Rock Climbing Hand Injury with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto. He's the owner, clinical director of Insync Physio in Vancouver. And we're gonna talk about rock climbing hand pain. How you doing Wil? 

Wil: I'm not doing too bad. Thanks, Mark. 

Mark: So, what kind of symptoms would, obviously their hand is gonna hurt, but are there other indications that would kind of lead someone, a rock climber to understand, Hey, you've got hand pain, that's just not gonna go way by itself. You need to get in and get some help. 

Wil: Yeah, so there's a couple of different types of presentation to this. So the first type is what I would term as a traumatic injury, where someone does something and they feel like a pop or they hear a pop, audible loud sound or whatever. Or if they're climbing and they feel it pull right away. And so that's what I would term like the traumatic side of things. 

And then there's also the non-traumatic, which is sort of like I'm not really sure when it started. I kind of just woke up the next day after climbing and it started getting a little sore. So I wanna talk a little bit more about the non-traumatic because we've been seeing a lot of that in our clinics lately.

And we treat a lot of rock climbers. And one of the things that really pops up is the history, like looking at what kind of things that this individual's been doing. So first of all, are they a relatively new climber? Like did they just start? And usually if they're a new climber, they're hitting the gym a little bit more. And so they're probably going at like a frequency, maybe two or three times per week. 

And if they're like super avid, which I've seen before and our group of physios have seen before, like, of the four or five times a week as a newbie. And when this starts presents, it's usually like three, four months post after they started climate because they've just started to go hard at it.

And then they don't necessarily, like I said, feel any tweak or pulling, like when they have their session or if they go outside, they don't necessarily feel that day. They may feel later that night and then the next day and then it starts to build or it may go away after a little bit, and then they go climbing again, and then it starts to get even more sore the day after. So builds in that way. 

It's really important when you're looking at those type of climbers, to look at what else they're doing. Now, even for more intermediate and more veteran climbers, and then even our competitive climbers, like I'm treating some competitive climbers, where you know, you gotta look at what's going on in their training. And did they take a break for some time. There's an individual that I'm treating right now as a professional competitive climber who, you know, took a long break because of an injury. And so are there other compensations happening when they start back up. 

But usually we're looking at the slower, like the gradual onset. You wanna look at what's different in the training volume and what are they doing for recovery. And that's pretty consistent, like what they're doing or what they're not doing. Whether it's a beginner, intermediate, veteran, or competitive climber. So those are important things to look for. 

And so most likely when you're looking at what's actually going on. Then okay, so maybe they strained a tendon. Maybe they have some what's called tendonosis or reactive inflammation, because it's just chronic overuse. There's a lot of imbalance going on, and they haven't been recovering properly. So they haven't been doing the things that really looking at, you know, making sure the far muscles are less tense, so it puts less force and tension on the actual tendons that go all the way down into the hand and the fingers.

Because when you have that constant tension in the forearms and it's not being released and you're not recovering from that properly, then what happens is then you have that constant tension and force pulling down, and then you're climbing 2, 3, 4 days a week and you're doing car gym sessions. Then something's gotta give. And it can be that gradual onset.

The other thing that's also really interesting with a lot of these, even intermediate to veteran climbers, that are doing these sessions in the gym or whatnot, where they're getting this gradual onset of hand pain is that they have other stuff going on higher up. 

Like treating another individual right now, who has shoulder issues. And actually three, I can count actually right now, we're treating three climbers right now who have actual shoulder issues that are related to their hand pain and the hand injuries. And one of them had like a strained rotator cuff five years ago that was never really addressed. Another one had sprain in the shoulder and didn't get it rehabbed properly and it's way weaker. And then another one just started like developing shoulder pain in addition with the hand pain, which is interesting. 

And then if you go even higher up, then you're looking at the neck. And a lot of these climbers they have issues with the neck where it can actually start to compensate. And you get all this what's called a neuropathy, and then neuropathy, big word but basically it's a dysfunction of the nerve related to the muscle going all the way down from the neck to the shoulder, arm, forearm and fingers. So we see a lot of that as well. 

Mark: So diagnosis becomes really important. I guess one of the things that I wondered about right away when we started talking about this, was how do you tell the difference or how important is it to know or diagnose the difference between someone who might be having arthritis showing up in their hands ,compared to they're over training?

Wil: Yeah, that's actually very important too. Because with rock climbers and we've treated quite a few veteran rock climbers now, who you know, they have hand pain and they have arthritis in combination. So that is super important to have an accurate diagnosis. Because if we're just treating the symptom, it's just putting a bandaid on it, obviously. Like for example, this one individual was getting treatment just for their hand with like a really good hand therapist that I know, but they weren't really addressing the stuff up here. Within like three or four treatments as we started addressing this stuff and the hand stuff at the same time, the hand stuff started getting better.

And so it's really important because if you're just treating the hand, like it may feel better and then they stop doing stuff. But climbers they wanna know when they can get back climbing again. And so you need to direct root cause of what's going on. So yeah, there might be a specific issue. You may have arthritis. Okay, so let's, you know, work on mitigating that. And they may have some of the other stuff that I was talking about, with like the reactive tendon overuse stuff or whatever. And then there's more serious things going on that can happen in the hand like pulley injuries. But that's usually more on the traumatic side of things.

But ultimately we need to figure out what is the root cause? Is it coming from up, like is this stuff up in here in the neck or the shoulder, or even the elbow driving that hand pain?

Mark: Of course, I guess it's gonna depend on what the actual cause is or what's happening. But what's a typical course of treatment going to look like?

Wil: Yeah. So once we identify what are the driving factors, then we wanna treat those areas. And that's why the diagnosis and figuring out the driving factors are that important. So in addition to treating, you know, normally, like someone that has that pain going on. We're not gonna be treating the hand. We maybe be like doing some stuff to take down the swelling, but we're gonna look at okay, the forearm, like those muscles, what are they doing? They're just pulling, they're not letting go.

So we gotta treat that. And then we gotta look at, okay, so if the posture is really offset, then we gotta reset that. And if the neck is really driving and we gotta reset that. So there's all these things that we gotta do to address those driving factors on a postural level, on a mobility level, and on a strength level. And then finally on muscle coordination or muscle activation level. 

Mark: Yeah. And that's where each piece is connecting to the other and perhaps causing the issues, but also then becomes really important to not re-cause it later on. 

Wil: Exactly. 100%. 

Mark: Complicated, essentially. And of course, turned around when something that we've talked about quite a bit before, which is in order for this to be healed, you still have to keep moving. It's not a question of just quitting and not doing anything for three months and it's gonna go away. That ain't gonna fix it.

Wil: Yep, absolutely. We need to keep addressing the mobility factors in this whole issue with the hand pain and look at what's not moving from the hand all the way up to the neck. 

Mark: You need expert diagnosis. You need experts who can actually find the root cause of the issue and you need to keep it moving in a way that's not gonna cause more problems, but it's actually gonna accelerate your healing. And the guys to see who are experts in all of this are Insync Physio. You can book online at insyncphysio.com, or you can call the Vancouver office at (604) 566-9716. Thanks Wil. 

Wil: Thank you, Mark.