Training for Climbing, 2nd: The Definitive Guide to Improving Your Performance (How To Climb Series)

brief. By contrast, the immature climber may try to climb through the injury, which all but guarantees a worse tear and an even longer, eventually forced, exit from climbing.
    The goal during the first few days following injury is to control inflammation (if present) with ice and non-steroidal anti-inflammatory (NSAID) medicines like ibuprofen or Naprosyn. Cease use of NSAIDs within three to five days (or less), since long-term use has been shown to impede the healing process and may even weaken tendons (see “Vitamin I” later in this chapter). “Buddy taping” (to an adjacent finger) or splinting of the injured finger can be beneficial during the first few days following injury, especially if you find it hard to limit use of your injured finger.
    Depending on the severity of the tear, pain typically subsides in two to ten weeks. Becoming pain-free, however is not the go-ahead to resume climbing! This is where many climbers go wrong—they return to climbing too soon and reinjure the partially healed tissue. As a general rule, wait an additional two weeks beyond becoming pain-free, then slowly return to climbing. In the case of a modest A2 pulley injury, this may mean a total of about forty-five days of climbing downtime.
    A French study of twelve elite climbers with A2 pulley injuries found that eight subjects were able to successfully return to climbing after forty-five days of rest (Moutet 1993). More severe pulley tears, however, may require as much as two or three months of rest before you can progressively return to climbing. The bottom line on these frustrating pulley injuries is to nip them in the bud by immediately initiating a rest and healing period away from climbing. Each successive day you continue to climb on the injured finger may effectively multiply the length of the healing process (and your eventual time away from climbing).
    In the case of a complete or multiple annular pulley rupture (Grade IV injury), surgical reconstruction is necessary. Hand surgeons have long performed reconstruction of annular pulleys in nonclimbing cases where a deep laceration had damaged the flexor tendon and tendon pulleys. Free tendon grafts are the most common method of pulley reconstruction (Seiler 2000). The grafts are most often harvested from the dorsal wrist extensor retinaculum or the palmaris longus, and loops of the tendon are sewn in place of the damaged pulley (Moutet 2003; Seiler 1995; Lister 1979). It has been shown that reconstruction with three loops can withstand as much force load to failure as a normal annular pulley (Lin 1989).
    An Austrian study reveals that annular pulley reconstruction has produced good functional and subjective results in climbers after eighteen to forty-three months of recovery time (Gabl 1998). Still, American physician Joel Rohrbough has examined numerous climbers who exhibit chronic bowstringing and continue to climb hard without disability. Based on this, he recommends against surgery, though he does encourage individuals to make an educated choice after discussion with a qualified surgeon (Rohrbough 2000).
    So how can you protect injured fingers from further damage? Reinforcing flexor tendon pulleys with cloth athletic tape is a popular method—but is this practice really effective? Several physicians are on record as stating that firm circumferential taping is beneficial. Rohrbough (2000) notes that “tape is a tremendous help, giving support to a weak or healing pulley, helping to hold the tendon against the bone.” Robinson (1988) says, “Use of tape around the fingers between joints is helpful,” because it acts to reinforce the flexor tendon pulleys, protect the joint from extreme positions by limiting range of motion, and helps protect the skin. Jebson (1997) advises using protective taping for two to three months upon returning to climbing after an A2 pulley injury.
    Despite these endorsements of prophylactic taping, I’ve seen one magazine article stating that taping “doesn’t make the tendon any stronger—in fact, it may restrict blood flow to the repairing tendon and weaken it” (Crouch 1998). Furthermore, a study done in Texas found “no statistically significant difference in load to A2 pulley failure between taped and untaped fingers” and concluded that “we do not support taping the base of fingers as a prophylactic measure” (Warme 2000). Let’s sort things out.
    Based on an objective analysis of all available studies, it seems that the