Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner, the principal physiotherapist of Insync Physio in Vancouver. Many time winners of best physiotherapist in Vancouver. His office has won best physiotherapy clinic in Vancouver, numerous times. And they're one of the best. Wil, how are you doing?
Wil: I'm doing great. Thanks. I'm doing awesome.
Mark: So we're gonna talk about rock climbing, specifically hand and finger injuries, which might be kind of counter intuitive to people who haven't done this, but it's really common in the rock climbing community. What's going on here?
Wil: Yeah. So finger and hand injuries are one of a subset of injuries that tend to be more exclusive to climbing and it's quite easy to really sustain injuries into your fingers and specific type of injuries, which I'll discuss. And it's easier than you think to get injured.
Let me give you a perfect example. I'm a climber, I'm a very avid climber and I really know, you know, the ins and outs of like preventing these types of injuries, but yet I've had some pretty serious injuries into my fingers. And I still, you know, can't prevent them from happening in the moment.
So I know better now. I'm wiser. So it's interesting, right? It's one of these things that I think sometimes with climbing, it's a sport where you just, all these things, adrenaline rush and you overtrain and injuries can happen. So you just have to be wise about what you do.
Mark: So what's the most common cause of these kinds of hand and finger injuries. Is it from trauma, from stress, from falling? Is it from over-training like you mentioned, is it just the heat of the moment? Kinda chronic stuff? Where's most of this coming from?
Wil: Yeah. So that's a really good question, Mark. It really comes down to not enough recovery. So as beginner climber, when you first get into the sport, you can overtrain and not actually allow your tendons and your ligaments and especially your pulleys to actually fully recover before you do your next climbing session.
And as you become more of an intermediate and especially a competitive climbers, that actually compete, then what ends up happening is, at that level of climbing and training, you know, you're really pushing yourself even more where sometimes you haven't fully recovered. And you have another training session where you're probably maybe 75% recovered and then you're stressing those ligaments and those tendons and the pulleys even more.
So I think one thing that'll be really helpful is to really just go over a really basic understanding and anatomy lesson. So there's a diagram here that I want to pull up and it's just a really basic diagram of the pulleys and the finger tendons. So if you actually look at it, when you look at the finger, the finger tendons actually are made up of two parts.
So you have what's called the superficial part. So basically that's the flexor digitorum, superficialis, the FDS, and that's the green tendon and it attaches, you can see how it goes all the way along to this, the middle bone of the finger. So let me actually just reorient you in the anatomy of the finger bones.
So your metacarpal is actually your hand and then your fingers actually made up of the three bones, which is proximal phalanx, the middle phalanx and the distal phalanx. And so you're flexor digitorum superficialis, which is one of the parts of the finger tendons attaches onto, right just distal or just away from one of the pulley ligaments, which I'll kind of describe in a second here. And so the deeper tendon, which is the flexor digitorum profundus extends all the way down to the distal phalanx, which is basically the tip of the fingers.
And so you have, there's a tendency to have a lot of overuse happening called tendinosis. Which you can develop swelling and over use in the tendon and it gets thickened. And that can be a huge problem when you're over-training and you get these types of overuse injuries in the tendons. It's very common. I see that quite a bit. And so that can happen a lot around that A3 pulley and on that flexor digitorum superficialis tendon.
So the interesting thing about climbing injuries that are a little bit more related to the pulleys now. So let me give you a little description of what the pulley is exactly. So as you can see on the diagram, so there's five pulleys in your fingers. And so they're labeled A1 to A5.
And so what a pulley actually is, a ligament that binds the tendon close to the bone. To provide a pulley structure to give your tendon more leverage. So when you think about climbing, you think about the tensile forces that you're producing. You want to, obviously, as you start off climbing, as a beginner climber, or if you've taken a large chunk of time off for whatever reason, if you've had kids like myself, or if you've just had an injury to something else where you couldn't climb or work or whatever it is, you want to start to really condition, not just those tendons that I just talked about, but even the pulleys. So what that means is that it's a gradual process and you want to load them lightly and allow them to recover. So that way you can basically increase the optimal loading gradually. And you always want to work within an optimal load.
So when you first start off, your optimal loading is gonna be lower. And then as you get stronger and as you build more strength into those tendons and into those pulleys and ligaments and your ultimate loading will be up to here. And where you have a injury starting to happen is when you start to go beyond that optimal loading.
So when you have a big layoff, you're obviously in suboptimal loading, so you're down here and then you go back to training and then now you may hit a bit of optimal loading, but then you go into overload and that's the danger zone. It's basically when you underload and then you go up to overloading and then your tendons just basically are the weak points and so are your pulleys.
And so the pulleys, the main ones that usually get injured, as you can see from the diagram are basically your A2 and your A3 pulleys. And I actually myself had an A3 pulley ligament injury along with the flexor digitorum superficialis tendon and having a tendinosis issue, which is inflammation and overuse and a partial rupture of the A3 pulley.
So one of the things that you can really look for is just basically like sometimes there may not even be pain during a session. It may come after, or you may hear like a pop in your finger. And you may get like swelling right away and it may balloon right up like a sausage. And so there's sort of guidelines that you want to actually take in terms of how much time off. Sometimes if it's just a minor strain, you don't need me to take any time off, but you want to decrease the amount of climbing that you do from say, like, if you're like climbing at a 100% to like less than 50%.
And essentially there's five different grades of assessing and diagnosing your, any of the pulley injuries or ruptures or tears. So when you look at like the first grade, it's really just a very minor strain, that's less than 25% of it being injured. And so at that point, you know, depending on how sensitive and what's going on, usually there's not really much swelling and you don't typically feel anything during the session you feel it like afterwards, and then especially the day after.
And so you don't necessarily have to take time off, but depending on what's going on, you might want to take a few days off to let that, if there is a bit of swelling to let that calm down, and then you can actually starts in light climbing within a week or two. But light being like safe, you're like you know, an avid climber that climbs that a 100% of 512, then you're only going to be doing 510s and really easy stuff. And certain specific holds you're going to actively try to avoid.
And you get in to grade two, then it's going to be more than 25% or less than 50% partial tear. And then at that point too, you want to take at least a week off, really let things settle down and then you can get back to the climbing.
As you get into the higher grades, grade three is a complete rupture. Here you want to take, depending on the nature of what else is going on, if you have other flex or tendon issues happening with overuse, and if you have other ligament injuries then you want to actually take a good, full two weeks off minimum. It can be up to two, maybe up to four weeks.
And in some cases, you know, if it's like really swollen and if it is a grade three injury, actually, you might need to immobilize it. So it's really important to get that swelling down initially. And then you do want to start to activate it and mobilize, do some therapy and I should actually reiterate that in the first two grades, grades one and two, you also want to do some active therapy and doing some things to get things moving and to actually rehabilitate it pretty quickly. But you're not going to be climbing right away for sure at a grade three, which is complete rupture.
A grade four injury is where now you start to have, you know, more than one of the pulleys being ruptured. So it could be like a full rupture of your A3 that we talked about and maybe a rupture of your A2. Here you want to definitely stop climbing for a certain amount of time and immobilize it to help take the swelling down and decrease the strain on the pulley so that it has a chance to heal. And that's actually really important at this level of an injury for your pulleys.
And then we're looking at like a grade five injury. The grade five injury, it's basically a full rupture to multiple pulleys, but also damage to ligaments and structures of other areas like your flexor tendons and with this. And also grade four, I'm not an expert in this area in terms of surgery, but this is where we might want to get a little bit more referral base and have a consultation with a specialist when we think it's a grade four and a grade five. Because that's where, you know, it's been a lot of benefits shown to have some kind of more intervention to really stiffen up those areas. Because essentially if you want to get better and get back up to the level of climbing that you were before, which is possible. Totally possible. You know, when you have multiple ruptures, especially if they're full ruptures, then you want to possibly look at some more expert intervention into that.
Mark: So for the first three grades, what's the kind of treatment protocol that people would typically be looking at?
Wil: Yeah, definitely a conservative management. And what that means is the first two to four weeks, definitely activation of your rehab stuff to really get the mobility going. That act of actually getting the finger tendons moving and gliding through the sheath and in the blood flow is really helpful for the healing process. And you don't want to overstress it either. So you got to let it heal. Let the swelling settle down before you, you start to progress to that.
And then once that settles down and you progress to that, then you want to actually start the load it a little bit. And the loading can be even just things that you can do not climbing wise, but just doing things where you're strengthening with certain implements, like, hand putty and certain things with elastic bands and really getting the whole kinetic chain too. So it's not just the hand and forearm, but also the shoulder and your core stability. Because that all is going to play a factor into it.
And then when you're looking at you know, climbing, that's where you really want to actually start loading it a little bit more because that will actually help and taping when you're climbing, you know, can actually help with decrease, decrease the forces in the actual pulley to help with your recovery process. And specific types of taping, like H taping, which you know, I can describe it in a later segment or provide a picture to that as well.
Mark: So some of this, I guess, is from people with access to climbing walls, indoor gyms, something that's not all that new, but for an old guy like me, it's completely foreign. I mean, we used to go outside and have to climb. So you weren't able to climb into winter unless you were ice climbing. And not that I climbed very much, but this new access kind of, and the ability to be there almost every day has probably allowed people to address their muscle strength way faster than they address their tendon and ligament strength. Is that a fair statement?
Wil: Yeah. I mean, there's definitely an accuracy to what you're saying, Mark. And one of the biggest things, like I mentioned before is that you know, when you start off too soon, it's the optimal loading that you want to be able to stay within that optimal loading zone. And so when we go back to that concept of that, then when you're looking at your muscles, your muscles are always going to be stronger.
They're going to get stronger, faster as well. So when you start you know, training sessions ramping them up, or even just starting training, if you've taken a big layoff, your muscles are going to get stronger faster, but it's the tendons that need to recover. That take longer recover. And they're usually the weak points, their tendons and the pulleys are usually the two weakest points.
And so when you're actually looking at that optimal loading zone, then you you're actually thinking about taking that optimal loading zone into more of a graduated higher and higher, like graduated level like this for your tendons and for your ligaments and for your pulley.
Mark: Yeah. So there you go. If you had a hand injury climbing, Hey, if you're climbing, you probably have had. The guys to see who are experts in it. Wil what did you want to say?
Wil: No, I was just gonna say that so there's actually really interesting statistic that 15% of 200 climbers that they surveyed in a two year period, have had a hand or finger injury. And then when they looked at competitive climbers that actually competed and whatnot, that increased up to 40%. And that was just in a two-year period of 200 climbers.
Mark: If you've got hand problems and you want to get back climbing, the guys to see are Insync Physio. You can reach them at (604) 566-9716. Or just go to the website. That's the Vancouver office on Cambie Street. The North Burnaby office is at (604) 298-4878. The easiest way is to go to the website insyncphysio.com. There's online booking there. You can set it up. You can try to get in to see Wil, he's an expert and a fellow climber, but he's always super busy and booked ahead.
They're all experts in this kind of stuff. They all talk and work together. They're going to get you feeling better fast, and if they can't, they will refer you to the right people who will be able to get you better fast. Insyncphysio.com. ThanksWil.
Wil: Thanks Mark.