Rock Climbing and Finger Injuries- The Five Things You Need To Know

Admittedly, my boyfriend and I have some pretty random hobbies: soap making, kombucha brewing, tie dying, and meat smoking to name a few. We like to try things, what can I say?

Mid summer 2015, we got hooked on rock climbing and decided to add it to the mix. Immediately, we started climbing 4-6 days per week working on our crimps, pinchers, slopers, jugs, and mastery of climbing lingo in general. We were redlining those betas, man. 

Until one day Nash was bouldering and felt a sharp pain into the middle of his ring finger. He promptly ignored this, hid it from his physical therapist girlfriend, and continued climbing for another 2 weeks. As his finger pain worsened and he admitted to being truly injured, I decided to take some time to brush up on my hand and finger anatomy. It was a good but unfortunate opportunity.

The flexor digitorum profundus (FDP) diving underneath and through the flexor digitorum superficialis (FDS)

The flexor digitorum profundus (FDP) diving underneath and through the flexor digitorum superficialis (FDS)

The hand is an amazing and clever system of tendons and pulleys. It mimics the foot closely in terms of anatomy (after all, our feet are basically hands that we learned to walk on) but is a bit more complex because we generally use our hands more often and require intricate dexterity. 

One of the reasons I always found the hand to be so-freaking-interesting is that we have two tendons which allow us to bend our fingers. The short one, called the flexor digitorum superficialis or FDS, travels along the soft side of our palm and splits to form a "V" just after our second knuckle. The longer tendon, the flexor digitorm profundus or FDP, travels even closer to the bone underneath the FDS and literally dives through the little "V" to attach further up our finger bone. I wanted to post a real life surgical picture as an example, but figured the above sketch might be a bit more pleasing to look at.

If we just had one long tendon, we could only make an "L" shape with our hands, which would make holding, carrying, and grasping hugs very difficult!  

If we just had one long tendon, we could only make an "L" shape with our hands, which would make holding, carrying, and grasping hugs very difficult!  

Why does this matter? Imagine what would happen if we just had one tendon and it ran all the way up to the end of our finger. If this were the case, we would only be able to do this with our hand. The tendon would pull from point to point, bringing the very tip of our finger straight to our palm along the shortest path. Can you imagine trying to crimp, carry a grocery bag, lift a dumbbell, or hold your partner's hand with an "L" grip like this?

Fortunately, our bodies are super intelligently designed and instead we are able to curl our fingers around objects to grasp and manipulate them. Each knuckle can bend and straighten somewhat independently of the other, which allows us to accommodate varying surfaces and perform different tasks. 

Note that we can make a smooth, graduated curve with out fingers instead of sharp angles. Imaging trying to throw a ball or peel an orange if you couldn't!

Note that we can make a smooth, graduated curve with out fingers instead of sharp angles. Imaging trying to throw a ball or peel an orange if you couldn't!

Note the 5 annular pulley tendons (A1, A2, A3, etc), one right before and right at each bend in our fingers. 

Note the 5 annular pulley tendons (A1, A2, A3, etc), one right before and right at each bend in our fingers. 

The other super-clever thing about our hands is that we have a series of ligaments called annular pulleys that hold the FDP and FDS tendons flush to the bone. These annular pulleys give us a mechanical advantage, meaning that it takes less muscular effort to produce a certain level of grip strength. More importantly, these annular pulleys prevent our tendons from bowstringing away from our finger bone. In fact, if one of these ligaments ruptures, this is exactly what happens-

I don't think I need to describe why a rupture of an annular puller = OUCH. 

I don't think I need to describe why a rupture of an annular puller = OUCH. 

All this goes to show that if you plan on climbing crazy things with your hands, you cannot ignore finger pain. So what can you do to prevent such a small body part from becoming a big issue?

1. GET AN ACCURATE DIAGNOSIS

Find a Certified Hand Therapists or a Physical Therapists with an interest and knowledge of your sport. It may seem obvious to say...but all finger injuries are not the same, nor are they created equal. An injured flexor tendon should be treated differently than an injured finger pulley. The severity of the injury also matters; a "strain" or "pull" will have an entirely difference course of recovery as compared to a complete rupture.

We know that the hand is anatomically complex and the various parts are small, so how confident are you that you can correctly diagnose yourself via a google search and a hunch? Know what you don't know- spend the time and money to be evaluated by a professional. Get an assessment of your unique injury, a diagnosis of what was specifically injured, and an educated estimate of how long it will take to heal. This will likely save you time, money, and heartache in the long run. 

2. REST!

Do you have slight pain while you warm up but then it goes away, and you are no worse for wear after climbing? Fine, keep at it! Does it get worse as you climb, and/or last for hours or days after? Well then you are asking for a miracle. Don't ask for a miracle- realistically you just can't work through some. An injured tendon or ligament in the hand can take time to heal, and to climb through pain will prolong the healing process or worsen the original injury. Don't justify it. Don't pretend like you are going to just climb 5.5s with one hand. Don't say "well it only hurts when I hold like this..." Just don't. 

Rest from all activity that aggravates your pain until you have an accurate diagnosis and a plan for recovery. You can take a week or two off now and thank yourself down the road, or be forced to take months off and hate yourself for not being more patient. 

3. PROTECT

There are a variety of taping techniques and finger splints available to protect certain injuries. This is necessary if you are having pain with day to day activities OR if you are nervous about returning to the rock and just want extra protection. You may already know some trusted taping techniques. If so, use them. If not, contact a Certified Hand Therapist or knowledgable Physical Therapist for help. Here is a quick, easy to follow video for taping the most common finger injury occurred in rock climbing, which is an A2 pulley injury. 

4. STRENGTHEN (when appropriate) 

An appropriate and progressive strengthening program may actually speed your healing process if you can do it pain free. If you can grip a squeeze ball, lift weights, or even do yoga without pain this will help you retain strength, flexibility, and blood flow while your injured tissue heals. It's also a great opportunity work on something you normally wouldn't spend time on, like stretching or core strength. Not sure what is ok to try and what may be harmful? A Certified Hand Therapist and/or Physical Therapist will be able to help guide your training during recovery. 

Once your pain is reduced or non-existent with daily activities, it is time to jump back on the rock and start making up for lost time, right?

Wrong. Starting back aggressively may cause a relapse of pain or entirely new injury. Test your hand first by lifting weights, using the rowing machine, or climbing at a grade much lower than your typical level. Everything feels fine? Great! Gradually progress the next time you hit the wall or gym. Just don't get antsy and waste all of your time off by re-injuring yourself right out of the gate. 

5. DON'T FREAK OUT, AND BE PATIENT!

Being injured sucks, there is just no way to sugar coat it. If climbing is your passion it is also likely a main source of exercise, stress relief, and social life. It may not be ideal, but find something to keep you occupied in the meantime. Ride a bike. Swim. Elliptical. Do a plank challenge. Cook an 8 layer cake. I don't care, just find something that is marginally entertaining and does NOT hurt you.  

Stay safe, stay smart, stay knowledgable, and always... feel free to share this post. Knowledge is power, spread the wealth.

Until next time friends,

Your Neighborhood PT

leahsawyerpt.com