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Post by jlarson on Sept 25, 2015 9:21:40 GMT -7
stpatty,
It certainly seems to meet the criteria for a chronic/overuse injury, 5 months is a long time dude!
Normally your tendon slides through an outer sheath when the finger contracts, imagine a thread getting pulled through a plastic drinking straw maybe? Trigger finger is when a cyst/nodule forms on the tendon and does not allow the tendon to pass easily through the outer sheath. Imagine pulling a thread with an attached bead through the straw, it would get stuck when the bead hit the end of the straw.
Because we have flexors that are much stronger than our extensors, we can generate enough force to pull the cyst through the sheath when we make a fist. When we try to splay our hand flat on a table our extensors can't generate enough force to pull the cyst through the sheath so the finger gets stuck. You can manually straighten the finger using the free hand or probably feel a lock then pop sensation when you move the finger.
Tenodvaginitis is the climbing equivalent to tennis elbow and is the general inflammation of the tendon sheath. This sounds more like what you've described so far. Rest is definitely important to get the inflammation down initially but it seems physical therapy (v. easy hangboarding?) is the only thing that will truly fix the problem. That and diligent stretching/warmups before climbing sessions.
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Post by jlarson on Sept 25, 2015 9:28:42 GMT -7
And for the record I had a similar issue while completing my first campus cycle. I rested an extra day (which helped a little bit) and just climbed through the pain. I'm just about to finish my season and begin a two week rest period. The finger hurts a bit especially in the morning, but once all the joints get warmed up things are mostly fine. I'll post an update if I can remember when I'm in the midst of my next training cycle.
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Post by stpatty on Sept 29, 2015 6:00:11 GMT -7
Tenodvaginitis is the climbing equivalent to tennis elbow and is the general inflammation of the tendon sheath. This sounds more like what you've described so far. Rest is definitely important to get the inflammation down initially but it seems physical therapy (v. easy hangboarding?) is the only thing that will truly fix the problem. That and diligent stretching/warmups before climbing sessions. J, What would you consider physical therapy other than easy hangboarding? Last night I did my second hangboard rehab session - with 50% of previous best hang weight + 5 lbs. I took three full rest days in between rehab session 1 and session 2. This morning the finger doesn't feel too sore, which seems promising, and if anything it's much better than two weeks ago. I think I'm going to continue along this path, adding 5 lbs each workout unless the finger becomes very aggravated again. I'm curious to what you would suggest differently though, for physical therapy?
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Post by jlarson on Oct 5, 2015 13:56:19 GMT -7
Tenodvaginitis is the climbing equivalent to tennis elbow and is the general inflammation of the tendon sheath. This sounds more like what you've described so far. Rest is definitely important to get the inflammation down initially but it seems physical therapy (v. easy hangboarding?) is the only thing that will truly fix the problem. That and diligent stretching/warmups before climbing sessions. J, What would you consider physical therapy other than easy hangboarding? I'm curious to what you would suggest differently though, for physical therapy? Full disclosure here: I've not suffered a prolonged period away from climbing due to finger injury. When I've had finger soreness (I usually get it in the morning after a period of intense climbing such as a full weekend of bouldering) I just take a couple extra rest days and periodically stretch the fingers throughout the day. I've never been injured to the point of needing to use the hangboard rehab protocol (though it seems to make quite a bit of sense). My experience with physical rehab is limited to a meniscus tear in my knee. After a consult with an orthopedist I had several sessions of physical therapy and electro therapy and then instructed to lightly exercise the stabilizing muscles in my knee using a theraband. I diligently followed through with the home rehab and have no lingering affects four years later. If my fingers were the problem I think I would follow the hangboard protocol outlined in the RPTM as well as doing finger extensions with a rubber band looped through my fingers a couple of times a day. Lightly working out the antagonists certainly won't hurt anything, right? The key to recovery is probably low low low intensity and diligently/patiently following a rehab program.
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Post by jlarson on Oct 7, 2015 9:33:49 GMT -7
I've read and thought a bit more about the reasoning behind training antagonist muscle groups, the "why?" behind the exercise. So I'll add an addendum:
I think the key difference is between a tendon strain/tear and inflammation associated with overuse. Strains and tears will require physical repair of the tendon. This can only be accomplished by time and blood flow. The idea behind starting a studpidly low intensity hangboarding protocol is to:
a.) not cause any additional trauma---hence the importance of STUPIDLY easy b.) increase blood flow to the fingers in the most specific way possible---blood flow is actually the healing manna that is required to fix the problem
It's going to take a while to fix the problem completely because tendons are not a terribly vascular tissue--- blood flow is more of a trickle than a waterfall. The stupidly easy hangboard recovery protocol also provides a useful benchmark for recovery: once you're back to your previous personal bests and pain free.
Inflammation associated with overuse should respond to rest alone, once the inflammation subsides you should be pain free and good to go. Chronic pain associated with overuse (tennis elbow, carpal tunnel, tendovaginitis) is probably coming from a muscular imbalance. Every movement has at least two muscles associated with it, one to pull in one way and an antagonist to pull in the opposite way and reverse the movement. In a neutral position both muscles at rest will still exert a small pull in opposite directions. If one of these muscles is much stronger than the other it will constantly exert a slight pull in it's favored direction, a pull that is primarily absorbed by the tendon attaching the muscle to the bone. The constant pull on the tendon causes the tendon to become irritated and inflamed.
This is why I believe the necessary correction to a chronic inflammation/overuse injury would be rest (a couple days) and exercise of the antagonist muscles (in this case the finger extensors) to correct the muscular imbalance at the root of the problem.
Hope this is helpful!
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Post by stpatty on Oct 23, 2015 7:21:00 GMT -7
Thanks for the feedback, J. I've added the Power Fingers antagonist exercises to my workout days, to be honest - not sure if I can tell any difference. I've been hangboarding concentrating on rehab for a month now - I've only done 6 workouts, taking more than 3 days rest in between on several occasions. Taking the rest I think was really conservative, but was trying to listen to my body's response. I typically judge this by how the A2 feels in the mornings - stiff? painful to touch? etc. Through HB'ing I was able to discover grips that do not cause any pain - 2FP MR deep, 3FP IMR shallow, WP, and sloper. So I'm progressing through these as I would in strength training. Been doing the half crimp grip on two grips, both on the SVDER (med edge) - one on the far left and another on the far right. These are beginning to feel better, I think - but I haven't even come close to previous best hanging weights yet. I feel like I may be over-analyzing how the A2/tendovaginitis reacts. I'm struggling to differentiate normal/good pain from half-crimping on a HB vs. bad, tendovaginitis pain from an injury. Good news is, it is beginning to feel less aggravated, and palpation on the A2 in the morning is less painful, although still kinda tender.. Even though its hard to tell where the injury stands, I'll plan to continue with the HB rehab workouts in hopes to eventually get back to previous best hangs, and I'll post progress here.
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Post by MarkAnderson on Oct 23, 2015 16:28:04 GMT -7
It's really hard to know how much pain (and what quality of pain) is acceptable. I try to avoid giving recommendations on the subject, because I don't want to get someone hurt. I know what works for me, but I have zero confidence that my pain threshold will work for someone else (with a different training history, injury history, age, baseline strength, etc). Even if I thought I could predict the correct amount of pain for someone else, I seriously doubt I could communicate it precisely. So, it is possible that you are being more conservative than you need to be, but you didn't hear that from me
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Post by stpatty on Nov 2, 2015 9:16:24 GMT -7
It's really hard to know how much pain (and what quality of pain) is acceptable. I try to avoid giving recommendations on the subject, because I don't want to get someone hurt. I know what works for me, but I have zero confidence that my pain threshold will work for someone else (with a different training history, injury history, age, baseline strength, etc). Even if I thought I could predict the correct amount of pain for someone else, I seriously doubt I could communicate it precisely. So, it is possible that you are being more conservative than you need to be, but you didn't hear that from me Thanks for the honesty and input, Mark. I felt like I was being too conservative and not actually making any rehab progress, but with little experience with a tendovaginitis injury it was hard to tell. Your comment gave me the extra confidence to begin increasing intensity more aggressively in order to see how it responds. I've done three hangboard workouts since I last posted (2 rest days in between). Yesterday I was failing at my limit, albeit much weaker than previous strength phases, but regardless, I was failing at the end of the grip's hang as I normally would in a HB workout. There was no pain during the hang and the next morning only some tenderness at the A2, but not any pain. I need to restrain myself from pressing on the A2 to make sure it still feels okay though. I plan to continue through 3 more HB workouts and then transition into power. I guess the real test will come then, as in the past this is when the tendovaginitis started - so I plan to take it conservatively and obviously monitor how it responds. For now though, I can't explain how psyched I am to be back in "training mode" on the hangboard, feels good to try hard and get amped instead of being bored out of my mind hanging with less weight in "rehab mode".
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