Category Archives for "Hand"

Hand and Finger Injuries – Rock Climbing Rehab – Hand Intrinsic Muscle Strengthening Part 2

If you’ve injured your finger tendon or a pulley ligament from rock climbing, then doing specific strength training for them can help you better rehab from it.

Start with your wrist in neutral, not flexed or extended. Then flex your index to last fingers at the knuckle joints only - or the Proximal Inter phalangeal joints, and then spread all the fingers apart (into abduction).

Return the fingers together and repeat this for 30 seconds doing 3 sets 2 times daily.

This exercise can help you heal, recover and rehab more effectively and increase your contact strength after a hand or finger injury from rock climbing. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Hand and Finger Injuries – Rock Climbing Rehab – Hand Intrinsic Muscles

If you have a finger tendon or annular pulley ligament injury, then doing strength training for the intrinsic muscles of your hand and fingers can help you rehab much better!

Start with your wrist in neutral, not flexed or extended. Then flex your index to last fingers at the knuckle joints only - or the Proximal Inter phalangeal joints. Return the fingers to the start position and repeat this for 30 seconds doing 3 sets 2 times daily.

This exercise can help you heal, recover and rehab more effectively and increase your contact strength after a hand or finger injury. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Rock Climbing: Hand and Finger Injuries

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.

Carpal Tunnel Syndrome – Dahra Zamudio

Hey guys, it's Dahra from Insync Physiotherapy here. And I'm here to talk about carpal tunnel syndrome and how physiotherapy can help individuals with this condition. So basically carpal tunnel syndrome is a compression of one of the nerves that travels through your forearm known as the median nerve.

So usually include pain, numbness, or the feeling of pins and needles and tingling in your hands. And typically involves some variation of the thumb, the index finger, middle finger, and one half of the ring finger, the side closest to your thumb. Here's a simple stretch, often prescribed, that stretches out the wrist flexors and decreases the compression of the median nerve.

So you lock your elbow out straight. Use your other hand to pull your wrist back until you feel a stretch in your forearm and hold this position for about 30 seconds and perform it three times a day. 

If you do suffer from this condition, physiotherapist can also give advice about workplace ergonomics and activity modifications that could potentially be exacerbating your symptoms. Physiotherapists can also guide you through therapeutic modalities and prescribe you a gradual progressive exercise program to help relieve your symptoms and get you back to the activities that you enjoy.

In the present day, with the onset of the Covid-19 pandemic, those who now need to work at home or have more free time at home, may find themselves spending more time on electronic devices. The issues that may arise from all this screen time is carpal tunnel syndrome.Generally those who have diabetes or arthritis are vulnerable to carpal tunnel syndrome. This includes: pregnant women (because of water retention), workers in trades or manufacturing jobs, the fishing industry, cleaning, culinary, cashiers, hairdressers, and those who participate in yoga, ultimate, and knit religiously.

Anatomically, the Carpal tunnel is found on the anterior side of the wrist and is known as the narrow passageway for 9 tendons and an important nerve known as the median nerve. When people complain about pain in their wrist, the pain is referred to as carpal tunnel syndrome which the National Institute of Neurological Disorders and Stroke states is“- the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.”

Carpal tunnel is a result of repetitive hand movements such as typing on your laptop or texting on your phone. It is also associated with improper positioning of the hand, mechanical stress on the palm, and grip holds. The pain felt is due to the lack of lubrication between the tendon and sheaths in the wrist causing friction with movement which leads to inflammation of the tendon area. The inflammation puts pressure on the median nerve in the carpal tunnel. With any injury, improper healing can lead to susceptibility to repeated injury and chronic pain. If carpal tunnel is left untreated the inflammation can lead to the thickening of the tendon and fibrous sheath resulting in decreased mobility in the wrist.

This syndrome causes numbness, tingling and pain in each digit and the thumb which the median nerve innervates. The pain may also radiate to the forearm and is intense enough to wake people or prevent people from sleeping. The median nerve controls the thumb, middle and ring finger, index finger and is vital in carrying movement and stimulus signals from the control centre, our brain.

Prevention Methods:
use of a splint to prevent further compromisation of the median nerve.
holding the wrist in dorsiflexion, having the wrist in a 70 degree angle toward you) overnight to relieve symptoms. Dorsiflexion stretches are a good way to alleviate wrist tightness.
corticosteroid injections into the carpal tunnel can be used.
If surgery is needed a surgical decompression of the carpal tunnel Will be done.

How can a physiotherapist help? Physiotherapists will guide you through a variety of therapeutic modalities and how to properly execute these exercises and stretches to relieve the strain as well as prescribe easy at home or at work exercises for instant relief of pain

Dequiverians – Texting Syndrome – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. How are you doing Adam? 

Adam: Doing well. How are you doing Mark? 

Mark: Good. So we're going to talk about something really a bit bizarre, but very common I think, or more common, perhaps texting disease or the dequiverians syndrome. What is this? 

Adam: Dequiverians syndrome is basically a tendonitis of the thumb and so it can be quite painful to the point where it's debilitating. And I was going to talk about a client who is a waitress and also a guitarist. And so she was using her thumb a fair bit to strum and it got to the point it started as like a nagging ache, but then she was carrying coffee pots to her customers and she was constantly turning that pot over. She just felt extreme pain to the point where she almost wasn't able to hold onto the pot. 

And you said it, it's actually kind of nicknamed in the medical field as the texting disease, because when you're using your thumb a lot to text, which we all do nowadays, it's an overuse injury. So it can typically cause inflammation of the muscles on the outside of the thumb. 

Mark: So how do you go about assessing this and determining what exactly is going on?

Adam: Yeah. So in this case, a big clue is pain location and then we do a thorough orthopedic assessments. We looked at her grip strength. We looked at her wrist range of motion. We also looked at her thumb movements. We checked the ligaments and bones in the area, and then we found where the inflammation was. And there's a couple of special tests, which stress that area. So we gently perform those tasks and were able to find out that there was some inflammation in the tendon called the extensor pollicis longus, and at that point we had a diagnosis. 

Mark: So, how did you go about treating, I guess does it vary from the first treatment onwards or how did that protocol work?

Adam: So a lot of this is education because it is an overuse injury. So we explain how to stretch some of the muscles in the hand that might be excessively tight when strong, and then how to strengthen the muscles that were aggravated in a safe manner. So the idea is that the thumb muscles on the outside of the hand are not strong enough to handle the load that she's putting in on it.

So there is a period of rest. And then, eventually we have to increase load capacity so the tendon can handle that load. First session, though, we definitely did some gentle isometric contractions, which are just contractions without movement of the inflamed tissue. And that really did take the pain away.

So there is some research that shows that isometric contractions can reduce pain or have an analgesic effect. The other thing we did since she was actually off work, she wasn't able to carry coffee and we all know how grumpy we get when we don't get our coffee, we taped her thumb. So we restricted range of motion into the painful direction, so she could actually work and she could trust herself that she wasn't going to stress the thumb in any way and be able to lift things.

We taught her a couple of stretches of the thenar eminence or those tight muscles in the front, in the palm part of the hand, in here. And together that was our first treatment basically. 

Mark: So future sessions, how did it progress from there? 

Adam: Yeah. So again, just a bit of load management. We start with kind of increasing the intensity of the isometric contractions. We start to make sure that we address some of the deficits that we found in grip strength. So we found that she was a lot weaker, even in her dominant hand in terms of grip strength. And then we taught some more advanced thumb strengthening exercises with movement and that sort of thing. And we were able to increase her amount of time without the tape on her hands. So she could start working without tape. And that was really helpful. 

Mark: And how is she doing now? 

Adam: Well, she's playing guitar. I don't think she has any shows due to COVID-19, but, she's working and she has no pain. So we were able to get this problem under control pretty quickly. 

Mark: Well, allow me to throw a curve at you. This is something that I have. Oh, are these things any good? 

Adam: Well, I would say certainly they're good. One of, interestingly enough, I just read a study that shows that grip strength, especially for elderly females, not necessarily you Mark, is one of the best indicators of longevity. So grip strength as we get older is really important. And so if you're working on your grip strength I'm impressed.  

Mark: So if you're having any issues with your hands from texting too much, it might even be bothering your neck a little bit. 

Adam: Absolutely. 

Mark: Insync Physio in Vancouver. You can book Adam Mann online at insyncphysio.com. They have two offices, one in Vancouver and if you want to talk to human being (604) 566-9716 is in Vancouver or in North Burnaby, six Oh four, two nine eight four eight seven eight to book. You have to book, they're always busy. Adam's always busy. He's an expert in this kind of stuff, but he'll get you feeling better and back doing all your favourite activities as soon as possible. Thanks Adam. 

Adam: Hey, have a good day. Keep on working out that grip strength.

Hand and Finger Injuries – Intrinsic Muscle Strengthening

Have you sustained a hand or finger injury, whether it’s a minor sprain by jamming it or something more serious like an annular pulley ligament tear? After letting the injury heal enough, then you need to work on strengthening the intrinsic hand muscles.

Start with the forearm vertically with the fingers pointing straight up. Keep your wrist straight and avoid bending it by bracing it with your other hand. Then perform finger flexion with your “MCP joints” or the knuckle joints of your index to pinky fingers. Do 3 sets of 30 reps daily.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your hand or fingers, consult your local Physiotherapist before continuing. 

Hand Muscle Stretch – Injury Prevention for The Hand

This stretch is great to do after doing some self massage on your hand when your hand feels tight or crampy. The deep inner hand muscles can get quite tight when doing high repetitions and especially with high loads with your hands and fingers. In the clinic we see many rock climbers that come in with various finger and hand injuries that also have elbow injuries related to this.

Start by making a closed crimp grip with the joints of your fingers, but avoid closing your hand so you don’t make a fist. Then place the meaty part above the heel of your opposite hand under the finger tips of your hand to be stretched, wrap your fingers over the knuckles of the hand and flex that wrist to extend what’s called the proximal Metacarpal joints.

This will give you a deep stretch into the hand. Hold this for 30 - 60 seconds doing 3 sets on each side.

If you’re unsure about the technique or have uncertainty about what you’re doing, consult your local Physiotherapist before continuing. 

Rock Climbing Hand Recovery – Healing Self Massage & Injury Prevention For The Hand

Having good contact strength is one of the most important things to have as an avid and competitive rock climber. Knowing how to help yourself in the recovery of your hand after a good climbing session is just as important as knowing how to train to increase that strength. This will help you reduce and prevent injuries which can help you be a stronger climber.

Start by grasping the webspace of your hand between your thumb and index finger with your other thumb and index finger. Then applying pressure, use your thumb to massage the top portion of the webspace of your hand. Turn the hand over and apply pressure to the palm side of the hand pushing out those knots.

Then, push with deep pressure and massage out the lumbrical muscles that sit in between each finger space on the palm side of the hand. All these spots can get really tight! Spend about 60 seconds on each of them for a total of 5 minutes doing some self massage after each work out session. 

Unlike other bigger muscles in your body, the hand doesn’t have redundant blood supply. So this means a little bit of this after each workout can go a long way for increasing blood supply and helping over worked muscles recover better and faster, so you can be better and stronger on your next climbs. If you’re unsure about the technique or have uncertainty about what you’re doing, consult your local Physiotherapist before continuing.