Pushing Through the Tweaks, Twinges, and Pains: Fingers and Elbows.

I've been a little hesitant to write this blog post, so let me get this out in the open right now: I'm not a doctor.  I'm not a physical therapist.  Hell, I don't even like to go to the doctor, which ironically is my only qualification in writing this post. That, and this is my blog so I can write whatever the hell I want.

One more thing: I'm in no way suggesting that you take any of my advice.  I'm merely telling you what has worked for me.  Many of you may believe my advice to be dangerous.  Welcome to earth, newcomer, where the mortality rate is 100%.  What are you going to do with your short time?  Rest away all the tweaks and twinges, or push through the pain and keep getting better?  I suppose that's up to you.

What you absolutely SHOULD do is decide for yourself whether the severity of the pain or injury is enough to warrant seeing a doctor, and only embark on a course of healing that you feel comfortable with.

Now that we understand that I'm no medical professional, let's get on with it.  All of us are going to get hurt at some point.  A finger, a shoulder, an elbow, a knee; something.  Probably all of them.  Probably all of them several times.  And then a few more.  Climbing is hard on our bodies, particularly if you make a habit of going for it, pushing yourself, or giving maximum effort.  I've got some experience in this department.  I've nursed myself through multiple tweaks to each of my four middle fingers, strains to both knees, both shoulders, several cases of tendonitis in both sides of both elbows, and one very odd tendonitis in the back of my hand that did scary things.  I currently have (this is my own diagnosis) medial epicondylosis in my right elbow, and a strain (or possibly tendonitis) of the supraspinatus tendon in my right shoulder.  The thing that all these have in common is that I climbed (or am climbing) through them, and that they all eventually disappeared and allowed for mostly pain free seasons.  In fact, the only injury that has forced time off was a broken hand, which I sustained while belaying my friend Justin Edl on an ultra thin RP seam in Vedauwoo.  He fell, his gear pulled, and I tried to physically catch him.  We rolled in the talus, he bruised his heels, I broke my hand.  The resulting time off was the period of inactivity that confirmed to me that I had to start training and get better at this climbing thing. Thanks, Justin.

Why not just rest until the tweak is no longer tweaking?  Frankly, I've never heard of anyone, though they may exist, who rested through one of these injuries, continued training, and never had a recurrence of the same injury.  More often I hear that someone has taken two months off to clear up a sore elbow, and saw it return within a week.  In my opinion, resting is ignoring the issue.  You're letting the symptoms go away, but you're not addressing the root of the problem.  There are steps you can take to strengthen the weakened, injured areas that don't require you to stop climbing entirely.  In fact, in most cases, where the injury is a tweak or twinge rather than something more severe, continuing to climb will actually help the healing process.

Let's take a look at a few of the common climbing injuries I've had over the years, and I'll tell you what I did to help the healing process and how (if) it changed my climbing at the time.  Again, these instances are merely anecdotal evidence that it can work; what you choose to do about your injury is entirely up to you.  This post is only part one and will deal exclusively with fingers and elbows.  Later, I'll discuss shoulders and knees.

Fingers

I'll start with the most common: those fragile fingers.  The tiny crimps and tweaky pockets, combined with the big dynamic movements that make up many a difficult gym problem, can be hell on your fingers.  Add in the fact that the wood and plastic flex a little, then pull back on your fingers, adding to the forces, and you have a recipe for potential disaster.  I've had dozens of minor tweaks in my fingers and none have amounted to an epic story.  Nearly every one has been the common pulley injury, usually at the A2 pulley.

I'll be honest... the first thing I do when I have a finger injury is go to an online article written by Dave MacLeod.  I decide on a diagnosis, and based on Dave's advice, I choose a path of action.  He's the expert in the matter, and has compiled loads of good information on his site concerning finger injuries.  If I'm not mistaken, he has a book in the works on the subject.

While I haven't had a finger injury in a few years, I generally follow the same protocol I learned from Dave's site.  I take a day or two off of training to allow the inflamed tissue to quiet down.  Once back in the gym, I sometimes tape the digit, not for support, but more as a reminder that it's hurt.  I climb only open-handed for a while, and if I encounter a move that particularly strains that finger, I just don't do it.  No big deal.  As far as therapy goes, I use the "ice therapy" and "deep friction massage" advice from Dave.  I could explain it here, but I'd rather you go read Dave's article, and do not skip over the "ice therapy" section... it isn't what you think and I've had great results from it.  A few weeks of this, and my fingers are as good as new.

Prevention

Before you begin pulling on nasty little holds, be sure to warm your fingers up thoroughly.  If your intended project involves tweaky pockets, do some easier pocket pulling.  Same for crimps.  Ease into it... you'll know if your fingers aren't ready yet, and don't push it until they are.

There is one important thing that I can't stress enough: climbing in control is a must if you wish to avoid finger injuries.  This doesn't mean that you can't jump or make huge deadpoints.  This simply means that you should always strive to be in control of your movements.  Precise anticipation of the moment of contact when you're jumping to a small crimp will go a long way to reduce the risk of injury.  Flop to the small crimps, and you should probably go ahead and keep Dave's article up in your browser permanently.

This is by no means the only injury that can happen to your fingers; it is simply the most common.  Use your own judgment in proceeding with any course of treatment.

Elbows

If you've just ramped up your training intensity or volume, or you've recently visited the squeezefest nightmares of Horsepens 40, your elbows are probably screaming at you.  Once upon a time I regularly had to battle bad elbows.  I discovered how to rid myself of the problem, only to rediscover the pain on a recent trip to those same southern slopers.  No matter, I'm two weeks post trip, haven't slowed my training at all, and the pain is nearly gone.

Being familiar with the injury, I didn't need to do any research to reach diagnosis.  However, normally I'd have gone back to an old article that was first published by Julian Saunders in Rock and Ice, called "Dodgy Elbows".  After years of battle I found this article, and within a week my pain was gone.  I've made a few alterations to my course of treatment, which for me has worked every time, and as long as I keep up with the treatments somewhat regularly, the pain is kept at bay.  Medial epicondylosis or epicondylitis (Golfer's Elbow) occurs on the bony protrusion on the inside of the elbow.  The lateral version (Tennis Elbow) occurs on the bony protrusion on the outside of your elbow.  I've had both, so let's take a look at them.

Golfer's Elbow

This is the one that hits me most often.  As I believe what I am most often afflicted with is tendinosis, I don't use any anti-inflammatory drugs as I would with tendinitis.  Instead, at least five days a week I use a 20 lb dumbbell to complete the exercises shown here and detailed in the Saunders article:

I hold the dumbell in the palm of my hand, thumb against my fingers.  I let the weight slowly roll out to my fingertips and lower slowly.  At the bottom of the movement, I use the other hand to pick the weight up and return it to my palm.  I make sure to keep my arm at an angle that hurts the most.  Also, I treat this not like a therapy exercise, but as a workout.  I do sets of 10 or 12, and a final set until failure.  It hurts.  A lot.  And then the pain is gone.  Generally speaking, if I get back to doing this exercise at the first sign of pain in the elbow, it disappears immediately.  I try to keep at it for a few weeks or the twinges will return.  After the exercise, I ice the elbow, something like 5 minutes on, 5 minutes off, for about 30 minutes.

Tennis Elbow

For this exercise, I prefer to use a rubber "Flexbar" made by TheraBand (I have the green one).  When I tried it with the dumbell, the weight I needed to make the exercise effective only served to hurt my thumb.  The "Flexbar" can also be used for Golfer's Elbow, but I find it less effective than the dumbbell method described above.

Tennis elbow treatment is essentially the opposite of the exercise used for Golfer's Elbow.  What the picture below doesn't show is that after you finish these motions, you release the bar with the noninvolved hand and return to the first step, Figure 1A, and repeat.  You can see the full sequence in this video:

Again, I treat this like a workout, and not as if it's therapy.  I push through the pain, and do several sets until it hurts.  And once again, I ice the elbow afterward.

Prevention

Elbow injuries can result from a number of factors, one of which is improperly balanced biceps/triceps.  Climbers use their biceps constantly, but only engage the tricep during the odd mantle move.  Doing pushups and tricep extensions will not only make you stronger and better balanced, but keep your elbow at a lower risk of injury.  Just as with finger injuries, climbing in control is paramount.  Excessive crimping will wreak havoc on the elbows, so try to climb in an openhanded grip as much as possible.  For me, the squeezing of a true compression problem is the worst culprit.  Constantly mix up the style of problems that you're climbing, and be careful not to overwork any one style.  Be sure to get plenty of rest between training sessions and your elbows will be much happier at the start of the next session.

Once you've had these injuries, you're more prone to have them again.  I've noticed that when I'm dilligent about the exercises and treatments listed above, I can climb relatively pain free.  The work has to be done - there are no shortcuts.

Side note:  I'm currently in a power phase, in which I've included campusing.  Campusing is the exact thing that started the ball rolling with my elbow problems, so in light of my elbow condition, I was tempted to skip it.  In fact, I would suggest to anyone else that they skip it.  This time around, I'm going to try and be extra diligent about the treatments, be smart about the campusing, and see how it goes.  So far, the elbow pain is diminishing at the same time as I'm getting stronger on the campus board.  

I'll report back and let you know the deal. 

Next week:  Shoulders and Knees.