Climbing – Finger injury

Squamish is well known to have some of the most beautiful and accessible rock climbing in the world, therefore attracts the best climbing population. Training for competitive or recreational climbing involves dedication and discipline. Focussing on a balance lifestyle and training is recommended to perform in any kind of sports, including climbing. Too much of the climbing community participates as weekend warriors and don’t perform proper warm up before getting on the crag. In the list of the overuse climbing injuries, 40% of the injuries occur to the fingers. The flexor tendon pulley injury, well known as the climber’s finger, is being the most common injury of the upper extremity in the climbing population. It can range from microscopic to partial tears, and in the worst-case scenario, to complete rupture. 

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The pulley system is a series of annular and cruciate fibrous band. Most common injuries are at A2 and A4 pulley.

Pulley ruptures occur most commonly following falls with the hand in the crimp grip position. This position brings the tendon near a maximal contraction to resist body weight and creates the injury. Typically, patients will hear a loud pop in presence of a complete rupture, with a feeling of giving away of the proximal interphalangeal (PIP) joint. Severe pain is normally present at the base of the proximal phalanx and will be aggravated by the finger flexion against resistance. It can also be followed, several hours later, by swelling. Pain only present on the proximal phalange and palm area are indicative of flexor tenosynovitis, compared to a bowstringing injury where the flexor tendon appears to resist bending may be an indicator of a multiple pulley rupture.

Also, pulley rupture mostly occurs when there is already micro-damage accumulation. Allowing full recovery after more minor injuries may help reduce the incidence of pulley rupture. On the other hand, repetitive gripping and pulling without stretching, and failure to exercise the antagonist’s muscles, which are the extensor digitorum muscles, can lead to relative overdevelopment, contracture and reset of the functional length of these muscles.

Healing progression: 

Tendons and ligaments need time and progressive loading to heal compared to muscles. A gradual return to climbing is permitted when 80% of the prior strength and pain free motion is present. It usually takes a minimum of 6 weeks to reach that goal. A lower grade annular pulley injury typically heals in about 2-3 months, and after 4-6 months it can bear normal loads. 

The use of Non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of musculoskeletal injury has shown negative impact in recent studies. It reduces tenocyte and fibroblast proliferation as collagen formation, and therefore negatively affects tendons and ligaments healing. 

Factors modifying the load: 

  • Biomechanical: previous injuries and misalignment can relate to abnormal forces and abnormal motions. Make sure your grip technique, as your CORE and body position are efficient when you train or you climb.

  • Training: ongoing use of high absolute load magnitudes, rates and accelerations may reduce the body ability of adaptation to heal and even lead to micro-damage accumulation.

  • Muscle: When a muscle is dysfunctional (weakened, fatigued or altered in their activation patterns) its ability to attenuate loads becomes compromised.

  • Playing surface: some wall and holds require a higher load on the fingers and hands. After an injury, be smart on the progression and surface you are training or climbing on. 

Training/climbing tips: 

  • Restricted taping can be applied during training or climbing to limit hyperextension of the finger. It helps to take tension off the injured pulley. 

  • After a finger injury, isometric training on a fingerboard can be started once ROM exercises are painfree. A return to climbing can be initiated when the climber is able to avoid grip positions that produce pain.

  • Build up load on your tendon. Gradually use holds that involve more loading in your training as to build up weight resistance on your fingers. Full crimp and half crimp grips use up to 3 times more loading on the tendons and sheaths than an open hand. 

  • Take some rest days, depending of your body adaptation and training intensity. 

  • WARM UP! To do a proper warm up helps to lubricate the pulleys and to activate the muscles. 

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Here’s the key: Train smart and properly. 

There is a ton of climbing guides, trainers, coaches and health care providers that can help you achieve your goals. 

Dr Valerie Brabant, Chiropractor, Dc

PhysioFocus Squamish