A good assessment should include the following at a minimum: A thorough subjective history which typically identifies the mechanism of injury, past medical history, and climbing goals among other things, Strength measurement using a device such as a crane scale in different grip positions (e.g., crimp vs. open grip), differentiating which is more painful, and identifying the primary site of pain or discomfort. The effectiveness of your rehab should be tailored specifically to your needs. Gentle range-of-motion exercises. This will allow you to get a good workout to scratch that climbing itch while minimizing your risk of injury. Flexor tendon pulleys (we will focus on the Annular pulleys), named A1 through A5, act as a ligamentous strap to keep the tendon in close contact with the phalanges.The best analogy for this is a fishing rod. Avoid pushing through pain. If you think you’ve experienced one of these unfortunate injuries, there are some important principles for you to consider that will ensure you get the most out of your tendon rehabilitation: *Note: This article is designed for informational purposes, and is not designed to replace an individualized rehab protocol. To obtain clarification regarding any unfamiliar terms, feel free to directly email the author at jsmith@grsm.ca. (In this latter case, consult an orthopedic surgeon, as it can indicate a serious, grade 4 tear; see “Treatment.”). For A2 pulley injuries, the most common pulley injury for climbers, the pain usually arises at the base of the finger and is noticeable when trying to straighten or bend the finger. Static stretching is best reserved for rest days and post-climbing, as some studies have shown that static stretching prior to an activity can decrease performance. A loud “pop” and then significant swelling and pain often indicate damage to the flexor-tendon pulleys. Rotate the palms forward toward the floor until you feel a good stretch. No muscle-tendon system is stressed more than the finger flexor group of our hands and forearms. Rotator Cuff Tears. Now perform the same exercise, only straighten the finger. With your other hand, bend your fingers down toward the ground until you feel a stretch. Functional exercises will begin at the full 4 week mark, and EASY climbing will commence after a 6-8 week period from injury onset. Once your finger has a full, pain-free range of motion (often one to two weeks after starting the rehab exercises), you can begin gentle re-strengthening. Then, tear from each end to leave a ½” bridge connecting the two ends. Injuries present with pain and swelling over the affected pulley, and patients may feel or hear a pop at the time of injury. Tennis elbow is the layperson term for lateral epicondylitis which means inflammation Gentle range-of-motion exercises. Rest! Almost half of all climbing injuries concern fingers with most frequent injuries of flexor tendon pulleys. Surgery is often necessary to repair complete tendon tears. Wrist and finger flexor stretch: Straighten one elbow, and reach that arm forward with your palm up. The load should be progressively applied, and progressively let go over the course of 5 seconds, with the goal of achieving close to, A typical load integration strategy I use with my clients is a, Use the following guidelines during load integration, Perform one arm at a time, twice weekly with your feet on the ground unless advised otherwise. The flexor tendons that run underneath the pulleys can also tear or stretch when climbing. Surgical repair is recommended due to the increased risk of fixed flexion contractures, an inability to fully straighten the finger. While hangboarding, use your feet and avoid crimping—or any movements that cause pain—for at least six weeks post-injury. Jay graduated from McMaster University in 2011 with a Masters of Physiotherapy. Copyright © 2020 | GRSM Serving Cambridge, Kitchener, Waterloo, Jason Smith, MSc(PT), CSEP-CPT, CIDN, FCAMPT, What Everyone Needs to Know About Tennis Elbow, Prevention and Management of Low Back Pain, Originating from the inner aspect of the elbow, branches into 4 separate tendons that attach on the 2, Lies deeper to the superficialis, with the same origin running all the way to the end of our finger tips, Studies have shown stress through the tendon pulley system and FDP is greater than the FDS during crimp gripping, and hence it is. As a rule, avoid dynamic movements, especially to crimps, and focus on slow, precise footwork and core engagement. An example of a recovery hangboard protocol is as follows: 5s hold, 10s rest. Eventually, assuming you’ve sustained some damage to a tendon or pulley, your injury will progress from scar tissue formation to a remodelling phase. This is further associated with a 13% crimp strength increase while taped compared to no tape. The finger flexor group is composed of many tissues. There is support from studies for use of H-taping with tendon pulley injuries, showing decreased tendon bone distance up to 16%, which partially restores the mechanical advantage of the pulley system. H-taping (see below) for three months while climbing. For A2–A4 ruptures, there may be bowstringing—bulging at the base of the finger—which can be detected by resisting finger bending at the fingertip. For outdoor climbers, that means the approach. Our tendon pulley system is a series of short bands that keep our long finger flexor tendons close to our bone. Biomechanical properties of the crimp grip position in rock climbers. This is when your therapist will advise that you begin to load the injured tissue. This anatomical design increases strength of these tendons, and prevents “bowstringing” of the tendon away from the finger during gripping. Flexor tendons in the fingers attach to muscles in the forearms that pull on the tendons, bend the fingers, and allow us to crimp. Either the A4 pulley is completely torn, or A2 and A3 are both partially torn. Approximately 50-80% of the adult population will experience it at some point in their life. However, prolonged mouse and keyboard use is also a common activity amongst people that develop this irritation. Complete A4 or partial A2, A3 tear/rupture 3. Place the middle section along the palmer side of the joint in the middle of the finger. Complete A2 or A3 tear/rupture 4. Three bones and three hinged joints make up the finger. The Flexor digitorum profundus tendons. Typically, this injury stems from either warming up poorly or a desperate, dynamic move to a tiny crimp, often with poor footwork and body positioning.

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