RPHB 2 Finger (Deep) Pocket Tendon Injury

[Brew Horn]

I was on the RPHB 2 finger deep pocket in my 4th Hangboard workout. I made the mistake of only taking one rest day in between hangboard workout #3 and #4, just due to life schedule, and didn't want to rest 4 days in between #3 and #4. Regardless, at the end of my second round, hanging with 10lbs added, I heard a small pop. I dropped immediately, not necessarily for pain, but just reaction to the audible pop. The pain slowly set-in in the belly of my forearm initially, but now resides mostly in the wrist - on the middle and ring finger tendons. 

After a rest day, I went out for some moderate climbing, nothing truly hurt when I was climbing - but I made sure to always pull with all 4 fingers. After another rest day, I went to the gym and did a WBL (V0-V5), and felt fine with all 4 fingers on the holds. I felt pain when I hit a hold with my middle, ring and pinky (index dropped), and I immediately came off. So, it seems that I can climb pain-free with all 4 fingers on, but if any digit is dropped - I feel shooting pain in the wrist/forearm.

At this point, I am putting everything on hold and plan to rest until it doesn't feel so tender, taking it day by day, doing light stretching and ROM flexing of the fingers, plus some ice baths a couple times a day. I still feel minor pain even in daily activities like doing dishes, if I turn my wrist and apply pressure with only a couple fingers, etc. Any ideas what type of injury this is? Did I just aggravate my tendon, rupture something in my wrist? Also has anyone had results with ARCing for rehab? Or is the primary rehab suggested the RPHB with considerably less resistance?

Thank you all for the help and insight!

Cheers,
Sean

[MarkAnderson]

It sounds like a "Flexor Unit Strain"

Dr. J has a comical write-up on the injury that is worth reading (scroll down to the second question, from "Gunks76"):

www.drjuliansaunders.com/resources/askdrj/ask_dr_j___issue_193/

The bottom line with any finger injury is that the treatment is far more relevant than the diagnosis. In the real world, a good diagnosis is used to determine the best course of treatment. That is rarely the case with finger injuries, since so little is known about them, and the best treatment is hangboarding + rest 99% of the time. /end rant

ARCing is ok as long as you are disciplined and avoid making things worse. The best way to go is hangboarding. On the grips with no pain, you can push it as you normally would. For grips that cause pain (presumably MR and MRP, and perhaps IMR and/or IM), reduce the resistance substantially. Add at least one extra rest day per week for the first few workouts, until you can see how the injury is responding. Icing, stretching, and massage are good ideas. You might experiment with tape in various places to see if that helps (like, at the base of one or more fingers, around the wrist, just below the pisiform).

You'll be back to 100% before you know it.

[stpatty]

Thanks for the quick response, Mark. I had a feeling it was related to a Flexor Unit Strain, but I don't really have pain in the forearm muscle - more so in the wrist, but I guess the location of the pain is not necessarily to determining factor - more so that the tendon itself was aggravated?

I will move forward with hangboard workouts as rehab, dropping the resistance substantially on the MR and MRP grips and taping up. Happy to hear that you recommend still progressing in the pain-free grips, as most other resources I've looked into online are pretty alarming and recommend to cease training all-together - rest for up to 4 weeks and ease back into extremely easy climbing. I'll report back with results after the first couple hangboard workouts, with an extra day rest added.

Thanks again,
SP

[stpatty]

Just wanted to post an update since I initially injured my tendon(s) on the MR 2 finger deep pocket (left hand). As Mark suggested, I began rehabing this grip through more hangboard workouts, still pushing the grips that did not hurt and considerably lessening the weight on the 2 finger pocket. I have since completed my strength phase, and I'm back to about 85% on the 2 finger pocket, almost nearing the weight I was hangboarding when the injury occurred. Psyched!

I still feel some minor tweakyness randomly though, and just try to avoid anything that hurts. For example when I stretch on not-warmed up muscles, it feels tendor and tweaky (so I stopped doing that). I would feel I'm close to 100% but I'm very wary to actually "try-hard" on the grip out of fear or re-injury. I'm still stretching post workouts and doing light massing during the day. Hopefully I can feel close to 100% soon, so I can pull on pockets with an easy mind.

Thanks for the help, Mark. Much appreciated and successful results.

[MarkAnderson]

Awesome! Glad to hear it.

May 13, 2015 13:38:31 GMT -7 stpatty said:

...when I stretch on not-warmed up muscles...

Ya, you shouldn't do that Sounds like you figured that out though.

May 13, 2015 13:38:31 GMT -7 stpatty said:

I would feel I'm close to 100% but I'm very wary to actually "try-hard" on the grip out of fear or re-injury.

I consider this the last phase of rehab--convincing your subconscious mind that you're healed. I imagine its a defense mechanism against re-injury, and its probably not such a bad thing. I wouldn't worry about it, before you know it you find yourself cranking on it, only realizing after the fact that there was no pain and you totally forgot it was injured. That's when you know you're 100% healed!