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JenningsN


Mar 11, 2013, 12:30 PM
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Finger Tendon Pain
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I've been climbing for about a year now, and I'm really starting to get into it. Got nice aggressive shoes, and my footwork is not looking like a piece of shit (at least it feels good), and I'm starting to break high 5.11s.

The problem is I'm starting going 2-4 times a week for the last two months and my fingers are starting have some pain in them. Not just skin, but my tendons. They hurt pretty bad on crimps, but feel great on slopers. I understand that I am not supposed close my thumb off so I stay clear of that. I kept climbing through pain, because I'm really starting to love climbing. Is there any recommendation to expedite my recovery process?


bcrigby


Mar 11, 2013, 2:23 PM
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It depends on whether you're talking all around 'general' pain, or pain in a specific part of each one or more fingers (such as a specific joint). No one can diagnose you over a forum, but it sounds likely you're suffering from general inflammation. My bias is diet, so that's the advice I can give you for recovery and prevention of inflammation.

Short-term advice: Up your vegetable and spice intake. Get some fresh ginger, and if possible turmeric, and blend an inch or so of them up with some water. Drink with a fat-containing meal, or with an oil-based supplement (fish oil, for example). Do this daily until the pain resolves, and afterwards if you'd like as a preventative measure.

Long-term advice: Increase intake of EPA/DHA--1.5 to 3 grams combined (NOT 1.5 grams 'fish oil', which may be only 500 mg EPA/DHA) per day is a good amount, though your individual biochemistry will determine your true need. You can get an AA/EPA ratio test done, if you're interested, though it's probably not worth the expense. If you're on any blood-thinning medication, do consult your doctor before taking EPA/DHA in large amounts as they inhibit platelet aggregation.

You are what you eat. Certain amounts of inflammation are inevitable in rock climbing (or any form of exercise), but you can minimize inflammation's effects and speed its recovery with the right tools.


JenningsN


Mar 13, 2013, 8:19 AM
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bcrigby wrote:
It depends on whether you're talking all around 'general' pain, or pain in a specific part of each one or more fingers (such as a specific joint).

I have pain in the middle finger and ring finger of both hands. The main pain is in the second joint of those fingers when I bend the knuckle to about 90 degrees and put pressure. Another thing is when I take my pointer finger and thumb to squeeze the area between my third pad and fourth pad I feel pain on the front of my fingers, in that spot. That pain doesn't happen on my pointer and pinky finger.

bcrigby wrote:
Get some fresh ginger, and if possible turmeric, and blend an inch or so of them up with some water.

What is an inch of ginger and turmeric?

bcrigby wrote:
Increase intake of EPA/DHA--1.5 to 3 grams combined. You can get an AA/EPA ratio test done.

What is EPA/DHA, and a AA/EPA ratio test?


I also heard to ice on 10 minutes and 10 minutes warm water. This has helped substantially to reduce the pressure my pads feel when closing my fist. Also has increased the flexibility in my fingers for typing. Before the icing I had decreased sensitivity in my fingers, and that makes me agree with your idea of inflammation


bcrigby


Mar 13, 2013, 9:44 AM
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Sorry for the shorthand, I'll do my best to explain while being concise!

An inch of turmeric or ginger would be to take the fresh root and chop off about an inch in length to use. It's not the most exact method, because the rhizomes could be really thick or thin, but it's probably easier than weighing out a certain amount and ultimately it will probably be pretty close to the same amount each time.

EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are biologically active omega-3 fatty acids, which are a specific type of polyunsaturated fat. AA (arachidonic acid) is our biologically active omega-6 fat. Both of these fats, after we eat them, get incorporated into our cell membranes where they aid our body in responding to illness and injury. AA produces highly-inflammatory cytokines (chemical messengers, like short-range hormones). EPA and DHA also produce cytokines, but they are much less inflammatory and they also produce other ANTI-inflammatory compounds called protectins and resolvins, which protect from and resolve inflammation (as their names imply)!

The diet we consume, and specifically in this case the omega-3 fats and omega-6 fats we consume, determine how much AA gets incorporated into our cell membranes and how much EPA/DHA. The standard American diet (aka 'SAD') is very high in omega-6s and very low in omega-3s, so the ratio of AA:EPA becomes inflated, and our cells literally create significantly more inflammation than they do when AA and EPA are more balanced.

You can test to find out what your ratio is with an AA/EPA ratio test. As I mentioned though, it's probably not worth the cost unless you also have some other serious health condition which is mediated through inflammation, like heart disease, cancer, or an autoimmune condition. By consuming plenty of omega-3s, especially in EPA and DHA form, and minimizing consumption of omega-6 fats (like corn oil and basically every other oil used in processed food), you can be 99% certain that your ratio will be in the happy zone and that future inflammation will be well-regulated.

When I say 1.5 to 3.0 grams EPA/DHA combined, NOT fish oil, here is what I mean: When you look at fish oil supplements, particularly cheap ones, they might advertise "1,000 mg of fish oil per capsule!" but then when you look at how much of that fish oil is EPA and DHA, you discover that you're only getting 250 mg per capsule (let's say 150 mg EPA and 100 mg DHA). The rest is "filler fat"--completely non-important to our needs, and definitely not what you would take a fish oil supplement for.

There are lots of great fish oil supplements out there, but a lot of them are quite expensive. Here's an example of a less expensive, but still high-quality one:

http://tritonnutrition.com/catalog/omega-prime-fish-oil-950-mg.html

You'll see that it has 1.35 grams total fat, 1 gram total polyunsaturated fat, and 950 mg combined EPA/DHA per capsule. 2-3 a day would be sufficient at this potency. If you get a supplement with less potency, you just need to take more of it. Not a big deal, but it gets annoying to take 9 pills a day just for fish oil!

You can, of course, also get it from diet, but thanks to our lovely pollution you now get a sizeable amount of mercury from fish and it must be limited in consumption. Sardines are one exception--1/10th the measured level of mercury as tuna, and still high in omega-3s. You can also get it from plants, but it's much less potent as our body only converts 10-15% of the plant-based omega-3s into biologically active ones. Chia and flax seed are good sources for this sort of omega-3, and are pretty rockin' foods anyway. I consume them and fish oil on a daily basis.

Well, I failed my conciseness test, but hopefully it's a little clearer!


jt512


Mar 16, 2013, 10:07 AM
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bcrigby wrote:
It depends on whether you're talking all around 'general' pain, or pain in a specific part of each one or more fingers (such as a specific joint). No one can diagnose you over a forum, but it sounds likely you're suffering from general inflammation. My bias is diet, so that's the advice I can give you for recovery and prevention of inflammation.

Short-term advice: Up your vegetable and spice intake. Get some fresh ginger, and if possible turmeric, and blend an inch or so of them up with some water. Drink with a fat-containing meal, or with an oil-based supplement (fish oil, for example). Do this daily until the pain resolves, and afterwards if you'd like as a preventative measure.

Long-term advice: Increase intake of EPA/DHA--1.5 to 3 grams combined (NOT 1.5 grams 'fish oil', which may be only 500 mg EPA/DHA) per day is a good amount, though your individual biochemistry will determine your true need. You can get an AA/EPA ratio test done, if you're interested, though it's probably not worth the expense. If you're on any blood-thinning medication, do consult your doctor before taking EPA/DHA in large amounts as they inhibit platelet aggregation.

You are what you eat. Certain amounts of inflammation are inevitable in rock climbing (or any form of exercise), but you can minimize inflammation's effects and speed its recovery with the right tools.

That is just about the worst advice ever: keep climbing and take some unproved supplements. You should have quit after "No one can diagnose you over a forum."

Tendon pain is a warning sign of impending injury. You need to take some time off climbing and let your tendons heal. A few weeks of rest now, before an acute injury occurs, is preferable to months of time away from climbing afterward.

Go ahead and take the unproved supplements. They're unlikely to cause harm, and might even help a little, but you need to rest your fingers.

Jay


bcrigby


Mar 16, 2013, 11:02 AM
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I never recommended he keep climbing, and I specifically mentioned I can only address the nutritional side of things.

Ginger and turmeric are far from "unproven". Quite the contrary in fact, a quick search of PubMed will bring up hundreds of articles in relation to the ways they affect our biochemistry, including the down-regulation of inflammatory cytokines and transcription factors, the resolution of wounds and cutaneous injury, and the protection of connective tissues.

Here's a highly-relevant article on the effects of curcumin (one of the active compounds in turmeric) on human tenocytes (tendon cells):

http://www.jbc.org/...nt/286/32/28556.long



Here are some of the findings:

1. Curcumin suppresses the pathways which cause tenocyte degradation, pathways which "affect normal tissue remodeling and lead to the development of tendinopathy."

2. Curcumin reduces local inflammation of tenocytes, reducing COX-2 expression. Reduced COX-2 expression reduces pain.

3. Curcumin stimulates tenocytes and enhances transcription of tendon-associated collagens.

4. Curcumin exerts no toxic effects, and no dose-limiting toxicity.

Final statement in the study: "[C]urcumin might have prophylactic potential for the treatment of tendinitis."



This is not voodoo, it's science, and there are very specific reasons I made the recommendations I did. I am well-versed in the biochemistry of inflammation, including acute and systemic, and from a research-based standpoint I can attest that ginger, turmeric, and EPA/DHA will all produce measurable change in levels of inflammation, improve resolution time, and be protective against future injury, including for the tendons.


jt512


Mar 16, 2013, 11:29 AM
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bcrigby wrote:
I never recommended he keep climbing, and I specifically mentioned I can only address the nutritional side of things.

Sorry, but any response not including the word "rest" is a bad response.

In reply to:
Ginger and turmeric are far from "unproven". Quite the contrary in fact, a quick search of PubMed will bring up hundreds of articles in relation to the ways they affect our biochemistry, including the down-regulation of inflammatory cytokines and transcription factors, the resolution of wounds and cutaneous injury, and the protection of connective tissues.

Here's a highly-relevant article on the effects of curcumin (one of the active compounds in turmeric) on human tenocytes (tendon cells):

http://www.jbc.org/...nt/286/32/28556.long



Here are some of the findings:

1. Curcumin suppresses the pathways which cause tenocyte degradation, pathways which "affect normal tissue remodeling and lead to the development of tendinopathy."

2. Curcumin reduces local inflammation of tenocytes, reducing COX-2 expression. Reduced COX-2 expression reduces pain.

3. Curcumin stimulates tenocytes and enhances transcription of tendon-associated collagens.

4. Curcumin exerts no toxic effects, and no dose-limiting toxicity.

Final statement in the study: "[C]urcumin might have prophylactic potential for the treatment of tendinitis."



This is not voodoo, it's science, and there are very specific reasons I made the recommendations I did. I am well-versed in the biochemistry of inflammation, including acute and systemic, and from a research-based standpoint I can attest that ginger, turmeric, and EPA/DHA will all produce measurable change in levels of inflammation, improve resolution time, and be protective against future injury, including for the tendons.

Just about every supplement that ever became popular was supported by a body of pre-clinical research that suggested that the supplement ought to have some benefit—that's why they became popular in the first place. But just about every one that ever reached the clinical trial stage was found to have no benefit or to be harmful. Until a supplement has shown consistent benefit to hard endpoints in randomized controlled trials in humans, published in high-quality peer-review journals, the supplement is unproven.

Jay


bcrigby


Mar 16, 2013, 12:47 PM
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jt512 wrote:
Just about every supplement that ever became popular was supported by a body of pre-clinical research that suggested that the supplement ought to have some benefit—that's why they became popular in the first place. But just about every one that ever reached the clinical trial stage was found to have no benefit or to be harmful. Until a supplement has shown consistent benefit to hard endpoints in randomized controlled trials in humans, published in high-quality peer-review journals, the supplement is unproven.

This is a blanket statement with little truth. Your assumption that in vitro tests on human cells offer no worth would be a revelation to the bioscience research community, who use this method because it allows them to much more easily control for variables and determine the exact mechanisms of action. It is exceedingly hard to perform biochemical research in vivo in humans, not least of which is because many studies require sacrifice of the test subject in order to determine effects. For obvious reasons, this is not an option for humans, and this limits the researchers' options.

What I am curious about is why you choose to disregard a huge host of research in favor of the argument "[it] is unproven". With these words, you don't actively engage in debate, you step away from it assuming that nothing can supersede this premise. You don't actively search PubMed to find papers to support your argument, you simply presume they do not exist, and with that presumption you order the execution.

You can choose to be paralyzed by the fear that extensive in vitro human cell research and in vivo animal research will lead to no results in humans, or you can choose to believe that this research is pertinent to humans. I do not doubt that when a double-blind placebo-controlled trial is performed in a large human sample, the results will be attenuated compared to rodent models and human cell cultures, yet I also do not doubt that the phytochemical constituents of plants play important roles in human physiological processes, and to ignore their important role in human health is dangerous.

I am more than happy to debate the relationship of nutrition and health, but everybody will benefit more if you provide something more substantial than "it isn't proven". By your standard, even rest has not been 'proven' as a method to repair tissue damage as most of what we know about the healing processes of the body have come from in vitro human cell studies and in vivo rodent studies. Anecdotally, we know that human tissue does repair itself over time, presumably by the same mechanisms as elucidated from research. Anecdotally, we also know that the phytochemicals in ginger and turmeric, and the preformed long-chain omega-3 fatty acids EPA and DHA, lead to reductions in levels of systemic inflammation, also presumably along the same biochemical pathways elucidated from research.

In the whole complexity of human biochemistry, it is certain that there will be other pathways which attenuate the results observed from research, factors which improve or worsen healing. Yet we are also certain that the pathways observed from research are not irrelevant, and that modulating them will produce physiological change.


jt512


Mar 16, 2013, 3:29 PM
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bcrigby wrote:
jt512 wrote:
Just about every supplement that ever became popular was supported by a body of pre-clinical research that suggested that the supplement ought to have some benefit—that's why they became popular in the first place. But just about every one that ever reached the clinical trial stage was found to have no benefit or to be harmful. Until a supplement has shown consistent benefit to hard endpoints in randomized controlled trials in humans, published in high-quality peer-review journals, the supplement is unproven.

This is a blanket statement with little truth. Your assumption that in vitro tests on human cells offer no worth would be a revelation to the bioscience research community, who use this method because it allows them to much more easily control for variables and determine the exact mechanisms of action. It is exceedingly hard to perform biochemical research in vivo in humans, not least of which is because many studies require sacrifice of the test subject in order to determine effects. For obvious reasons, this is not an option for humans, and this limits the researchers' options.

What I am curious about is why you choose to disregard a huge host of research in favor of the argument "[it] is unproven". With these words, you don't actively engage in debate, you step away from it assuming that nothing can supersede this premise. You don't actively search PubMed to find papers to support your argument, you simply presume they do not exist, and with that presumption you order the execution.

You can choose to be paralyzed by the fear that extensive in vitro human cell research and in vivo animal research will lead to no results in humans, or you can choose to believe that this research is pertinent to humans. I do not doubt that when a double-blind placebo-controlled trial is performed in a large human sample, the results will be attenuated compared to rodent models and human cell cultures, yet I also do not doubt that the phytochemical constituents of plants play important roles in human physiological processes, and to ignore their important role in human health is dangerous.

I am more than happy to debate the relationship of nutrition and health, but everybody will benefit more if you provide something more substantial than "it isn't proven". By your standard, even rest has not been 'proven' as a method to repair tissue damage as most of what we know about the healing processes of the body have come from in vitro human cell studies and in vivo rodent studies. Anecdotally, we know that human tissue does repair itself over time, presumably by the same mechanisms as elucidated from research. Anecdotally, we also know that the phytochemicals in ginger and turmeric, and the preformed long-chain omega-3 fatty acids EPA and DHA, lead to reductions in levels of systemic inflammation, also presumably along the same biochemical pathways elucidated from research.

In the whole complexity of human biochemistry, it is certain that there will be other pathways which attenuate the results observed from research, factors which improve or worsen healing. Yet we are also certain that the pathways observed from research are not irrelevant, and that modulating them will produce physiological change.

Textbook example of a Gish gallop.

Jay


bcrigby


Mar 16, 2013, 3:40 PM
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jt512 wrote:
Textbook example of a Gish gallop.

Jay

I'll take your Gish Gallop and raise you a One Single Proof


jt512


Mar 16, 2013, 6:20 PM
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Here are the results of two recent review articles of clinical trials for dietary supplements. Each supplement studied was backed by a large body of pre-clinical research suggesting that the supplements should be beneficial.

In the first, study, a meta-analysis, Marik and Flemmer (2012) analyzed the results of 63 randomized placebo-controlled trials of 15 dietary supplements, including vitamin A, C, D, E, B6, and B12; folate; beta-carotene; selenium; zinc; calcuim; omega-3 fatty acids; gnikgo biloba; saw palmetto; and milk thistle. Their conclusion: "With the possible exceptions of Vitamin D and omega-3 fatty acids there is no data to support the widespread use of dietary supplements in Westernized populations; indeed, many of these supplements may be harmful." So of the 15 supplements included in the analysis, there was no clear-cut benefit for any of them, two showed promise, and several showed some evidence of harm. The good news for you is that omega-3 fatty acids was of the two that showed promise.

In the second study, Rosenbaum et al (2010) conducted a systematic review of clinical studies of dietary supplements for osteoarthritis (OA) or rheumatoid arthritis (RA). Their conclusions: "Three studies support cat's claw alone or in combination for OA, and two studies support omega-3 fatty acids for the treatment of RA. We cannot recommend use of vitamin E alone; vitamins A, C, and E in combination; ginger; turmeric; or Zyflamend (New Chapter, Brattleboro, Vermont) for the treatment of OA or RA or omega-3 fatty acids for OA. Whether any of these supplements can be effectively and safely recommended to reduce nonsteroidal antiinflammatory drug or steroid usage is unclear and requires more high-quality research." The news for you is mixed: omega-3's appear to be supported, but neither tumeric nor ginger are.

Every supplement in these analyses was supported by a large body of pre-clinical research that suggested that the supplements should be beneficial, indeed, that is why they were tested in clinical trials. Yet, the vast majority of clinical trials fail to support the benefits that the pre-clinical research appeared to promise, and some even showed evidence of harm. That was exactly my claim: when tested in clinical trials, nutritional supplements rarely deliver the benefits that pre-clinical research appeared to promise.

Jay

Refs:

Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K (2010). Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis. Altern Ther Health Med. 2010 Mar-Apr;16(2):32-40.

Marik PE, Flemmer (2012). Do dietary supplements have beneficial health effects in industrialized nations: what is the evidence? MJPEN J Parenter Enteral Nutr. 2012 Mar;36(2):159-68.


bcrigby


Mar 16, 2013, 7:42 PM
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Thanks for sharing the references; I've only read the second one so far as it is more pertinent to turmeric and ginger. For the record, I'll be the first to agree with you that the majority of supplements are not warranted, and can be harmful when used outside of their intended (and sometimes in their intended) manner. However, there are a handful of supplements which do have robust research in favor of their efficacy and lack of toxicity. Turmeric and ginger are two of them.

In the second review you cited, by Rosenbaum et al., it should be noted that lack of recommendation should not be interpreted as recommendation against. When reading the review to see why a recommendation was not placed, it was because of lack of clinical trials in both OA and RA patients.

There was a single trial reviewed for turmeric in RA, which compared 1,200 mg curcumin against 300 mg phenylbutazone. Both groups experienced significant improvements in stiffness, walking time, and swelling; it was noted that phenylbutazone generally improved symptoms to a greater extent.

For ginger, there were no trials for RA, only for pain in OA. Of the four studies analyzed, three had significant limitations including very small sample sizes. The least limited study demonstrated that both ibuprofen and ginger had equal effects on pain reduction in OA. Of the three remaining studies, one was positive, one negative, and one mixed.

I wholeheartedly support well-designed double-blinded, placebo-controlled clinical studies to measure the efficacy of phytochemicals and other therapeutic agents in the resolution and prevention of disease, but in the meantime I also firmly believe we can use well-designed preclinical research to guide our decisions. In the case of ginger and turmeric, despite relatively few clinical trials, there is a wealth of research which all comes to basically the same conclusion: they are hypoalgesic and anti-inflammatory.

At any rate, none of this is either good or bad news for me, but it is good news for people in pain who don't want to risk GI bleeding or liver damage, two notable side effects of NSAIDs.

References:

Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K. Antioxidants and Antiinflammatory Dietary Supplements for Osteoarthritis and Rheumatoid Arthritis. Altern Ther Health Med. March to April 2010;16:32-40.

Haghighi M, Khalvat A, Toliat T, Jallaei S. Comparing the Effects of Ginger (Zingiber officinale) Extract and Ibuprofen on Patients with Osteoarthritis. Arch Iranian Med. 2005;8:267-71.


notapplicable


Mar 16, 2013, 8:46 PM
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I hear it works wonders




agnivsen


May 1, 2013, 11:32 AM
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So much for a god-damn tendon!

IMHO.... if you're tendons are hurting real bad, take 3/4 weeks off climbing... if pain persists, go see an orthopedic surgeon.

Nothing else can be done/said over a forum.


onceahardman


May 1, 2013, 2:59 PM
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Surgeons tend to see the world as people who need to be cut open.

Medical doctors tend to see the world as people who need to take medicine.

PTs tend to see the world as people who need to exercise better.

Nutritionists tend to see the world as people who need to eat better.

Chiropractors tens to see the world as people who need their backs "adjusted".

Acupuncturists tend to see the world as people who need to get their chi flowing.

Everybody gets some people better. Nobody gets everybody better.

Make your own judgement on people who try to sell you herbal products. If they really worked on most people, insurance companies would gladly pay for them. They are WAY cheaper than surgery and hospitalization.


lofstromc


May 1, 2013, 4:57 PM
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2 to 4 days a week, huh?
Does that means some weeks you rest between days and some weeks you climb multiple days in a row?
Your obviously stressing some part of your body and need to rest it!
Take at least three weeks off (IMO) and focus on core strength and flexibility. I mean, go crazy doing those exercises. When you get back on the plastic (im assuming) you'll be better off.
I'd also look into the proper way to crimp on a hold.
I used to get hurt on crimps all the time and then realized I was doing it wrong.
If you want, Ill try to explain...


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