Giving finger pain the middle finger

Josh first came to the clinic June of 2022 with an injury to his middle finger after projecting a boulder out at Red Rocks. He had gotten the send, but been left with a nagging injury to his PIP joint. He tried resting a couple weeks, only to re-injure things when climbing again.

I included Josh's responses from our interview to help paint a picture for others.

He told me:

"I experienced swelling, increased pain, and inability to fully close the joint. I initially took 2 weeks off to let it heal. Then when I came back to climbing, I would repeatedly reinjure it to the point where I decided to take a full month off. Afterwards, I returned to climbing and still had the same issues."

Swelling of the PIP joint 3rd finger

Decreased range of motion during finger flexion

"All the methods I had tried on my own were not working so I wanted to seek out professional help."

During his initial assessment, Josh's signs and symptoms were consistent with PIP joint capsulitis and a collateral ligament sprain. When we looked more closely at the boulder problem he attributed the injury to, it had a pretty mean sidepull on the crux, which meant repeated tries of crimping and twisting. These motions are a common mechanism of injury.

Like many clients I've worked with, when Josh first came in, he was already doing some of the things I would recommend for this rehab. In my experience, climbers are pretty resourceful and there is a wealth of information online about how to come back from injuries. However, one thing that is often lacking is the right dosage and right timeline for progression. Knowing when to progress rehab exercises and how to return to activity, ie. climbing, makes a tremendous difference in coming back from finger injuries.

Josh's range of motion returned on a pretty standard timeline for healing, much like other joint injuries I've seen. Unlike others, his pain was still pretty nagging.

I remember telling Josh to trust the process and stay the course. It had taken quite a while for things to get this bad, which can mean a lengthier time to recovery. Slow progress is still progress, but it's about as much fun as watching water boil.

Improved range of motion

With improved mobility in his finger, he started on a progressive loading program. This included finger eccentrics using a dumbbell, some unique finger "dancing" to promote healing and support of the collateral ligament via opposing muscle groups, and a hangboarding protocol to start his return to climbing.

This was where things really started to turn the corner. Josh was able to load his fingers in a controlled manner. He was soon getting back to climbing, and stoked about that, but far from his pre-injury level. In rehab, we focused on incorporating a greater repertoire of grip positions, and saving that full crimp for the times when it is really truly needed. Every time we met, he was progressing in difficulty and having decreasing symptoms.

Then came a setback. A day of outdoor climbing left him with sore fingers for 3 days in a row.

But actually, this ended up being less of a setback and more of an "aha" moment. From our previous sessions, Josh already had the tools to manage his symptoms. He was able to take 1 step back in rehab exercises, and then by the time we met again in person, he was again making strides and getting closer to his 100%.

As a PT, this is my favorite point in the rehab process. All sorts of fun stuff happening including hangboarding, fingerboarding, and full body exercises. Trying hard and listening to your body. Some soreness is to be expected, but in the right context it means that we our body is responding appropriately to what we ask of it.

At our last session, Josh had met his goals and was back to 100%. He said it best:

"My performance is where I would like it to be. I can try with full effort and confidence.

I mentioned it before, but the guidance and resources were invaluable. Everyone’s situation is different, and it helps to have personalized professional help. I not only recovered but also gained the knowledge and tools to help me prevent and treat similar issues in the future."

When I asked what was most helpful during his rehab process, Josh said:

"I believe the most helpful part was the overall support and direction. It was helpful to have someone tell me how much to push or not push myself at each point in the rehab process. Aaron was able to give me a structured rehab protocol/timeline, what to expect, and most importantly make adjustments as needed for my particular situation. He was a valuable resource in terms of guidance and was able to answer my many questions along the way."

Full effort and confidence

Research consistently shows that early physical therapy leads to better outcomes. Rehab progresses in a faster, more predictable manner. Especially with finger injuries, I always encourage people to seek professional medical help as early as possible so that they can get back to climbing and sending at 100%.