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Pull my finger… No, WAIT!

Have you heard of finger pulley injury? Neither did I until I started climbing.

A few years ago, I thought to myself, "Hey, I think Milton could use a climbing gym... I wonder what it would take to start one?".  Weeks later, I heard about a climbing gym opening in Milton! My hopes of renewed entrepreneurship were dashed.  However, my hopes of restarting my climbing hobby were suddenly on the horizon!

Enter Aspire.  Awesome cool place to hang and learn to climb.  I rediscovered how much I enjoyed climbing.  I carved out time in my schedule, took the time to go to the climbing gym on the regular, and I went hard!

Too hard.

You know those blog posts, and articles that I've shared many times in the past where there's talk about easing into a sport or new physical activity? Well let's just say that I should have listened a bit more closely to that advice.  I got excited.  I thought I was in pretty good shape, and up for the challenge.  Well it turns out that my fingers weren't.  You never realize how much you use your fingers for everyday tasks, until you can't use one anymore!

So my injury is somewhat common to climbers, however pretty well unheard of outside the climbing community.  I had what is referred to as a 'finger-pulley injury'. If you ask your doc about it, they will probably look at you like you have two heads.

So what is a 'Finger-pulley'?

So to understand what a 'finger-pulley' is, we need to look at some hand anatomy (eww, boring!) I know, but bear with me.  Let's start with the basics: your fingers don't have any muscle in them. Nada, zip, zero.  Everything making your fingers work is all based on tendons and ligaments. The muscles are actually in your forearm, and attached to your fingers via long, thin tendons.  To keep your tendons following the skeleton of your fingers, you have what are referred to as 'pulley tendons'.  These are basically little rings of tendon that wrap around your finger, and act like pulleys to allow your flexor and extensor tendons to move your finger the way you'd expect.

In each finger, there are 5 'A' pulleys which are numbered 1 to 5 starting at the base of your finger. See figure below courtesy of Training for Climbing, by Eric J. Horst.:

injury-a2-finger-anatomy-1

OK, so how does a finger pulley get injured?

Lots of ways. The most common injury, is an A2 pulley injury.  This usually occurs in the middle or ring fingers and it is due to excessive load on the A2 pulley. This excessive load is commonly generated with a slip/fall while crimping. (If you don't know what crimping is, check out the different types of climbing grips here.) This sudden load combined with finger position, place huge stress on the A2 pulley and it is common that the pulley can be torn.  A tendon tear may be partial or full.

The next most common cause of this type of injury is due to overuse.  You can read all about overuse injuries in my previous blog here, however it ultimately amounts to doing 'too much, too soon' resulting in micro-tears.  In my case, my PIP joint (see above) is hypermobile, and was frequently overloaded without sufficient rest or conditioning. If you're not sure what 'hypermobile' is, think about your knee buckling, but in my case it was my first knuckle on my middle finger...

So how do I handle a pulley injury?

Number 1 - see your Medical Doctor, Chiropractor or Physiotherapist.  Ask them if they have experience treating climbers and/or fingers.  Nearby your local climbing gym, I would expect to find healthcare practitioners that are somewhat familiar with these types of injuries.  If you need help, ask at your local climbing gym if they know anyone who's had this type of injury and find out where they went.

Treatment should involve:

  1. NO CLIMBING. Yes, you have 9 other fingers. That doesn't matter. Climbing WILL aggravate the injury, and lengthen your healing process.  Be patient.
  2. NO CLIMBING. Like 'Fight Club', this is important enough to take up 2 rules.
  3. Upon initial injury - Ice to reduce swelling, if there is any
  4. Advil (or other NSAID) if the swelling is pronounced
  5. Once swelling goes down, you can use heat to promote blood flow (2-3 times per day for about 15 minutes)
  6. Ultrasound, frictions & other modalities - these improve blood flow and speed healing
  7. Rehabilitative training - as your tendons rebuild, some stress will be needed to ensure that they come back strong
  8. 'Light' climbing - choose routes that have easier, more comfortable holds, and good foot holds to reduce the stress on your hands and fingers

How long to take off climbing, when to start rehab, and when to start back climbing is dependent on the injury severity.  For a moderate grade injury, expect to be off climbing for 4 to 6 weeks. For the tendon to fully heal, it may take up to 5 months or more.

When returning to climbing, prophylactic taping is usually recommended. Basic taping would be to wrap 1/4 to 1/2 inch wide tape around your first and second phalanges, however this has not been shown to be very effective.  Rather applying tape in an 'X' pattern, or 'Figure 8' with the 'X' supporting the PIP joint has been shown to be somewhat more effective, and more supportive still is the 'H' taping method found here.

How do I avoid a pulley injury in the first place?

Ease in to it.  Climb a lot, but don't go 110% on every route.  While it can be infuriating to climb below the grade level that is challenging for you, it is the experience that's important.  Take the time to improve your technique, and build up strength in your finger tendons so you can be ready for when you really need to pull hard.

You should also look to change up your climbing regularly.  Try to vary your grip type, between open crimps, half crimps and use full crimps only when necessary.  You can also vary the types of holds you use, between jugs, pinches, slopers and edges.  This will help develop your overall hand strength in a variety of ways.

And perhaps most importantly - REST. Make sure to take regular breaks and days off.  As with any physical activity, using your body causes damage. To put it simply, damage with rest should result in improved strength and performance, but damage without rest will result in injury.

Resources

  1. http://trainingforclimbing.com/
  2. http://nicros.com/training/training-articles/finger-tendon-pulley-injury/
  3. https://www.thoughtco.com/six-basic-finger-grips-face-climbing-755397
  4. https://www.ukclimbing.com/articles/page.php?id=6193
  5. https://www.tensionclimbing.com/tension-climbing-blog/2017/2/12/pulley-injury-review
  6. https://www.climbing.com/skills/avoid-finger-blowouts/
  7. http://cruxcrush.com/2013/10/24/climber-problems-the-a2-pulley-strain/

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