Bumps, Lumps, and Sore Spots that get Hard: Understanding your bodies healing response to climbing.
Above: Dupuytrens Contracture in the palm of a climber.
Your fingers are what you make them. They can age drastically in one summer or the can be damage free after years of climbing as hard as you want. If you load them with say dynamic aggressive bouldering, they look drastically different from if you do gentle yet high grade trad climbing. After doing hundreds of ultrasounds in office on climbers just like you (professionals, weekend warriors, over exuberant newbies, etc), here's a bit of guidance on how to understand, and base your climbing decisions, on these lumps, bumps and sore spots. Should you be afraid of them? Should you climb through them and view them as normal?
As your body modifies itself to your uses, you need information on which to base your climbing decisions. What type of a climber you are directly relates to how long your fingers will last, not in regards to pain but in regards to bone spurs, tears and other forms of degeneration that you might not feel or see with the naked eye. Pain is secondary. The last to arrive and the first to disappear.
The photo shown to the left is a boulderer, mid-20's and an active gym rat. He works at a climbing gym, and of course he does it for fun too. You can tell by looking at his finger, that his body has tried its very best to respond to the load he has put upon it. He eats well, he sleeps well, and he tries to take time off after hard weekends, but climbs year after year with an aggressive manner. Set up for this abnormality, he is predisposed by genetics however his sport of choice speeds up the cycle. Let's learn from it.
You see, a climbers finger is not loaded symmetrically. Think about at how you place your fingers on each hold. The fingers are never loading as a knee would bend, in a straight symmetrical fashion. Instead, the hand is almost always rotated towards centerline with the outer portion of the finger being loaded MORE than the inner finger. This often gives rise to abnormal loading patterns of the FDS tendon near its insertion. The Flexor Digitorum Superficialis tendon splits into two bands to attach into the climbers calloused and irritated distal finger. Loaded for almost all of your hand motions more on the 5th digit side than the thumb side. The body does its best to then beef up this region (after repetitive load through climbing) by creating more scar tissue and more granular tissue around it at the site of abnormal load. So as you see, the photo above is not symmetrical (the left does not look like the right side of the photo. We shoudl be able to fold the image in half and have it look identical. Instead there are white bumps (granular scar tissue) and black (swelling) on the left of the image and NOT on the right.
Long story short, the more SHARP stuff you pull on, the more skin and superficial changes you will have. Your skin will become calloused (duh) but beneath the surface, you will get tendinous and soft tissue abnormalities due to the repetitive loading process. In the finger above, there are all these white bb looking dots on the upper left of the screen. This is in the soft tissue above, or superficial to the flexor tendons and is a direct consequence of loading over and over again into a tender and healing region. This climber did not listen to his body OR his body adapted and responded to light loads with increased granular tissue. The WHITE BBs are a denser tissue. And around them can form swelling as they are pressed repeatedly (with love) onto our favorite holds. If you feel a hard circular nodular bump, that feels unattached to tissues below, it might just be this case. The diagnosis can be as bad as 'trigger finger' where the body places this scar tissue onto the tissues overlying the tendon (such as the pulley) or they may be int he tissues surrounding the tendon, diagnosed as stenosing tenosynovitis.
In these climbers, guidance is essential to ensure that the proper climbing ettiequte is used. We don't want to MASH this area into sharp holds, it'll only make it worse and lead to more degeneration. Instead, we want to press any irritating rocky crystals or sharp edges above or below the region to safeguard it. This is a management case. We cannot delete or erase this new tissue with surgery or drugs. No amount of massage, pokey finger ring, or grating on it with tools will remove it, instead, it makes it worse as this is the bodies response to load and pressure. So in the end, proper diagnosis and guidance for climbing style, use and home-care is essential.
Before I forget, I did mention these changes are the result of REPETITIVE loading of the region. Consider mixing up the load, changing your style or making your style more 'finger friendly' as a nice compromise would go a long way to helping you to continue to enjoy your season and/or climbing life span? But first, if you are in pain and/or healing. Let it rest first. Then we can revisit the how/why.
The Bottom Line:
Self-care can seem intimidating for those who have never done it before. Often it seems scary to try to heal something as you might fear making your climbing injury worse. However, if you figure out how you want to heal yourself, what will make your injury worse and what will make it better, you will have less fear and more success healing your climbing injury. To speed your learning, For a limited time I am offering my very own self-care injury prevention book, Climbing Injuries Solved with the purchase of a Skype visit. Book a visit now and get this book in your inbox with a few other bits of important information to ensure you heal better than your teammates or your favorite climbing buddy.