I was trying hard on a V7 project in the gym today...a sit-start straight into a two finger pocket in a cave. Felt a pop in my A2 when I went to the pocket. This is my first climbing injury... scary honestly - climbing is such a huge part of my life. Thank you for putting this information online for us. I will be referencing this over the next few months for sure.
Hey Dude! I first found your video a few years ago when I - you guessed it, had a pulley injury. I find your video one of the most helpful and complete there is in the climbing world. I now write an article about injury prevention and I will include your video in it. It's amazing, thanks for sharing your knowledge, it's been really helpful!
Super helpful video! Some photos/diagrams of what you're talking about around 11 min mark would be very helpful for those of us who are not doctors or PTs!
Happy you enjoy the videos! That would be a good idea to help aid in the clarity. I'll try to add something like that for my future lectures. But for now, hopefully the below helps: Isometric grip with isotonic pull: Gripping a portable hangboard attached to a resistance band or cable in front of you and rowing your arm back and forth into your body Isotonic grip with isometric pull: Same set up as above, but row the portable hangboard into your body, keep it there, and open and close the fingers (1/2 crimp to open hand) Isometric grip with isometric pull: Stand under a hangboard on a thin edge (or weight your body) and pull down (the arm and fingers don't move)
This is amazing. Didn’t expect a climbing specific analysis going in. Even putting in what’s considered easy climbing vs moderate for regionalization and types of holds to avoid was amazing to see
I am a certified hand therapist. I did some climbing years ago but no longer lives in an area where I am likely to see this injury I am sure Hand therapists who climbers will really appreciate the detailed progression for return to sport. I have a client with pulley injury from other causes and reviewed making the pulley splint from your video. Thanks
Thanks a lot! Added a moderate A4 injury to my resume three days ago. Although I am lucky enough to live in a country with free healthcare (have already seen a hand specialist and will see a hand therapist next week to get a pulley ring fitted), it is hard to find someone with climbing specific experience and advice in real life.
Below is a resource of medical providers who treat climbers all over the world. Scroll to the button and click "Click Here to See a List of All Accepted Members." Although I cannot vouch for the clinicians on the list (other than that they are climbers and medical providers) - at least its a start! theclimbingdoctor.com/portfolio-items/rock-rehab-community-2-2/
This is so enlightening! You’re such a fantastic teacher. Have you ever personally experimented with gyroscopic tools such a the Powerball? I previously suffered from carpal tunnel syndrome and was able to significantly reduce symptoms by using this as it encourages blood flow, use of hand and forearm muscles, as well as progressive loading through the force and rotation angles and weight of the Powerball selected. I will be following this rehab system as well as strengthening with the Powerball once I get to a level where pain is minimal. Thanks Jared!
Yes, gyroscope balls are great for wrist range of motion, stability, and sensory motor control. They can be used as a great supplement to a pulley rehab program!
I am 90 seconds into the video and already relieved quite a bit. The pandemic just sucked in so many ways: - don't have real rock around (barring prohibitively long drives) - gyms were shut down a lot - gained weight This in combination with rather good technique lead me to hop on the harder stuff maybe sooner than I should have. The muscles were fine and apart from quite small holds I could hold on to everything I could before. Tendons are a different story though. About two weeks ago I fell off a small pinch in the overhang after my foot slipped. Based on symptoms it's definitely just a strain, but working in retail and needing functional hands this is a good relief. Thank you so much for this explanation and input. Subbed and liked.
Awesome. Glad you like it. It took a while to put together but I wanted to make sure that I made a highly detailed single video that could guide climbers in the right direction after a pulley injury.
Thanks for sharing this information! I've been using a copy of the Ultimate Climber for years now and should probably pick up your book. Did you have a premonition? Unfortunately, this video was posted on a very useful day for me.
Hey Paul, psyched you have a copy of my original book. It’s been out of print for a while! Bummer about the recent finger injury. Hopefully the video helps!
Hi! Thanks for an informative video! 4 days ago my pulley popped while pulling from a crimp. At first, it seemed like a grade 3 pulley injury but now the healing process has been surprisingly fast and it doesnt’t hurt at all in daily activities. Only crimping with the finger creates pain but even that has decreases a quite a lot during these few days. What grade do you think this is and how long will the rehabilitation last?
Go to the second table in the article below and perform the testing - either yourself or a medical provider (recommend). You will then be able to identify the grading. theclimbingdoctor.com/how-to-rehab-a-climbing-pulley-injury/
Hi! You mention how many times per week you should perform No Pain Hangs (3x/wk), but not for easy climbing if I recall. What's the volume of climbing I should aim for per week while simultaneously performing No/Low Pain Hang Stages? Thank you!
Hi! Would you alter the rehab period for a pinky pulley injury? I've somehow strained my A4 pinky pulley and am hugely tempted to just keep climbing open handed/ 3 fingered/ where there is no pain. Ironically, pain only occurs on larger holds/ jugs that are grabbed. Crimps, particularly on small holds, feel fine (perhaps because the pinky is too short to engage?).
They are a great supplement for a "hang" or "no hang" strength exercise and I list finger curls as a level 2 strength exercise in my book since they can be performed at a lower weight and take the fingers through a full range of motion. However, since climbing is mostly an isometric sport for the fingers (or you could argue isometric with small range concentric and eccentric) some type of "hang" or "no hang" should be built into the rehab.
Thank you for putting out such useful content! I've listened to all of your TrainingBeta episodes and have learned so much from you and Neely. Question: for the loading stages that have more than 1 type of hold, do we do all sets of each hold type listed? For example, in No Pain stage 2, do we do 3 sets of open hand and 3 sets of 1/2 crimp (total of 6 sets)?
Hi Kellie, thanks for the nice words. A lot of the dosing for the hangs is dependent on the climber's ability and tolerance to volume. So protocols often need to be modified to the climber. However, with that being said, you are correct with the current protocol being 3 sets of 7 reps open hand. And 3 sets of 7 reps half crimp. A total of 6 sets. As long as they are pain-free and low load, this is an acceptable amount of load. If there is bowstringing on the ultrasound (Tendon bone distance greater than 2mm), then the hands must be performed with taping to protect the pulley.
Thank you for the great video! I ruptured A4. Can you tell, if a pulley protection splint shall be placed directly over the ruptured A4 pulley or over A2 close to the pip? I did not find out in the internet. Greetings from germany.
Huge thank you for sharing this great video! I got an a2 pulley rupture in my LH middle finger two weeks ago, and this video is really helpful! I’d like to ask a question that.. taping/wearing pulley splint during the rehab will be helpful/beneficial in terms of healing the pulley? or should I take off tapes/splint during the loading process?
In the early stages of a pulley rupture it is highly recommend to wear a pulley protection splint for up to 6 weeks. There has been research studies on the timeframe with effective results. A benefit of splinting is it keeps the tendon close to the bone and prevents scar tissue from forming underneath the tendon. Tape does not achieve the same result. There is a discussion currently among us medical providers in the community of whether or not the pulley splint needs to be worn for 23 hours a day and if it is okay to just wear when loading. Although there is the potential for that to be the case, there is currently no evidence to support it, so best practice currently is still to wear all day the splint for up to 6 weeks. So yes, it should be worn for sure when loading if in those time ranges.
Thank you for kind reply! Then, after 6 weeks, when I do the hangboarding (for rehab), pulley splint is necessary? or taking off the splint during the hangboard session and wearing it for daily life?
@@SNUYounghoon Yes, remove the splint but still tape when hangboarding or climbing. There is a good video that outlines the timelines clearly below: ua-cam.com/video/YU2-K4NFXnk/v-deo.html
Thank you for this material! I'm having problem with distinguishing Flexor Tenosynovitis and Pulley strain. I'm having this problem with my middle finger for about 4 weeks. During that time, I kept climbing, but the pain didn’t go away, so I stopped training 6 days ago. USG has shown increased fluid in tendon sheath (At the same time, it showed the same increased fluid in the sheath in the other hand, where there is no pain). I had no swelling and no traumatic mechanism of injury. I've noticed pain day after training. I have pain on slopers and pinches and mild pain with palpation over A4 region. I have no pain with passive extension, no pain while crimping and no pain while open grip. I have full range of mobility without any pain while moving my fingers. Is it Flexor Tenosynovitis or Pulley strain? The specialist couldn't tell during the ultrasound examination, he only noted more fluid...
If you’re utilizing diagnostic ultrasound - it should not be difficult to differentiate tenosynovitis from a pulley injury. A pulley injury will show measurable bostringing of the tendon from the bone. Tenosynovitis will show a 2 mm halo effect. If the halo effect is present on the opposite side, it is not a valid finding as it is common for fluid to surround the tendon sheath of rock climbers.
@@TheClimbingDoctorthank you for your answer. So I’m guessing it wasn’t specialist if he couldn’t differentiate these results. Based on symptoms what would you suspect?
@@erwinsokolski4337 It is best differentiated from a clinical exam coupled with US findings. You may want to requested the images or a real time video recording and seek a second opinion.
Thank you for all this information! The orthopedic doctor I saw after my pulley popped said to by a pulley splint. That’s it. No exercises. No tips or pointers of any kind. Should have just watched UA-cam instead of paying him.
Thanks for sharing the information!!!! Only one question, is it necesary (or better) to have the damaged pulley taped all day? or is it better to tape just for exercise, it seems to me that better circulation is important in healing. Thanks again!
Depending on the grade of injury, you may need to wear a pulley protection splint throughout the day for up to 6 weeks. Taping is performed during exercises to improve tendon bone distance, it won't do much during daily activities since it needs to be wrapped tightly to be effective.
Hello Jared, With clinically examination, if someone is experiencing pain with mild blanching palpation (Moderate category), but falls within the Mild category for the rest of the tests, how would you characterize them? Could you please elaborate a bit more on taping? Should it always be applied during rehabilitation?
Palpation is one of the more unreliable assessments of the cluster, so I would recommend classifying as “mild” in the case you mentioned. On the topic of taping, research by Lutter er al. indicates taping should be used after a pulley sprain as follows: Grade 1, 2 and 3: 3 months Grade 4a: greater than 12 months
Thanks for the video. Really helpful. I have a question tho: Should the splint be taken off for the mobility exercises? Have an A2 rupture, but don't feel a lot of pain at all. Not quite sure if extending and flexing the pip joint through full range of motion could be dangerous for the tendon bone distance.
It typically depends on two factors. The grade of injury and the amount of finger stiffness. For a fully ruptured pulley on a finger that is not very stiff; no - keep it on. For a partial rupture on a stiff finger; likely yes - but substitute with H taping during the exercises. Those are two examples of simplified extremes - but oftentimes it is best for a medical provider to make the judgment call.
Totally forgot to write back. Thank you very much for the answer, definitely very helpful. I have one additional question: I tried finding info on it, but no answer anywhere. Can I belay with the splint on or should I just not belay in general with the injury?
Hi Antoine, Thanks for your feedback. The goal of the video is less to show the exact exercises to perform but more to show the categories of exercises and the proposed timelines based on the grade or severity of injury. However, for more added context, see below for specific exercises videos as they may help with your understanding. See below and hopefully that helps clarify: Pulley protection splint creation and use: theclimbingdoctor.com/pulleyprotection/ H-taping: ua-cam.com/video/oJWHdwxdyXU/v-deo.html Accupressure rings: ua-cam.com/video/v8HQlnLN0ao/v-deo.html Tendon glides: ua-cam.com/video/BqvhdhFuoZs/v-deo.html Varius methods to hang: instagram.com/p/CZ2TAtaODHc/
If I don't have access to an pulley protection ring will you recommend to use instead one of the typing technics? not only in climbing but through out the day
There are several ways to get a pulley protection splint since there are now ones that are commercially available. 1. If you type in a search engine: "pulley protection splint" you can see the commercially available options. 2. You can make one for your finger that is custom by following the instructions below: theclimbingdoctor.com/pulleyprotection/ 3. You can see a local hand therapist who can fabricate one for you. Hope that helps!
When improving circulation, gliding the tendon, and restoring mobility do you leave the tape or pulley splint on or take them off? In my case i am H taping and using a splint on my a2 and a4
For gliding the tendon and restoring mobility it is typically recommended for grade 2 injuries to perform in the early stages with tape on. For grade 3 and 4 injuries, it is recommended in the early stages to perform with the splint on, and then after the recommended 6 to 8 weeks of splint usage, to transition to performing with tape on. I recommend you to consult a medical provider for a your specific case scenario.
@@TheClimbingDoctor i did he told me I didn’t need surgery and to follow your protocol 😂 he was also very impressed by my h taping plus pulley pal splint combo
I was doing 2 finger hangs on a hangboard and i felt a small strain on my index finger, it only hurts to hang on 2 fingers but no pain at different positions. How severe is this?
If it was a pocket and hurts more open hand with the opposing fingers flexed vs. a crimp then you may want to make sure you didn't injury your lumbrical or flexor tendon. If you suspect a pulley injury you can use the criteria in the article below to identify if it is mild moderate or severe. Use the criteria from the chart below: theclimbingdoctor.com/how-to-rehab-a-climbing-pulley-injury/
The rehab is very similar but the grading is different. See the article below. Also, for taping, we are currently performing a research study to see if taping and splinting is necessary for A4 injuries since only one tendon travels beneath it whereas for A2 there are two tendons beneath it. Grading info below: theclimbingdoctor.com/climbing-pulley-injury-anatomy-biomechanics-and-research/
This is an incredibly useful and helpful video that I've always come back to. But MAN, the presentation is so dry. I hope this gets remade in the future for a bigger audience but maybe with more enthusiasm and less padding.
Thanks for the feedback on the presentation. I am glad that you find it helful. This video was orginally part of a paid course for medical providers - so this may be a bit of the reason why the delivery isn't "exciting" since the targer audience wasn't originally for climbers on UA-cam - but the content is so strong and useful for climbers that I decided that the information needed to be free for anyone to access.
Oh bummer. Well, know that bowstringing (bone tendon distance) it is actually a natural occurrence that happens any time that we put load onto the fingers. However, if the load exceeds capacity, the pulley can rupture and the distance is excessive. The good news though is that video outlines exactly what to do if and when it happens. So hopefully that puts you a bit more at ease!
I was trying hard on a V7 project in the gym today...a sit-start straight into a two finger pocket in a cave. Felt a pop in my A2 when I went to the pocket. This is my first climbing injury... scary honestly - climbing is such a huge part of my life. Thank you for putting this information online for us. I will be referencing this over the next few months for sure.
Glad that the video is a helpful reference.
How did your recovery go?
@@samuelboriss9435 I made a full recovery. I'm climbing a grade harder than I was a year ago.
@@samuelboriss9435 Sadly he succumbed to his injury. :(
@@samuelboriss9435he’s dead
Hey Dude! I first found your video a few years ago when I - you guessed it, had a pulley injury. I find your video one of the most helpful and complete there is in the climbing world. I now write an article about injury prevention and I will include your video in it. It's amazing, thanks for sharing your knowledge, it's been really helpful!
I am glad that you find the video useful!
Super helpful video! Some photos/diagrams of what you're talking about around 11 min mark would be very helpful for those of us who are not doctors or PTs!
Happy you enjoy the videos! That would be a good idea to help aid in the clarity. I'll try to add something like that for my future lectures. But for now, hopefully the below helps:
Isometric grip with isotonic pull: Gripping a portable hangboard attached to a resistance band or cable in front of you and rowing your arm back and forth into your body
Isotonic grip with isometric pull: Same set up as above, but row the portable hangboard into your body, keep it there, and open and close the fingers (1/2 crimp to open hand)
Isometric grip with isometric pull: Stand under a hangboard on a thin edge (or weight your body) and pull down (the arm and fingers don't move)
this class is gold
This is amazing. Didn’t expect a climbing specific analysis going in. Even putting in what’s considered easy climbing vs moderate for regionalization and types of holds to avoid was amazing to see
Glad you found it helpful!
I am a certified hand therapist. I did some climbing years ago but no longer lives in an area where I am likely to see this injury I am sure Hand therapists who climbers will really appreciate the detailed progression for return to sport. I have a client with pulley injury from other causes and reviewed making the pulley splint from your video. Thanks
So glad you find this helpful! Below is the article for the pulley splint as well for reference!
theclimbingdoctor.com/pulleyprotection/
One of the best video found finally...Thanks
Thank you! Glad you found the video helpful.
Thanks a lot! Added a moderate A4 injury to my resume three days ago. Although I am lucky enough to live in a country with free healthcare (have already seen a hand specialist and will see a hand therapist next week to get a pulley ring fitted), it is hard to find someone with climbing specific experience and advice in real life.
Below is a resource of medical providers who treat climbers all over the world. Scroll to the button and click "Click Here to See a List of All Accepted Members." Although I cannot vouch for the clinicians on the list (other than that they are climbers and medical providers) - at least its a start!
theclimbingdoctor.com/portfolio-items/rock-rehab-community-2-2/
This is so enlightening! You’re such a fantastic teacher. Have you ever personally experimented with gyroscopic tools such a the Powerball? I previously suffered from carpal tunnel syndrome and was able to significantly reduce symptoms by using this as it encourages blood flow, use of hand and forearm muscles, as well as progressive loading through the force and rotation angles and weight of the Powerball selected.
I will be following this rehab system as well as strengthening with the Powerball once I get to a level where pain is minimal. Thanks Jared!
Yes, gyroscope balls are great for wrist range of motion, stability, and sensory motor control. They can be used as a great supplement to a pulley rehab program!
I am 90 seconds into the video and already relieved quite a bit. The pandemic just sucked in so many ways:
- don't have real rock around (barring prohibitively long drives)
- gyms were shut down a lot
- gained weight
This in combination with rather good technique lead me to hop on the harder stuff maybe sooner than I should have. The muscles were fine and apart from quite small holds I could hold on to everything I could before. Tendons are a different story though. About two weeks ago I fell off a small pinch in the overhang after my foot slipped. Based on symptoms it's definitely just a strain, but working in retail and needing functional hands this is a good relief.
Thank you so much for this explanation and input. Subbed and liked.
Thank you for sharing your story. Happy that you have found relief from the video.
Really helpful, really detailed GREAT VIDEO
Awesome. Glad you like it. It took a while to put together but I wanted to make sure that I made a highly detailed single video that could guide climbers in the right direction after a pulley injury.
Thanks for sharing this information! I've been using a copy of the Ultimate Climber for years now and should probably pick up your book. Did you have a premonition? Unfortunately, this video was posted on a very useful day for me.
Hey Paul, psyched you have a copy of my original book. It’s been out of print for a while! Bummer about the recent finger injury. Hopefully the video helps!
Hi! Thanks for an informative video! 4 days ago my pulley popped while pulling from a crimp. At first, it seemed like a grade 3 pulley injury but now the healing process has been surprisingly fast and it doesnt’t hurt at all in daily activities. Only crimping with the finger creates pain but even that has decreases a quite a lot during these few days. What grade do you think this is and how long will the rehabilitation last?
Go to the second table in the article below and perform the testing - either yourself or a medical provider (recommend). You will then be able to identify the grading.
theclimbingdoctor.com/how-to-rehab-a-climbing-pulley-injury/
Oh hey its Jared Vagy. I take your movement impairment system courses on Medbridge!
Great to hear from you. Glad you enjoy the courses!
Hi! You mention how many times per week you should perform No Pain Hangs (3x/wk), but not for easy climbing if I recall. What's the volume of climbing I should aim for per week while simultaneously performing No/Low Pain Hang Stages? Thank you!
Hi! Would you alter the rehab period for a pinky pulley injury? I've somehow strained my A4 pinky pulley and am hugely tempted to just keep climbing open handed/ 3 fingered/ where there is no pain. Ironically, pain only occurs on larger holds/ jugs that are grabbed. Crimps, particularly on small holds, feel fine (perhaps because the pinky is too short to engage?).
Great video. Can finger rolls/curls be used for rehab similar to pulls and hangs?
They are a great supplement for a "hang" or "no hang" strength exercise and I list finger curls as a level 2 strength exercise in my book since they can be performed at a lower weight and take the fingers through a full range of motion. However, since climbing is mostly an isometric sport for the fingers (or you could argue isometric with small range concentric and eccentric) some type of "hang" or "no hang" should be built into the rehab.
Thank you for putting out such useful content! I've listened to all of your TrainingBeta episodes and have learned so much from you and Neely. Question: for the loading stages that have more than 1 type of hold, do we do all sets of each hold type listed? For example, in No Pain stage 2, do we do 3 sets of open hand and 3 sets of 1/2 crimp (total of 6 sets)?
Hi Kellie, thanks for the nice words. A lot of the dosing for the hangs is dependent on the climber's ability and tolerance to volume. So protocols often need to be modified to the climber. However, with that being said, you are correct with the current protocol being 3 sets of 7 reps open hand. And 3 sets of 7 reps half crimp. A total of 6 sets. As long as they are pain-free and low load, this is an acceptable amount of load. If there is bowstringing on the ultrasound (Tendon bone distance greater than 2mm), then the hands must be performed with taping to protect the pulley.
Greeat video! I presume taping should be used only when climbing/doing excercises - or should tape be on 24/7?
Yes, taping is only when climbing or performing exercises.
Thank you for the great video! I ruptured A4. Can you tell, if a pulley protection splint shall be placed directly over the ruptured A4 pulley or over A2 close to the pip? I did not find out in the internet. Greetings from germany.
For A4, it is typically recommended to place them past (distal) the PIP joint closely over the ruptured pulley.
Huge thank you for sharing this great video! I got an a2 pulley rupture in my LH middle finger two weeks ago, and this video is really helpful!
I’d like to ask a question that.. taping/wearing pulley splint during the rehab will be helpful/beneficial in terms of healing the pulley? or should I take off tapes/splint during the loading process?
In the early stages of a pulley rupture it is highly recommend to wear a pulley protection splint for up to 6 weeks. There has been research studies on the timeframe with effective results. A benefit of splinting is it keeps the tendon close to the bone and prevents scar tissue from forming underneath the tendon. Tape does not achieve the same result. There is a discussion currently among us medical providers in the community of whether or not the pulley splint needs to be worn for 23 hours a day and if it is okay to just wear when loading. Although there is the potential for that to be the case, there is currently no evidence to support it, so best practice currently is still to wear all day the splint for up to 6 weeks. So yes, it should be worn for sure when loading if in those time ranges.
Thank you for kind reply! Then, after 6 weeks, when I do the hangboarding (for rehab), pulley splint is necessary? or taking off the splint during the hangboard session and wearing it for daily life?
@@SNUYounghoon Yes, remove the splint but still tape when hangboarding or climbing. There is a good video that outlines the timelines clearly below:
ua-cam.com/video/YU2-K4NFXnk/v-deo.html
@@TheClimbingDoctor Thank you! 🥰
Gracias!👌🏼
Thank you for this material! I'm having problem with distinguishing Flexor Tenosynovitis and Pulley strain. I'm having this problem with my middle finger for about 4 weeks. During that time, I kept climbing, but the pain didn’t go away, so I stopped training 6 days ago. USG has shown increased fluid in tendon sheath (At the same time, it showed the same increased fluid in the sheath in the other hand, where there is no pain). I had no swelling and no traumatic mechanism of injury. I've noticed pain day after training. I have pain on slopers and pinches and mild pain with palpation over A4 region. I have no pain with passive extension, no pain while crimping and no pain while open grip. I have full range of mobility without any pain while moving my fingers. Is it Flexor Tenosynovitis or Pulley strain? The specialist couldn't tell during the ultrasound examination, he only noted more fluid...
If you’re utilizing diagnostic ultrasound - it should not be difficult to differentiate tenosynovitis from a pulley injury. A pulley injury will show measurable bostringing of the tendon from the bone. Tenosynovitis will show a 2 mm halo effect. If the halo effect is present on the opposite side, it is not a valid finding as it is common for fluid to surround the tendon sheath of rock climbers.
@@TheClimbingDoctorthank you for your answer. So I’m guessing it wasn’t specialist if he couldn’t differentiate these results. Based on symptoms what would you suspect?
@@erwinsokolski4337 It is best differentiated from a clinical exam coupled with US findings. You may want to requested the images or a real time video recording and seek a second opinion.
Thank you for all this information! The orthopedic doctor I saw after my pulley popped said to by a pulley splint. That’s it. No exercises. No tips or pointers of any kind. Should have just watched UA-cam instead of paying him.
Yeah, I would definitely supplement with the tips from the video (I.e. ROM and progressive loading).
Thanks for sharing the information!!!!
Only one question, is it necesary (or better) to have the damaged pulley taped all day? or is it better to tape just for exercise, it seems to me that better circulation is important in healing.
Thanks again!
Depending on the grade of injury, you may need to wear a pulley protection splint throughout the day for up to 6 weeks. Taping is performed during exercises to improve tendon bone distance, it won't do much during daily activities since it needs to be wrapped tightly to be effective.
i got a nice new pulley injury yday ready for the new year. stupid overhanging v5 wasnt even that hard just not warmed up enough
Bummer. Well, hopefully this video will help get you back on track.
Hello Jared,
With clinically examination, if someone is experiencing pain with mild blanching palpation (Moderate category), but falls within the Mild category for the rest of the tests, how would you characterize them?
Could you please elaborate a bit more on taping? Should it always be applied during rehabilitation?
Palpation is one of the more unreliable assessments of the cluster, so I would recommend classifying as “mild” in the case you mentioned.
On the topic of taping, research by Lutter er al. indicates taping should be used after a pulley sprain as follows:
Grade 1, 2 and 3: 3 months
Grade 4a: greater than 12 months
@@TheClimbingDoctor Thank you for your answers and the instructive video!
Thanks for the video. Really helpful.
I have a question tho: Should the splint be taken off for the mobility exercises? Have an A2 rupture, but don't feel a lot of pain at all.
Not quite sure if extending and flexing the pip joint through full range of motion could be dangerous for the tendon bone distance.
It typically depends on two factors. The grade of injury and the amount of finger stiffness. For a fully ruptured pulley on a finger that is not very stiff; no - keep it on. For a partial rupture on a stiff finger; likely yes - but substitute with H taping during the exercises. Those are two examples of simplified extremes - but oftentimes it is best for a medical provider to make the judgment call.
Totally forgot to write back. Thank you very much for the answer, definitely very helpful.
I have one additional question: I tried finding info on it, but no answer anywhere. Can I belay with the splint on or should I just not belay in general with the injury?
Have someone demonstrate the exercises you're talking about. I have no idea what this should look like.
Hi Antoine,
Thanks for your feedback. The goal of the video is less to show the exact exercises to perform but more to show the categories of exercises and the proposed timelines based on the grade or severity of injury. However, for more added context, see below for specific exercises videos as they may help with your understanding.
See below and hopefully that helps clarify:
Pulley protection splint creation and use: theclimbingdoctor.com/pulleyprotection/
H-taping: ua-cam.com/video/oJWHdwxdyXU/v-deo.html
Accupressure rings: ua-cam.com/video/v8HQlnLN0ao/v-deo.html
Tendon glides: ua-cam.com/video/BqvhdhFuoZs/v-deo.html
Varius methods to hang: instagram.com/p/CZ2TAtaODHc/
If I don't have access to an pulley protection ring will you recommend to use instead one of the typing technics? not only in climbing but through out the day
There are several ways to get a pulley protection splint since there are now ones that are commercially available.
1. If you type in a search engine: "pulley protection splint" you can see the commercially available options.
2. You can make one for your finger that is custom by following the instructions below: theclimbingdoctor.com/pulleyprotection/
3. You can see a local hand therapist who can fabricate one for you.
Hope that helps!
When improving circulation, gliding the tendon, and restoring mobility do you leave the tape or pulley splint on or take them off? In my case i am H taping and using a splint on my a2 and a4
For gliding the tendon and restoring mobility it is typically recommended for grade 2 injuries to perform in the early stages with tape on. For grade 3 and 4 injuries, it is recommended in the early stages to perform with the splint on, and then after the recommended 6 to 8 weeks of splint usage, to transition to performing with tape on. I recommend you to consult a medical provider for a your specific case scenario.
@@TheClimbingDoctor i did he told me I didn’t need surgery and to follow your protocol 😂 he was also very impressed by my h taping plus pulley pal splint combo
@@michaelvogel7905Haha, that's awesome. Best of luck on the rehab!
I was doing 2 finger hangs on a hangboard and i felt a small strain on my index finger, it only hurts to hang on 2 fingers but no pain at different positions. How severe is this?
If it was a pocket and hurts more open hand with the opposing fingers flexed vs. a crimp then you may want to make sure you didn't injury your lumbrical or flexor tendon.
If you suspect a pulley injury you can use the criteria in the article below to identify if it is mild moderate or severe. Use the criteria from the chart below:
theclimbingdoctor.com/how-to-rehab-a-climbing-pulley-injury/
Nothing about taping a4 or anything specific about a4? Maybe you have a different video? Is tape effective for a4?
The rehab is very similar but the grading is different. See the article below. Also, for taping, we are currently performing a research study to see if taping and splinting is necessary for A4 injuries since only one tendon travels beneath it whereas for A2 there are two tendons beneath it. Grading info below:
theclimbingdoctor.com/climbing-pulley-injury-anatomy-biomechanics-and-research/
@@TheClimbingDoctor thanks for the information I will read it
This should be displayed in every climbing gym 24h 365 for every climber to be exposed and educated. Amazing video
Happy that you enjoy the video and feel so strongly about it!
This is an incredibly useful and helpful video that I've always come back to. But MAN, the presentation is so dry. I hope this gets remade in the future for a bigger audience but maybe with more enthusiasm and less padding.
Thanks for the feedback on the presentation. I am glad that you find it helful. This video was orginally part of a paid course for medical providers - so this may be a bit of the reason why the delivery isn't "exciting" since the targer audience wasn't originally for climbers on UA-cam - but the content is so strong and useful for climbers that I decided that the information needed to be free for anyone to access.
Today I learned that the words "bone-tendon distance" make me very uncomfortable.
Oh bummer. Well, know that bowstringing (bone tendon distance) it is actually a natural occurrence that happens any time that we put load onto the fingers. However, if the load exceeds capacity, the pulley can rupture and the distance is excessive. The good news though is that video outlines exactly what to do if and when it happens. So hopefully that puts you a bit more at ease!