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Training with a finger pulley/flexor tendon issue


Original Post
John Gassel · · Boston, MA · Joined Jul 2011 · Points: 573

I've been dealing with some pain in my right ring finger for the past few weeks. I've gone back and forth with my own opinion on what it might be. Pretty sure it's either: A2 pulley or flexor tendon strain. Sounds Similar to This

Sadly I'm waiting another 2 weeks before I can get in to see a hand specialist. So here I am, hoping to get some advice from people who might have had similar injuries.

My big questions are:

- Should I be trying to do rehab for it (e.g. forearm extensor exercises, rice bucket, etc.)?
- Can I be doing easy climbs that don't involve crimping?

I know it's impossible to diagnose here but I welcome any suggestions for what they're worth. Thanks!

Ross Ayer · · Southington, CT · Joined Apr 2015 · Points: 60

I have the same question.... I am in week 4 with a left ring. Please help us MP!!!

Charlie S · · Ogden, UT · Joined Aug 2007 · Points: 1,556

Realizing that I am not a professional, I can relay info to you based on my A4 pulley sprain and FDP and FDS strain (I did see a therapist for this injury):

I was off climbing for about 6 weeks, though my injury was pretty bad. No ruptures but pretty close.

Unless it hurts, no ibuprofen. The swelling helps stimulate the tendon recovery. Warm/cold baths for your hand/finger are helpful.

Thera-putty works wonders. Use it to a "comfortable" level of soreness (making fists and "clawing" at it), and nothing extra. You want to make sure that you gently rebuild strength and even more important: range of motion. I was unable to make a closed grip/fist for almost 2 months.

In the long run, waiting two more weeks is not a bad idea. Your pulley is in a weakened state. Is it worth potentially more damage while it tries to heal? Patience is the name of the game.

Be very careful as you ramp your training back up. After 6 weeks, I spent a whole month of very light hangboarding (read: lots of weight removed!). I still haven't recovered my entire two-finger pocket strength, and that was 9 months ago.

Once you feel comfortable enough in the strength, tape the finger to the point of immobility. That way you can't accidentally crimp AND it reminds you you're injured. After you've gotten comfortable with that and more strength is back, use the H-tape method, again, mostly for immobility.

The biggest risk of climbing while injured is psychological: you forget you're injured or you end up "going for it" on a whim.

Hope that helps. Heal up quick!

David Galbraith · · Unknown Hometown · Joined Mar 2015 · Points: 0

One thing to try (Not sure where I read/saw this) is put a wide piece of tape around your middle or second knuckle not real tight, 2-3 wraps. It will keep you from bending that knuckle more than about 45-60 degrees. (first knuckle is at the palm, second is middle of your finger, 3rd is at the tip) Start the wrap at your first knuckle and go up to between the 2nd and 3rd knuckle. 3rd knuckle is left bare.

Flex the finger a few times, you should be able to bend it a bit when you first put the tape on. Maybe about 20-30 degrees, but as you climb you'll stretch the tape and you can cup your hand and hang on holds just fine...

What that inability to bend the second knuckle to the 90 degree does is make it very difficult (if not impossible) to crimp with that finger. That way you don't forget you have an issue and crimp onto something and hurt the finger more.

I did that when I had an A2 pulley issue and was able to keep climbing and the injury healed up just fine.

Laters,
-d.

Jon Clark · · Philadelphia, PA · Joined Apr 2009 · Points: 521

Do you know how you sustained the injury? I have torn a pulley, strained a finger flexor (local to the finger/hand), and strained a flexor in my forearm (pain refers to the palm).

A reduction in volume and intensity is helpful, but a significant layoff is generally unnecessary.

For the pulley and finger flexor injuries, I taped my finger straight (so that I couldn't bend it at the PIP joint), avoided crimping (half crimp too), and found ways to not use it at all while climbing.

Dave MacCleod has a wealth of info on his site regarding finger injuries. He also has an excellent book on injuries, "Make or Break."

There is a healing time table for pulley injuries in the book "One Move Too Many."

For a forearm flexor injury, don't split you fingers while gripping. Particularly avoid curling your pinky into your palm as people tend to do in finger cracks and using an open handed grip.

Relevant Dr. J article
Pocket Trauma

J. Albers · · Colorado · Joined Jul 2008 · Points: 1,793
Charlie S wrote:Realizing that I am not a professional, I can relay info to you based on my A4 pulley sprain .... Hope that helps. Heal up quick!
Charlie's advice is pretty good and more or less communicates the rehab parameters that you will get from anyone who has successfully dealt with tendon injuries.

Honestly this is a pretty simple fix if you have not completely torn the pulley (even if you have, you more or less treat it the same way, but it just takes longer).

What I outline below is more or less what partners and I figured out on our own through years of trying various remedies, some of which worked better than others, and some that didn't work at all. Interestingly, our conclusion more or less matched exactly what the Anderson brothers describe in their recent book on training. Thus if you want a more detailed description beyond what I write below, then get their book...on second thought, just get their book anyway because its got tons of useful insights beyond training to climb hard. The problem with going to see a doctor or other such hand "specialists" is that they will likely have zero experience dealing with the types of trauma and recovery that are inherent in hard climbing. That is where the Anderson brothers book shines: sport specific information from two guys armed with real data, real life experience, and education on the subject. Get their book here:

fixedpin.com/collections/tr…

Keep in mind that what I write is a very simplified view of how to fix this. The issue with tendons is that they have very little blood flow, which makes healing an issue. Thus in general, simply not using the hand will not fix the problem (at least not in a reasonable time period.) You essentially need to aggravate the tendon to stimulate blood flow and healing, but not so much aggravation that you make it worse. In general you want to continue to climb, but at a very reduced level of load. This varies depending on the person.

I will use myself and a recent injury as an example. When I am healthy, I train and climb somewhere in the 5.13 range. When I recently injured my A2 I dialed back my training to easy 5.11 for a few weeks to a month. I then incrementally raised the limit until I was maybe doing one 11+ per night. And then I started adding an easy 5.12 a night etc etc. The key here is that you want minor soreness in your hand, but no actual pain. If you have actual pain, you pushed too hard. Try digging gently into your pulley at the end of the workout. Is it slightly tender? If so, then great. If lightly digging causes you to wince, you need to dial back your workout. I generally do some taping during this phase just to crutch the pulley, but some might argue against this. After a month or two, I was pain free and climbing hard again. Depending on the person and the injury, the time scale of rehab and intensity of rehab may vary, but only you can figure this out by feel.

My regimen is pretty simple, but it always works. If you want something more intense, the Anderson bros book goes through hangboard routines etc., but the principle is the same. For the record, I have never completely torn a pulley, so perhaps if that happens you do need some initial "no climbing" recovery time...I believe that the Anderson book covers this scenario too.

Hope this helps.
Jon Clark · · Philadelphia, PA · Joined Apr 2009 · Points: 521

While it doesn't affect the rehab protocol for an injury to a pulley, pulleys are not tendons. They are ligaments that support the flexor tendons of the fingers.

I'm also not sure the OP has a pulley injury since the OP in the post he referenced describes pain in the palm down into the wrist when pressure is applied to the ring finger in the open handed position (especially when the pinky is curled into the palm). That sounds more like a flexor strain. Pulley strains and ruptures are most symptomatic in the crimped position and can be completely asymptomatic in an open handed grip.

John Gassel · · Boston, MA · Joined Jul 2011 · Points: 573

Thanks for the replies everyone. I was finally able to get in to see a specialist about the injury this afternoon. For reference, I saw Dr. Herndon at MGH in Boston.

He didn't seem to have a lot of experience with climbers per say, but he understood my injury and my passion for getting back to climbing. I was very glad to go see him.

Let me back up a bit first. Here's what has happened with my injury and what I've done over the last few weeks...

  • Injury occurred in mid-august. No single rupture, pop, or anything noticeable. Just went to the gym one day (after a rest weekend) and it was quite sore on my first climb in the area of my A2 pulley. Only thing I can think of is the week prior at the gym, after a hard session, I hopped on the hangboard for a few try-hard pinch hangs.
  • Climbed on it for 2 weeks. While I didn't go real hard, I tried climbing decently hard grades and styles.
  • Realized something was wrong and needed rest. The month of September I didn't climb in the gym at all.
  • 2 weeks in early September pretty much off. No training. Nothing. Iced it twice daily and massaged it myself.
  • Started rehab at that point for extensors, flexor tendon, lots of massage. Used a rice bucket a lot. Some forearm exercises and some general lifting. Stopped icing.
  • Continued the above from mid september through the first week of October. Climbed a slab route one weekend. Climbed juggy 5.3's at the Gunks another weekend.
  • This past weekend I managed to climb up to 5.8 and lead a 5.7 hand crack. Felt good. After the weekend it actually felt about as good as it has in a long time!

Okay..so back to the visit today with the specialist. He pretty much ruled out a flexor tendon problem. That's good news! A surprise to me, he thinks my main injury is an A1 pulley injury! He thinks there is some damage to the A2, but that's secondary.

We talked a lot about the time frame for recovery and he said the next step was an MRI if I really wanted to find out what was wrong for certain. However, he didn't think it was necessary in my case. I agreed, once he confirmed that the MRI wouldn't change the recommendation of how recover. Rest. No shocker there. He thinks I'm okay to continue getting back into climbing as long as there's no pain. He doesn't think it's worth it to train other things (forearm, etc.) if there is pain.

He did say that consulting other climbers who have had the injury is definitely worth doing. I'll do some more research on A1 pulley injuries myself since it's a bit different than what I was thinking all along. If anyone has some past experience with it, please let me know!

Cheers,
John
Guideline #1: Don't be a jerk.

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