The following article is a compilation of what I have learned about finger injuries and how they are treated. I am not a medical doctor, and cannot tell you how to treat an injury. My objective is to share with you how I and others have handled or avoided finger injuries. If you have an injury that you are concerned about, talk to your medical doctor.
Rock climbing puts a lot of stress on our fingers. If a 150 pound climber hangs from eight fingers, each finger carries an average of almost 19 pounds! It is no wonder that these tiny appendages take a beating while climbing. I have listed below, the most common finger injuries experienced by rock climbers, and explain how they are typically treated and avoided.
There are two tendons, the FDS and FDP tendons, which flex your finger. These tendons are held in place next to the bones and joints of the finger by a series of ligamentous bands called pulley tendons.
Annular pulley tendons (A1-A5) hold the FDS and FDP flexor tendons near the fingers and joints during flexion, while Cruciform pulley tendons (C0-C3) stabilize the finger joints and are not that important to finger flexion. The most common pulley tendon injuries occur in the annular pulleys A2, A3, and A4. Injuries in A1 and A5 are much less common, and cruciform pulley injuries are also less common. Pulley tendon injuries in A2, A3, and A4 in the middle and ring fingers account for 30% of finger injuries in climbers.
Injury of the A2-A4 pulleys range from small tears in a single pulley to complete rupture of all three. Complete rupture is characterized by severe pain and swelling, and complete loss of finger function. If this happens to you, see your physician, as you may need surgery.
Smaller tears in these tendons typically heal well within a few weeks to months with the right treatment. Such tears are characterized by swelling in the region of the tendon, pain or discomfort when crimping or pinching holds, and tenderness to the touch. If you experience these symptoms, the following can help you heal more quickly.
How Pulley Injuries are Typically Treated
Rest: You should lay off from climbing in the initial phase of recovery, where inflammation is present. This phase may last one to three weeks. If you start climbing again too soon, you risk making the injury worse or slowing your recovery. If you lay off too long, you risk weakening the tissue and potential scarring. Once you can move the finger through its normal range of motion without pain, it’s time to start using it again gently. Using the injured finger encourages healing in the same way that training makes your body stronger. According to a physical therapist that I know, not putting stress on the finger during recover can actually make it weaker and more prone to re-injury.
Ice: Increasing the blood flow to the area helps to speed healing significantly. An effective way to increase blood flow is ice therapy. When moderate cold is applied to tissue, there is an initial reduction in blood flow followed by significant dilation of the blood vessels and subsequent increase in blood flow of up to 500%. To ice your finger, place your injured hand in a bucket of cold water with a few ice cubes. Leave your hand in the water for 20-30 minutes. Do this at least once or twice a day.
Massage: Massage helps to break up scar tissue which forms in an injury, helping improve realignment and strength. Rub the pulley with your thumb, applying firm pressure along the affected part of the finger. Only use massage when your injury is past the initial inflammatory stage and stop if you feel the massage is irritating the pulley or causing excessive pain. Massage for a few minutes at a time and repeat a few times a day.
Physical therapist use a technique called scraping, which is a form of massage. They apply a lubricant to the skin, and use an instrument with a moderately sharp edge to scrape the skin. This breaks up scar tissue in the muscles and connective tissues, which form from trauma. This scar tissue is often the source of aches and pains and interferes with smooth movement. After scraping, which breaks up the scar tissue, your body will lay down new scar tissue, hopefully in a smoother way. Stretching helps ensure the new scar tissue is smoother.
Stretching: Stretching is another important treatment to ensure adequate healing. Stretching promotes blood flow and tissue growth. You should stretch the finger until it feels tight and you should hold this position for 30 seconds. Never stretch the finger aggressively to the point of being painful. Stretch the injured finger as often as you like. It is important to stretch before and after a climbing session.
Stretching is used after an area is scraped, to help your body lay down more smooth scar tissue rather than lumpy scar tissue.
Anti-inflammatory drugs: Some climbers use anti-inflammatory drugs such as Ibuprofen (a class of drugs called Non-specific Anti-Inflammatory Drugs – NSAIDS). NSAIDS are used to reduce inflammation and allow continued training. Use of NSAIDS can be useful to ease discomfort as you return to training, but should be used with caution. Using them to interrupt the natural inflammation cycle can retard healing. Use that allows you to climb through pain, can result in further injury or retard healing also. I would avoid them for pulley injuries.
Finger Taping: Taping takes up to 10% of the strain off the injured pulley. Scientific studies have shown that taping is effective in the early stages of healing of an A2 injury. The best results came from taping near the middle finger joint where A2 was injured. The studies also showed that taping provides no benefit in later stages of healing or in pulley tendon injury prevention.
Pain caused by swelling in the finger joints can hinder your climbing. Joints are held in place and supported by ligaments and an outer covering known as the joint capsule. The inner layer of the joint capsule is called the synovial membrane and this produces the oily liquid (synovial fluid) that lubricates the joint. Inflammation of the joint capsule can be termed capsulitis or synovitis. Synovitis is generally accompanied by an increased production of synovial fluid causing some swelling of the joint. When the swelling occurs in the synovial membrane, it is referred to as synovitis. When from the fibrous joint capsul, it is called capsulitis.
Synovitis/capsulitis responds well to a combination of rest, ice, and stretching. Laying off of climbing for a week or two is usually enough for the swelling to reduce to the point where light climbing can be introduced without pain. Ice therapy as described for pulley injuries will help increase blood flow and accelerate recovery. Here’s the link to an article by Julian Saunders, DO (http://www.rockandice.com/lates-news/fingers-torn-a2-pulley ) where she discusses these injuries.
How Pulley and Synovitis/Capsulitis are Avoided
There is an old saying that says that an ounce of prevention is worth a pound of cure, and nothing could be more true with finger injuries. While some finger injuries can sneak up on you over a period of time, they most often are the result of a traumatic event. Typical scenarios are shock loading one finger when others pop off a hold or when there are forces on your fingers in an uneven or awkward direction. These situations place unusual loads on your tendons and can cause tearing. So, you often never see these injuries coming. How are you supposed to prevent them?
The best way to prevent them is to be sure that your fingers are warmed up prior to any potential high load situations. Climb some routes that stress them, but that don’t over stress them. It’s also a good idea to do some finger stretching exercises when warming up. Using your fingers and working them through their full range of motion will improve blood flow and synovial fluid flow and help prevent injuries.