Fin­ger Flexor Pul­ley In­juries

Climbing - - SKILLS - BY MIKE GABLE

You sit below the crimpy Go Granny Go (V5) on the Grandma Pe­abody boul­der in Bishop, Cal­i­for­nia. With one last ef­fort, you lunge for the top rail. Then, sud­denly, your feet skate and a loud “pop” echoes off the wall. Pain sears through the base of your mid­dle fin­ger— you’ve blown a digit and your climb­ing trip is over. As the owner of Eastern Sierra Phys­i­cal Ther­apy and Well­ness, the au­thor of Be­yond Tape:

The Guide to Climb­ing In­jury Treat­ment and Preven­tion, and a lo­cal Bishop climber, I see fin­ger pul­ley in­juries reg­u­larly—they’re the most com­mon climber fin­ger in­jury. To climb longer and stronger, it’s im­por­tant to un­der­stand our hand anatomy and how pul­ley in­juries hap­pen, as well as how to pre­vent and treat them, and to re­strengthen an in­jured digit.

ANATOMY

Three bones and three hinged joints make up the fin­ger. Lig­a­ments con­nect and sta­bi­lize the bones, while ten­dons con­nect mus­cle to bone, trans­fer­ring to the bone any forces cre­ated by the mus­cles. Flexor ten­dons in the fin­gers at­tach to mus­cles in the fore­arms that pull on the ten­dons, bend the fin­gers, and al- low us to crimp. Con­nec­tive tis­sue en­cases the ten­dons, form­ing a sheath with five thick­ened ar­eas that cre­ate the an­nu­lar pul­leys (A1, A2, A3, A4, and A5), which keep the ten­don close to the bone when bend­ing the fin­gers.

CAUSES

A loud “pop” and then sig­nif­i­cant swelling and pain of­ten in­di­cate dam­age to the flexor-ten­don pul­leys. For A2 pul­ley in­juries, the most com­mon pul­ley in­jury for clim­bers, the pain usu­ally arises at the base of the fin­ger and is no­tice­able when try­ing to straighten or bend the fin­ger. For A2–A4 rup­tures, there may be bow­string­ing—bulging at the base of the fin­ger—which can be de­tected by re­sist­ing fin­ger bend­ing at the fin­ger­tip. (In this lat­ter case, con­sult an or­tho­pe­dic sur­geon, as it can in­di­cate a se­ri­ous, grade 4 tear; see “Treat­ment.”)

Crimp­ing in­creases the risk of in­jury be­cause of the in­creased forces ex­erted on the pul­leys, es­pe­cially the A2. A fully closed crimp grip, with the thumb over the in­dex fin­ger, ex­erts even more force. Typ­i­cally, this in­jury stems from ei­ther warm­ing up poorly or a des­per­ate, dy­namic move to a tiny crimp, of­ten with poor foot­work and body po­si­tion­ing.

PREVEN­TION

The best way to deal with fin­ger in­juries is to not get them in the first place. Preven­tion re­quires warm­ing up well, climb­ing with proper technique, and static stretch­ing.

Warm up

Warm­ing up well be­gins with an aer­o­bic warm-up—hik­ing, jog­ging, cy­cling, or el­e­vat­ing the heart rate for 20–30 min­utes. For out­door clim­bers, that means the ap­proach. For gym ses­sions, try jump­ing rope for a few min­utes. Then en­gage in dy­namic stretch­ing—stretch­ing a mus­cle through con­tin­u­ous mo­tion, briefly bring­ing it to its end range. Fi­nally, be­gin a sport-spe­cific warm-up of easy climb­ing for ei­ther 100–120 moves, 8–12 boul­der prob­lems, or 3–4 routes. In the 2001 study “Sport Climb­ing From a Med­i­cal Point of View” in Swiss Med­i­cal Weekly, An­drea Sch­weizer showed that warm­ing up in­creased the pli­a­bil­ity of the fin­ger flexor ten­dons, which al­lows them to ab­sorb more force.

Climb­ing technique and body aware­ness

Proper foot­work and avoid­ing in­tense dy-

namic move­ments may de­crease the risk of pul­ley in­juries by re­duc­ing over­grip­ping or shock­load­ing of the fin­gers. As a rule, avoid dy­namic move­ments, es­pe­cially to crimps, and fo­cus on slow, pre­cise foot­work and core en­gage­ment. Note any pain or twinges to pre­vent fur­ther in­jury.

Static Stretch­ing

This in­volves hold­ing a stretch for at least 30 sec­onds, two to three times. Static stretch­ing is best re­served for rest days and post-climb­ing, as some stud­ies have shown that static stretch­ing prior to an ac­tiv­ity can de­crease per­for­mance.

Prayer stretch: Place the palms to­gether in front of the chest with the fin­gers point­ing up. Ro­tate the palms for­ward to­ward the floor un­til you feel a good stretch.

Wrist and fin­ger flexor stretch: Straighten one el­bow, and reach that arm for­ward with your palm up. With your other hand, bend your fin­gers down to­ward the ground un­til you feel a stretch.

TREAT­MENT

If you get in­jured, first seek a di­ag­no­sis from a climb­ing-knowl­edge­able physi­cian or or­tho­pe­dic sur­geon, who can as­sess the dam­age with an ul­tra­sound or MRI. This will help de­ter­mine the level of care needed as well as rule out dam­age to nearby struc­tures. Let’s look at the grad­ing scale of fin­ger in­juries as well as re­hab so­lu­tions:

Grade 1: Pul­ley sprain

DEF­I­NI­TION: A par­tial tear of a sin­gle pul­ley SO­LU­TION: No need for im­mo­bi­liza­tion. Be­gin gen­tle range-of-mo­tion ex­er­cises—bend the fin­ger un­til it feels tight, hold for 2–3 sec­onds, re­lax, and re­peat 10 times for sev­eral ses­sions each day. Now per­form the same ex­er­cise, only straighten the fin­ger. Avoid push­ing through pain.

Grade 2: Com­plete A4 or par­tial A2, A3 tear/rup­ture

DEF­I­NI­TION: Ei­ther the A4 pul­ley is com­pletely torn, or A2 and A3 are both par­tially torn

SO­LU­TION: One to two weeks of im­mo­bi­liza­tion with a fin­ger-im­mo­bi­liza­tion splint or a pul­ley-pro­tec­tion splint, avail­able on­line. Gen­tle range-of-mo­tion ex­er­cises. H-tap­ing ( see side­bar) for three months while climb­ing.

Grade 3: Com­plete A2 or A3 tear/rup­ture

DEF­I­NI­TION: A2 or A3 pul­leys are fully torn SO­LU­TION: One to two weeks of im­mo­bi­liza­tion with a fin­ger-im­mo­bi­liza­tion splint or a pul­ley-pro­tec­tion splint, avail­able on­line. Gen­tle range-of-mo­tion ex­er­cises. H-tap­ing ( see side­bar) for six months.

Grade 4: An­nu­lar Pul­ley Rup­tures

DEF­I­NI­TION: Sin­gle or mul­ti­ple rup­tures with pos­si­ble lum­bri­calis mus­cle (the mus­cle be­tween the metacarpal bones) or col­lat­eral lig­a­ment trauma

SO­LU­TION: Sur­gi­cal re­pair is rec­om­mended due to the in­creased risk of fixed flex­ion con­trac­tures, an in­abil­ity to fully straighten the fin­ger. (Some stud­ies have also rec­om­mended sur­gi­cal re­pair for grades 2 and 3, es­pe­cially for elite-level clim­bers.) Con­sult with your sur­geon about re­hab op­tions, as they can vary de­pend­ing on the dam­age to your ten­dons.

RE-STRENGTH­EN­ING

Once your fin­ger has a full, pain-free range of mo­tion (of­ten one to two weeks af­ter start­ing the re­hab ex­er­cises), you can be­gin gen­tle re-strength­en­ing. Use a hang­board, fin­ger-strength­en­ing de­vice, or any train­ing ap­pa­ra­tus that al­lows for con­trolled move­ments and the abil­ity to mod­ify force on the in­jury site if you feel pain. While hang­board­ing, use your feet and avoid crimp­ing—or any move­ments that cause pain—for at least six weeks post-in­jury.

Once you’re not­ing zero pain with nor­mal grip po­si­tions on the hang­board, you can re­turn to climb­ing. A full re­turn to ac­tiv­ity is re­al­is­tic in six weeks for grade 1 and 2 in­juries, and six to eight weeks for grade 3 in­juries, with a full func­tional re­turn by three to four months min­i­mum. Mean­while, grade 4 in­juries re­quire around 4 months off, with a full func­tional re­turn af­ter 6–12 months.

To fur­ther help heal­ing, check for myofascial re­stric­tions (aka trig­ger points) in the wrist and fin­ger flexor mus­cles in the fore­arm and ap­ply di­rect pres­sure to any area that feels tight or ten­der; hold for 2–3 min­utes, feel­ing for a re­lease of the re­stric­tion. Mas­sag­ing the flexor ten­dons and pul­leys pre­vents scar-tis­sue for­ma­tion and in­creases range of mo­tion.

MIKE GABLE l i ves i n Bishop, Cal­i­for­nia, with his wife and two en­er­getic l i ttle kids. A climber of 10 years, he owns Eastern Sierra Phys­i­cal Ther­apy and Well­ness, and do­nates 100 per­cent of the net prof­its from his book Be­yond

Tape to ser­vice- ori­ented l ocal and global non­prof­its.

PHIL WIESE MI­CRO- CRIMP­ING ON FRENCH CON­NEC­TION ( V6), HAPPY BOUL­DERS, CA.

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