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Finger Training for Climbing

 

The  human hand gives us the ability to have an amazing amount of control  over the world around us. For Rock Climbers the human hand is  everything. Our finger dexterity, strength and health are a vital  component of climber’s relationship with the outside vertical world.  Unfortunately the human body has evolved to be supported by our legs  rather than our hands. Rock climbers ask more of their hands then our  fingers are designed to withstand and this can lead to injury without  proper training and respect of our fingers limitations.

The  anatomy of each finger is very complex but here is an overview.  Each  finger (index, middle, ring and fifth digit), outside of the thumb, has  three main bones including the proximal, middle and distal phalanges.  Between boney structures are three hinged joints including the distal  interphalangeal (DIP), proximal interphalangeal (PIP), and  metacarpophalangeal (MCP) joints. The thumb is a little different in  structure with a distal and proximal phalanx. In the thumb there is an  interphalangeal and MCP joint. Joints are held together by volar plates,  collateral ligaments that connect to dense fibrous connective tissue.  The dorsal extensor tendon extends the PIP joint and the DIP joint. The  flexor digitorum superficialis and the flexor digitorum profundus are  referred to as volar tendons. The flexor digitorum superficialis tendon  flexes the PIP joint. The flexor digitorum profundus tendon flexes the  DIP.

This is how I think of it.  For a climber’s finger to flex  and grab a crimpy hold, something has to shorten on the “palm” side of  the finger. Tendons run on the palmer side of the finger and when the  forearm muscle flexes this tendon, or I like to think of it as rope gets  shorter, and flexes the finger allowing us to grab things such as rock  climbing holds.

The finger has 5 annular ligaments and three  cruciate ligaments that hold the flexor tendon in place along the bones  of our digits. You will hear people refer to the annular ligaments as  pulleys. Pulleys are like little doughnuts of tough tissue that the  flexor tendons run through. The Pulleys keep the tendons in place.  Keeping flexor tendons in place is advantageous as it increases our  finger’s strength.

Having some understanding of basic finger  injuries is important for all climbers in today’s modern climbing world  of pulling hard, sport climbing, rock gyms, and hang board training.  According to Schoffle and Hochholzer (2003) 40% of all climbing injuries  are to the fingers. A significant portion of these injuries happen to  the flexor tendons. Climbers and even medical providers often  underestimate the severity of climbing finger injuries and ambitious  climbers keep cranking hard on a pathway to finger integrity disaster.

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Select Finger Injuries

 

Flexor Pulley (Annular Ligament) Injury:

Fingers  pulley’s are vulnerable sites of injury when rock climbing, especially  when closed hand crimping, over training or working the same crimpy  project move over and over. The A2 and A4 pulleys undergo the greatest  forces with pinch and grasps according to Crowley (2012). With crimping  the flexor digitorum tendon applies tremendous force to the A2 pulley.  According to Lin and Cooney (1990) the A2 pulley can withstand 400N of  force! But strength is greatly decreased with eccentric loading.

Climbing  friends are always asking me why their fingers maintain a curves  position that is hard to straighten out. The hallmark of a pulley injury  to the naked eye is what we call “bowstringing.” Think of a violinist’s  bow. Imagine if a pulley ruptured that was supposed to hold the tendon  along the finger bone. Underneath the skin the flexor tendon would pull  away from the bone resulting in a “bowed” finger. Bowstringing usually  results from injury to the A2 or A3 pulley. Damage to the pulley may  result in a partial or a complete tears.

Pulley injuries can be  graded from grade 1 though 4. Grade 1 pulley injures are a sprain. Grade  4 are much more severe and can involve ruptures and tears with  associated ligament damage. Most grades, 1-3, will require conservative  management such as rest, anti-inflammatory medications, ice, and  physical therapy. Some authors recommend protective taping for 3 months.  The heart breaking reality of pulley injury is even grade 1 injuries  will take 4 – 6 weeks to heal fully no matter how much climbing tape you  use.  The injured finger will be weaker than the unaffected side for  several months. Some specialist say the injured finger can take up to a  year to return to its previous level of strength. Grade 4 injuries will  require a tendon graft by a qualified hand surgeon. Diagnosing the  extent of a pulley tear, or how many pulleys are affected, can be very  difficult in the primary care setting. If there is any question an MRI  can give more details on the extent of the injury. Of the 5 annular  pulleys the A2 pulley is most often injured or torn. As above not all  injuries are surgical, a single pulley injury is usually not treated  surgically.

On a personal note I have had two pulley injuries  over the last 23 years of climbing. Both resulting in a loud pop that  made everyone around me turn their head like a fart in church. A pop  does not always indicate a complete tear but may be a substantial  partial tear. Most pulley injuries will produce tender spots at the base  of fingers (by the palm) or closer to finger joints with palpations.  Swelling often without much bruising might also manifest. Initially  treatments of pulley injuries include hydration, rest, ice, elevation,  anti-inflammatory medications, possibly buddy tapping and eventual light  stretching and massage. With many orthopedic injures there is much  debate over anti-inflammatory effect on the healing process…….


 Flexor Digitorum Profundus (FDP) Tendon Injury:

You  might hear folks refer to their chronic Flexor Digitorum Profundus  Tendon (FDPT) injury as “Jersey Finger.” I always thought it had to do  with a common gesture while driving in New Jersey but was wrong. The  name actually comes from the typical culprit, a player getting a finger  caught in another player’s jersey during team sports. Jersey finger  happens when the actively flexed DIP is forcibly extended resulting in  injury to the Flexor Digitorum Profundus Tendon. Tenderness will present  on volar aspect (palm) of DIP joint and you may not be able to flex the  DIP joint. FDPT injuries should be splinted right away and you should  see an orthopedic hand surgeon immediately for best prognosis.
 

Extensor Tendon Injury at the Distal Interphalangeal (DIP) Joint:

Extensor Tendon Injury can lead to a deformity over time called “Mallet  Finger.” Extensor Tendon Injury at the DIP typical results from  forceful flexion of an extended DIP joint from an object sticking it.   Injury can be a simple stretching of the tendon, or a more serious  partial or complete tear or avulsion fracture. Signs of injury to the  Extensor Tendon at the DIP joint include pain at the dorsal DIP joint.  Many individuals will have difficulty extending the distal phalanges.   In the absence of avulsion (bone pulled away with tendon) rehab (guided  by a trained professional) will include splinting the DIP in a neutral  or bit of hyper-extension position with the PIP remaining mobile. This  injury may need immobilization for up to 6 weeks. To aid healing it’s  important to avoid flexion of the DIP joint!

Central Slip Extensor Tendon Injury:  

Central  slip injuries can result in difficulty extending the PIP joint and lead  to a deformity overtime called “Boutonniére deformity.” The finger  takes a bizarre position with flexion of PIP with hyperextension of the  DIP and metacarpophalangeal joints (MCP) with repeat insult. The tendon  injury results from forcible flexion of the PIP joint when it is  extended (common with basketball players). One will often have  tenderness over the dorsal aspect of the middle phalanx or PIP joint.  Central slip extensor tendon may require 6 weeks of professionally  guided splinting in full extension.

Collateral Ligament Injury:

Typically  occurs in the PIP joint resulting in tenderness along the collateral  ligament. Sometimes you will hear folks refer to a collateral injury as a  “jammed finger.” If the joint is stable you might get away with buddy  taping for several weeks (2-4 weeks). Make sure to tape above and below  the joint. If the “ring finger” is injured tape it to the fifth digit to  avoid exposing the fifth digit to injury (the fifth digit is naturally  extended and vulnerable).

Volar Plate Injury:

Usually  result from finger hyperextension and affects the PIP joint. These  injuries can require progressive extension splinting depending on  severity. In minor injuries buddy taping is usually adequate. Treatment  needs to be guided by a trained professional.

All finger injuries  should be diagnosed by a medical qualified professional. Additional  treatment and rehabilitation should be administered by a qualified  medical professional, orthopedic specialist or specialized hand  occupational or physical therapist. Any of these injuries that have  significant avulsion fractures associated (30%) need to be treated by a  hand specialist. One needs an x ray to diagnose a fracture. It’s always  worth getting an expert opinion!


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Avoiding Finger Injuries in Rock Climbing

 

Get  in a routine of light finger extension exercise every few days. You can  do them on the cheap with plain old rubber bands or by a commercial  device. Keep it light, easy and don’t overdo it. Keep a rubber band  ready on your night stand and in the center council of your van.

If you are “resting” a climbing finger injury this means no activity that causes pain or aggravation of the injury.

Return to climbing slowly, incrementally and with caution when injury heals!

Warm  up on easy climbs and climb consistency. Don’t ski all winter in Marble  and then hop on your high end project in the park at the first thaw.  Make a point to climb throughout the winter.

Any of my climbing  partners will tell you I harp on not trying the same climbing move you  can’t do to many times, this mostly has to do with not hurting your  precious fingers, Try a hard move 3-4 times and then move on!

If  you feel, hear a pop, or have any finger pain go see a medical provider  that is proficient in diagnosing a finger injury. Consider follow up  with a hand specialist and get a rehab plan from a certified hand  physical or occupational therapist.

Consider 2 weeks of rest and immobilization for a suspected partial tear of A2 or A3 pulley.  

If you have a grade 1 pulley injury when you get back to climbing in 6 weeks consider taping for the next three months.

Vary  your climbing, climb steeps, slab and cracks not just crimpy technical  rock routes. Trying the same move over and over repeatedly stresses the  same tissue and leads to injury.

With the training craze on You Tube, Instagram and in the magazines don’t forget about resting your fingers.

When  new to climbing focus on routes with big holds and spend time on foot  work. Take it easy on trying harder climbs without building a solid  foundation. We often get a boost in muscle strength prior to our hand  strength catching up. The same concepts apply when making the transition  from the rock gym to outside rock.

Don’t beat yourself up if you  hurt a finger. With proper diligent treatment even with an A2 pulley  injury you will eventually be able to climb again.

Make an effort  to climb smooth and focus on precise movement rather than throwing  yourself at a climb. Erratic movement with sloppy feet and poor core  stabilization increases the stress on your fingers.

Stay well  hydrated! When we are dehydrated our tendons and ligaments are like  dried out over stretched elastic bands and more vulnerable to injury.

If you suspect a partial tear climb easy stuff for a couple weeks, real easy. At least you will be climbing.

Keep your feet on the wall. Wild feet equal more stress on fingers!

Practice  open hand crimps to disperse injurious forces. Closed crimps like most  of us fall back too when the climbing gets hard puts tremendous stress  on the A2 pulley.

Do not rely on taping to keep you from getting  hurt! If you do have an injury and tape, learn to tape properly from a  PT or hand specialist. (Tape at the distal end of the Proximal Phalanx)

Overall if longevity and injury prevention is your goal avoid crimpy routes, they will blow out your A2 pulley like no other.

Spend  time focusing on sloppers, pinches and jugs. I do this on my home wall  so that on a hard climb if a crimp is shutting me down I instinctively  look for an alternative to a crimp to get through a section.  

As  a rule of thumb if you are climbing through a finger injury and it is  causing pain you can count on slowing the healing process.

Prophylactic  taping will not prevent rupture of a pulley rupture, but some sources  suggest it may limit some flexion and reduce A2 load. At the end of the  day do not count on tapping to prevent a finger injury.

 

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