Tuesday, 11 August

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A2 inflamation?

Tina Spang (f)
Hej! I have pain at the base of the middle finger, where the A2 pulley is. When I press at the base of the finger it hurts and  when i grab holds with my fingers in 90 degrees angle it hurts. I can feel the pulley inside and it feels like it is swollen. I never noticed an instant injury, the pain appeared after a workout. I have had this pain for almost two months now and am starting to get really sick of it. I have tried Ipren for five days two times, I have tried icebaths, I have tried warm water baths, I have tried rest for almost two weeks and nothing helpes. The only change is when I had the restperiod and after/during the rest it got worse. I am now considering an injection of cortisone. Is this the way to go. I have heard you can get a lot of bad side effects of cortisone but what are they. And what are the god thing about cortisone? Still hoping for the best and for an magic answer. Thanks! //Tina

Daniel Krist
Do not get a cortisone shot. That will only temporarily reduce inflammation, not help heal your damaged pulley. Stop taking ibuprofen, for the same reason. Look here for a great explanation of pulley injury rehab: http://www.onlineclimbingcoach.blogspot.com/2010/05/pulley-injuries-article.html some more good info: http://www.onlineclimbingcoach.blogspot.com/2012/03/injuries-problem-with-lay-off.html Progressive rehabilitation is the key. Pulleys are slow to heal; this is more likely to be a process of months, not weeks. Patience is key. 
Anders Ljunggren
Had this on three fingers, don't stop climbing, but climb only with open hand. Do NOT crimp, not even open crimp, just use holds where the hand is open. I tape the hurting finger so that it's impossible to crimp, cause once in a while you forget yourself. It will take many weeks to get fully recovered, but you will get strong on open hand which isn't a bad thing.
Tina Spang (f)
Thanks for your replys, and for your reading tips, wich I already have read. I have some experience myself regarding these kind of injury. Three years ago the A2 pylley on my ringfinger ruptured with the classic loud "pop". As strange as i may be I never had any pain from this and my finger never got swollen. Since that injury i never crimp on holds, I learnde how to get strong with the open hand position. Anybody out there who has excperience with akupunkture to reduce inflamation? Thanks again! //Tina
Gonzalo R
Use the X taping technic to lower the movement of the to first two phalanxes, lower the intensity of your trainings (use better hand holds and lower volume) and finally progress into a more open kind of grip. You will feel strange for some months, because its a different kind of climbing, but eventually open grip will become a bit more strong and you will safer that way. Keep using tape for some months until you dont notice pain. Keep the icebaths. Maybe some low intensity exercises during rest days may benefit on the inrush of blood to the zone. You can use theraband elastics, plastic balls or tennis balls. All is fine as long it doesnt hurt. LOTS OF STRETCHING and never cold stretching.
Tina Spang (f)
Update. I have now seen a doctor, not a specialist but experienced.  He advised me to have a restperiod for two months. He objected to cortisoneinjection. He also said I should not squeeze anything with my hand. The hardest workload he recomended was playing the piano. If anybody professional recomend me to continue climbing, that is what I will do, because two months without climbing will drive me crazy!
Ron Berends
Such a familiar case unfortunately. I am suffering multiple A2 (and A4) injuries for already 6 months. After some months of struggle I have consulted a sports physician (linked to the Dutch climbing team). Conclusion: tendons and pulleys are not adapted to the abnormal forces. The only thing that helps is to give your body enough time to adapt to climbing. Please remind that it takes at least 2 years before your pulleys are adapted to climbing, depending on the age when you started climbing. After a injury, it takes at least 1 year for a pulley to fully recover and have the 'old' strength. Because pulleys are slowly healing including the connective ('scar') tissue that has to adapt as well. Therefore, always use supportive taping for old injuries (1-2 years), and keep stretching your fingers to prevent 'trigger' fingers. I do not believe in complete rest for 2 months since you have to 'remind' your body to the activity of climbing. Supportive muscles such as forearms and core muscle need to be strong to prevent injuries. Even in acute ruptures you only take 2 weeks complete rest and immobilisation. I have experienced that you have to decrease the intensity to a minimum level. For me this was 5a when my redpoint level is 6c. Decrease the amount of climbing sessions per week and allow at least 2 days of rest in between. This is almost as hard as not climbing, if not worse. Try to prevent crimping and overhanging routes. After 2 months you can slowly increase the intensity. When you notice it did not help, decrease the intensity even more to the level at which you experience improvement. Additional therapy for me includes taking glucosamine during recovery after a training session. Glucosamine is an essential building block of your ligaments and tendons. It even has a slight anti-inflammatory effect. Please note that there is no scientific proof at all that this might help for pulley ruptures. However it makes sense. Glucosamine is a nutritional supplement and over the counter available in the Netherlands. but please consult your doctor first before taking it. Furthermore, I was adviced by my sports physician to squeeze in rubber balls or rings with a frequency of 180 times per hand! Do not focus on maximum power but on slowly expanding the ball to its normal size. This will train your pulleys for the eccentric powers of climbing, and trains your forearms as well. Again, this is not proven scientifically but copied from similar injuries in other ligament injuries. Last but not least, push ups will train your forearms, larger muscles and core muscles to fully support your fingers. So, quite a large story but I hope it will help. If you love climbing as much as we all do, then please allow yourself to recover. This will prevent you ending up in frustration and provides much climbing fun on a long-term.
Tina Spang (f)
Thanks again for your answer. What an enormous amount of experience we can collect here:) I have been climbing for twelve years, so I guess you can call med quite experienced. I almost only boulder nowwdays since it is a lot easier running after your kids when you are not attaced to a rope;). I guess you did see a hand/fingerspecialist. When I ruptured (not complete)my pulley three years ago I was advised complete rest for ten weeks. I guess doctors do not have enough injurys to study yet to know which treatment is the best. Thanks for your training tips also. I already do them all... I have a theory that lack of sleep weakens your body/tissues, or that constant tirerdness makes you not noticing when you get tired and should go home istead of giving it one last try. Last time I hurt my finger my second child was about the same age as my third on is now when I got injured again. Anybody professional who can confirm? Regards //Tina
Tina Spang (f)
Anybody knows if this forum is read by the doctor? Mabye he has been to Thailand for the last weeks? Still no change in my finger btw...:(
Jon Smith
My experience with A2 injuries, and I've had several in different fingers, is that rest is the way to go. I've sometimes rested for several months, even though I have nothing to do on my free time when I can't climb. Usually a few weeks rest is enough but when you eventually return to climbing make sure to start by climbing easy routes, use big handholds and footholds and avoid overhangs, then slowly progress to harder stuff. This is my experience anyway and it has been proven to work (on me).
Tina Spang (f)
Thank you for sharing your experience!I now have an appointment with a handspecialist on monday. Really nervous about the weridict!Still no word from dr Stromberg...
Caroline Even
Hi Tina, any update on your status? How did you end up recovering? I have had an A2 + A4 strain/pulley for 12 weeks now, and it is still painful to touch at times, and still feels weak. I initially kept climbing on it, took 2 weeks off as things were not getting better, started climbing again, and stopped again - I am now 4 weeks off climbing, but I load the injury on my fingerboard every now and then on open hand crimps and pull ups. I guess things improved slightly, but no miracle and I am getting very frustrated like you!