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Hangboard: Injured fingers degenerate.

Above: A healed but traumatized finger that shows signs of heavy wear and tear while climbing. The above climber is more likely to be a boulderer vs. trad climber.

Time to make sure YOU are getting what YOU need. Forget the future, forget your climbing goals. If you are in pain or have symptoms, it's time to discuss NOT loading the area. For now. To ensure you have a big beautiful climbing future and to ensure that you set yourself up to attain your climbing goals

Seen all the injury based training plans out there? Tread carefully. These are NOT in your best interests if you are currently on a plan that is loading the injured tissue while it heals. These trainers might THINK they are helping you, but read below to learn WHY you should look past their sales pitches and invest in yourself the right way, with science backing you up.

Knowing the anatomy that changes when you load a healing tissue during this important recovery phase. This is the goal of this article. TO empower you to help yourself. Let's go!

1. Tendons need TIME to heal, not load.

Contrary to anything you might have heard from 'better' climbers or those trying to sell you something... If you load your finger tendon (be it pulley, flexor tendon, or the synovium (lining) between the pulley and the flexor tendon) while it is trying to heal, this tissue is going to pick a tissue that is not native to the area. This is a NO NO.

Lets use common building materials we can all visibly see. Think of the materials used to build the trails that you approach your favorite project on. They begin as natural materials, but if washed away with flood or wear and tear (me slipping and falling down them most likely), they need to be repaired with new materials just like the tissues of your own body do.

In this example, you are walking on an access trail to your local boulder/crag... if that trail starts to shift or fail what does the Access Fund or Parks Service put in? Rocks. Boulders, Metal stakes. Shoveling soft dirt into the region. This modifies what the trail used to look like. The native materials are gone (washed away) and instead the region is replaced with something that can handle many many climbers plodding up and down. Here in boulder we use stone steps and logs. Check out their amazing trail work the next time you think about it!

What does your body repair with in response to load?

Our body responds in the same way as these trail builders do. Instead of picking sand to repair a tissue, the body picks heavy dense tissue that is harder to tear. Physiologically, with load/use the tissue as it repairs and heals, your body will either pick a super soft material that cannot handle the loads placed upon it with climbing ( such as mucoid tissue; think snot). Soft and useless when it comes to strength under load, this tissue isn't designed to bear the load of you hanging on your fingers over time.

The second response your body will decide to try (these usually happen together with spots of dark mucoid tissue and brighter fibrous or calcific material). If, in this second response, your body decides to go in with the extra strong material, fibrous or calcium based deposits, it is strong but not flexible. Tears often occur at the junction between the normal tissue and the calcium deposit (calcific tendonosis).

Training through injury creates WORSE tears and RAPID degeneration.

Ignore how your finger or elbow FEELS and consider what it is going through. Often we are unable to know at the cellular level what our bodies are experiencing.

As a climber, it might sound nice to have this tendon becoming stronger in this damaged region with the results of our less-than spectacular repair process. It appears to the untrained eye that a more rigid stiff tissue option would be valuable but consider the loads applied to this tissue. Strong with an unchanging load in the mid substance of this new tissue, the junctions where it meets your uninjured tissue is easily damaged.

Imagine grass and concrete. You can rip up the grass, a weaker structure to replace it with the far superior concrete (if we're talking strength and rigidity) but there is no way to blend the two at the junction of grass and concrete where the connection is as strong as the concrete itself. Under load, the two structures would easily break apart. This is the same concept in regards to the melding of repaired tissue to undamaged tissue. We often see improper bonding and a zone that is easily re-injured.

The downside to your new stronger calcific or fibrotic tissue, is that instead of flexing under load (without tearing), under the normal climbing scenario of pulling on a hold or popping off a hold, this tissue is shock-loaded and it fails. .What this means is that your old tear can suddenly reappear and is at risk of getting bigger and bigger. This repetitive cycle is called tendinosis.

Hangboarding on an injury causes Tendinosis. As does slapping, jumping to and aggressively popping off of holds....

A form of tendon degeneration, Tendinosis is NOT a positive form of healing the tendon. Instead, it sets you up for less years of use before a massive tear occurs. Most of you will have an idea of this long before you hit this level. Your finger will give you the tell tale signals that it is undergoing progressive abnormal wear and tear. Take heed and support it accordingly.

Learning from our Injuries.

As each finger is different, this is an excellent opportunity to ask WHY this finger is wearing out prematurely (how many fingers do you have?!?)

As your healchare provider, it is my job to evaluate how far along on this tendinosis pathway you are and to educate you as to preserving this tissue so you have many decades of climbing ahead of you.

Any burning, swelling or weakness out of your tissue (no matter how momentary and non-reproducible) is a big fatty red flag that you should NOT be climbing on this tissue and instead should be letting the poor tissue heal.

During your ultrasound evaluation, we can not only manage tears but we can prevent your tendinosis from progressing. If you are a smart, calculated climber, there should be no reason why you shouldn't have years and years of pain free climbing ahead of you.

If I've caught you after the fact of damage, load, time off, damage and cyclic injury, it is my goal to educate you, catch you in the act, and hopefully revert you to a self-control status in which you know which finger to manage (and which you can continue to have fun with).

In my office, an ultrasound is invaluable. For example this week we had a climber come in with multiple finger injuries. Upon evaluating his painful finger, we saw current swelling but the structures were stable. In the finger next to it, we found a big bone spur and a tendon that had been irritated, that it was farther down the tendinosis degeneration pathway than his current injury. The good news is that he now can unload and manage the old injury and knows that any mono pockets or dyne moves onto the old nasty finger are to be avoided (in comparison, the current injury will heal and there is no reason why, if he follows my care plan to a T, that he can't continue to climb normally on it after recovery to his fullest with no modification).

Want to learn more about sonography? Check out this link.

Climb in Health,

Dr. Lisa

Continued Reading:

Shoulder Sonography-Why We Do It. Sharlene A. Teefey MD. J Ultrasound Med. 2012 Sep;31(9):1325-31. 01 September 2012

Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley-Protection Splint—A Series of 47 Cases. WILDERNESS & ENVIRONMENTAL MEDICINE, 27, 211–218 (2016). Micha Schneeberger, BS; Andreas Schweizer, MD

The pulleys of the flexor apparatus: anatomy, pathologies, treatmentFlexor tendon pulley system: anatomy, pathology, treatment. Author links open overlay panel. F Moutet. Hand surgery.Volume 22, Issue 1 , 1-12. 01 January 2003.

Also, check out my tendonosis blog to cover/learn more about this fascinating process.

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