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Finger Injuries and Treatment

October 23, 2009 0 Comments

fingers_injury1When you consider the astonishing array of forces we, as climbers, apply to the extremities of our bodies, it’s not hard to see why the further one gets from the central core the more susceptible to injury, through rock climbing, the body is. Due to the biomechanical complexity of the fingers, their lack of “specific design for the job” and the fact they are literally at the sharp end of nearly every climbing movement; it is here where most climbers encounter injury woes. The obvious first port of call when sustaining an injury would be a specialist sports physician. Unfortunately this is an unrealistic option for most people, for a number of reasons. Firstly, it is unlikely many people have the cash and time to spare on numerous visits to a private sports injury consultant. Secondly, without witnessing the injury taking place and/or taking a series of Magnetic Resonance Imaging (MRI) scans (costing even more money); it is unlikely that the consultant will be able to give you a definitive diagnosis of your injury. With this in mind it is important that the climber is aware of their own body’s normal behaviour when pushed to its personal limit, thus giving him/her a good chance of identifying the exact type of injury from the moment of trauma. In assessing ones own injury it is important to have a rough idea of the mechanical goings on of the area in question: There are two tendons which flex your fingers when in use, whether it is rock climbing or picking up a jar of jam - the Flexor Digitorum Profundus (FDP) and Flexor Digitorum Superficialis (FDS) tendons. These are attached via a series of Annular and Cruciform pulleys – ligament bands stretching over the tendons – to form the flexor pulley system.

Pulley Injuries

These usually occur through excessive strain of an isolated finger (mono), the use of a two to three finger uneven edge/undercut (usually in full crimp), and unexpected shock loading, due to a foot slipping or hold breaking etc. The resultant injury manifests itself in one of three ‘Levels of Severity’. The lowest level of injury is generally just spraining of the ligaments, this displays itself in the form of tenderness around the pulley area and a dull ache after climbing. The second level of severity is a partial rupture of the pulley; this is generally noticed through a twinge at the moment of damage and possibly a slight audible ‘pop’. Initially the finger may feel dull and without much feeling. You will then notice pain locally at the pulley, when squeezing or climbing and possibly when you attempt to extend the finger fully. Finally, the most serious injury of this type is a full rupture of the pulley. In this scenario you will again hear the audible ‘pop’ and also a sharp pain around the area in question. You will then notice a bowstringing of the tendon, swelling and possibly bruising, and pain when squeezing, extending or even just moving the digit.

Finger Anatomy

finger_anatomy In all cases cease climbing immediately, as some level of inflammation will take place. Contrary to many people’s beliefs this initial inflammation is a good thing, it is an important part of the healing process; however you should not continue to climb on the inflamed area. If you feel that you have fully ruptured the pulley it is advisable to seek out a specialist for consultation and possibly an MRI or CT (computerised tomography) scan, as serious damage may require specialist treatment. For the two lesser forms of injury follow the treatments below.

Other Finger Injuries

Flexor Unit Strain

These are the next most common form of finger injury amongst climbers. This occurs when the tendons (rather than the pulleys) are strained whilst open-handing, usually when two or three fingers have been isolated. This condition can be identified through the fact that pain twinges are felt through the finger, palm and sometimes into the forearm. Volar Plate Injury Volar plate injury most commonly results from landing on the hands with the wrist too straight (i.e. falling off when bouldering) rather than actual climbing. This puts the initial force on the fingers, bending them back too far. When the ligament on the underside of the middle knuckle gets too tight, it may partially or fully rupture. Needless to say if this occurs it presents a similar problem to a standard pulley injury.

Stress Fractures

If the middle knuckle of any of your fingers is painful and swollen you may have a stress fracture. This is especially common in younger climbers. If you feel as though this maybe the case, seek out medical assistance. As with any stress fracture, the only treatment is rest - between 1 and 3 months. Once the pain and swelling has subsided, begin climbing on easy ground (jugs) to increase blood flow to the area. As the injury is skeletal there should be little or no soft tissue damage, allowing you to see vast improvements once the fracture has fully repaired.

Pulley Injury Treatment

As pointed out earlier when an injury is encountered, cease climbing immediately. This prevents further damage to the area and allows you to assess the degree of severity in a calculated way – see ‘Levels of Severity’ above. Due to a generally poor blood supply, ligaments are notoriously slow healing parts of the body. Fortunately however, those in the fingers are amongst the quickest for healing and can be assisted in a number of ways. Remember this information is given for minor pulley tears. If you feel you have a more serious injury it may be wise to seek out professional council in the shape of a sports injury consultant.

Rest

An important part of the initial recovery is of course rest. That said, a common mistake amongst many activists is to stop climbing and completely disregard the injury for an overly long period, then expect the injured area to be ‘race fit’ once they have deemed themselves to have had a long enough lay-off. Basically, the climber should completely rest the injury until the initial inflammation has subsided, this can take between 5 and 20 days, depending on the severity of the injury and physiology of the climber. Once you can move the finger through its normal range of movement without pain – don’t mistake the ache of the weakened digit for serious pain – it is time to start using the finger again. It is important to begin the mobilization of the injury as soon as possible, this helps break down scar tissue and prevent long term weakening of the damaged area, plus it speeds up the healing process. Don’t jump in at the deep end and get straight back on your 8c project! Break yourself in gently with some relatively easy climbing on jugs, cutting out any lunging or dynamic movements. This will get blood flow into your fingers without straining them too much. If you feel any kind of a negative reaction through climbing (or any other rehabilitation exercises) stop straight away and assess whether the discomfort is due to over-strain or the gentle stretching of stiffened tissue (a positive), a tricky balance, and one that only you can strike.

Cool Water Therapy

A treatment I have found to be particularly effective and something I only recently discovered is a variation on the Contrast Bath treatment. A Contrast Bath is where the patient puts the injured finger in cold water for a few minutes, and then places it immediately in a bowl of warm water for a further few minutes. You then repeat the action 3-5 times, finishing with the cold water; the idea being to flush the finger with blood and thus aid in the repair of the damaged area. Cool Water Therapy is a more calculated approach which utilizes a natural phenomenon known as the “Lewis reaction”. Basically the treatment is designed to cause the same flushing of the injured area, yet in a more continuous way. This is done by placing the hand in a bowl of cool water (cold tap water is usually fine) and leaving it there for around 30 minutes. Initially (in the first 5 to 10 minutes) you will find your hand becomes cold and numb – your body essentially “thinks” you have been submersed in cold water and endeavours to protect the core by pulling blood flow back from the extremities. After a short period the body “realises” there is no danger to the vital organs and overcompensates for the cold hand, flushing the extremity with blood. Once this has taken place leave you hand in the water for a further 15 to 20 minutes – a warming and pleasant experience. When initially experimenting with this therapy I found it takes a couple of 30 minute sessions for the body to fully acclimatize to the treatment, and you may find you need to adjust the temperature of the water. For example tap water may even be too cold initially, where as once you have been using the therapy for a few days, you may need to cool the water with the aid of a few ice cubes. It is said that this mechanism can improve blood flow to the fingers by up to 500%, in which case it is advisable to use this method a couple of times a day until the injury has completely healed - low blood flow is the single most limiting factor in the rehabilitation of finger injuries. This treatment should only be undertaken after any initial inflammation has subsided.

Stretching and Massage

Another important part of recovery is the use of massage and stretching. Both exercises increase blood flow and help break up scar tissue. Never stretch or massage the finger aggressively with jerky movements or if it is still painful. When stretching the digit hold it at the point where it becomes tight for around 10 seconds, shake it off and repeat the exercise 2 or 3 times, this can be repeated throughout out the day. With massage it is important to apply firm pressure for maximum effect; rub the pulley with your thumb motioning lengthways along the effected part of the finger. grip_saver

Recovery Aids

In conjunction with stretching and massage the patient can also enlist the help of recovery aids, such as Warm-Up Putty, Gripmaster or foam recovery balls. In my experience the foam recovery balls (e.g. Metolius Gripsaver) are the most effective of these aids. The tension of the Gripmaster’s can often be a little too strong and the putty doesn’t ‘spring back’, which can lead to manoeuvring the fingers into unusual positions in an effort to re-constitute the putty. The balls, on the other hand, spring back easily and offer just the right level of resistance to increase blood flow and break up scar tissue – remember you’re recovering, not training!

Taping

Taping is an obvious precaution when climbing on a recovering digit. Remember to tape between the knuckle and central joint, and the central and last joint; regardless of which pulley is injured, full support of the digit is vital. Once an injury is fully recovered, cease taping. To continue may, over time, weaken the fingers internal tissues as it becomes reliant on the support. Many articles on finger injuries recommend the “Buddy Taping” strategy (strapping the injured finger to a healthy digit). Personally I have found this counter productive, in that, as all the fingers are different lengths and climbing holds are often irregular you seem to end up loading the damaged finger in unusual ways often to the detriment of the injury. I find individually strapping the injured finger well seems to work fine.

ibuprofen-gel-35gDrugs

Anti-inflammatory drugs (collectively known as Non-steroidal anti-inflammatory drugs or NSAIDS) such Aspirin, and more commonly, Ibuprofen are often used by climbers to treat finger injuries. Whilst these are effective in subduing pain and inflammation, it is only advisable to use them in moderation during the initial period of rest. Personally, I find the externally applied gel versions of Ibuprofen to be a good option, as these can be targeted directly at the injured area. In addition, Ibuprofen has been shown to cause stomach problems if taken in excess and can have side effects in those with respiratory disorders, such as Asthma. As such the gel versions of this drug at least partially negate these issues.

Prevention

The following is a list of top tips for the prevention of finger injuries but more specifically pulley injuries: 1.Stretch properly before climbing, holding all stretched positions for around 10 seconds. 2. Warm-up gently, start well within your limit, gradually moving through the grades. Combine this with good rests between warm-up climbs. It is advisable (if you have a regular wall or crag) to have a set warm-up routine, i.e. a selection of easy to mid grade climbs that you know and can execute smoothly, without the likelihood of slipping off and subsequently overloading fingers and limbs. 3.Varying Grip: This is an important factor which many neglect. Often climbers have a preferred grip, sometimes due to learning to climb indoors (where evenly cambered edges promote crimping) or at one specific crag, were holds are uniform throughout the venue. If a climber can deploy a series of holding strategies (crimp, open-hand, pinch, guppy etc.) not only is injury minimised but the ability to climb harder on varying terrains is vastly improved. 4. Technique: Along with varying your grip, technique can go along way to minimising injury. One of the main causes of finger injury is shock loading through the climber slipping or missing a hold. Take time to critically analyse your movement on the rock and maybe ask an experienced climber or one of your peers to give you some feedback. It’s not just a simple case of static climbers being 'better' than dynamic climbers, more a case of knowing when to apply the appropriate style. For example don’t climb dynamically when it is unnecessary, but equally momentum can be useful in saving energy, moving smoothly and alleviating stress to joints – it’s all about being in control. 5. Supplements: Another area, which many climbers prescribe too, is that of dietary supplements - the two obvious choices being Fish Oil and Glucosamine Sulphate. The success, or otherwise, of these naturally occurring supplements seems anecdotally varied. Having, in the past, been pretty susceptible to finger injury, I began taking 1000mg dose's of both supplements, once a day, around 3 to 4 years ago. Since then I have noticed a marked reduction in finger tweaks and injuries (almost none), and feel that taking the supplements is a positive and worthwhile measure. If you do decide to give them a whirl it's worth bearing in mind that you will have to give the supplements at least 4 to 6 months to work in to your system, before any positive or indifferent effects can be judged. 6.Sleep: Get plenty of rest, especially during an arduous training period or climbing trip. This goes along way toward minimizing the likelihood of injury and massively aids in the recovery of existing damage.

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