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

restricting blood flow or flexion.
     

     
    The X method may provide additional tendon support to the A3, A4, and cruciform pulleys, and it’s very effective at preventing skin wear (and pain) when you’re climbing on sharp pockets or rough indoor holds. Tear a long strip of tape, approximately 16 inches in length by 0.75 inch wide. With a slight bend in the finger, begin with two turns of tape over the proximal phalanx (on top of the A2 pulley), and then cross under the PIP joint and take two turns around the middle phalanx. Cross back under the PIP joint and conclude with another turn or two around the base of the finger.
     
    Therefore, it seems that taping should have a small positive effect in reinforcing the A2 pulley, and you should consider this practice for providing some protection of a previously injured tendon. Three different taping techniques are shown in the “Prophylactic Taping Methods” box above.
FLEXOR TENDINOSIS, AND TENDON RUPTURE AND AVULSION
     
    Several other injuries can produce pain and diminished function in ways similar to an injured annular pulley. (As stated earlier, diagnosis can be difficult—see a physician to be completely sure what you are dealing with.) Tendinosis can develop in the FDS or FDP tendon as a result of repetitive stress. In this case pain may be limited to the palm side of the finger or extend into the palm or forearm (Jebson 1997). Extended rest is the primary treatment, followed by a gradual return to climbing a few weeks after cessation of pain (as described for tendon pulley injuries).
    In rare cases a flexor tendon may rupture or avulse (pull out at the point of insertion). Jebson (1997) states that an FDS tendon rupture may occur with the crimp grip, while an FDP tendon rupture is more likely with a pocket grip. Either rupture or avulsion would occur acutely with immediate onset of pain. Jebson states that symptoms include pain at the FDS or FDP tendon insertion, finger swelling, and an absence of active flexion of the PIP joint (FDS rupture) or DIP joint (FDP rupture). Surgical reattachment may be required.
    You may be surprised to learn that flexor tendon ruptures, avulsions, and to a lesser extent annular pulley injuries occur occasionally among football players. These acute injuries, commonly called “jersey finger,” occur when a tackler with an outstretched arm catches a finger on the jersey of the ball carrier sprinting past him. It is interesting to observe that many linemen and linebackers use prophylactic taping to support the flexor tendon and the A2 and A4 pulleys—it would seem that professional football players have also concluded that prophylactic taping works!
COLLATERAL LIGAMENT INJURIES
     
    Ligaments connect bone to bone across a joint, providing stability (see figure 11.3). Collateral ligament sprains and avulsions at the PIP joint are known to occur in climbers, particularly as a result of a powerful lunge or awkward torque off a “fixed” finger (as in a jam or tight pocket). A sprain manifests with mild to moderate pain and swelling around the PIP joint, but with no loss of stability (Jebson 1997). A rupture or avulsion will produce significant pain and swelling as well as loss of stability, medially or laterally.
    Treatment of incomplete collateral ligament injuries typically involves splinting of the PIP joint for ten to fourteen days, after which buddy taping can be used and range-of-motion exercises started (Bach 1999). Climbing can gradually be reintroduced despite persistent low-grade pain and swelling, which may take months to resolve (Jebson 1997).
    Complete collateral ligament injuries at the PIP joint are usually treated operatively. If the collateral ligament is completely avulsed from the bone, non-operative treatment may result in chronic swelling and long-term instability (Bach 1999). Surgical repair can improve this, and full function is often restored in approximately three months.

Other Finger and Hand Injuries
     
    A wide variety of other finger and hand injuries are possible in a sport that requires fingers to crimp, pinch, and jam under high passive and dynamic force loads. No doubt, you will experience your share of household injuries like torn tips, palm flappers, or back-of-hand gobies. There are a few more subtle injuries that can affect climbers, however, including carpal tunnel syndrome, swollen or arthritic PIP and DIP joints, and growth plate injury among youth climbers.
CARPAL TUNNEL