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.
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!
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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