upper back and neck. If you sit at a desk for long periods this might be a contributory factor.

Regarding the fall, you probably hit a nerve around the elbow and this is causing the weakness in the arm. I would rest from climbing for a couple of weeks and then slowly load the arm. Bursitis shouldn't cause weakness in the arm so be careful with this injury. If it persists or you get increasing weakness see your GP.
Thanks
Steve H

 

[HPclinic]

Thanks for reopening this.

I've picked up an odd finger tweak on my left hand middle finger. The background is that I have felt very slight discomfort in the PIP joint on that finger and on my ring finger of my right hand for a few weeks, which only appears in some circumstances mainly when pulling on slopers and (though I'm not totally certain about this) when there is some sideways torque on the joint. For that reason I had more or less dismissed it as a twinge from old collateral ligament injuries, which I had suffered on the affected fingers.

The current flare up just affects the left hand middle finger as I said. I was doing easy bouldering four days ago and towards the end of the session I noticed that there was some discomfort straightening the finger. I don't have a recollection of a particular 'pop' moment. The discomfort got worse later in the evening and the next day the PIP joint was quite swollen and tender on the palm side, right at the joint rather than near or towards the A2 and not around the sides of the joint. Also the main discomfort was if the joint gets flexed sideways at all, ie if I knocked it off something and also trying to straighten the finger, the last few mm of going from slight bend to fully extended are what seems to cause the problem. I've been keeping it more or less immobilised since and a few days later the swelling is mostly gone though it's still fairly tender.

Based on Dave McL's injury book I suspected 'tenosynovitis', mostly because I've had a few pulley injuries in the past and it doesn't feel like that at all (more a diffuse tenderness rather than a particular sore spot and not in the right place) and it's not around the side of the joint like a collateral ligament injury.

It'd be great if you had any suggestions about diagnosis and treatment, one thing is whether I should keep it immobilised til it feels normal, there seems to be conflicting advise on this.

Thanks for the question. Your problem certainly sounds like a local finger injury given the mechanical nature of the issue i.e difficulty straightening the finger in the end stages of extension as well as the swelling issues. That said there is usually a reason for these issues and it would be worth getting the problem looked at as the mechanics/movement of the shoulder/trunk could be a contributory factor. Local tenderness could indeed indicate a tenosynovitis type problem, especially as you experience the pain whilst on slopers. The foream flexor muscles/tendons are mainly loaded++ in such a way to utilise both main finger tendons when using slopers whereas when crimping a hold, the fingers rely on tendon and ligament tension. The best advice is relative rest i.e low loading/easy climbing for a short period and avoid slopers for a while as they are often a culprit developin finger/tendon problems. The usual cold therapy applies locally and gentle forearm stretching. Obviously with not being able to see/assess the problem these are only suggestions, nothing can substitute a physical assessment of the problem to establish a more clear diagnosis and also a cause for the problem i.e possible shoulder or trunk asymmetry/weakness/stiffness which may contribute as you compensate during climbing.

 

[Simon Lee]

Thanks for all the replies Steve :2thumbsup:

 

[mrjonathanr]

Jonathan.
Thanks for your question. It sounds like you are losing some control around the shoulder joint and the previous trauma is exacerbating the situation. A few thoughts: Stop stretching the joint and start strengthening with something stronger than theraband (ok for some people but the strength needed for the average climber I would use higher weight/resistance). Careful with yoga and don't overstretch the shoulder and I agree you could be getting a degree of 'impingement' or loss of control. As you are finding, the shoulder gets easier with climbing so it doesn't appear to be a serious pathology. The problem occurs after load as the tissue is being over stressed. I would reduce your climbing few a couple of week but concentrate on strengthening the shoulder and not stretching. I see more climbers with hypermobile shoulders but tight lats and thorax, usually as a result of sitting at a computer or the nature of pulling all the time (or both). If you have climbed for 30 years the shoulder joint will be work hardened and just need to change your loading pattern. I would think this problem will respond to conservative management.
Thanks
Steve H

Hi Steve,
Thank you for giving your time to share that answer, I am sure you have plenty of other demands on your time too. That seems really astute, thanks.
Best wishes
Jonathan

 

[Ken_Kaniff]

Hi, Steve. I'm not sure I can still post in this thread. I'd appreciate your comment on my niggle. I didn't pick it up climbing but it prevents me from doing it.

Last week I woke up with a shooting pain in the area of my shoulder blade. The pain went down my arm and resulted in the hand numbness. In the past 3-4 days, after I started exercising my upper body with theraband, the pain in the back and arm has decreased substantially. As for the numbness, it has passed but I still have problems clenching my fist as hard as I used to.

I saw my GP about the pain and he believed it was a pinched nerve in my neck, possibly resulting from terrible posture, a desk job, and a two-week cold I'd had prior to the incident.

It'd be fantastic if you had any suggestions about the issues my GP couldn't help me with:

a) whether I should do any other exercises aside from my theraband routine?
b) how long should I expect for the numbness (inability to grip on holds) to last?
c) when will it be safe to return to training and bouldering and what what type of exercises to avoid in the initial stage?

I look forward to your comments,
Ken

 

[Simon Lee]

Hi, Steve. I'm not sure I can still post in this thread. I'd appreciate your comment on my niggle.

Yes you can - but it most likely won.t be until next friday that he replies

 

[cheque]

Hi Steve,

after a summer filmmaking rather than climbing (so lots of carrying heavy loads and juggling) I seem to have developed very tight and stiff shoulders in what Google tells me is the deltoid region.

I don't have an injury per se, but I've lot a surprising amount of movement (if hold my arms out in a crucifix position I can barely raise them at all) and when
I climb or train now the first couple of times I pull on anything above me it will hurt a bit, with the pain (but not the stiffness) subsiding as I warm up.

How do I fix this? Is it just a matter of stretching my deltoids?

Cheers, Mike.

 

[HPclinic]

Hi, Steve. I'm not sure I can still post in this thread. I'd appreciate your comment on my niggle. I didn't pick it up climbing but it prevents me from doing it.

Last week I woke up with a shooting pain in the area of my shoulder blade. The pain went down my arm and resulted in the hand numbness. In the past 3-4 days, after I started exercising my upper body with theraband, the pain in the back and arm has decreased substantially. As for the numbness, it has passed but I still have problems clenching my fist as hard as I used to.

I saw my GP about the pain and he believed it was a pinched nerve in my neck, possibly resulting from terrible posture, a desk job, and a two-week cold I'd had prior to the incident.


It'd be fantastic if you had any suggestions about the issues my GP couldn't help me with:

a) whether I should do any other exercises aside from my theraband routine?
b) how long should I expect for the numbness (inability to grip on holds) to last?
c) when will it be safe to return to training and bouldering and what what type of exercises to avoid in the initial stage?

I look forward to your comments,
Ken

Hi Ken
I agree with your GP and you probably have a nerve injury. This should resolve with time and the pressure might have come off your neck but you need time for the nerve to repair. Any nerve injury is generally slower than muscles, tendons etc. so I would stop the theraband exercises and climbing for 3-4 weeks. During this time the numbness should resolve but it depends on how much pressure there was on the nerve. If you woke with the medial (inside shoulder on back) shoulder pain consider your work position and change regularly if you sit all day. Many climbers tend to get low shoulders caused by over active lats which can cause pressure on there nerve roots in the neck.So you might not have injured it during climbing but it might contribute to its onset. Its complicated!
Cheers

Steve H

 

[HPclinic]

Hi Steve,

after a summer filmmaking rather than climbing (so lots of carrying heavy loads and juggling) I seem to have developed very tight and stiff shoulders in what Google tells me is the deltoid region.

I don't have an injury per se, but I've lot a surprising amount of movement (if hold my arms out in a crucifix position I can barely raise them at all) and when
I climb or train now the first couple of times I pull on anything above me it will hurt a bit, with the pain (but not the stiffness) subsiding as I warm up.

How do I fix this? Is it just a matter of stretching my deltoids?

Cheers, Mike.

Mike

Muscles are very robust and no more so than in climbers. If both deltoid muscles are damaged you are very unlucky to hurt 2 at same time (highly unlikely) or you have a referred pain from another structure (more likely in my experience from the history). Don't stretch the deltoid and consider if either your neck or thorax are tight and/or painful. Try stretching your lats (side lying with arm reaching above head) and see how your pain in the shoulder goes.
Thanks

Steve H