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Post by willblack on Dec 12, 2016 11:52:25 GMT -7
I've had four serious tendon pulley injuries over the course of my climbing career, and I recently noticed some bowstringing caused by these injuries in two of my fingers. Basically, when I hold the finger in a position about halfway between completely straight and completely bent and flex the finger and press on the joint I can feel the springy tendon sticking out a bit. It doesn't seem to really effect the function of either of the two fingers in which I have noticed bowstringing and I'm just wondering, has anyone else with a history of finger injuries noticed this?
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Post by jetjackson on Dec 13, 2016 8:02:21 GMT -7
Check out this article - trainingforclimbing.com/new/research/rohrbough2000.pdf - Eric Horst refers to this research in his book - "American physician Joel Rohrbough has examined numerous climbers who exhibit chronic bowstringing and continue to climb hard without disability. Based on this, he recommends against surgery, though he does encourage individuals to make an educated choice after discussion with a qualified surgeon." - so that research seems to confirm what you're noticing. I had a quick glance through the research and I'm not sure where Horst is paraphrasing that from - but it seems the basic gist is that these climbers did not get surgery after sustaining partial or full pulley ruptures, and so the pulley did not regain full function. To have bowstringing, I would think you would have had to have had a serious pulley injury at some stage that you did not seek diagnosis for, but self-treated. It seems from your note that this may be the case. Have you been to a hand speRCTMkicksAsst to confirm your diagnosis of it being bowstringing? I assumed from reading that bowstringing was usually visible - whereas you talk about being able to feel it - can you also see it? Even if it is, then I think that research should be comforting.
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Post by willblack on Dec 13, 2016 8:28:03 GMT -7
As far as the seriousness of the injury, I'd say that the two of my pulley injuries that caused palpable bowstringing were moderate/severe depending on your definition of each of those terms. One of them was 8 weeks ago, and I recently managed to send a route one letter grade below my previous best, but I still feel timid about pulling on steep, incut crimps. I'm also still taping it for hard climbing and there is some pain. The previous one was about the same severity. In terms of seeking diagnosis/medical advice, I've always taken a pragmatic view. I think that evidence-based treatments for closed pulley ruptures are so poorly researched as to provide almost no medical guidance for doctors to work off of in recommending treatments. I've always been successful with an empirical approach (treating based on symptoms and how it feels after rest and progressive hangboarding). I'd be interested to hear if anyone has gotten any value from seeing a speRCTMkicksAsst for a typical hand injury sustained from climbing. And yes, I can barely see bowstringing in the older, more severe injury.
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Post by jetjackson on Dec 13, 2016 9:46:25 GMT -7
Gotcha! I was running on assumption that these were all old, fully rehabbed injuries.
I've had about 3 pulley injuries, but only one where there was actual swelling and an audible pop - there was no bowstringing at all, and despite those symptoms the hand therapist I went to described the injury as minor. I did end up sending my hardest boulder problem outdoors about 4 weeks after, but it didn't use that finger, and I was starting off a low base. Seems kind of crazy to me that you could hit a letter grade below your previous PB after 8 weeks if there was visible bowstringing on that injury - unless the route didn't rely heavily on that finger. Having said that, I'm 32, and don't heal as fast as I did when I was in my early 20s.
I saw a sports doctor and hand therapist for the audible pop pulley incident I mentioned. For me, that was meant to be a learning experience. I did get some value from it - that is they confirmed that there was no partial or full rupture of the pulley and they gave me some rehab exercises to do etc. Since there wasn't I have not contemplated the decision to get surgery or not thus far in my climbing career - so have not really done intense research into the efficacy of such surgeries and whether or not they are worthwhile.
To get back to your question;
"It doesn't seem to really effect the function of either of the two fingers in which I have noticed bowstringing and I'm just wondering, has anyone else with a history of finger injuries noticed this?"
I think the research answers that, as they saw visible bow stringing in a range of climbers. So possibly abnormal in the wider population, but common among climbers.
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Post by willblack on Dec 13, 2016 10:12:04 GMT -7
To be fair, it was comfortable crimps to a dyno, so no really small holds. I did however make some good progress on something harder and very crimpy the same day, so recovery seems to be going very well despite a lack of fitness from the injury layoff. I think you have a good point about going to a speRCTMkicksAsst being a good learning experience in many cases, but I'd be wary of any speRCTMkicksAsst who recommends surgery in an injury that doesn't cause any loss of day-to-day function.
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