Pulley

[jetjackson]

Two weeks out from Hueco and it looks like I will have to reschedule and change plans. Last night I was limit bouldering and on a problem I had designed specifically for training a route at Hueco. I had 3F left hand on the left side of a crimp, and IM on the right hand side of this crimp, on the 45 at my mates house. Pulled down on it to launch up for a right hand pinch, as I put my weight on to launch I heard that right middle finger pop. Stopped climbing immediately and iced/ibuprofen. 

The pop wasn't extremely loud, just like a knuckle crack, and there was only one. There was no pain, but if I engaged the finger I could feel a sort of pressure in the left, palm side of the finger. There is no swelling, so I hope it is only a minor pulley strain, my self-diagnosis would suggest it is the A4 pulley. This morning it is tender if I press on the A4 area, and is slightly sore when I open and close my hand.

I've had two mild A2 strains before, early last year, both which came on more like an RSI. This was more acute, and in the instant, and the first time it was associated with that pop sound. Unlike the other two, this came out of nowhere - in the sense that it wasn't sore in the lead up to it, and I didn't feel it coming. I was limit bouldering with only 48 hours rest after a campus session, and was not fully recovered going into the LB session - I'd say that was what did it, but I honestly didn't think I was risking injury on the move. 

At this stage, I'll rest it for a week, ice it etc. and get in to get a proper diagnosis this week. Then look at light climbing/hangboard rehab after that. Hopefully I can be back to full strength in 6-8 weeks - last time it took about that with the A2's, adnd I'm hopeful given the lack of acute pain at the time, and the lack of swelling. I guess I will have time to work on core and left handed 1 arm chinups.  

[MarkAnderson]

That's a bummer. I wouldn't necessarily re-arrange your entire season until you learn more. Another possibility is that it could be a collateral ligament strain (based on your description of pain on the left side of the finger). Were you crimping with the IM at the time? There's something about crimping with less than 4 fingers that seems to be quite threatening to the exposed finger. (not really helpful after the fact, I know!)

[jetjackson]

Thanks!



I feel like I was half crimping, but I could have moved into a full crimp through the range of movement as I was going to the pinch. I was on the 45, I was using the hold in the top right of the above image, with three fingers to the left of the peak, and two fingers to the right, I was launching to grab the bottom middle hold, which I have set up sideways as a pinch. 

Trying to get in to see someone asap and get diagnosis. I called the nurse line for my health provider, but the nurse didn't seem to understand my obsession for getting back to climbing. She suggested that given no swelling, no bruising, and no limited ROM, that I don't need to see a doctor, and should take a 'wait and watch' approach. I suggested that I wanted to get back to being able to hang my bodyweight on two fingers as soon as possible, and so she reluctantly suggested I book in with a sports medicine speRCTMkicksAsst. As an expat I don't really know how to navigate the health system here. I'll call a sports medicine doctor on Monday and go in and see them. 

[RichF]

Feb 13, 2016 11:06:18 GMT -7 jetjackson said:

As an expat I don't really know how to navigate the health system here...

None of us do.  They like it that way.  We spend less when we don't know what we're allowed to do.

Bummer about the injury.  Hope you heal up quick!

[Charlie S]

Reading your description, sounds very similar to what I did 5 weeks ago. Except I have swelling (still). Doc said it can 3-4 months for the swelling to go down.

Did you lose any strength?

If you're feeling it on the side of your finger, it's possible that you strained your flexor digitorum superfiRCTMkicksAss, which splits at the PIP joint. A really interesting assembly going on at those joints. You can get a diagnosis from a certified hand therapist (CHT). In my case, no special tools (i.e. ultrasound, MRI, or xray) were required.

Regarding the healthcare system:
1, Check with your insurance: Do you need a referral to see a speRCTMkicksAsst? If yes, go see a general practitioner then proceed to 2.
2, Go to a hand/finger speRCTMkicksAsst (Google search or ask on mountainproject.com for any local recommendations). Preferably one that is familiar with climbing.

Try to check and make sure that who you're seeing is covered by your insurance.

[jetjackson]

It's hard for me to quantify strength loss vs. pain. I have not wanted to aggravate the injury by jumping on a right handed crimper and reef down to test my strength. Certainly I can't do with my right hand, what I could 2 weeks ago.

Having said that I did go climbing in Austin over the weekend. I was able to climb a couple of outdoor 5.10b's with no pain - there were no RH crimpers. It started raining and so we went to check out Austin Bouldering Project - which is pretty awesome btw - 60,000 square feet of bouldering. I was like a kid in a candy store. They have grade bands there, and I was onsighting many routes in the V4-6 band range. The choice there was massive, so any route where I hit a right hand crimp, or a dynamic move to a right hand, I just got off the problem and went and tried something else. Interestingly, climbing isn't aggravating the injury very much. With the last pulley injuries I have had, the soreness/pain was stronger the day after climbing and would taper off by the 2nd-3rd day after a session. I know I'm still in the early stages, but the soreness is consistent day to day, and is only slowly going away. Perhaps I'm just getting better at being disciplined while climbing with an injury.

I'm still going to Hueco tanks this Friday. I have been scouring YT to find problems that don't require right hand crimps. I've got my eye on the more overhanging problems that demand core and shoulder strength, and are mostly slopers/pinches and open handed grips... unfortunately outdoor problems are nothing like these modern indoor competition style problems that are often just a bunch of massive open sloped moon dishes, so the choice at Hueco isn't that broad.   

I've put off going to the doctor. If the injury doesn't improve and start to follow the pattern typical of other pulley injuries I have had. I'll go and see a speRCTMkicksAsst. I've been doing the ice water at night on the hand, squeezing a foam ball throughout the day to promote blood flow, as well as massaging a stretching the finger.

[jetjackson]

I went to the hand therapist today. She described my injury as most likely a strain, or very light tear of collateral ligament, or pulley. She said it's not worth getting the MRI, as the treatment will be exactly the same. I've not climbed in a week, and there is still swelling. She suggests that I stay off climbing for another 10 days or so, until the swelling goes down, and then slowly ease back into climbing after that.

I think she is being overly cautious. My thoughts are that I should just stay off for one more week, and then start with very light ARC, and then do that for 3 weeks, limiting my climbing to 5.10a and less, building up the volume again, and then take a week off (I have a holiday in Nevada booked for a week) before starting a hangboard rehab program, off really light weight, and then skip campusing for this season, just doing bouldering as much as I can handle for a couple of weeks, and then jump into power endurance before a performance peak. I'll have plenty of time in Austin, and a trip to Horseshoe Canyon Ranch, so I'm considering targeting 5.12a/b 'jug hauls' during that performance phase, such as this and this.

Any thoughts on that for a strategy? I don't want to stay off for too long and risk losing too much climbing fitness. I figure that my 'rest' week, can consist of rehab exercises, and plenty of core work, with some power and strength maintenance work in the gym.