Treating and preventing finger tendon pulley injuries

Connor Magee asked the following via Twitter:

First off, I’m hesitant to give advice on injuries because I’m not a doctor or physiotherapist. So as a disclaimer the points in this blog should be viewed as general suggestions from one climber to another.

With that out of the way, as a general principle for climbing injuries, always think about the long term and remember that any injury you get could nag you for the rest of your climbing life. For example, my A2 pulley, right hand, ring finger suffered an epic tear over 10 years ago which required around 4 months off climbing altogether. Now that sucked. To this day I still crimp with some reservations although I can still crimp pretty well. But I far prefer the open crimp grip when I can get away with it. My point is that you should be calculated in the risks you take on bad holds – or more specifically crimps since this is an article about tendon pulleys.

Connor asked how to help it recover so I’ll make some recommendations, followed by some ideas on how to prevent such injuries.

  • When the injury first happens (or you think it might have happened), stop climbing immediately. Don’t be a hero and try to convince yourself it’s ok. If in doubt, err on the side of caution. Ice it frequently (a few times a day) and most professionals recommend anti-inflammatories like ibuprofen. The reason you want to do these things is to keep inflammation down because inflammation can cause secondary damage whereby blood doesn’t get to the tissues surrounding the injury and as a result more cells die from lack of oxygen and/or nutrients.
  • In the first few days or so, it’s hard to diagnose what really happened because of the inflammation and also because you body is cleaning out the dead tissue. You want to let it run its course before you start loading it again because you don’t really know how severe it is yet.
  • After a couple of days’ off of climbing altogether (note: other training that doesn’t involve significant gripping is ok), if it seems significant – i.e. pain/discomfort is not gone – see a physiotherapist. It’s good to find one that has worked with climbers before. If you don’t know of one, ask the ‘mature’ climbers at the gym who have been at it for a decade or more, surely they will know of one. :) I definitely have my “go to” physio in Vancouver but luckily I haven’t had to see him for a few years!
  • Once the initial inflammation/pain part has subsided, and you can imagine climbing without cringing (that’s not a typo, I mean cringing, not crimping) you can probably start back with easy route climbing on jugs, or crack climbing. Bouldering is not advised because I find even the easiest problems strain the pulleys if they are sensitive, and climbing V0’s gets boring really quickly if you’re climbing much harder than that normally. ICE it after climbing, and as often as you can. (Sometimes if feels good to take an ice cube and massage your finger with it… I don’t know if that is a clinically accepted practice but I like it.)
  • Ok, now you’re climbing again, albeit on very easy terrain. Proceed with caution though because it’s easy to get overzealous and cause re-injury which is BAD and will prolong your recovery big time. Check your ego at the door and once you feel fatigue and you’re not in full control, you should stop. Obviously if you feel sharp pain, stop climbing and call it a day. ICE, ICE, ICE.
  • As your confidence builds bouldering probably becomes more feasible, and you can start pushing yourself a bit more on the routes. However, make sure that you use the open crimp grip instead of the closed crimp grip. Basically this means you do not hook your thumb over your index finger when holding edges. As above, if you sharp pain, stop climbing and don’t fight your way up routes or boulders; you want to be in control. This is also a good phase to work on core strength, pull-ups and antagonist like the chest, shoulder and triceps muscles.
  • Keep doing the above and at some point you will realize it’s not such a big deal anymore you can start trying harder routes and push closer to your limit. Still, go easy on the crimps – opt for slopers, wide pinches and other open handed grips if you have the choice. Occasionally you can try closed crimping, but use caution.
  • Finally you are not injured anymore. Congratulations! Now you can continue working on your crimp strength more specifically, so that crimping doesn’t become a major weakness compared to other hand positions. (One upside is that your open crimp strength will be better and you won’t have to crimp as much as you did.)

Other considerations:

  • To tape or not to tape: generally I say YES because it mechanically supports the tendon pulley. But don’t go crazy on the tape because if you can’t feel anything then you don’t know if you’re doing damage or not.
  • Use of pain killers / anti-inflammatory is a double edged sword. It has its place but you don’t want to mask the pain, otherwise you can be causing damage without knowing it. Personally I rarely use them on the same day that I am climbing/training.
  • Nutrition: eat lots of fruits and vegetables and keep processed food to a minimum. If your body is to heal it needs nutrients, especially antioxidants to deal with the free-radicals resulting from cell damage.
  • If it’s longer term pulley injury (months) and you are having a hard time getting back to climbing you can try Theraputty to start stressing the tendon pulleys again and stimulate them to get stronger.

Theraputty

Ok, now on to prevention.

  • Warm up properly – I believe 100 moves are a needed before your pulleys are ready for hard crimping.
  • Stay hydrated so your tissues are well-lubricated.
  • Personally I like to tape my middle and ring fingers on the closest part (phalanx) to the palm because I’ve injured these pulleys many  times – not always severely – so I like to do this as a protective measure for all workouts or climbing days.
  • Train the open crimp more than the closed crimp because the closed grip puts the greatest strain on the pulleys. On the flipside, you should still do some closed crimping otherwise when confronted with a bad crimper with a nice thumb-catch you will not be prepared for it and could be at a greater risk of injury.
  • Don’t do marathon training sessions. Try to keep in under two hours for bouldering – maybe longer if you’re doing routes. I find the finger tweaks usually happen when I’m fatigued, after hour two. Doing more frequent session that are shorter is way more effective and safer in my opinion.
  • Vary your routine – try different workouts to mix it up and not always strain your body the same way. Train on different angles, hold types , setting styles, route/boulders, etc.

There you have it, some general recommendations on treating and preventing tendon pulley injuries. Be safe, have fun and take care of your body so you can climb until a ripe, old age! :)