
Finger flexor tendon pain is the most frequent overuse syndrome in climbers’ fingers. Aggressive and frequent forceful flexion of the fingers, especially in an open hand position, can lead to pain in the fingers or palm. In an overuse situation the climber experiences gradual onset of pain as she continues to load the tendon excessively without adequate rest, this can occur over weeks or months. Acute injuries can occur with a sudden slip of a foot or forceful loading often while initiating speed and force when quickly loading tendons by pulling fast and hard to get to the next hold.
A finger flexor tendon injury can take on several different profiles. They can be a tenosynovitits, tendonopathy, or a muscle strain involving the lumbricals. All of these variations can result in a similar pain profile with some variations.
Finger flexor injuries often presents with pain on the palm side of the fingers, palm of the hand and even into the forearm. You may have these symptoms:
Painful and swollen fingers/difficulty closing fingers into a fist
Difficulty bending your fingers due to pain or limited range of motion
Tenderness and pain on the palm side of the affected finger and hand
Pain may cross the wrist and run up the palm side of the forearm
Pain is reproduced with forceful or resisted finger flexion
The extent of weight on your fingers that you tolerated may speak to the severity of your injury. For example, if simply resisting finger flexion with your opposite hand hurts, it will likely not go away inside a few days. The immediate pain may ease but if you climb it will flare it back up. Rest from climbing is appropriate. A strategy of intentional dosing is recommended. This is a process of graded progression of tension and load on the tissue. Any weight you use should always be pain free. If you are experincing swelling, loss of mobility, and pain, back off on climbing. Work on active pain free high repititiom range of motion o create fluid pumping to flush out fluid and to lubricate and nurish the tissue. If you can tolerate load without pain, add pain free resistance in the form of a dumbesll or rock ring and curl the fingers straighten them slowly through flull range for about 10 reps. Do these 2 separate times a day seperated byu at least 4-6 hours. This is eccentric emphasis training which provides optimal stimulus for tissue healing of tendons.
When working back into pain free climbing be sure to:
· Choose routes without open grip holds or slopers
· Choose routes with ample foot placements to minimize loads on your fingers
· This is a great time to practice foot work, balance, or endurance
· Avoid projecting and climbing at your highest grade
· Allow increase rest time between climbing session for recovery
· If you do not have pain during climbing but notice swelling of fingers afterward, this is a sign you need to increase your rest and recovery times and or increse intensity and volume.
Finger flexor injuries should be differentiated from a finger pulley injury and other hand and wrist injuries. How do I know if I have a pulley injury or a tendon injury?
· Pulley pain is typically isolated to the finger and pain is localized to a small region
· Flexor tendon pain can run along the palm side of the finger or be felt in the palm (lumbrical strain) and even up into the forearm
· Flexor tendon pain tends to be worse in an open hand grip or sloper hand positions and less painful in a crimp grip position. Pulley injuries usually present to opposite pattern.
If you are uncertain as to your injury, consult a physical therapist trained in treating climbing injuries.
Lastly, have pateints, collegen tissues like tendons and ligaments are slow to heal. Continuing to climb when it provokes pain and swelling prolonges the healing process. You can take a few weeks to months off and work through a graded progression of loading back to full intensity for next season or push it too soon and drag out the pain and limitation for months and months. It may be hard to stop now so you can be better later but I will leave it up to you. Reach out if you have questions.
References
(Schoffl et al.) Schoffl, V., et al. (2020). "Tendon Injuries in the Hands in Rock Climbers:Epidemiology, Anatomy, Biomechanics and Treatment An Update." Muscle Ligaments and Tendons Journal 10(02).
Schöffl VR, Schöffl I. Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness. 2007;47(1):70-8.
Comments