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Finger POP When Bouldering - Suggestions?


Original Post
Henri Alexander · · Dallas · Joined Mar 2014 · Points: 511

Hello all, I've got a painful injury and was looking for some direction. 

Injury
Right index finger pain along flexor digitorum superficialis tendon at mid-proximal phalanx. Auxiliary pain in the deep transverse metacarpal ligament and general, transverse fibers on either side of the finger. Surrounding areas are tender but not painful. Difficult and painful to open/close hand. Unable to fully close fingertip down to palm.

Supplemental: I can pop the metacarpophalangeal and proximalphalangeal joint of the finger without joint pain. The issue is in-between the joints. Keep in mind this is my own assessment and I'm open to hearing clarifying analyses. 

How it happened
Last night, I was bouldering and pulled up on an undercling. My right hand was holding on while my left went up for the next hold. Because of the angle, I remember more weight/pressure being on the ring finger than the "primary digits". As I shifted over, my ring finger went POP! and made the loud, audible sound of a squishy rubber band snapping. My hand started to hurt like a MF'er. Today, I can't even pick up a water bottle without it hurting.

Pictures below show specific areas of pain.

I know the basics of RICE, stretching, strengthening, yoga, water, snake oil, etc. to deal with a pulley as I've self-treated many over the years. I will likely go to a primary care physician anyway (to make sure something isn't permanently torn), but I was hoping some climber/medical people with specific experience in this injury could put me on a focused path.

JCM · · Seattle, WA · Joined Jun 2008 · Points: 95

Your primary care physician will likely be totally useless. Most doctors know nothing about climbing injuries, but are too arrogant to admit it. Best case scenario they will admit that they aren't sure. Worst case scenario they will give you spectacularly bad advice that will sidetrack you from recovery.

Don't bother. The sad state of affairs is that internet bro science is generally better than medical practice when it comes to finger injuries.

TrainingBeta recently did a podcast on finger injuries. The advice given there is rock-solid. So go listen to that podcast. It is better than the advice any doctor is likely to give.

In summary, rest at least a week to let the initial pain and swelling dissipate. Then begin careful, gradual, progressive rehab.

Rui Ferreira · · Boulder, CO · Joined Jul 2003 · Points: 869

I also recommend that you listen to this podcast as a starting point

https://www.trainingbeta.com/media/esther-fingers/

and as indicated in the podcast get expert help.  

this forum also has some practical advice

https://www.mountainproject.com/forum/topic/112846067/middlering-finger-flexor-injury (not the part about 100% rest...)

Good luck with the recovery

Alexander Stathis · · Athens, GA · Joined Jan 2016 · Points: 80

Dave MacCleod's book is supposed to be excellent.

https://www.amazon.com/Make-Break-Climbing-Injuries-Dictate/dp/0956428134

Henri Alexander · · Dallas · Joined Mar 2014 · Points: 511

@JCM - I agree, but seeing a doc is to check whether something is torn. I don't trust my limited med training enough to do that on my own.

@Rui - Thanks! I'm listening to that podcast now. I also read that forum post which confirmed recovery practices I already do.

@Alexander - Good looking book. I'll keep it in mind. ($45 is a bit pricey, but I suppose it's worth the cost to help heal injuries.)

Thanks for the info, everyone! I'm also holding out for anyone with specific knowledge about this injury. I know the standards of treating finger injuries... just not those on the anterior side at the lower phalanges.

Andrew Ryder · · Arizony · Joined Jun 2006 · Points: 3,800
Henri Alexander wrote:

@JCM - I agree, but seeing a doc is to check whether something is torn. I don't trust my limited med training enough to do that on my own.

The likely scenario is that the doctor will tell you to rest and rehab, and come back for imaging (MRI etc) if it doesn't improve. If the imaging reveals a tear, there still isn't much they can do besides needlessly invasive surgery. JCM is right that unless you have a very savvy doctor they're unlikely to have much of a clue.

I've recovered completely from multiple finger injuries, including one very, very similar to what you describe (loud pop and intense first knuckle pain in the ring finger - I think it was even on an undercling!), using only the "bro beta." 

But, if anecdotal advice isn't enough and seeing the doc is what you need to put your mind at rest and it won't wreck you financially... go for it.

Henri Alexander · · Dallas · Joined Mar 2014 · Points: 511

@Andrew - Thanks for the "bro beta". Haha! I kind of figured all of the things everyone is saying. It just helps to get confirmation. 

We're (climbers) all in this together. I'm eager to see the science get much more developed on this stuff.

I've been contacting a few climber-specific sports medicine doctors and will at least do a Skype session with them and then employ the tried and true methods I've used for my other fingers.

Andrew Ryder · · Arizony · Joined Jun 2006 · Points: 3,800
Henri Alexander wrote:

@Andrew - Thanks for the "bro beta"...

I've been contacting a few climber-specific sports medicine doctors and will at least do a Skype session with them and then employ the tried and true methods I've used for my other fingers.

No prob man! The chain of ancient magick bro wisdom shall remain unbroken.

That's awesome that you're digging into the science, keep us all in the loop with what you find out!

lucander · · Stone Ridge, NY · Joined Apr 2009 · Points: 240

A3 pully and Vincula.  I did that in 2012, same *pop* climbing.  Went to a specialist who wanted to cut me open right away after seeing a MRI.  Went for 2nd opinion from a climber/doctor, he was like "you're out for the season regardless - let it heal."  I laid off rock for 6 months, wrote two books, and came back stronger & more motivated than ever.  Surgery on small tendons doesn't do much.

David L. 

Gunks, NY

Alexander Stathis · · Athens, GA · Joined Jan 2016 · Points: 80

I listened to the podcast. Most of it is just them chatting, which is sort of annoying, but there is good info in there consistent with the other sources I've read online. I'm not a doctor and it's only one person's opinion, but Esther's credentials speak for themselves and I think that if you follow her advice you'll heal up fine. Seems like there's plenty of anecdotal evidence, and a lack of solid scientific evidence, to suggest doing anything else. 

Jack Quarless · · Unknown Hometown · Joined Feb 2011 · Points: 0

Read the book "One move too many". I too had the all to common pully tear four years ago, and came back stronger than ever. Enjoy the next two to four months off. 

SethG · · Unknown Hometown · Joined Aug 2009 · Points: 252

Yer gonna die.....

..... of boredom while you rest that finger.

longlep · · Reno, NV · Joined May 2014 · Points: 20

I had a really similar injury in December,  It was in my middle finger though.  Immediately after I couldn't even type or do everyday tasks.  I followed advice from http://rockprodigytraining.proboards.com, the rock prodigy book, and Dave McCleod's website and took like three weeks off.  Then I started hang boarding with about 60 pounds less weight then I would normally use and slowly worked my way back up to full weight.  I recommend the recovery hang boarding.  I was back to 100% in 4 months and never had any set backs (knock on wood) where I felt like I did further damage.  

Steve Williams · · Denver, CO · Joined Jul 2005 · Points: 235

Amputate at the neck.  That'll fix it fer sure.

Henri Alexander · · Dallas · Joined Mar 2014 · Points: 511

Thanks for the info, everyone. I've been doing some self-healing work on it and it is already significantly better.

Treatment:

- Followed advice on training beta podcast
- Manual massage, FDM and Airrosti type manipulation
- Hangboard with only enough weight to feel a strain on finger
- Stretch fingers often
- Stretch arms, pec major and pec minor a couple times a day
- Lacrosse ball forearms and chest
- Ice at night or after workout/stretching

Improvements:
- I can make a fist now with only minimal achy pain in the finger
- I climbed the other day up to a 5.10a without any pain (ya ya, I'm gonna take it easy)
- Hangboard weight has slowly increased over time

Thanks again to all.

Guideline #1: Don't be a jerk.

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