Effective Treatment for Capsulitis of the PIP Joint?

[bannyong]

Does anyone have experience in training through capsulitis of the PIP joint in the middle finger?

I used to have Capsulitis in the PIP joint of 3 of my fingers, but healed to of the fingers by taking 8 months off and then getting a cortisone shot in each of my affected fingers. 1 of the fingers has not completely healed, but I'd like to get through this macrocycle before taking time off of training to completely heal the last finger. Thus, I'm wondering if anyone has good advice for how to continue to train through a macrocycle without aggravating capsulitis too much. I've gotten an MRI and the doctor tells me that continuing to train won't cause long-term damage.

I'm following a lot of the protocol that is listed in One Move Too Many for treating capsulitis (icing, gently pulling on the finger for 30+ seconds, not full crimping).

Ultimately, I'd like to get through the 2nd half of this training macrocycle. Once finished, I think I'll get a cortisone shot right at the beginning of the rest phase. Then, the way that the macrocycle is structured with 2 weeks of rest followed by ARC'ing and Hangboarding (none of which aggravates my capsulitis), I think that I can completely heal the finger during the next macrocycle as long as I get through this one without messing it up too much.

Does anyone have any experience or opinions on this approach? Is it dumb? Do you disagree with my approach? Are there preventative measures you'd recommend?

Also, if anyone knows a good hand doctor for climbing in the Austin, TX area, please let me know.

[MarkAnderson]

When did you get your first cortisone shot? What were you doing that caused capsulitis in three fingers? Are you still doing those things, or have you evolved your approach?

[bannyong]

Q: When did you get your first cortisone shot?:
A: In July 2016. I've heard that you want at least 6 months in between shots, so getting my next one in January 2017 at the end of this macrocycle is what I'm thinking.

Q: What were you doing that caused capsulitis in three fingers?
A: I was climbing like a total newb. Too many days a week. Full crimping on pretty much every hard move. Pretty much just jumping on routes outside at my max limit and hangdogging like a hero. I was doing pretty much everything you could imagine an overanxious underinformed climber might do when they first start.

Q: Are you still doing those things, or have you evolved your approach?
A: Thanks to RPTM, I've evolved my approach! I am following the plan pretty strictly. I've noticed that ARC'ing has been the most effective method of breaking my habit of crimping (a lot of forums say "just stop doing it", but it's hard to break such an ingrained habit without training it out). The info you provided regarding resting has seriously changed my life. I come from a background of competitive ultimate frisbee, a relatively nascent sport that is just now evolving past the Spartan approach for training. In short, I've been chronically overtraining in everything I do for the past decade or so. With the RPTM's emphasis on rest combined with some heart rate variable monitoring, I feel as healthy and strong as I've ever been, with the exception of this one finger with a little bit of capsulitis. Luckily, with how little climbing I'm doing thanks to the RPTM, the Capsulitis just seems to be staying at a steady state and not getting any worse.

[MarkAnderson]

Ok, that's great to hear.

I would not advise another cortisone shot. Maybe ever, but at least not until you've had a chance to see what the long term effects of those first two shots are. Cortisone shots have risks, and I think they are controversial. My understanding is that they don't really heal anything, they just interfere with the body's pain/inflammation response. This can be good if inflammation was preventing your body from healing itself (which is theoretically possible, by restricting bloodflow, etc). Or, it can be bad if it merely allows you to keep right on overtraining, without receiving the critical warning signals from your body that you're damaging yourself. Furthermore, I believe there is some evidence out there that cortisone can actually damage connective tissue.

Hopefully none of these bad things will happen to you, but you probably won't know until after the effects of the cortisone have completely worn off. And then you would be wise to take some more time to evaluate the long term effects. So my advice is to keep with the program, and hope that your third finger heals itself now that you are taking sufficient rest days and training intelligently. If that doesn't happen, wait and see what happens with your other two fingers after the cortisone has left your system (I think they usually say a cortisone shot "lasts" 6 months) and go from there.