May 26, 2011, 8:47 AM
Registered: Nov 14, 2002
Once you are pain free, and not inflamed, you can start very gentle resistive work. You can do this however you want, but if you were my patient, I'd have you proceed in a more controlled fashion than even easy climbing.
Out of curiosity, and in case I ever get another pulley tear...
1 - How do you define the point where you are pain free and the swelling has gone down? In my case, IIRC, I had very little swelling, and the pain was mostly present with climbing or direct pressure.
2 - Until that point, would you recommend trying to brace/immobilize that finger?
For really active, acute inflammation, pain at rest is a reliable indicator. Once you reach the subacute phase, pain which occurs at loads below the normal pain threshold would be a good, but less reliable, indicator. If you are generally healthy, and don't continue injuring yourself, this subacute phase should gradually decline over time.
Swelling can be measured with a tape measure, or more accurately, by measuring the volume of water displaced by (say) a finger. Again, this should improve over time.
Bracing or immobilizing can be good for certain injuries. Fractures, severe strains (ligament tears resulting in instability). I don't like immobilizing for pulley injuries UNLESS (a) you work a job where you need to use your hands a lot, and you would otherwise keep injuring it,, so you immoobilize only at work, or (b), you have tried relative rest with AROM, then PROM, and you still have pain at rest, indicating an injury so severe it shouldn't be moved for a while.
That answers question 2 - your answer would be a clear NO, if I understand you correctly (for a partial pulley tear).
For question 1 - Sorry if I wasn't clear with my question. I wasn't asking how you can tell what "phase" of pain\inflammation you're in, or how it is measured, but what exactly you mean when you say "pain free, and not inflamed". That sounds like neither acute nor sub-acute.
I mean, in an absolute sense, it took years before there was zero pain associated with the injury site, and there is still some "swelling" in the sense that the sheath/pulley is much thicker on that finger now (presumably due to scar tissue).
So you must have meant "when pain and swelling have dropped to ____________". I'm asking about how to fill in the blank. Is it when the pain and swelling is sub-acute? If so, then that means pretty much immediately, in my case.
I think you are really looking for a black-and-white answer to kind of a "gray" question.
No, I really am not looking for a black and white answer.
What I'm looking to do is to reconcile this:
"Once you are pain free, and not inflamed.... when the pain and swelling have dropped to the point that you can no longer tell an injury occurred.... you can start very gentle resistive work. "
"I don't think it's inconsistent with anything I said above. 1-3 weeks of total rest from climbing (or until the acute inflammatory phase is over), Then start rehabbing, including easier climbs with open grip. "
Unless I'm missing something, the first would lead to no resistive training for six months or longer, while the second would wait only a couple of weeks for the same injury. That's a factor of 12 difference.
You yourself seem to recognize the issue, when you say: "When I said they can be 1-6 month injuries, that does not mean no climbing for 6 months. That means you may well have pain for 6 months, or even longer. They can be very stubborn. "
So if it can take 6 months or longer to be pain free from an injury, and you can be climbing long before the end of that time, but you don't recommend even light resistive training until you are fully pain free...
(This post was edited by cracklover on May 26, 2011, 8:53 AM)