Friday, November 29, 2013

Recovering from climbing finger injuries

I seem to always be recovering from a finger injury, and I'm not entirely sure what to attribute the frequency of my injuries to. I'm sure the age at which I started climbing has something to do with it. Starting when I was 28 has made it difficult for my connective tissue to cope with the gains I've made in strength over the last 8 years, though at this point I generally feel that I'm able to really try hard without my tendons popping. Surely being injured so much is also due to me pushing myself too hard too often, and not recognizing when I'm in an overtrained state. See my article on overtraining for more on that.

There is one thing I know for sure. Bouldering is very hard on the body, and on the connective tissue of fingers specifically, and injuries are very much a reality for many climbers. Obviously its very frustrating to be injured, but finger injuries don't have to mean taking months off. A combination of active recovery and contrast bath therapy can help fingers recover in weeks.

Please note that its always a good idea to consult with a physician to judge the extent and severity of any injury. Though rare, some injuries can be quite severe and require surgery for a full recovery. The recovery regimen outlined here is intended to treat partial ruptures of the finger pulleys, which is one of the most common climbing injuries of the fingers and hand. For a full treatment on common climbing injuries, I recommend the book One Move Too Many.



Passive Recovery Period

Though its not necessary to take full rest for months, it is important to give acute injuries between 2 and 6 weeks of rest in order to let the injured area mend, depending on the severity of the rupture. Mild injuries may only require 2 weeks of couch time, while more severe injuries might need up to 6 weeks or more to mend.

The challenge here is knowing when to start your active recovery. Its very difficult to judge when this is, but with some guidelines and experience (the more injuries you recover from the more experienced you will be), knowing when to get moving doesn't have to be total guesswork.

Judging the Recovery

The injured area will be sensitive to the touch throughout the recovery. Pain tolerance is different for everybody, but I like to measure the pain on a 1-10 scale, and I have a few different ways to read it.

  1. Putting the finger in the crimp position and lightly activating the finger.
  2. Applying pressure to and probing the injured area.
  3. Tapping and rapping the injured area with your knuckles.
Often the injury will not be painful when lightly activating the finger (resist the temptation to grip hard!). I'd say if you feel pain from 3-10 on a 10 point scale, its probably too early to start active recovery.

I usually don't feel pain just when probing the injured area. If you feel pain from 2-10 on a 10 point scale, its probably too early to start active recovery.

Rapping or tapping the injured area with the knuckles of the opposite hand I've found to be the most effective way to judge the pain level and the progress of the recovery. If you feel pain up to 4 on the 10 point scale, you are probably OK with starting active recovery.


Active Recovery

One of the great misconceptions with recovering from climbing injuries is that you can't start climbing until all the pain is gone from the injury. This couldn't be further from the truth, in fact the injury probably won't be fully without pain until it has been climbed on for a month or more.

Though its important to start climbing again, respect the injury and take it slow at first! Since the crimp position is typically what causes these injuries, its important to avoid using the crimp position for the first couple of weeks of active recovery. Climb on slopers or jugs, and use the open hand position. At all costs avoid dynamic moves! Dynamic movement is the greatest risk for re-aggravating the injury.

High volume and low intensity is optimal for recovery. In other words, climb routes well below your onsight level. Bouldering is not a good idea! I recommend starting with routes two number grades below your onsight level. A climber onsighting 12c should start recovery by climbing routes in the 10c range.

Over the course of 4 weeks, progress to climbing near your onsight level. Here's an example regimen for a climber who onsights at the 12c level:

  • week one: two climbing workouts, each of 4 routes in the 10c-11a range
  • week two: two climbing workouts, each of 4 routes in the 10d-11b range
  • week three: up to three climbing workouts, each of 4-5 routes in the 11a-11d range
  • week four: climbing routes up to 12b, bouldering up to V5 (low volume bouldering)
  • week five: climbing routes up to 12d, bouldering up to V6 (low volume bouldering)
The injured area is expected to be a little more sore at the end of workouts and the following day. Two days after workouts, it should feel better than it did before the workout. Pay attention to the level of pain in the injured area before, after, and two days after workouts to help judge if you pushed too hard or not hard enough.

When the injured area feels better the morning after workouts, you know that you are on the way to a speedy and full recovery.



Taping

Some folks swear by taping, in the past I've been a strong proponent but these days not so much. If you must climb when injured, then I think taping is a good idea. There are two methods that are especially effective for supporting pulley injuries, the H-tape method, and the figure 8 method. Personally I like the H-tape method, and the level of support can be adjusted by how many layers of tape are used (each layer being another H), and by how tightly the tape is applied.

My final thought on taping is that if you think you need to tape, you probably shouldn't be climbing or shouldn't be climbing so hard.

Contrast Bath Therapy

The one thing that I absolutely swear by is contrast bath therapy. Rather than just icing, contrast bath therapy takes advantage of the body's natural reactions to hot and cold temperatures to dramatically improve local circulation and help recovery. Exposure to cold constricts the blood vessels, while exposure to heat dilates the blood vessels. Going back and forth pumps stagnant fluid out of the area, and conversely pumps in fresh fluid.

First, you'll need two bowls, one with ice water, one with hot water. The ice water should have enough ice such that it doesn't all melt by the time you are done. The bowl for the hot water needs to be something you can put over a burner. Put the hot water over a burner on your stove (do not turn on the burner unless your hand is in it!). Put the cold water somewhere nearby. When you are bathing your hand in the hot water, turn the burner on and off such that the water temperature stays about as hot as you can comfortably take.

Here's the regimen:
  1. cold water 1 minute
  2. hot water 4 minutes
  3. cold water 1 minute
  4. hot water 4 minutes
  5. cold water 1 minute
  6. hot water 4 minutes
  7. cold water 1 minute
Do this 2-3 times per day through passive and active recovery, and especially immediately following workouts!

Supplementation for Repairing Connective Tissue

Supplementation is a big subject on its own, so I'll briefly give my daily regimen for repairing connective tissue:

Well I hope this helps. The recovery process starts slow but accelerates as the injury heals. And remember, hardly any send is worth re-aggravating the injury.

Happy healing.