The internet is full of advice on what to do when a finger injury happens, but most of it seems incomplete, conflicting, and really darn confusing. So, I decided to put together this step by step guide based on my own experience.
Please note I’m not a medical specialist, and the list below only sums up what I got to know through reading and asking around. It worked for me, it might work for you, but possibly something else would work even better, so keep an open mind.
- THE INJURY
If you’ve heard the noise of a snapping ligament, or experienced sudden pain, it’s most likely a serious injury. Stop climbing immediately.
Since you don’t know what happened (it might even be a stress fracture to the bone), it’s better to protect your finger from moving and avoid aggravating it by accidentally grabbing something. Take a twig and some finger tape and make a loose splint, but make sure not to compromise blood flow.
- THE DIAGNOSIS
Get it done, period. An MRI scan is ideal but expensive and not always available, so an ultrasound (USG) will do just as well, as long as you are seen by a specialist who knows about fingers. A person who typically deals with stomach scans is unlikely to be familiar with orthopaedics or sport injuries.
My diagnosis was grade III tear to the A2 pulley. I believe this means the tendon was around 75% gone, and the crux of things is not to rip it apart entirely, which is a much more serious and difficult injury to manage.
- THE DOCTOR
Show the scan result to an orthopaedic surgeon. They will let you know if your injury can heal without cutting you up. Most likely they will also tell you to keep immobilising your finger.
Keep in mind that surgeons think about dealing with the particular problem, and not about the general fitness or integrity of your hand.
The doctor will help you understand the scan result, and refer you to a physio.
- THE PHYSIOTHERAPIST
Even if you don’t get the doctor’s referral, make your way to a physio. Be sure to chose someone who deals with climbers. They will have hands-on knowledge of how finger injuries are managed, and most likely tell you not to immobilise your finger.
Two climbing physiotherapists told me not to immobilise, while another one, as well as my surgeon, said it’s crucial to wear a splint to make sure the ligaments attach back together. (Yes, that’s when it often gets confusing. Read on.)
The physio will also give you a set of exercises to maintain your finger’s dexterity and minimise muscle atrophy, as well as perform cross friction massage. You can learn this technique for yourself and employ it alongside other means of speeding up the recovery.
The physio will also be able to estimate how much weight-bearing is advisable, and the timeframe of your recovery.
- THE RESPONSIBILITY
This is by far the the most important part, but it can only be accomplished after following points 2 to 4!
With not much research done around finger injuries, and even medical professionals offering conflicting advice, the crucial thing is for you to take responsibility for your recovery.
Whether you’re an athlete or a fitness freak, chances are you have a good awareness of the body, and most likely a history of past injuries. Use this to your advantage. Ask yourself what feels good, but be sure to put your desire to get immediately back into climbing on hold. It would trick you into not listening properly to your body.
You need a quiet, observant mind, and a detached attitude, and most likely you will be able to determine what’s best for your finger, and make sense of the varied advice received from medical professionals.
For me, it was no climbing for 4 weeks. In the second week, I introduced gentle hangs and pulls on a wide bar, just twice a week. As one physio told me, slight discomfort during exercise is normal, as long as it’s not followed by increased pain the day after.
After a month, I started climbing in the gym, only on *massive* jug holds, fully in control, and at first for no longer than 20 minutes. The time frame is not arbitrary in any way, but it was exactly what my body seemed happy to manage.
I was slowly increasing the intensity of exercise, slowing it down if my finger responded with swelling or pain, and now, after four months, I’m back to crimping on the rock. However, I continue to tape my finger and stay alert to any discomfort.
- THE RECOVERY
It’s all about blood flow. The more fresh blood goes into your finger, the better. The first question is, should I ice my finger?
The RICE method is still commonly employed, but research shows, it might actually be counterproductive. Your body produces inflammation and swelling precisely in order to heal the injury, so over-the-counter drugs, such as ibuprofen, are no use.
Icing was believed to bring the inflammation down, but what it really does is slow the blood flow through narrowing the veins. Most likely, that’s no good.
The only ‘sensible’ icing is cryotherapy. Grab some ice cubes, and apply on the skin until it becomes white. Yes, it’s the first step to getting a frostbite. Very well. Your brain with think ‘danger!’ and, as soon as you stop icing (just don’t over do it…), it will send more blood to your finger. Score!
All forms of massage increases the blood flow. Learn about cross tissue from your physio. Although it seems quite violent and can be painful, some specialist recommend it as soon as after 48h from the injury.
Nobody really knows if using stuff like Crimp Oil, arnica, or other traditional remedies do anything to help healing, but it for sure makes massaging more pleasant, nourishes your skin, and smells nice.
From what I understand, flossing is a relatively new technique, and I have no idea where the name comes from. You don’t need any fancy kit – just a strip of a rubber band will do to temporarily (!) restrict blood flow, and then abruptly release it to allow the rapid influx of fresh blood do some healing magic.
Given that your injury occurred as a result of gripping, it’s very likely that there are no reasons you can’t start training antagonist muscles straight away, but to be on the safe side, check with your physio. If they give you a green light, use Power Fingers, or a rice bucket to practice opening your hand. This will bring more general strength and stability, speed up the recovery, and help prevent future injuries.
Hopefully, using the methods listed above, you will be back on the rock in no time. By all means, do your own research, and instead of despairing, be proactive in finding ways to get back on track. Finger injuries are just a normal part of climbing, and all we can do is prevent, and manage.
Don’t forget to let me know in comments if you know any other good methods of enhancing recovery.