Treatment of climber hand and finger injuries

This article is written from a physical therapist perspective. Obviously, this article is NOT medical advice and should not be misconstrued as medical advice. This article is mainly to give you some guidance on paths to seek in terms of recovery and rehabilitation of particular exercises.

So you were climbing or bouldering and an injury occurs. Some examples of this are:

• There was a pop or two when pulling on a hold
• You pulled on a hold hard, and one of your fingers felt like it strained and injured
• Your foot or hand slips and your hand or finger gets tweaked

Climbing finger injuries are fairly common. The general consensus of “RICE” or “rest and allow it to heal” is not specific enough recovery. Hence, this article aims to address what you should do after receiving a finger injury to get back to your sport without much regression.

I promised to write this article up for http://reddit.com/r/climbharder so check them out!

Cover image from: https://frictionlabs.com/blog/taping-fingers-in-rock-climbing

---

First, get seen by a orthopedic doctor or hand specialist or physical therapist ASAP

The type of rehabilitation you do for a particular injury depends on the diagnosis. You need a solid diagnosis about what is actually wrong in order to begin an appropriate rehabilitation process. It could be a tendon, muscle, ligament or other connective tissue injury. Figuring out what type of injury you have through a professional diagnosis is paramount, as there is a lot going on in the hand:

View post on imgur.com

Image from https://ittcs.files.wordpress.com

The reason for this is that you would NOT do the same thing for a strained muscle that you would do for a pulley (A1 to A5) strain. You would NOT do the same thing for an A1-5 strain that you would for a strained tendon. If you have multiple things wrong, you would have separate rehabilitation exercises for all of those different things.

I cannot stress getting it checked ASAP if possible. The faster you get it checked, the sooner you have a direction for rehabilitation.

---

Second, do not stop working out

What I mean by “do not stop working out” is that you should continue with your non-climbing activities if at all possible. This includes workouts. Getting out of the habit of working out and taking a long time off of rest is a bad idea because it leads to quick deconditioning which will negatively affect you when coming back. Losing your overall body strength, endurance, and other attributes is bad.

You may have to substitute or remove exercises depending on a particular injury and if you can grip a barbell, dumbell, rings or other training implements, but stick with good habits.

Full rest is almost NEVER indicated.

There’s numerous studies everywhere that show detrimental effects of deconditioning on athletes. Even people who have surgery will go to physical therapy and do early movement of the particular area(s) unless there is a contra-indication to movement from a particular surgery. However, in many cases, the contraindications are being removed for most injuries aside from potential non-weight bearing injuries. ACL tears, like most ligaments, seem to benefit from early mobilization and so on.

---

Third, minor, moderate, and major injuries

I think a a distinction versus minor versus major injurious on the Internet is somewhat dubious. Although I do not suggest “self rehabilitation,” for those who have no insurance or access to healthcare, this may be the only option. Hence, I will provide some information on some important points. However, any information disclosed in this section is taken at your own risk.

• Minor injury — Movement quality starts to get better with immediate movement within a few minutes after the injury. The pain may go away mostly or completely with movement after the injury. Over the course of the next few days, the injury is already close to 80-100%. The injury starts to heal rather quickly and by 1-2 weeks is fully healed.
• Moderate injury — Movement quality may remain impaired but does improve after the injury with movement. May take a little bit for the pain to dissipate. Movement removes some of the pain, but not all of it with movement. Over the course of the next few days it improves, but is still nowhere near 100%. Often in the 50-80% range over 1-2 weeks, and recovery is slowly if you fully rested.
• Major injury — Usually major pain and disability. A tendon partially or fully tears. Muscle strain very badly. Can be accompanied by mild, moderate, or major swelling and/or bleeding depending on the injury. Over the next few days, capacity remains below 50%, and the healing process is slow.

Moderate and major injuries you should definitely get checked out like I mentioned earlier. There’s really no way around this. The earlier the better.

Minor and less severe moderate injuries

• Any minor to less severe moderate injuries may allow you to climb non-painfully on the same schedule. Some types of grips may aggravate the condition. Avoid those grips and stick to holds that do not aggravate the particular injury.
• Rehab should go along with non-painful climbing. Generally, this should be done under controlled circumstances such as in the gym with light weights or on hangboard de-weighted such as with a pulley device or with a no hang device. In these circumstances, it is best to train with (1) very light weights, (2) higher repetitions, (3) not-to-failure with (4) adequate rest times (>3 minutes between sets) to minimize chance of re-injury. Obviously, higher intensity increases risk, as well as going to failure when you are fatigued, and less rest times (as your muscles may fail).
• Exercises are generally based on the particular injury. If it’s a muscle strain, there needs to be higher repetition work and also eccentrics to injury proof the area.
• Taping may help to reinforce the area while doing non-painful climbing while you do rehabilitation.

Overall, climbing should be lighter and focusing on technique. The key with continuing climbing is to avoid particular types of holds or hand positions that may easily reinjure the particular areas. In conjunction with this, rehabilitation and taping will help to improve the injury back to normal while you continue with as much sports specific practice as necessary.

More severe moderate and major injuries

Get thee to a medical professional!

• Any type of more severe moderate and major injury may prevent any climbing without pain and/or aggravation. Thus, a major injury may not allow you to climb on it right away.
• If you are able to get a medical professional who can diagnose you right away and get into physical therapy, usually within a couple days of the injury there will be some type of rehabilitation you can do at low intensity and low-moderate volume (depending on what the injury is).
• Hangboard can be used effectively, especially unweighting with pulleys and no hangs if possible.
• Taping may still be used in the rehabilitation process, especially when starting to climb again to give some support to the areas.

Usually an athletic sports medical professional will tell you that you can get back to sports specific activities as long as there’s no pain and/or you are not aggravating the particular injuries with the climbs and/or specific hand positions and holds. This may take anywhere from a few days to a few weeks and maybe rarely a month or more depending on the particular injuries. YMMV. Talk to your medical professional to get his/her opinion.

Rehabilitation will generally be much more conservative and focus on mobility and endurance at first, and slowly progress into strengthening exercises as pain and function improve.

In terms of getting the hand moving for mobility and adding a bit of resistance, I like rice bucket.

This is a decent video. There is also this article on different hand movements you can do with a bit of humor. https://www.trainingbeta.com/way-iron-fist-forearm-training/

Some other alternatives to rice bucket for strengthening the fingers again include:

• Putty to exercise the fingers
• Rubber band exercises
• Manual resistance (use your other hand to isolate and provide light resistance)
• Slowly finger curling a very light dumbell
• Deloaded hangboard work where you use weight from a pulley or assist or just put light weight on the fingers while standing on the ground

All of these are solid options. The main goal is to slowly build up resistance training on the fingers again to get them back to full capacity. Don’t try to go fast or push through the injury to get back. Take your time as it’s very easy to reinjure them.

Fourth, Specific injuries

Let’s talk about some of the specific strains.

• Pulley strains — Pulley strains are much  more likely to occur with full crimp grip than half crimp or open hand. You’ll usually see these appear when cranking very hard on full crimp grip, although they can happen with half crimp as well. Generally, anywhere from A1 to A5 strains can occur. Most common are typically A2-4 pulleys with A2 being the most common, and you will feel pain on the front of the finger.

View post on imgur.com

Image from climbing.com

• Ligament and capsular strains — These are much like pulley strains, but are definitely a bit rarer. Usually for the collateral ligaments of the fingers, the pain will manifest on the side of the joint rather than on the front of the finger.
• Muscle strains — Typically, these occur nearer to the end of sessions when your muscles are fatigued and you’re trying that one last climb. They can also occur as your fingers get “pulled” from a full or half crimp position into an open hand position. They will also occur on pocket climbs. Some of the most commonly injured muscles in the hand are the interosseus and lumbricals. The pain is typically centered on them rather than up in the fingers. The forearm muscles can also be strained. See On muscle strains for more on rehabilitation.

View post on imgur.com

Image from: joelvanderlugt.files.wordpress.com

• Tendinopathy — Generally, tendinopathy does not occur within on session. It usually gets worse over multiple sessions over time. There are some rare cases where tendinopathy can develop rather rapidly, but usually not the case for what we are talking about here. See Overcoming Tendonitis for rehabilitation.
• Tendon strains or partial tear — generally very rare, but can happen with a very strong jerking or force motion. Pulley and muscle strains tend to be more likely though.

For grouping purposes, generally strains to connective tissues such as pulleys, ligaments, capsules, and so on tend to be treated the same. Low resistance, higher repetitions, not-to-failure and the focus is building endurance and good remodeling of the healing tissues first, then strength training afterward.

Muscle strains, tendinopathy, and tendon strains tend to be very similar in treatment. Eccentrics are critical to healing. Staying away from fatigue during eccentrics is critical. Lower intensity moving into higher intensity eccentrics during rehabilitation.

There are other injuries that occur, so climbing hand injuries generally are not limited to this. However, these are some general groupings that tend to rehabilitate similar.

Goals of rehabilitation

Pain is not necessarily an indicator of injury, but it is usually present when an acute injury occurs. As the rehabilitation process goes on, it tends to lessen as an indicator. Obviously, one of the goals of most is to climb pain free, so it can be one of the goals as you improve.

1. Full range of motion — make sure you can move the fingers or hand through full range of motion with your other hand.
2. Full mobility — make sure you can use your muscles to move your fingers or hand through full range of motion
3. Add endurance — higher repetitions, lower sets, low to moderate volume, not-to-failured aimed at remodeling and connective tissue/muscle integrity.
4. Add strength — finally, add strength to bring the muscle or tendons or pulleys back in line.

Depending on how fast an injury progressions, these phase may only take a several days each to 1-3 weeks for each of them. For example, very mild injuries you may be able to regain range of motion and mobility within a session without pain. Hence, the only thing you need to do after several days is to work on endurance and strength again. On the other hand, more severe injuries may require a few weeks to regain full range and mobility, and another few weeks on each of endurance and strength resulting in 2-3 months of rehabilitation. It all depends.

These are generally the main steps that you want to go through prior to going to the next as they all help build off each other. Usually if you don’t have full mobility you can have some exercises aimed toward endurance but you won’t be skipping ahead toward strength.

Justin Marsan has some good tips here on how to apply this for pulleys specifically.

Conclusions

Things to keep in mind as a summary and a few new things.

1. Get it checked by a medical professional for a diagnosis. Especially one who works with athletes is preferable.
2. Don’t stop working out in terms of non-climbing workouts to keep in good habits.
3. Depending on the injury AND what your medical professional says, you can likely still climb if the injury is only mild or moderate and there is no pain or aggravation of the injury. Rehabilitation is concurrent with climbing.
4. If the injury is moderate or severe, generally you probably won’t be able to climb right away. However, you will usually be able to start rehabilitation soon.
5. For all injuries, early mobility is critical. Massage may help. Icing does not help. If there’s swelling, compression works better than ice for swelling. If there is pain, analgesics tend to work better than ice for pain.
6. For more severe injuries, simple exercises with rubber hands, squeeze objects, rice bucket, or light dumbbells will be performed first. Moving into climbing specific rehabilitation, no hang devices, hangboard with or without pulleys, and so on may be used to get the fingers/hand accomodated to lighter resistance hand positions or grips.
7. As you start to get toward 100% climbing, keep in mind that the greatest predictor of an injury is a previous injury. Be careful when you’re fatigue later in your sessions, and try to avoid hand positions or specific holds that may cause you to re-injure yourself much easier.

Rehabilitate well and stay safe!