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Post by Lundy on Nov 20, 2016 19:15:17 GMT -7
I've mentioned in a post before that I barely every get outside -- in fact, my trip to Hueco Tanks now was my first time out since a trip to the Red last fall. Needless to say, the year of training and four months of dieting had me super stoked... Right up until I ruptured an A2, I believe, about half way through my first day out. Awesome.
So now I'm back home, totally bummed, hoping I don't have to wait another year to get out, and starting to plan how to rehab this thing.
My question for everyone is, how do you know when you need to go to a doc and get it checked out vs. just do some rest and start rehabbing? I ask because this is only my second finger injury in about 23 years of climbing, but also because the pop was soooo loud that the crowd at the boulder were sortof all shocked and sickened - they couldn't believe it was my finger. It sounded like a gun, honestly... So I'm worried that it might be a full rupture rather than a partial tear, and that the treatment for that might be different (surgery??), but I have no idea how to self-diagnose, and haven't really found anything online that's too useful.
Would love to hear folks' thoughts.
Thanks, all. Now I'm gonna go get fat eating ice cream... That's good for my finger, right?
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Post by willblack on Nov 20, 2016 20:46:13 GMT -7
If it was me I'd take two or three weeks off and see if that is enough for the pain and swelling to diminish, then see how it does with some hangboarding (with lots of weight removed). I've had finger injuries with pretty loud pops that rehabbed just fine, and sometimes really bad finger injuries don't make a sound. Another thing you could try is to look for bowstringing by curling your finger halfway and flexing and then pressing in where the hurt pulley is to see if you can feel the tendon bowstringing. Comparing to the other side is helpful as well, however bowstringing isn't necessarily a great measure either. I have some very noticeable bowstringing left over from an A3 injury I had about a year ago but there are no functional deficits in that finger at this point. If it's been a couple days since you hurt your finger it might make sense to see what kind of ROM you have right now, if you can move your finger at this point I would be really surprised if you needed to have surgery. That being said, I'm just some dude on the internet so you probably shouldn't listen to anything I have to say. On a related note, I hurt my A2 a month and a half ago, and I find that while ice cream is somewhat effective treatment for finger injuries, it's best used as an adjunctive treatment to bourbon and self-hate.
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Post by daustin on Nov 20, 2016 22:31:39 GMT -7
I've only had one pulley injury (A4 in my pinky, about 10 months ago), but it was also accompanied with a very loud pop, and I had a lot of the same questions as you.
I had only minor swelling, which resolved within no more than a week. After 2-3 weeks' rest, I started a rehab HB routine, with extremely low weight. My work schedule was a bit hectic, so my rehab was a bit erratic, but basically I did a lot of low intensity HB and ARCing over a few months, and within ~6 months I felt more or less healed. I also used a cheapo acupressure finger massager and did a lot of self-massage on the finger to promote circulation.
I don't have great advice, but I'd at least give yourself a week or so to see how the swelling progresses and how it feels (if it hasn't been a week already?). My gut instinct is that your pulley injury won't be different in kind from the many pulley injuries that us prodigies deal with on a somewhat regular basis, and that light HBing and ARCing will get you back in shape before you know it, but YMMV.
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Post by MarkAnderson on Nov 21, 2016 10:49:29 GMT -7
Ah man, that is such a bummer. Every time I see a new thread in this forum I get a sinking feeling in my gut. I've never had a full rupture (to my knowledge), so I can't really say, but it sounds like you have some really good data points above. I would think visible bowstringing would be the smoking gun. I would also check out One Move Too Many (if you don't have a copy, let me know and I'll look it up tonight). I think even with a complete rupture surgery may not be necessary, or even advisable, but I think the best course of action for now is to let the swelling subside and gather more information about the injury and treatment options.
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Post by Lundy on Nov 22, 2016 7:42:22 GMT -7
Thanks, all.. One more quick question. When you've injured an A2, where is the pain localized? I assumed it would be in the area between the first and second knuckle, as that's obviously where the pulley is, but for me the most intense pain is actually right at the first knuckle where the finger meets the palm. Is that consistent with what you've all experienced?
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Post by MarkAnderson on Nov 22, 2016 8:47:18 GMT -7
Yes. The skin can distort our perception of the anatomy below the surface, making all the anatomical drawings you've seen seem slightly off. If you look at the palm-side of your hand, you really only see about half (the distal half) of the proximal phalanx (the other half is hidden in the palm). If you look at the back of your hand, and think about where the pain is from that perspective, it will appear to be more in the "right" location.
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Post by Lundy on Nov 22, 2016 8:54:41 GMT -7
Yes. The skin can distort our perception of the anatomy below the surface, making all the anatomical drawings you've seen seem slightly off. If you look at the palm-side of your hand, you really only see about half (the distal half) of the proximal phalanx (the other half is hidden in the palm). If you look at the back of your hand, and think about where the pain is from that perspective, it will appear to be more in the "right" location. Nailed it. Thanks. That makes great sense.
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Post by Lundy on Dec 3, 2016 21:05:22 GMT -7
So... After going back through Dave MacLeod's book, I decided to go see someone and get an MRI, which is currently scheduled for Wednesday. I'm still hoping it's not a complete rupture and I can just get on with it, but I want to be sure, as it still hurts quite a bit in some weird ways, which is the topic of this post... So a few question for people: 1. For the first few days after the injury, it was sore at the site, but nowhere else. As a matter of just general rehab, I was spending a lot of time every day just trying to open and close a fist to keep the thing moving. A few nights ago, though, I started experiencing a lot of pain on the back of the finger (on the extensor side), as well as tightness pulling in my palm. It would occassionally get to the point where it was so tight in the palm that I couldn't extend my finger all the way. Has anyone ever experienced this before? So in addition, today it was feeling that way and I was very gently trying to open and close my hand and something sort of "clicked" in my palm, the issue resolved immediately, and I've had no pain since. What the f? My guess is that somehow my flexor tendon was hanging up on something in my palm and not running smoothly through the sheath, and that was making it hard to open my finger and causing the pain on the extensor side? I have really no idea, but just curious if anyone's ever experienced anything like this before? Very weird/awful feeling (though not necessarily super painful) in the palm. 2. Now, assuming my MRI Wednesday comes back nice and pretty with just a partial tear in the A2, when folks have started rehab using a hangboard, how quickly after the injury have you started hangboard rehab, and how did you determine your starting weight? I'm frankly feeling terrified about the idea of it, so want to be super cautious. 3. What HB protocol are you using for rehab? Still three sets at 7/6/5? Just one set? Is there some systematic way that folks are transitioning from one to the next? 4. Once you start to feel better, how do you make the transition back into a normal HB cycle? Or do you just keep adding weight each week from your rehab and eventually get back to where you were? That seems like an awfully long HB cycle, as I'm thinking about starting like really, really a long way away from my max... Thanks, everyone. I really appreciate the insights into how to come back from this... E
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Post by MarkAnderson on Dec 4, 2016 10:13:10 GMT -7
1. Ya, that's weird. I think you're probably right, but I really have no idea. When you have a traumatic injury you will get a lot of inflammation in the surrounding area, not just in the injured tissue, so maybe some of that swelling has created greater friction, etc. Perhaps repeatedly opening and closing your fist aggravated things. Anyway, I wouldn't worry about it unless it comes back, but maybe reduce the frequency of your fisting (haha).
2. I would start pretty quickly, but you want to take off tons of weight. Pretty much take all the weight you have, and put it on the other end of the pully, and go from there. If you have 60 or 70 lb, with friction in the pulley setup, you'll barely be flexing your forearms. It should feel really easy at first. Also, you won't do any closed crimping, or any grip that directly stresses the Ring A2, for a while. So, open grips only.
3. I use the advanced protocol. I don't get too hung up on rest between sets though, especially in the first few sessions when you're dialing in resistance, considering taping and other things that you don't normally think of. Remember the goal is getting healthy, not getting stronger, which requires a slightly different mindset while hangboarding. It's not about stepping up to the next level, it's about finishing the session (and arriving at the next session) feeling healthier.
4. The cart is way ahead of the horse on this one. However, when I had my really bad A2 injury I HBed for about a month at a time, then took a couple weeks off (usually with some easy outdoor climbing mixed in), then started over again. I did that 3 times. The third time I was at about 80-85% of my PRs at the end of the last phase. I then proceeded into a normal (though slightly weaker) training cycle and climbing season. By the end of the next season's strength phase I was 100+%.
I wouldn't recommend an endless hangboard phase with the goal of hammering away until you reach 100%. That doesn't work for me. During my rehab, as I got closer to my limit I would feel more and more tweaks, more inflammation, and I could tell if I kept going I would re-injure myself. Hence the breaks. I think this is because our fingers just can't heal fast enough to keep up with our hangboard schedule. Throwing in extra rest days isn't sufficient either (though certainly helps). It took months for my finger to recover. Perhaps had I kept the resistance static I could have just hangboarded straight through, but I don't know if that would have accomplished anything in terms of getting healthy faster.
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Post by willblack on Dec 4, 2016 10:18:08 GMT -7
Unforunately, I've had a fair bit of experience rehabbing finger injuries, so here's my personal experience though I'm sure other folks will chime in as well.
When to start hangboarding again: I have always started once the pain is no longer constant/severe, but still hurts when palpated, and at least two weeks after the injury.
Determining starting weight: I go as conservative as possible, it's better to take an extra month working back up to your baseline than to push too hard and injure yourself again. For my most recent injury I backed off something like 40 pounds from my normal starting weights. I think that ideally the first few workouts should feel extremely easy, the goal being just to get some blood flow to the injury without straining it too early on. You're right to be terrified, you really can't be too careful. Also, I only increase weight when I can COMFORTABLY complete the set at the current weight. If you complete the set with some pain or uncertainty, just keep the weight the same for the next round.
Protocol: I've always stuck to 7/6/5, but I could see the case for the beginner protocol.
Transitioning back to normal training. In the past I've taken a couple weeks off then started a normal training cycle. This time around, however, I hurt my finger right at the end of my hangboard phase, and after my rehab cycle I decided to take a couple weeks to climb outside and have fun instead of going back to the grind of training. This allowed me to keep my technique sharp instead of spending 14 weeks without any actual climbing. It also allowed me to determine the finger's comfort level with outdoor climbing and build up some psych for my next training cycle.
Stick with it man, finger injuries can be really demoralizing because they seem to come out of nowhere and make you feel so weak, and recovery is always slow and frustrating but chances are you'll be climbing stronger than ever a year from now.
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Post by Lundy on Dec 4, 2016 12:38:59 GMT -7
Thanks, fellas, for the great info.
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Post by daustin on Dec 4, 2016 15:46:26 GMT -7
However, when I had my really bad A2 injury I HBed for about a month at a time, then took a couple weeks off (usually with some easy outdoor climbing mixed in), then started over again. I did that 3 times. The third time I was at about 80-85% of my PRs at the end of the last phase. I then proceeded into a normal (though slightly weaker) training cycle and climbing season. By the end of the next season's strength phase I was 100+%. I wouldn't recommend an endless hangboard phase with the goal of hammering away until you reach 100%. That doesn't work for me. During my rehab, as I got closer to my limit I would feel more and more tweaks, more inflammation, and I could tell if I kept going I would re-injure myself. Hence the breaks. I think this is because our fingers just can't heal fast enough to keep up with our hangboard schedule. Throwing in extra rest days isn't sufficient either (though certainly helps). It took months for my finger to recover. Perhaps had I kept the resistance static I could have just hangboarded straight through, but I don't know if that would have accomplished anything in terms of getting healthy faster. I had a similar experience earlier this year. I injured my A4 in late January, and started a rehab hangboard cycle after about 3 weeks of rest. More because of a crazy work & personal schedule, I wound up doing 2 mini-cycles of rehab HBing, which were separated by about a month and only had 5 workouts in each cycle. In between, I also did a lot of ARCing. Not so much for fitness (though I can always use better fitness), but more so because it helped me feel like I was really increasing circulation in my fingers. Who knows if this had any therapeutic benefit, but it feels like it helped and it also let me get in a little bit of actual climbing which kept me from going crazy. I know that ARCing may carry the risk of uncontrolled forces on the finger and re-injury, but I made sure I did very low intensity, even for ARCing, and high volume -- never felt like being on the cusp of re-injury.
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Post by Lundy on Dec 15, 2016 19:58:57 GMT -7
So here's the depressing update... Went to the doc, got an MRI, and have a full rupture of the A2. Of course, the surgeon I've been working with (based on referral from my PCP), who understands climbing as well as I understand opera, says the only solution is surgery. As per both Make or Break and One Move Too Many, though, it seems that the current protocol, provided nothing else is wrong, is to conservatively treat this. MoB even states: "Surgery also seems to have good results even if conservative therapy is tried and fails to produce satisfactory results after several months..." So seems like I should ignore the doc for now and try the conservative approach, yes? But it gets a bit tricky...
MacLeod goes on to finish that sentence with: "...although flexion contracture resulting from delayed treatment may effect the outcome." Naturally, about two weeks ago (two weeks after the injury) I started to also experience some flexion contracture. It's not too significant, but I cannot extend my finger past probably 160-170 degrees, and it is QUITE painful when I try to push it further. I can also feel some pulling in the palm still that feels associated with this. Soooooo... my questions are: (1) Has anyone ever had any flexion contracture that they've had to deal with? What non-surgical treatment protocols have you used to try to address this? (2) Does anyone have the contact information for a hand surgeon who also might be a climber, who would understand some of this stuff, and might be up to speed on the literature, particularly that coming from Dr. Schoeffl in Germany? I would love to just talk some of this through with someone who is more knowledgeable so I can develop a plan for how to treat this with some confidence.
I'm also generally curious about the no-surgery treatment for a full-rupture. Is the idea just that your body learns to deal without the A2 pulley? Does this likely increase the probability of a future injury on A3 or A4?
Thanks for any references. Feel free to message me directly if folks don't want to give away contacts like that in a public forum...
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Post by aikibujin on Dec 19, 2016 12:08:44 GMT -7
Man, that sucks! I don't have any references, but I do wish you best of luck. I've been dealing with aches in different fingers for over a year now, I know how much finger issues can limit your climbing.
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nate
New Member
Posts: 15
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Post by nate on Feb 16, 2017 8:53:10 GMT -7
Wow, quite a bummer of a thread. Sorry you have to deal with this Lundy. How is rehab going for you?
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