How to Treat and Prevent the Most Common Climbing Injuries

Climbing is an ass kicking, total body workout that often leaves me breathless.  As with any sport, there must be an element of self-care we implement so that we can sustain our passion for the climb without burning out our bodies.  In rock climbing, the vast majority of injuries result from overuse, most often occurring in the fingers, elbows, and shoulders.

Overuse symptoms are no fun and can result in pain and permanent damage.  My own experience of nearly a decade of climbing and neglecting to take care of my fingers and joints in the early years has caused some unforeseen headaches and challenges.

Boutonniere deformities on middle and ring finger across both hands due to A2 pulley injuries

Boutonniere deformities on right middle and ring fingers due to A2 pulley injuries

The three finger injuries that climbers frequently experience are an A2 pulley strain or rupture, a flexor tendon tear, or a collateral ligament strain.

A2 Pulley Injury

The most common problem is an injury to an A2 pulley—bands of fibers that hold tendons flush to the bone, located in the meaty area between the base of the finger and the middle knuckle. Such injuries often happen when you’re crimping and a foot slips, putting unexpected force on the hand. Climbers may hear an audible “pop” and feel immediate pain, followed by swelling and possibly bruising later. The pain is usually localized to the base of the finger. An A2 pulley injury is the least serious of these three, as it usually doesn’t affect your strength significantly. It’s not recommended to have surgery even with a full rupture. However, you’ll likely always have to tape the finger after a rupture for support.

Flexor Tendon Tears

These tendons run from the inside of the elbow, down the forearm, and into the fingers, passing beneath the pulleys. They connect muscles and bones, allowing you to bend your hand and flex your fingers. When a tear or stretch occurs, pain is usually felt between the palm and wrist. You might experience an inability to bend one or more joints in a finger, and tenderness or numbness in the finger. If it’s a complete rupture, it likely will not heal without surgery.

Collateral Ligament Strains

The third injury occurs in the collateral ligaments, which surround each finger joint. Trauma here usually happens with sideways loading, such as when you’re gastoning or sidepulling with one hand and throwing up and out to a hold with the other. Pain will be felt at the side of the joint—usually the middle joint of the middle finger. This is another injury that might require surgery if severe enough.

Treatment

How do we treat finger injuries due to climbing overuse?  Check out these handy finger fixes from Climbing Magazine:

First, stop climbing immediately. If you can’t see a doctor right away, physical therapist and climber Aimee Roseborrough recommends assessing your hand for the next several days to determine how severe the injury might be. Meanwhile, she recommends combining ice baths (10 minutes, three to five times a day) with active range-of-motion exercises (gentle stretching and flexing) for the affected finger. The first 72 hours are most critical with icing, and you should continue the ice baths as long as there is pain with movement.

If bruising occurs, or if your joint is unstable and moving more than normal, see a doctor. If no bruising occurs, but there’s no improvement after resting and icing for five to seven days, make an appointment. The doctor might perform an MRI or diagnostic ultrasound to identify the problem, and will then make a treatment plan.

Recovery times vary depending on severity, but four to six weeks is a baseline guide for healing. A graduated approach— easy routes, big holds—is the best way to ease back into climbing once the pain is gone.

Taping helps to prevent and treat the most common finger injuries, e.g. A2 pulley injury

Taping helps to prevent and treat the most common finger injuries, e.g. A2 pulley injury

Prevention

Better yet, how do we prevent these pesky finger injuries to begin with?  Follow Jeanne’s Awesome 8 Step Plan to Preventing Common Climbing Injuries:

  1. Take rest days to recover
  2. Cross train to develop mus­cles that climb­ing neglects, ensur­ing that your mus­cles remain in proper bal­ance
  3. Support your tendons and tape up
    • Tendons, which are connective tissue that attach muscles to bones, are particularly susceptible to damage and injury by climbing. It is easy to hurt the tendons in your hands, especially if you climb in an indoor gym and on crimpy edge routes outside since your hands are pulling your weight. Use strips of tape to support your finger tendons and avoid crimp
  4. Warm-up your body and joints with slow, gentle climbs well below your climbing grade to effectively stretch out your fingers, hips, and shoulders
  5. Vary your climbing regimen
    • Don’t get tunnel vision and climb only hard routes. Climb on lots of different kinds of rock types and make lots of different kinds of movements. Learn to jam cracks Improve your footwork by climbing slabs, which saves your elbows from wear and tear. Make bouldering a habit by having regular sessions with your buddies so you can push yourself but also rest between problems. Likewise, don’t train all the time (refer to point i)
  6.  Avoid extreme climbing moves
    • Some types of climbing movements are more stressful to your body than others. If you are young and strong, then sometimes you might indulge in risky moves simply because you can. As you age though, those same moves can tweak your fingers, strain your elbows, and cause rotator cuff injuries in your shoulder. Extreme moves that can cause problems include dynos or leaping from a lower hold to a higher one because of the torque placed on the elbow and shoulder.
  7. Use big holds in gyms.
    • I like big holds and I cannot lie.  Avoid routes with small finger holds and you will avoid finger injuries. It’s easy to tweak a tendon or muscle when you’re climbing in a gym because most gym walls are either vertical or overhanging so most of your body weight is on your hands and arms. Some routesetters in gyms equate difficult routes with small holds, thinking “Okay, I’m gonna make this route hard by using crimp edges.” Big mistake since these are the kinds of holds that lead to long-term nagging finger injuries. If you are going to the gym for training, use big holds whenever possible. Good routesetters will incorporate jugs and big holds onto hard routes by simply turning the hold from its prime position to one that allows the climber to have to be creative when using it. Also, ask your gym to make some training routes with big holds on steep walls.
  8. Quit if you feel pain
    • If you feel pain in a finger, elbow, or shoulder, quit climbing immediately. If you’re on a toprope, let go and lower down. If you have any sign of injury, such as pain or an ache, then immediately stop climbing. Don’t continue by climbing easier routes. If you feel a pop in one of your fingers, that’s a bad sign. Again, stop immediately. Don’t go by the old adage, “No pain, no gain.”

And last but certainly not least, take time to heal up!  This prevention strategy is in a league of its own and needs its own list.  Tendon injuries are no joke since they can take a year or more to heal and rehabilitate. If you have any thought that you might have torn a tendon, then see a doctor, preferably acertified sports medicine specialist, and follow his advice. Tendons do not heal quickly since they receive meager blood flow when compared to muscle. A small tear or rupture can take months to heal so even if you feel better after a couple weeks, don’t go climbing and risk permanent damage.

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