Beating climbing injuries: PIP synovitis

Ever since about 2-3 years into climbing, the back side of my middle fingers (on both hands) would get aggravated fairly easily when crimping. This was more apparent in full crimp than half crimp, which is why I avoided full crimp for so long. This led to a weakness for outside climbing as you need full crimp for limit once the holds get exceptionally small.

I’ve posted several times on reddit about this type of injury, so this post is to consolidate that information while providing new information since I’ve eliminated completely (except when I do too much full crimping in a session).

First comment:

The main things that help mine are:

1. Less climbing (e.g. avoid aggravating exercises)
2. 3 finger drag / open hand hangs on hangboard
3. Finger rolls
4. Full range of motion exercises
5. Resting for 7-10 days usually resolves pain and irritation completely… but most can’t reasonably do this because it comes back immediately and hand strength and technique goes to crapper

Things [can] transiently help decrease pain and improve function but have not made a long term difference:

1. Contrast baths with range of motion exercises
2. Stretching
3. Joint mobilizations (e.g. voodoo, joint distraction, stretching the joint, etc.)
4. Self massage

Things that don’t help mine:

1. Antagonist work (can help some people’s, but did not help mine)
2. Taping (not in the previous post, but I tried taping and it actually makes it worse)

Also consider:

• https://stevenlow.org/treatment-of-climber-hand-and-finger-injuries/
• https://www.blackdiamondequipment.com/en_US/experience-story?cid=esther-smith-nagging-finger-injuries

Basically, at the moment I’m just cutting my climbing down to extremely low volume, trying to maintain my strength, and do more open hand and finger roll stuff with full range of motion exercises to resolve it. Might take a couple months to get fully healthy I’m thinking though

I’m a physical therapist, so I’ve been running myself through the gamut of stuff trying to figure out what works and what didn’t work for mine. Finger rolls have proved to be the most effective thing for improving my PIP swelling/pain, probably because they’re non-aggravating (hard half crimp and full crimp aggravate mine the most) and they’re good at remodeling the tissue with the open finger type of movement.

At the moment, I’m down to fairly minimal aggravation when doing hard climbs to light soreness the next day (from very achy or painful when climbing hard + still feels aggravated to bend and open the next day). Still a bit limited PIP extension though. Hopefully should be resolved in a few weeks.

Your mileage may vary as there are some other posts where some of things that didn’t really help mine helped some other people.

Also, FWIW, if you do actually have synovitis, NSAIDs should help significantly because the anti-inflams will counteract the inflammation “-itis.” If NSAIDs do not help, you do not have synovitis. If they help, that also does not mean you have synovitis but could mean you have it. Getting a diagnosis is always a good thing.

Second comment:

I’ve gotten mine to the point that if I take ~5 days off it’s pretty much fully healed. Unfortunately, 5 days off doesn’t allow you to train and progress. Also, it starts to come back after 2-3 sessions, albeit fairly minimally.

Aside from the stuff I mentioned in other posts, climbing non-maximally like ~V4-6 range if you can put down ~V7-8 in a session tends to be helpful to mine as well as long as I don’t dry fire or full crimp. Basically, climb in your flashing range. If I do this for a while it can conceivably be reduced to nothing I think.

Going light on finger rolls helps, going too heavy on them is detrimental. High reps seems to be the best, as long as you do full ROM. Max hangs aggravate it, so I’ve removed them for now.

If it was me and I had to re-do it from starting at my worst point:

• Minimal Anti-inflams may be useful if there’s swelling or the pain is excessive
• Low to moderate volume Sub-maximal climbing for a few weeks
• full ROM exercises everyday for fingers (straight and closed), Stretch wrists if you have limited range of motion
• Light high rep finger curls after climbing and/or light 3 finger drag
• Mobility work in hot water bath or hot tub once a day
• Extensor strengthening, if it helps
• Massage, if it helps
• One thing that I didn’t mention previously that has helped is performing finger tip pushup supports hold (just holding the top position) with straight fingers. Start on your knees and slowly shift weight onto your fingers. It will probably hurt at first. After you do that, do some ROM work. May or may not help within the session, usually helps it improve day to day though.

The fingertip pushups seem to be an “opposite” of a lot of the primarily bent/curling finger work which is why they might help in terms of mobilizing and strengthening the fingers in the straight position. Another comment on reddit (hogriderrr10291) said they helped him too.

Final analysis:

What actually got mine completely removed was the birth of my first son and I couldn’t climb for 2 weeks. This helped remove what little aggravation I had left down to nothing. This is what I did after I got back to keep it non-existent.

• I stayed away from anything full crimp for a while and mainly worked open hand and non-aggravating half crimp climbs.
• I kept doing light finger rolls (40-50 rep range) and if I did hangboard it was only open hand.
• I did the above 2 things for about a month or two, then I slowly started working in some full crimp climbs. Maybe 1-3 climbs per session at most and not full effort.. so V4-5 full crimping as opposed to something like V8-10+ full crimping. My fingers ‘felt’ it in the same exact areas, but the volume and intensities of the climb was enough that it didn’t start a cascade of aggravation. Eventually after a week weeks I was able to add in 1 or 2 more full crimp bounders.
• Doing the above, I was slowly able to build up the volume to where I could full crimp if I needed to during any climb without aggravating, but obviously I did not want to full crimp all the time as it increased propensity for re-aggravation.

TL;DR give me the basics:

1. Stop the aggravating exercises
2. Deload and aim to do some sort of mobility exercises and potential flexibility to regain any lost range of motion
3. Start loading the fingers again with isolation exercises
4. Slow integrate sport/climbing again with lower intensity
5. Slowly ramp down rehab as you increase climbing intensity and volume

If I was to start all over again, I would:

1. Remove aggravating exercises and improve range of motion — Stop climbing for about a week. NSAIDs + massage if it helps + do light flexibility and mobility exercises
2. Once the symptoms are minimal to none, start adding in isolation exercises to strengthen the fingers again — First Isolation work with finger rolls, extremely light tension block type loading with various grips, other finger mobility work over a period of 1-3 weeks.
3. After the fingers have resolved to no symptoms and strength is improving consistently for a few weeks, work back into climbing with sub-maximal open handed climbing and minimal half crimp (none if it aggravates it). Usually stay about 2-3 grades below flash level and develop rock climbing fitness again.
4. Continue to do finger rolls and open hand hangboard, especially if they don’t aggravate it to re-establish hand strength.
5. Slowly over months 1-2 or so work full crimp back into your climbing regimen very slowly over weeks starting with low to moderate intensity and volume. Start on sub-maximal larger crimp holds with only about 50% force to get used to the finger positioning without the high intensity to prevent any aggravation. You can feel it during, but you shouldn’t feel it after the climb or the next day.

It’s going to be much more difficult if half crimp aggravates your PIP synovitis, so you might have to take it slower than this. Usually if you aggravate the symptoms you need to take 1-2 weeks for them to calm down enough to where rehab can progress effectively again, so be patient and take rehab slow. This is where I tend to see most people mess up doing self rehab.

I have worked with a bunch of climbers and helped them solve this injury if you want to work with me. Else, this can be solved on your own, but generally you need to be very patient.

• Some more anecdotal climber experience for finger rolls (2019).
• Another climber’s (EpyJojo) take on what worked for him after reading this article (2022).
• And yes, I still don’t have synovitis anymore as of 2022 (this article was posted 2019).

Additional reddit success story with another protocol based on similar things:

• https://www.reddit.com/r/climbharder/comments/1aculml/potential_synovitis_success_story/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10266264/