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Agilis


May 24, 2011, 8:56 AM
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Need advice - Injured right ring finger - Full ROM
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Hello everyone,

I've been climbing for 2 years now & recently I injured my right ring finger - about 4 weeks ago. I was climbing a problem and climbed it too many times and ended up injuring my finger on one of the holds - If I were to guess I would say it was a 3 finger pocket hold. I didn't realize this practice, where I kept climbing the same route over and over, was bad. This is my first injury I have sustained from climbing. At the time of the injury, I never had any noticeable swelling and thought it was extremely minor and something not to worry about. When I tried to climb at my next session, I had sharp pains when I tried to climb on certain holds. This pain would extend down through the finger, and into the palm. I took that as a sign that I need to stop and a friend/experience climber recommended I take 600mgs of ibuprofen every 4 hours, 4 times a day for 3 days. During this time, I did ROM exercises but never had any ROM problems. I could move my fingers, in every direction, make a semi tight fist without any discomfort.

After 1 solid week off, I was climbing at a low level with hardly any pain with my finger taped. I could feel some pain but it was manageable. I took more & longer breaks between sends but soon as I tried to climb anything with crimps or difficult, the pain would be localized to my ring finger, and it was not manageable. I have been doing cool water baths with 55 degree ice water for 30 minutes, twice a day, but because of my schedule, I'm not able to do this nearly as often I should. I do get the 'Lewis Reaction' and my hand becomes pink so I know I am getting the blood flow needed.

Well, it's been about 4 weeks, climbing sporadically, and tried to climb last night with my finger taped, both buddy and for support, and certain jugs just caused too much pain to my finger. I'm scheduled to see my Doctor at the end of the week and would like some advice on what I could tell the doctor, etc. Since I lack any experience of this type of injury, I'm going in blind. The only place/time I feel significant pain is when I firmly squeeze on the top and bottom section between my middle knuckle and first knuckle. There is slight pain behind the middle knuckle but not nearly as noticeable as the other section. I still have full ROM and have no problems doing push-ups both - closed fist or open handed.

Thank you in advance and I apologize for the length of the post.


altelis


May 24, 2011, 1:35 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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It sounds like a pulley tear.

Look online here, there is a lot of information on pulley tears and treatment information.

Most people I know who've torn pulleys need to take about a month off, completely, and then come back slowly.

A couple things to think about:
1) If you aren't haven't any noticeable swelling, taking ibuprofen, especially that much, make lengthen recovery.

2) Buddy taping is not going to actually give the support your pulley needs, at all. Tape around the segment of your ring finger that hurts, only on that finger, as tight as you can without cutting off circulation.


Agilis


May 24, 2011, 1:48 PM
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Re: [altelis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Thank you for your reply altelis.

Things to mention: I only took the ibuprofen for the first week that I was initially injured. I have since been off of it.

Again thanks for your advice. I will browse here looking for more information, but sometimes it's hard to find what you need when the symptoms of almost every injury read as being similar.


altelis


May 24, 2011, 1:50 PM
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I totally hear you- easier to look for info if you have an injury name rather than a list of symptoms.


onceahardman


May 24, 2011, 6:50 PM
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Re: [altelis] Need advice - Injured right ring finger - Full ROM [In reply to]
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I agree, likely pulley strain, maybe with some lumbrical involvement, given the palm pain.

These can be 1-6 months, and sometimes they never get back to truly 100%. The injury is almost unknown outside of the rockclimbing community, so you may see some frustration as you seek out doctors who are familiar with the injury.

Keep it moving. AROM.

I'd like to see a study, that compared between groups. One group doing dedicated AROM. Next doing AROM with 55 deg. Lewis reaction baths. Next group doing the baths only.

My admittedly biased opinion would be...AROM group showing faster healing than cold bath group, with a statistically insignificant difference between AROM, and AROM plus bath groups. But I'd like to see the study.


(This post was edited by onceahardman on May 24, 2011, 6:51 PM)


Agilis


May 25, 2011, 7:47 AM
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I think the palm twinge/twang I felt was simply the fact I pulled on the A4 pulley when I first injured it not realizing the extent of the injury. This palm twinge has not been felt since and it's been 4 weeks.

I'm going to be doing AROM, just out of habit, might purchase some putty, but will be doing extremely light climbing as I back off from my climbing. I do subscribe to the theory that it's better to lightly climb then not climb at all because as logic would suggest, the new tissue needs to know it will have stress placed upon it so as the new tissue develops, it is strengthened.

When I go to the doctor's this Friday, if he cannot put me in contact with anyone who deals with climbing injuries/finger injuries I will take it upon myself to follow a strict regimen as follows:

Cool water baths as often as I can without over doing it.
AROM which will involve light climbing, to the point where after I warm up - My session is over. Still deciding on taping because the tightness I would need to achieve with the tape would no doubt cut circulation.

I don't mind taking a couple months off because it gives me a chance to weight train instead - Doing pull-ups and push-ups among other exercises yields no pain in my finger. As long as I can do that, my hopes are up.

Quick note: The 55 degrees was the temperature I found to work the best. After some research on the Lewis Reaction, it was said that the skin needs to be at 15 degrees Celsius, 59 degrees Fahrenheit in order for the Lewis Reaction to occur. So to achieve this, I'm filling a bucket up with tap water set to the coldest, which comes out at an even 60 degrees Fahrenheit and toss in about 10-12 ice cubes until the water drops to about 55-57. I believe I'm achieving the Lewis Reaction because my right hand becomes very pink, and the water no longer feels as cold as it was when it started, even though the water temp is still the same. My hand doesn't feel flush, then again I don't know what that even feels like.


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May 25, 2011, 10:03 AM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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I had a partial pulley tear, and I'm sorry to say, the medical establishment was entirely useless in diagnosis and treatment.

I wound up having to do all the research and treatment myself. The most useful single element was a book called "One Move Too Many". I cannot recommend it enough. By itself it was not everything, but it had tons of useful info and contained all I needed to search for further data on the internet.

I was in my mid 30s when it happened, so if you are younger, you may heal a lot faster. For me, it took a full year to be back to 100% of where I was before the tear, and a few years more before I could stop taping entirely.

Get the book, and stop climbing for now, or if you do climb, don't use that finger at all. (At the beginning, the only time I would climb would be if I taped my bad finger to my palm and dropped six number grades).

I'm not saying you shouldn't see a doctor. It's worth it just to rule out something like a stress fracture or tumor or something. And if you have access to a doctor with experience with climbing injuries, definitely make the extra effort to see that person.

GO


Agilis


May 25, 2011, 10:19 AM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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I'm 30 and in good health and hoping I'll heal fast enough where I can climb at the level before I got injured. I don't want to be out a year because of a pulley strain.

If I go to a doctor and he recommends an MRI, will the MRI be able show the difference between a tear and a strain?

What were the treatments you ended up following?


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May 25, 2011, 10:48 AM
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Agilis wrote:
I'm 30 and in good health and hoping I'll heal fast enough where I can climb at the level before I got injured. I don't want to be out a year because of a pulley strain.

If I go to a doctor and he recommends an MRI, will the MRI be able show the difference between a tear and a strain?

What were the treatments you ended up following?

I didn't say I was out for a year. I said it was a year before I was back to 100% of where I was pre-injury. You can't force your body to heal faster than it does.

An MRI will clearly show a full rupture of either pulley or tendon, but that would be fairly clear through other diagnostics. For less than a full rupture, OAH could say better than me, I'm sure, but my guess is that it depends on a lot of factors, including the degree of damage, how long between the initial injury and when the MRI is done, and who's looking at the images. In my case, by the time the MRI was done, the doctors saw nothing.

My treatment was first to back off climbing for a while and consult doctors. Then, once I had self-diagnosed myself, I stopped climbing entirely. Then I returned to climbing but did not put any weight on that finger. I gradually brought it back into climbing, while using less and less pulley-supportive taping methods. Oh, and I'll add that I also did some mild massage of the area.

GO


(This post was edited by cracklover on May 25, 2011, 2:33 PM)


onceahardman


May 25, 2011, 2:23 PM
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Agilis, what I say might be construed as insulting. I assure you, I don't mean it that way.

First, a strain IS a tear. By definition. A grade III strain is a complete tear.

Next, what you said above regarding AROM and climbing, and continuing climbing as your AROM. This really shows you don't know what AROM means. No offense, you just don't know.

There are two types of ROM...Active (AROM), and Passive (PROM)

Passive Range Of Motion (for fingers) is using the other hand, or another person, to move the joint(s) within the available range. The purpose is to maintain health of joint surfaces, and to maintain health of soft tissue around the joint. The purpose is NOT to increase range of motion, since you only move the joint within the available range.

STRETCHING is moving a joint beyond the available physiological range. It's purpose is to increase ROM.

Active Range Of Motion- is using one's own muscles to move a joint within the available range. It does everything that PROM does, but adds on active muscular contraction, so it will increase blood flow to muscles (etc.) much more than PROM will.

Resistive exercise- is adding resistance to normal physiological motions so as to provide a strengthening effect.

Climbing easy routes is therefore resistive exercise (as far as your finger tendons are concerned), not AROM. AROM is a safer option for early rehab of this injury. 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.


(This post was edited by onceahardman on May 25, 2011, 2:26 PM)


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May 25, 2011, 2:49 PM
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onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO


Agilis


May 25, 2011, 3:00 PM
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Thanks for your reply.

No, not insulting at all. Like you said I simply do not know.

Now if light climbing is not the way to go, why do so many sources I've read say that taking long lay offs from climbing can actually do more harm than good. Reason being, the new tissue is not put under any stress and injuring the new tissue once healed will be even easier?

Thanks for your advice and look forward to your reply.


onceahardman


May 25, 2011, 3:10 PM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.


onceahardman


May 25, 2011, 3:31 PM
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Agilis wrote:
Thanks for your reply.

No, not insulting at all. Like you said I simply do not know.

Now if light climbing is not the way to go, why do so many sources I've read say that taking long lay offs from climbing can actually do more harm than good. Reason being, the new tissue is not put under any stress and injuring the new tissue once healed will be even easier?

Thanks for your advice and look forward to your reply.

I really can't speak as to why other sources say anything. I'd like to read one or two of these sources, so I can understand better.

In general though, yes, first scar tissue forms, and then this scar tissue needs to be remodeled into a strong, extensible scar that more closely resembles the original tissue. Otherwise it will be weak.

I am of the opinion that for severe injuries, this tissue remodeling needs to be done in a well-controlled fashion, or else you risk re-injury. Start with gentle manual resistance, progress to putty and resistance bands, and finally, begin some easy climbing on comfy holds.

And, learn to use the open grip. Pulley injuries are more frequent when crimping.


(This post was edited by onceahardman on May 25, 2011, 3:34 PM)


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May 25, 2011, 3:35 PM
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onceahardman wrote:
cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.

Thanks again,

GO


onceahardman


May 25, 2011, 4:00 PM
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cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.

Thanks again,

GO

I think you are really looking for a black-and-white answer to kind of a "gray" question.

Acute inflammation is characterized by pain at rest, swelling, redness, and heat. (Dolor, Tumor, Rubor, Calor, first characterized by Hippocrates) It is believed to be caused by the presence of intracellular fluids released by cellular damage into extracellular spaces, where it comes into contact with nerves, causing pain at rest.

Subacute inflammation occurs afterward, and is characterized by a decreased threshold for nerve cells to register pain, i.e., you will have pain with relatively minor forces applied to structures, which when uninjured, would not cause pain. It is indefinite in terms of how long it lasts, exactly, and perhaps could have contributed to your pain of several years.

The final phase is the chronic phase, at which point healing has pretty much ceased, although some remodeling will still occur.


There really probably isn't a satisfactory answer to your question, other than perhaps, "when the pain and swelling have dropped to the point that you can no longer tell an injury occurred". For many severe injuries, there will be permanent effects, and sometimes, permanent pain. There is such a thing as a career-ending injury.

As far as your increased thickness at the pulley, it's not really swelling, but scar tissue, as you surmise. It is probably a permanent reminder of your injury, Scar tissue is how we heal, and in the early stages of healing, scar tissue is your friend, your want to let it form.


cacalderon


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Sounds like a tear.

My advice: months of rest (rest = no climbing).


Agilis


May 25, 2011, 7:41 PM
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onceahardman wrote:
Agilis wrote:
Thanks for your reply.

No, not insulting at all. Like you said I simply do not know.

Now if light climbing is not the way to go, why do so many sources I've read say that taking long lay offs from climbing can actually do more harm than good. Reason being, the new tissue is not put under any stress and injuring the new tissue once healed will be even easier?

Thanks for your advice and look forward to your reply.

I really can't speak as to why other sources say anything. I'd like to read one or two of these sources, so I can understand better.

In general though, yes, first scar tissue forms, and then this scar tissue needs to be remodeled into a strong, extensible scar that more closely resembles the original tissue. Otherwise it will be weak.

I am of the opinion that for severe injuries, this tissue remodeling needs to be done in a well-controlled fashion, or else you risk re-injury. Start with gentle manual resistance, progress to putty and resistance bands, and finally, begin some easy climbing on comfy holds.

And, learn to use the open grip. Pulley injuries are more frequent when crimping.

Thank you everyone for your replies and advice, really appreciate it.

The source that first gave me insight is here:
http://onlineclimbingcoach.blogspot.com/2010/05/pulley-injuries-article.html

This source and another source,
http://www.climbinginjuries.com/page/fingers

Share the same opinion. These links are given so you can read them since you mentioned you were interested in them.

I have adjusted my recovery regimen. It will consist of:

- Pulls ups w/ different grips and push ups
- General exercise
- Plenty of rest
- Sporadic climbing**

**Only climbing I will allow is climbing that allows virtually no stress on my right ringer finger's A4 pulley and will be once a week.

If my doctor thinks otherwise I will take his advice into consideration. It will be tough to not climb but a few months off will be good.


(This post was edited by Agilis on May 25, 2011, 8:09 PM)


onceahardman


May 26, 2011, 4:53 AM
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Agilis wrote:
onceahardman wrote:
Agilis wrote:
Thanks for your reply.

No, not insulting at all. Like you said I simply do not know.

Now if light climbing is not the way to go, why do so many sources I've read say that taking long lay offs from climbing can actually do more harm than good. Reason being, the new tissue is not put under any stress and injuring the new tissue once healed will be even easier?

Thanks for your advice and look forward to your reply.

I really can't speak as to why other sources say anything. I'd like to read one or two of these sources, so I can understand better.

In general though, yes, first scar tissue forms, and then this scar tissue needs to be remodeled into a strong, extensible scar that more closely resembles the original tissue. Otherwise it will be weak.

I am of the opinion that for severe injuries, this tissue remodeling needs to be done in a well-controlled fashion, or else you risk re-injury. Start with gentle manual resistance, progress to putty and resistance bands, and finally, begin some easy climbing on comfy holds.

And, learn to use the open grip. Pulley injuries are more frequent when crimping.

Thank you everyone for your replies and advice, really appreciate it.

The source that first gave me insight is here:
http://onlineclimbingcoach.blogspot.com/...njuries-article.html

This source and another source,
http://www.climbinginjuries.com/page/fingers

Share the same opinion. These links are given so you can read them since you mentioned you were interested in them.

I have adjusted my recovery regimen. It will consist of:

- Pulls ups w/ different grips and push ups
- General exercise
- Plenty of rest
- Sporadic climbing**

**Only climbing I will allow is climbing that allows virtually no stress on my right ringer finger's A4 pulley and will be once a week.

If my doctor thinks otherwise I will take his advice into consideration. It will be tough to not climb but a few months off will be good.

I made your links clicky. I read the McLeod article, and enjoyed it. 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.

I am of the personal and professional opinion that AROM is more effective at increasing the deep blood flow necessary for healing, and that the "flushing" effect of the Lewis reaction is really more of a subcutaneous effect. I'd like to see a comparative study.

I'll read the other article later. Thanks for supplying them.

PS...I think perhaps I communicated poorly above. 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.


(This post was edited by onceahardman on May 26, 2011, 5:08 AM)


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May 26, 2011, 8:47 AM
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Re: [onceahardman] Need advice - Injured right ring finger - Full ROM [In reply to]
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onceahardman wrote:
cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.

Thanks again,

GO

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. "

with this:

"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...

Um... what?

GO


(This post was edited by cracklover on May 26, 2011, 8:53 AM)


onceahardman


May 26, 2011, 11:09 AM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.

Thanks again,

GO

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. "

with this:

"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...

Um... what?

GO

When you jump around and ask a different question using quotes further downthread, it's kind of like "moving the goalposts" a bit...but I think I understand what you mean. I also answered it:

In reply to:
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.

Pain at rest is a reliable indicator of acute inflammation. Pain which comes on with very minor forces can still be an indicator of acute inflammation, but is less reliable,

Let's say you sprained your ankle. A bad sprain will be red, puffy, hot, and painful, even at rest, when not bearing any weight at all through it. It might be excruciating to bear weight.

A minor sprain might well be pain free at rest, but still quite painful when bearing weight, and very painful if you loaded the sprained ligament(s).

A sprained pulley would be similar. A complete tear can be quite painful, even at rest, for several days. As it begins to heal, macrophages clean up cellular debris, and lymph carries away inflammatory chemicals, and the pain at rest goes away, but you still have pain with minor loading (either compressive or tensile). And you could be in considerable pain if you specifically load the pulley by crimping.

So, in general, when you have no pain at rest, you can start ROM. Try AROM. If AROM is painful, back off. Try PROM. If that is still painful, Continue resting.

When you have full, pain free AROM, start gentle tensile loading. Be careful you do not do this too aggressively. You do not want to make it worse, and return to an earlier inflammatory stage, characterized by pain at rest, or pain with AROM. It's OK if it hurts a bit with the loading, as long as the pain does not remain worse as a result of that loading.

Continue to prgress the intensity of the loading exercises, as long as you can do so without making it worse. remembering you need rest between sessions.

I hope that's better.


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May 26, 2011, 12:11 PM
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Re: [onceahardman] Need advice - Injured right ring finger - Full ROM [In reply to]
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onceahardman wrote:
cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
cracklover wrote:
onceahardman wrote:
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...

2 questions:

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?

Thanks,

GO

Good questions.

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.

Thanks again,

GO

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. "

with this:

"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...

Um... what?

GO

When you jump around and ask a different question using quotes further downthread, it's kind of like "moving the goalposts" a bit...but I think I understand what you mean. I also answered it:

In reply to:
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.

Pain at rest is a reliable indicator of acute inflammation. Pain which comes on with very minor forces can still be an indicator of acute inflammation, but is less reliable,

Let's say you sprained your ankle. A bad sprain will be red, puffy, hot, and painful, even at rest, when not bearing any weight at all through it. It might be excruciating to bear weight.

A minor sprain might well be pain free at rest, but still quite painful when bearing weight, and very painful if you loaded the sprained ligament(s).

A sprained pulley would be similar. A complete tear can be quite painful, even at rest, for several days. As it begins to heal, macrophages clean up cellular debris, and lymph carries away inflammatory chemicals, and the pain at rest goes away, but you still have pain with minor loading (either compressive or tensile). And you could be in considerable pain if you specifically load the pulley by crimping.

So, in general, when you have no pain at rest, you can start ROM. Try AROM. If AROM is painful, back off. Try PROM. If that is still painful, Continue resting.

When you have full, pain free AROM, start gentle tensile loading. Be careful you do not do this too aggressively. You do not want to make it worse, and return to an earlier inflammatory stage, characterized by pain at rest, or pain with AROM. It's OK if it hurts a bit with the loading, as long as the pain does not remain worse as a result of that loading.

Continue to prgress the intensity of the loading exercises, as long as you can do so without making it worse. remembering you need rest between sessions.

I hope that's better.

Better? Hell, it's superb! Clarifies the situation, more than I thought possible. Thanks very much, I appreciate it.

GO


altelis


May 26, 2011, 5:28 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Couple of random thoughts, seeing a lot's gone on since I last checked in...

1) Diagnosis. Current literature shows that ultrasound is equally sensitive as MRI for diagnosis of A4 pulley tears. HOWEVER, the caveat here is that if there isn't a pulley tear on ultrasound, the specificity is too low to be able to rule a pulley injury out. And usually the ultrasound won't be able to give any more information.

MRI is better able to rule out a tear as well as rule in or out other possible concomitant injuries as well. There are, of course, some caveats.

It needs to be a 3 tesla MRI. A "normal" MRI doesn't give enough detail for a proper diagnosis. Also, the radiologist really needs to be an orthopedic specialist. This is borne out in the literature, and my own injury is a good example. MRI initially came back clean, but my orthopedist (a hand specialist) had enough suspicion that he had a second read of the films done by a radiologist who specializes in orthopedic imaging. Sure enough, found the tear as well as a strain in the extensor tendon, both missed originally.

There's the "short" answer about imaging.

2) Something to think about with pull-ups: light climbing as a recovery method involves putting as little weight on your finger as possible. Especially in the beginning- slabby climbs, climbs with very positive feet, etc. While you don't think about pull-ups as climbing, they are, in essence, full on climbing. They are fully weight-bearing. They don't have to be full weight on the injured finger, but you'll need to be deliberate on how you hold the bar/hang-board. Don't forget that part...


Agilis


May 26, 2011, 6:04 PM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
Better? Hell, it's superb! Clarifies the situation, more than I thought possible. Thanks very much, I appreciate it.

I agree. Judging from my own injury and what OnceAHardMan said, I have zero pain at rest, and I am at the AROM stage. I will still take a month off from any real climbing just tonbe on the safe side.

Thanks again.


Agilis


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Re: [altelis] Need advice - Injured right ring finger - Full ROM [In reply to]
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altelis wrote:
Couple of random thoughts, seeing a lot's gone on since I last checked in...

1) Diagnosis. Current literature shows that ultrasound is equally sensitive as MRI for diagnosis of A4 pulley tears. HOWEVER, the caveat here is that if there isn't a pulley tear on ultrasound, the specificity is too low to be able to rule a pulley injury out. And usually the ultrasound won't be able to give any more information.

MRI is better able to rule out a tear as well as rule in or out other possible concomitant injuries as well. There are, of course, some caveats.

It needs to be a 3 tesla MRI. A "normal" MRI doesn't give enough detail for a proper diagnosis. Also, the radiologist really needs to be an orthopedic specialist. This is borne out in the literature, and my own injury is a good example. MRI initially came back clean, but my orthopedist (a hand specialist) had enough suspicion that he had a second read of the films done by a radiologist who specializes in orthopedic imaging. Sure enough, found the tear as well as a strain in the extensor tendon, both missed originally.

There's the "short" answer about imaging.

2) Something to think about with pull-ups: light climbing as a recovery method involves putting as little weight on your finger as possible. Especially in the beginning- slabby climbs, climbs with very positive feet, etc. While you don't think about pull-ups as climbing, they are, in essence, full on climbing. They are fully weight-bearing. They don't have to be full weight on the injured finger, but you'll need to be deliberate on how you hold the bar/hang-board. Don't forget that part...

Hello there... Sure has. This topic blew up thanks to both the intelligent questions and answers posted.

1. That is kind of scary to think that if a climber experiences an injury more severe than mine, and really needs
propper diagnosis, that they might not get the correct diagnosis due ton he obscurity of these types of pulley injuries.

2. I agree with you which is why my pull-ups are being done on a bar instead of holds. The bar is always perpendicular to my grip/forearm. The contours of a lot of jugs I found irritated my A4 pulley not by pulling on it, but by the pressure being applied to it.

I appreciate the advice. I would not be doing my pull ups if I were in pain.

Thanks for your input. Tomorrow is my doctors visit and I'm armed with a wealth of knowledge thanks to everyone who participated in this thread and will reply tomorrow with a status update on how the visit went.


Agilis


May 27, 2011, 6:50 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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So saw the doctor which was a complete waste of time. It wasn't the doctors fault, simply had no idea about the type of injury I may or may have sustained and wound up educating him the entire visit. He performed a basic evaluation: Put pressure with his index finger the entire length of my hand down to the tip of my ring finger checking for any pain. There was none. Then he place both his index and middle fingers in the center of my open hands and asked me to squeeze as hard as I could. Again no pain.

The doctor ended up giving me a referral to see a hand specialist that specializes in the hand and made an appointment for Wednesday.

So to be continued.


altelis


May 29, 2011, 2:51 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Giving the physician the benefit of the doubt, it wasn't a waste of time. He was able to rule out other potential issues before sending you to a hand specialist. It seems straight-forward from the outside, but as many people can attest to, sometimes what looks like an obvious X is a presentation of something else entirely. Being able to rule-out those things is what makes a great primary care physician great.

All that said, yes, it was pretty obvious you needed to see a hand-specialist, and in your case it was probably not that useful to go through a gatekeeper. But from the public health/health-care rationing (because that really is what its about, though the idea is not a bad thing in and of itself), the system is needed.

Good luck with your ortho injury! Hopefully you'll get lucky- my hand specialist, though not a climber himself, is a young athletic guy (like most orthos), and climbing is one of the few sports that really intersects with his speciality, so he's really done a lot of research and seems to have figured out a lot, both about injuries and about the sport in general.


Agilis


Jun 1, 2011, 2:07 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Read this please, Useful information

Hello ladies and gentlemen,

I saw the hand specialist today. I explained to him what I may have done and he was impressed that I was educated in the types of hand injuries climbers risk and my injury. He couldn't believe that I knew so much about it and even asked why that was.

He proceeded to give me a thorough hand evaluation once he was done taking notes during my explanation of how I may have injured my finger.

He started off by feeling the tops of my fingers, where he said he felt some bone spurs and took it as a possible sign of arthritis. He said I was too young for arthritis to be developing so he was concerned.

He then had me place my hands and fingers in various positions to test the ROM of each finger. Afterward, he pushed on certain spots having me stop when I felt any pain. He then used a hammer-like device to trigger some sort of nerve sensation. He then had me bend my wrists back to back with my hands pointing down and had me hold there for a minute to see if anything would go numb. He then had me hold my fingers in various positions and grips where he then had me resist his own finger's pull and push motions.

After that, the Dr. used a tiny device with dull points coming out the center in order to measure sensitivity. He did 2 tests, 1 where he would have me watch and the second, would have me close my eyes. I was supposed to differentiate between 2 types of touches, 1 point, or 2 points.

After this was all said in done, he had me squeeze this device with each hand which measured the amount of lbs squeezed.

Finally, he took some X-Rays which turned out to be negative for arthritis then gave me his diagnosis.

He said that I don't have any pulley strains or tears. He said that the DIP joint is stiff and seems to be the problem. He said I have lost ROM in the tip of that finger because I can't fully straighten it. He didn't tell me how many degrees it was off, but he said it's enough to indicate that the joint is stiff and that's where my pain is coming from. He told me I probably won't get the ROM of motion back but told me how to treat it.

He asked me to take off 4 weeks, or 1 month from climbing then start back slowly. For my treatment, he said you can soak your hand in warm water twice a day. He then suggested I could buy a wax dipping machine, that allows you to dip your hands in melted wax, and once the hand is coated in wax, take it out and let the wax sit on the hand until you no longer feel it. Then peel the wax off.

He told me that when I get back to climbing, to tape around the joint, and can tape around the middle join as well. He recommended I use the following type of wrap:

http://www.amazon.com/...ze-yds/dp/B0017PJUUS

This type of wrap he said I should use when climbing, and if I wanted, use this wrap over the normal climbing tape for added effect. You can find this wrap at any pharmacy or drug store.

So I'm going to do what he recommends for treatment and hopefully I'll be back to climbing sooner than later.

I hope the information above is found to be useful. Any questions, just ask.


onceahardman


Jun 1, 2011, 4:17 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Agilis, I'm glad you went to the specialist.

He seems to have spent a lot of time looking for neurological problems- the hands back-to-back, holding the wrists in flexion sounds like Phalen's Test (for carpal tunnel):

http://www.turner-white.com/pdf/hp_jul00_tinel.pdf

And he also did quite a bit of two-point discrimination testing. These are standard clinical tests for neuropathies, and it's good to have them ruled out.

Sounds like he also manually muscle tested the intrinsic muscles of the hand, but it's hard to tell without having seen what the actual "various positions of the hand" you describe actually were. Intrinsic testing is likely though. (you can google "lumbricals" and "interossei" and see if the tests look familiar).

Climbers certainly develop bony hypertrophy in the fingers as a result of the enormous forces we put on our fingers. This may well be why he thought he felt "arthritis" in your fingers.

Remember that pulley injuries are almost completely unknown outside of the climbing population, and it is entirely possible that even a specialist has never seen this injury. If the strain is minor, the diagnosis will be exceedingly difficult, and maybe impossible with good reliability.

I'm glad you got some more info, though. Thanks for sharing it here, and stay in touch regarding your progress.

EDIT:

There is nothing you describe that sounds like a test that would stress the pulleys...EXCEPT THIS, which you said in the OP:

In reply to:
I took more & longer breaks between sends but soon as I tried to climb anything with crimps or difficult, the pain would be localized to my ring finger, and it was not manageable.

Crimping directly puts strain on pulleys. That, to me, is the best test for pulley injuries. And yours is (or was) positive for reproduction of symptoms.


(This post was edited by onceahardman on Jun 1, 2011, 4:29 PM)


qtrollip


Jun 1, 2011, 4:59 PM
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Re: [onceahardman] Need advice - Injured right ring finger - Full ROM [In reply to]
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Agilis, I am a physiotherapist as well and read through this whole post, and totally agree with all Onceahardman said. I still don't think according to everything you described the specialist did that you can rule out a pulley injury.

I would also add that for most tendon injuries an eccentric strengthening programme could be very beneficial. This could be done by doing a crimp position of the fingers and using the other hand to slowly open up (straighten) the fingers - this will cause a type of elongation-contraction.
You could try this in accordance with the other principles already mentioned regarding pain/inflammation etc.

Good luck!


Agilis


Jun 2, 2011, 6:57 AM
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Re: [qtrollip] Need advice - Injured right ring finger - Full ROM [In reply to]
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Thanks for the information Onceahardman & qtrollip.

First, the tests you both mentioned was exactly what he did. The link you linked me to Onceahardman was exactly what he did. I'm impressed I explained that so well :) Anyways, really appreciate both your input and insight.

Now I thought I mentioned the pulley test but I can see that I didn't touch on it like I should have and I apologize for that.

The test, now that I think of it, perhaps it was 2, that the specialist did to test my pulleys was first, he used firm pressure on the bottom of my fingers where the pulley locations were to see if I felt any pain. I told him I felt slight pain, located right where my finger meets the palm, but it was barely there, and from a scale 1 to 10, I told him it was like a 1.

He then had me hold my right hand in a crimp like position and had me pull against his fingers which didn't result in any pain from the pulleys, but I was able to pin-point the joint as the location of the pain. This is exactly what qtrollip suggested I do, only instead of me opening my hand, the specialist was the resistance.

Another test he did was he took my fingers and checked for side to side movement in the joint. I believe that was to test for the integrity of the collateral ligaments.

With that added information, any change of opinion? I really am sorry I forgot that information.


onceahardman


Jun 3, 2011, 3:02 PM
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Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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Agilis wrote:
Thanks for the information Onceahardman & qtrollip.

First, the tests you both mentioned was exactly what he did. The link you linked me to Onceahardman was exactly what he did. I'm impressed I explained that so well :) Anyways, really appreciate both your input and insight.

Now I thought I mentioned the pulley test but I can see that I didn't touch on it like I should have and I apologize for that.

The test, now that I think of it, perhaps it was 2, that the specialist did to test my pulleys was first, he used firm pressure on the bottom of my fingers where the pulley locations were to see if I felt any pain. I told him I felt slight pain, located right where my finger meets the palm, but it was barely there, and from a scale 1 to 10, I told him it was like a 1.

He then had me hold my right hand in a crimp like position and had me pull against his fingers which didn't result in any pain from the pulleys, but I was able to pin-point the joint as the location of the pain. This is exactly what qtrollip suggested I do, only instead of me opening my hand, the specialist was the resistance.

Another test he did was he took my fingers and checked for side to side movement in the joint. I believe that was to test for the integrity of the collateral ligaments.

With that added information, any change of opinion? I really am sorry I forgot that information.


Here's what I think:

If crimping duplicates (or duplicated) your symptoms, then a pulley injury is certainly "in play". The doc put you in a crimping position, but only loaded the joints up to the amount of force that his fingers could apply, rather than your entire bodyweight.

You need to load the position sufficiently to duplicate symptoms. A pulley strain is thus not ruled out.

Now, also still in play is this "stiff" DIP joint. If extending the DIP under load (as in crimping) duplicates your symptoms, then that would lend credence to the specialist's opinion. But, if the problem is purely the stiffness of the DIP, then (follow me here), the position of the PIP should be irrelevant.

That is, you should be able to duplicate symptoms by moving the DIP whether the PIP is flexed or not.

In crimping, the PIP is very flexed, while the DIP is extended, which puts maximal outward force on the pulleys, and would be expected to reproduce symptoms for a pulley injury.

Things that cause pain:

-normal force on abnormal tissue
-abnormal force on normal tissue
-abnormal force on abnormal tissue.

If we assume that crimping forces are "normal", (which is arguable), then painful crimping would result from loading damaged (abnormal) structures by crimping. But the end-range extension of the DIP would also not rule out a stiff DIP...UNLESS, the pain of extension goes away when you remove the flexion on the PIP.

I hope that makes sense.


(This post was edited by onceahardman on Jun 3, 2011, 3:03 PM)


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Jun 18, 2011, 12:37 PM
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Re: [onceahardman] Need advice - Injured right ring finger - Full ROM [In reply to]
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Well, nice timing on this, as I just blew my A3 pulley.

GO


johnwesely


Jun 18, 2011, 5:07 PM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

I hope you are trolling.


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Jun 18, 2011, 6:26 PM
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Re: [johnwesely] Need advice - Injured right ring finger - Full ROM [In reply to]
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johnwesely wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

I hope you are trolling.

If by that you mean lying, nope. Nice loud pop. Slight bowstringing under (palm side) of the first finger joint.

Climbing season over. Well, we'll see about the fall.

Cheers,

GO


johnwesely


Jun 18, 2011, 6:38 PM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
johnwesely wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

I hope you are trolling.

If by that you mean lying, nope. Nice loud pop. Slight bowstringing under (palm side) of the first finger joint.

Climbing season over. Well, we'll see about the fall.

Cheers,

GO

Sorry to hear it.


onceahardman


Jun 20, 2011, 4:24 PM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

sorry, man. Maybe use the time to try out sonething you have wanted to do, but didn't have the time, secondary to how time-intensive climbing can be.

Fly fishing. Peak bagging. Extreme minimalist backpacking. (i've heard of people doing a week outside with less than a 20 lb pack!)

good luck, keep your spirits high, don't get too low. If you have questions, I'm glad to help, but I'm sure i've expressed many opinions on the subject here already Laugh


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Re: [onceahardman] Need advice - Injured right ring finger - Full ROM [In reply to]
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onceahardman wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

sorry, man. Maybe use the time to try out sonething you have wanted to do, but didn't have the time, secondary to how time-intensive climbing can be.

Fly fishing. Peak bagging. Extreme minimalist backpacking. (i've heard of people doing a week outside with less than a 20 lb pack!)

Indeed, I've already got the back porch ripped up and will be replacing the rotten boards. That's only one of many projects that will likely get done in the upcoming weeks and months. What fun.

In reply to:
good luck, keep your spirits high, don't get too low. If you have questions, I'm glad to help, but I'm sure i've expressed many opinions on the subject here already Laugh

Thanks very much. I've got a nice metal brace I've fashioned that supports the finger very well. I only use it when I'm working with my hands (like the back porch I'm ripping up) or during the day when I'm working (I'm a code monkey, so lots of typing). I take it off the rest of the time, as per your suggestion to let the finger do some work, although I favor it whenever that hand needs to hold something.

There's surprisingly little pain and swelling. It aches a little if I've used it a lot, and if I accidentally grab for an instant with it I get a little sharper pain. But mostly it doesn't hurt at all, it just feels... weird.

Hoping if I'm good to it it will heal quickly.

But yes, in the meantime, I'll keep busy. After all, that homebrew ain't gonna brew itself.

GO


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Jun 22, 2011, 7:47 AM
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Re: [cracklover] Need advice - Injured right ring finger - Full ROM [In reply to]
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Okay, one question:

Ice baths or no ice baths? What are the arguments on either side?

I iced for a good chunk of the first six hours after the injury (well, after the nice 45 minute jog to get back to the car), and then once or twice for the next couple of days. Haven't iced for the last two days, and unsure about whether I should.

TIA for any input.

GO


onceahardman


Jun 22, 2011, 3:31 PM
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You aren't going to do any harm by icing, and you are likely to get some benefit, especially in the acute phase.

Once the injury moves from subacute to chronic, ice will be of limited benefit, but will still do no harm.

Some have advocated cool water baths as a means of increasing circulation. To my knowledge, this will increase blood flow to subcutaneous structures, but probably not to deep structures.

Ice is an effective physical (i.e. non-chemical) agent for reducing inflammation.


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Jun 23, 2011, 7:45 AM
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onceahardman wrote:
To my knowledge, this will increase blood flow to subcutaneous structures, but probably not to deep structures.

Well, the pulleys are pretty much just sections of tendon sheath that are reinforced/thicker, right? So wouldn't you consider them subcutaneous? So far as I can tell, the tendon itself is fine - it's just the pulley that's ripped. But maybe the problem is the section where the structure is supposed to attach the the bone, and maybe that's too deep? I dunno, I'm getting way out of my depth (pardon the pun) here.

GO


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Jul 18, 2011, 2:37 PM
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cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO


johnwesely


Jul 18, 2011, 5:19 PM
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cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point. Just keep the intensity of the exercises, I recommend theraputty, low enough to avoid pain.


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Jul 19, 2011, 10:00 AM
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johnwesely wrote:
cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO


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Jul 19, 2011, 10:26 AM
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cracklover wrote:
johnwesely wrote:
cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Sorry.


qtrollip


Jul 19, 2011, 11:46 AM
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Bummer about the pulley, Cracklover...
There is an interesting post about H-taping floating around somewhere on this forum.
I would suggest taping the fiinger for rehab (either try the H-taping or fig 8).
Theraputty is ok, but it has no "recoil" to it, so you would only be strengthening concentrically. Elastics are better, because you could do concentric, static and eccentric strengthening (remember, you are not trying to strengthen just the pulley, but the whole flexor unit).
Start off by flexing through as few joints as possible (ie only mcp, pip, pip and dip together, then hammer-grip) and keep the wrist in neutral position.

Slight pain (1-3/10) while doing the exercices are fine. Watch for post-exercice pain. If it is severe or long-lasting, then you over-exerciced. Pain at rest (ie night or morning pain) could indicate an inflammatory process - ice in this case!
Use common sense with exercising, light stretches before resisted exercises, etc.
Hope this helps
Quentin


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Jul 19, 2011, 1:43 PM
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johnwesely wrote:
cracklover wrote:
johnwesely wrote:
cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Sorry.

Hey, no, don't be sorry! At the very least, you bumped the post!

GO


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Jul 19, 2011, 7:21 PM
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cracklover wrote:
johnwesely wrote:
cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Clinically, I am a fan of taping (or bracing) to support weak ligaments. Functionally, pulleys are ligaments.

Taping sprained ankle ligaments is well-supported for allowing an athlete to participate in sports where the injury would otherwise make it impossible.

I am generally not a fan of bracing or taping to support weak musculature, like say, a back brace for a sore back. We have muscles to support the spine. If the brace is doing the work, the muscles are not. If the muscle is not, it is becoming weaker.

There is no muscle to strengthen which will support a torn pulley. External taping is (IMO) indicated.

I believe in very frequent re-taping, between every burn or maybe two, especially with a fairly fresh injury. Tape stretches.

That is also why you will see NFL running backs getting re-taped every time the team is on defense, not just once per game.


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Jul 19, 2011, 8:52 PM
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onceahardman wrote:
cracklover wrote:
johnwesely wrote:
cracklover wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Clinically, I am a fan of taping (or bracing) to support weak ligaments. Functionally, pulleys are ligaments.

Taping sprained ankle ligaments is well-supported for allowing an athlete to participate in sports where the injury would otherwise make it impossible.

I am generally not a fan of bracing or taping to support weak musculature, like say, a back brace for a sore back. We have muscles to support the spine. If the brace is doing the work, the muscles are not. If the muscle is not, it is becoming weaker.

There is no muscle to strengthen which will support a torn pulley. External taping is (IMO) indicated.

I believe in very frequent re-taping, between every burn or maybe two, especially with a fairly fresh injury. Tape stretches.

Every "burn"? You mean climbing? No way could I climb right now, with tape or without it. Even fully taped, anything more than moderate force applied with that finger makes it hurt. I'm looking for therapeutic exercises to help it. Or perhaps I've misunderstood you?

It is *much* better than it was immediately after the injury, which is why I thought I could start a rehab program.

GO


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qtrollip wrote:
Bummer about the pulley, Cracklover...
There is an interesting post about H-taping floating around somewhere on this forum.

Thanks, I'll look that up. I had been using a fig-8 style of taping to support it recently (no longer need this for light activities like typing, but still need it if I'm going to be lifting anything).

In reply to:
Theraputty is ok, but it has no "recoil" to it, so you would only be strengthening concentrically. Elastics are better, because you could do concentric, static and eccentric strengthening (remember, you are not trying to strengthen just the pulley, but the whole flexor unit).
Start off by flexing through as few joints as possible (ie only mcp, pip, pip and dip together, then hammer-grip) and keep the wrist in neutral position.

Any idea where I could get one? Do pharmacies usually carry it, or do I need to order online? I went to the local Wallgreens Pharmacy, but they don't have it. In the meantime, I'll try a particularly squishy stress ball I have.

In reply to:
Slight pain (1-3/10) while doing the exercices are fine. Watch for post-exercice pain. If it is severe or long-lasting, then you over-exerciced. Pain at rest (ie night or morning pain) could indicate an inflammatory process - ice in this case!
Use common sense with exercising, light stretches before resisted exercises, etc.
Hope this helps
Quentin

Right on, thanks very much!

GO


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Jul 20, 2011, 2:56 PM
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In reply to:
Every "burn"? You mean climbing? No way could I climb right now, with tape or without it. Even fully taped, anything more than moderate force applied with that finger makes it hurt. I'm looking for therapeutic exercises to help it. Or perhaps I've misunderstood you?

It is *much* better than it was immediately after the injury, which is why I thought I could start a rehab program.

Yes, I was talking about climbing. When it is time to start climbing again, I am a fan of taping.

There really isn't anything truly research-based regarding what kind of exercises to do. There is no a muscle to strengthen, as this is essentially a ligament injury. As stated above, some light resistive work with resistance bands (rubber bands are fine) into flexion and extension, concentrically and eccentrically, are probably called for. Don't work so hard that it gets worse.


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cracklover wrote:
johnwesely wrote:
cracklover wrote:
Well, nice timing on this, as I just blew my A3 pulley.

GO

I hope you are trolling.

If by that you mean lying, nope. Nice loud pop. Slight bowstringing under (palm side) of the first finger joint.

Climbing season over. Well, we'll see about the fall.

Cheers,

GO

Well it's been three months, and there's significant improvement.
- Metal brace no longer ever needed.
- Pain and swelling near zero unless I overdo things.
- If I overdo things slightly, a few days of icing gets things back to baseline.
- Able to put a little pressure (perhaps a pound) on the last pad with no pain, even without taping.
- Able to fully make a tight fist with no pain or "weird feeling".
- Using a tight H-taping method, able to climb up to two number grades below my pre-injury level, once or twice a week, with no problems from my finger and no setbacks.

Things I cannot do:
- Put any significant force on the last pad of that finger.
- Full crimp with that finger (or, oddly, the pinky, which seems to also be unhappy now)
- Climb harder than 5.10 without causing pain/swelling for several days.
- Climb more than 1 or 2 X per week.
- Use the finger for any activity more forceful than typing without taping it.

So this fall I will definitely be climbing again. It is a little hard to get motivated when I can't do anything that will push me much, though.

GO


suecharles


Nov 13, 2011, 10:20 PM
Post #53 of 53 (566 views)
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Registered: Nov 13, 2011
Posts: 3

Re: [Agilis] Need advice - Injured right ring finger - Full ROM [In reply to]
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you might want to look into PROLOTHERAPY... I think that is how it's spelled. good luck!


Forums : Climbing Information : Injury Treatment and Prevention

 


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