Beating climbing injuries: PIP synovitis

Climbing, Injuries

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.

Updated: Sept 2025

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What is “synovitis”?

Unfortunately, right now most of the climbing community not to mention medical community for the most part uses the term synovitis as a catch-all type of phrase for a few different injuries

  • Irritation of the synovial sheath of the tendon
    • Usually directly along the tendon sheath
  • Irritation of the synovial joint capsule (e.g. capsulitis) of the PIP or DIP joints
    • Can be located anywhere along the capsule
    • Usually accompanied by some swelling and decreased range of motion
  • Irritation and swelling of some of the surrounding tissues to these structures (e.g. ligaments, insertion of tendon to the bone, etc.)
    • Located around the joint and may have similar or different symptoms

This is an issue because rehab exercises responds different depending on what exactly the issue is.

Image from researchgate

Additionally, it appears from working with many different people on this issue that is someone has been consistently working out through symptoms for a long time (e.g. usually years), it’s possible for the synovial tissues to hypertrophy which makes rehab more difficult due excessive tissue in the area making it easy for the structures to be compressed and inflammed. This may predict some of the more irritable cases of synovitis that don’t respond as well to rehab.

Past comments and success story

Past comments without categorized information – 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).

My success story – 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.

As of this post and updates (Sept 2025) I don’t have any issues as long as I maintain full range of motion in my fingers and don’t do excessive volume. Also, I need to make sure my fingers don’t tilt off axis as well. Synovitis free since 2022.

Generalized rehab and specific types of synovitis

  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

Regarding the types of synovitis:

I’ve had both main types of synovitis: tendon sheath as well as joint capsule. Here are some of the distinguishing features of what can make rehab differ, BUT in most cases you will do most of these for one injury anyway.

  • Tendon sheath synovitis seems to benefit the most from:
    • Avoid aggravating movements
    • Usually little to no loss of range of motion
    • Forearm extensor stretches and tendon glides
    • Finger rolls or crimp up type movements
    • Open hand hangs
    • May need to rework your half or full crimp form
  • Synovial joint capsulitis seems to benefit the most from:
    • Avoid aggravating movements
    • Restoring joint range of motion to full range without symptoms – end range of the movements usually feel irritable or painful
    • Forearm extensor AND flexor stretches and tendon glides
    • Doing rehab exercises with straight fingers
    • Extensor strengthening
    • May need to rework your half or full crimp form
  • Other irritated structures seem to benefit the most from slow and steady progressive overload

This is just a broad categorization from what I’ve seen and treated. It is possible to have both at the same time from overuse and not just one of them. Also, some of these may fit the other category at times depending on the particular issues.

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 or two. NSAIDs (for a few days only, chronic use is bad) + 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. May need to rework half and full crimp if they are irritating and/or avoid certain climbs which put rotary stress on the fingers (e.g. gastons, some side pulls, some slopers, etc.).
  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.
  6. Other notes: See some of the links below for other early stage mobilizations, massages, and exercises if you need them.

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 and build up slowly. It’s usually the fingers are feeling good and then you introduce climbing intensity and volume too quickly that trips up climbers getting back into things.

Additional references and success stories

Scientific studies on synovitis

Generally speaking, Cortisone has potential long term negative side effects though but some scientific literature suggests 1 is probably fine, maybe up to 2, but definitely not 3. I’d get multiple opinions on this before you go this route though.

Some newer research on using radiosynovectomy and cortisone for extremely stubborn cases and/or rehab that has failed.

Radiosynovectomy can be helpful if there’s extra hypertrophied synovial tissue (capsule or sheath) from continual aggravation of climbing through symptoms for months or years. I know of a couple of radiosynovectomy success stories including one from my home gym.

Success stories

Author: Steven Low

Steven Low is the author of Overcoming Gravity: A Systematic Approach to Gymnastics and Bodyweight Strength (Second Edition), Overcoming Poor Posture, Overcoming Tendonitis, and Overcoming Gravity Advanced Programming. He is a former gymnast who has performed with and coached the exhibitional gymnastics troupe, Gymkana. Steven has a Bachelor of Science in Biochemistry from the University of Maryland College Park, and his Doctorate of Physical Therapy from the University of Maryland Baltimore. Steven is a Senior trainer for Dragon Door’s Progressive Calisthenics Certification (PCC). He has also spent thousands of hours independently researching the scientific foundations of health, fitness and nutrition and is able to provide many insights into practical care for injuries. His training is varied and intense with a focus on gymnastics, parkour, rock climbing, and sprinting. Digital copies of the books are available in the store.