Hi, it is great to see such content on "Pain science" and progressive load for recovery. A good supplement to the video on A2 Pulley Injuries, which I unfortunately have at the moment... :(. First real injury over more than 10 years of climbing... I have a question/clarification regarding the pain level protocol and monitoring: How should the pain level be monitored? During the load and timed after the load is clearly stated, but how do we let our body tell us? Meaning should we touch/move/apply some sort of pressure to the sensitive part or just without any touch/movement/pressure? Eg. for fingers and A2 pulleys. Thanks !
Awesome! Yeah after the A2 video we felt we needed a follow up on that to help bridge the gap even better. Sorry to hear about your injury though, that's a bummer. Good question regarding the monitoring. I think the foundation will be just how the force is causing your body to react. If it's not causing any pain it's great, if it is, listen to it and see how it unfolds. If it starts to go into those yellow areas (longer duration, more than a 3/10 pain) then I think it's OK to supplement with touch/movement to assess how it is doing. That way you can make a more educated assessment on "should I do more or less". Does that answer your question?
@@HoopersBeta Hi, Yes perfect :) thanks again. I am doing progressive loading for few weeks now, listening to my body, monitoring pain and inflammatory reaction for, hopefully, optimal recovery. Hard to ensure the right balance though. Yet, I see great progress and pain, while applying pressure, is low and disappear completely after 2 days rest. Again, thanks for the great content ! If you would need any input for future content and I could help, I would be happy to do so :)
@@charlesfourcade825 hi charles, i was interesed to know on how your injury is doing now (1month ish later?) i just hurt my a2 pulley yesterday and dont actually know how bad it is but i hope it will recover fast!
Hi @@kunlaialps, it is slow but still going in the good direction. I injured my A2 mid of July actually. Back then I could not put any load without pain on half crimp grip (open hand was never an issue). 4 months after I can now do series of repeater of half crimp on 8mm edge or one arm lock off on 20mm edge with 8kg help with pulley system (pain level at 3). Before injury I was doing it with 5kg added weight so it is still not fully recovered. I re-started outdoor climbing and Moon Board about 1 month ago. Everything is closed now though... I hope this help. We can exchange further if you want.
@@charlesfourcade825Hi Charles. I hope you’re well. I just wondered, when you had your A2 pulley injury, how long were you not climbing at all for? When you had pain crimping, did you still climb open hand? Thanks.
This makes so much sense now. Came back to climbing after almost 1 year of lockdown and an old popped pulley was still sore after said year of rest time, but now after a couple weeks of climbing the pain is almost gone!
Hey Urik? What did you do to rehab this? As I’ve got the same issue. But I can’t get the 4/10 pain to go. Trying to rehab it through density hangs. Most my pain comes when I involve some rotation to my crimp position. So trying to add a little rotation into my Fingerboard rehab in order to ‘re learn the brain’.
Thank you so much for this video. I started following this advice (more or less) in february and today I declare my finger officially healed. Today I climbed my orginal level, whitout tape, with small edges and most importantly without pain.
Injured my finger (i think A4?) in a bike crash 6 days ago. Splinted it for 2 days and WOW i was in pain when i took it off. 4 days of very light use and my finger has partial range of motion back. Good to know that retraining with slight pain is actually a good thing.
Man, this channel is so good. You do such a great job with injury recovery and prevention, but also with general training and strength. A wonderful combination of tasteful (most of the time) humor and brilliant (all of the time) material! Crush on bruuuutheerr!
In med school we learned about nociceptors which is a specific system developed to avoid tissue damage and are dedicated to different kinds of pain like monomodal vs. polymodal efferent signals. An example might be a monomodal function of thermal damage with information carried by the Thermal nociceptive receptors... these fire at 40-43 degrees Celsius and form a tetramer that allows the influx of calcium to signal imminent thermal tissue damage. Likewise- mechanoreceptors which are less understood- are clearly functioning (we feel pain) and they can be cultured... the molecular cellular signaling in vivo has not been worked out. So I take issue with "there are no pain nerves" as a sweeping statement. I do agree with the statement, "we have not identified the Calcium channel moiety that is stimulated by an excess of mechanical force within the unmyelinated penetrating nociceptive fibers," but that doesn't matter to the argument here. The argument here (as I understand it) is that we feel pain even when there is no ongoing tissue damage or a behavior that we should exhibit to prevent further tissue damage. In this case, I completely agree and would point to a whole body of literature on central vs. peripheral pain, the mechanisms of chronic pain- and how to learn to live within the envelope of this pain and still fulfill your physical demands. What might be missing also from this message is age- If you wake up at my age without pain? you're dead... so get used to it now. If you use your body (I run 50 miles/week)... then it will hurt. And the hurt is just your body telling you that living is happening. 30 somethings talking about pain (even elite athletes)... just haven't woken up at 70.
Thanks for this, I badly injured my finger when my bull attacked me (yeah, I'm not a climber), my finger was under his halter when he tossed me over his head. It's been two months tonight since the attack. This video has really helped, I've just tried some of the exercise and my finger is feeling better already!
I developed CRPS when the docs told me to rest my wrist for 6 months cause pain wasn’t going away. The pain went away when I pushed through it in PT to restore function. When you immobilize or baby a part of the body and are convinced that you are injured, it will signal your brain to send pain signals
This is great content... probably the best I've seen in free vlog format. Just wanted to note that the case study involves an A4 pulley injury and the pain science conversation used a tendon injury as the example. Different tissues respond differently to load.
This is all lines up with my tricep tendon issues (i suspect tendonitis). Developed bad pain in it, likely from overuse at the gym so i took a big break from the gym due to the injury and other circumstances. When I came back to it a year later i still had the exact same pain, even with low loads. I decided to just try working through it while being more cautious with my form and weight increases, and after a handful of months its almost completely faded away.
Not much of a climber, but coming from a basketball player, still very interesting content. We also sprain our fingers all the time, and it always takes months to heal.
wow, a rare instance where "meh, it doesn't hurt much, it's probably fine" is actually the correct attitude! love to hear it, was worried I'd have to completely avoid climbing for a while 🙌
Love the protocol you're describing! Very consistent with the net of what I've read and the protocols I use in my personal training (and a recent pulley rehab) Just a comment, please don't say you're "getting deep into understanding pain science" --because you aren't talking about hypotheses, experiments, testing, etc... i.e. Science, AT ALL. You're presenting your personal (and likely accurate because you're well read) interpretation of recent research and the presumed multitude of anecdotal cases you've experienced. You are NOT presenting comprehensive support for your personal opinions -- your background, the papers you've read, data, comprehensive explanations of your personal anecdotes, etc... insufficient support to help your viewers understand how to interpret the potential accuracy or error of your personal conclusions. You are presenting some papers to support your point of view (which generally I agree with) but you are NOT presenting a comprehensive review of the literature on this subject which may or may not include conclusions that conflict with your interpretation. It's easy to cherry-pick papers to support wrong conclusions. I don't think it's sufficient to present expert opinions on this topic anymore -- there are plenty of resources like Dave McCleod's excellent books which have given consistent and good advice on this topic for years. I'd love to seem more videos explaining the actual science (experiments, scans, tests, hypotheses that fail, etc...) rather than simple conclusions. This rings doubly true for teaching people how to learn scientifically (through personal experimentation) about their body and become better able to interpret the spectacular amount of data generated by their own senses -- i.e. the generalization that includes "pain science".
So fun dumb stuff: the only way i was able to regain my tendon range in my thumb i cut once was stretching it just to its limits and trying to match the positioning to the healthier thumb. Eventually it caught up to confort level and i believe both thumbs are back on par. It was over a year since that injury, 1 month to actually heal the cut, 3 months of forcing its range ever further, the remainder to ease into trusting it more
What if I feel almost no pain (left ring finger pulley) while climbing, but then after a session or the next day the pain/stiffness/swelling feeling sets in. Does this mean I still need to climb easier / shorter sessions?
2 years later and not a doctor but this is exactly my issue for a very long time and all I can really tell you from my reading and looking around is that I think that's more of a finger joint capsulitis/synovitis issue and not an acute tendon or pulley injury most content is aimed at. If you ever figured out some way to keep increasing results without injury let me know lmao.
I know this is an old video, but thought I would comment anyway on how I haven't seen much on your channel dedicated to toe health. I did see your ankle health video. But it seems that big toe injuries are quite common in rock climbing. So I would be really curious to see you cover this topic if it ever interested you. Thanks for all the knowledge. Cheers
Loved this, super thorough! However, i was wondering if you could suggest more exercises in addition to the farmer crimp you mentioned to progressively load more? Thanks!
Thanks for the awesome content, Cooper. Always come here for my climbing training and rehab advice. I'm current'y rehabing to me what seems to be a minor A4 pulley injury. I never actually "injured" it, but over the last month of climbing hard outdoors, it's sore when I warm up, I feel less confident with that finger/hand while climbing (even if I don't experience pain per se after warming up), and the next few day it feels swollen and 3/10 pain even just light crimping on a door frame, for example. When I do the farmer crimp protocol, I can actually work up to high loads (almost as high as my other, non-injured hand) with 0 - 2 /10 pain that dissipates within 10 seconds. However, the next morning, it fees swollen and sore (again 3-4/10 with the lightest crimping). Is this morning pain and swelling just a sign of tissue adaption? Do you think as long as I'm not producing more than 3/10 pain lasting < 10 secs while farming crimping that I'm safe, regardless of the morning after pain? Thanks so much!! - Dunavan
I hurt my index finger about 6 years ago, once and then another time after 2 weeks and the finger has been more stiff than normal ever since. The middle joint feels especially jank and the extensor tendon feels as if has become shorter/tighter. I've done physical therapy but it doesn't help. Will it ever heal or am I doomed?
Hello, thanks for the engaging and informative video. I am dealing with my first finger injury as a climber. My middle and ring fingers on my dominant hand are slightly swollen around the pip joints. The fingers often feel stiff and slightly weak when flexing against resistance. The range of motion is good and the fingers can be completely flexed and extended without pain if unloaded. There was no acute injury they just started to feel weaker and stiff in my last couple sessions so I have stopped climbing for a few days to assess. Does this sound like an injury to the pulley system or does it sound like more of a joint capsule thing? Do I sound like a good candidate for farmers crimps or should I wait until the swelling and stiffness has gone down? Also would finger extensions with a powerfingers help?
So I'm pretty sure I injured my middle finger A3 pulley by overload of my tendon on the heaviest part of deadlift. I was using an outward grip on my right hand and as the load was too high on my last rep, I think I really caused a lot of injury to this pulley whilst trying my best to hold onto the bar. I think this injury is connected to my distal bicep tendon which has also been hurting significant which I believe got injured in the same exercise. Funny that the only content I can find on this type of injury on youtube is coming from climbers who deal with this probably more often than most.
Hi, thanks for a very informative video! Do you have an understanding of how long to wait and rest after an acute injury before beginning this kind of rehab? Can I get right into very low pain stressing of the injured finger if no swelling or resting pain, or should one wait to begin this rehabbing? Thank you!
I think it's even worse with wrist and elbow injuries because with fingers it's easy (easier) to avoid certain activities to make sure that you are loading them just right for recovery while with wrists/elbows there are also those everyday tasks that you cannot avoid and cannot fully control (like you cannot avoid lifting your baby and you cannot control how many times per day you have to lift them - or sometimes you have to deal with firewood and it just has to be stacked in one weekend, etc.). So it's much harder to figure out the amount of exercise you should be doing to balance it with daily unavoidable activities.
10 years ago i felt a pop in my middle finger and just started climbing again since my 9 year old daughter showed interest and after a few weeks that finger swells up and gets stiff for a couple days after every climb
Sorry to hear that you're having issues after coming back to climbing! Volume? Intensity? If those are too high that can cause it. Similarly, over gripping?
@@HoopersBeta I am thinking volume and intensity, once I started working on v5 and 6 it started hurting again. Of course I let my ego take over knowing that it was too much for just a month back. Sticking to slopers, jugs, and anything that's comfy and open hand with light training in-between. Knowing a little discomfort and even a little pain that only sticks around for 5-10 seconds is ok was a big game changer for me and after just a couple weeks I am noticing some small changes in the right direction.
Hello, nice video! I would have wanted some information about whether isometric/eccentric/concentric movement affects and how does it do so on the tissue loading or rehabilitation factors. This particular 'farmer's exercise' is as i see it an isometric movement, which should be carried out on the early stage of rehabilitation, right?
Thanks for the awesome video! This is such an important (and difficult!) part of injury treatment. How would you interpret pain reappearing a while after the assessment is done? For example no pain right after loading, but 4 of 10 pain 2/30/60 minutes after loading?
You'll need to be cautious on your loading if your pain takes that long to respond to. Monitor your signs and symptoms after you have completed the loading and be sure to write down as many factors as possible to minimize those symptoms. You don't want a 4/10 pain 30/60 minutes after.
Hopefully I'll get a response. I had a partial (maybe complete) a4 rupture on my ring finger in almost 5 months ago. I've done your retraining protocol from the A2 pulley injury video and it went somewhat well. Currently, I still have pain, but I'm at a lost on how to proceed. I still H-tape and do my farmer crimps at least twice a week. I can do up to 35lbs without H-taping, but I need to H-tape once going higher. With the H-tape, I can do up to ~60lbs for 4 reps. Any tips on returning to full confidence?
This helps a lot thank you! I have been dealing with a chronic A2 pulley injury for over 6 months and it's been driving me crazy. I have a question though. While I don't feel much pain on the hangboard or when climbing (unless I go too hard), I have gotten into the habit of pressing on where the pulley hurts. Thus, I may feel a little pain while climbing and no pain when I stop, but I press on the tendon and its still really sore. The other day I was setting and after forerunning, while my finger only hurt a little while climbing, I could tell that pressing on it felt worse after that day. This is just a long way of asking, if it hurts more to press on the area, does that indicate anything about the injury?
I don't tend to put much merit into pain with palpation, other than to say it may not be at 100%, yet :) It could be well on it's way, heck it could even be 99% there! That pain on palpation is adding an external pressure over the tissue typically in the opposite fashion of which it became injured (most A2 pulley injuries occurr from bowstringing or pulling away from the bone, not pressing into it) Thus, it is not a great way of determining extent of injury. That pain upon palpation could be mostly neurological or that protective response and not a great indicator of the true status of the underlying tissue. Hope this helps!
@@HoopersBeta thank you so much! I feel like it’s easy to fixate when it hurts to touch, but in reality I have little to no pain without palpating it. Thanks again for the reply :)
I am a guitarist, not a climber....and somehow found this video. I’ve sliced a few fingers before, in the kitchen or opening stuff… still waiting on my middle fingertip to heal from a minor knife cut (still a pain to deal with cus it takes forever to heal) And all these people all over the forums and online recommend to use super glue and I think it’s the dumbest freaking thing in the world because fingertips are so sensitive and have several nerves which feel pain very easily. Use liquid bandage instead it’s not as harmful and is labeled as a first aid but it still didn’t make much of a difference in my healing. Do you have any therapy recommendations to help boost fingertip healing???
Had a few questions I hope you could answer. I had an a2 pulley strain about a month ago. I am doing a rehab routine to retrain the finger with light loading on farmer crimps. The initial sets have some pain in the 2-3 range, but in later sets this pain is down to 0-1 range. What is the explanation for this? That being said after the routine when I press on the injured area it is painful. The pain could even be going into the 3-5 range when doing this. Is this fine or should I reduce the weight and intensity? Also is there a difference between how the pain should be monitored when loading the finger versus pressing on the injured part of the pulley?
Thanks for the video, it’s very helpful! Do you have any tips for doing farmer crimps with no dedicated equipment? Replacing the weights is easy enough, but what can I use to replace the hold? I was thinking even a backpack with water bottles to control the weight, and using the upper lace as a hold. Would that work?
I injured my hands from defending karate kicks with my hands, even wearing fighting gloves. For more than 2 months I've felt weakness when squeezing my hand and almost a pain, as if the hand was warm inside. Especially when waking up. I had an MRI but it only showed some water inside the fingers and in a joint that hurts when I bend the finger. No arthritis or anything. The doctor said that finger injuries take time to heal but he didn't tell me anything else, not even about physiotherapy, medication, if I should stop or restart the activity. What do you think? I try to distract myself from it but the symptoms are there.
I’m about a year post injury and have been getting back to climbing, I have been doing this same thing on a hang board twice per week 3-5 reps for 10 seconds each, the pain is always at a 1 for less than 10 seconds after the hang. However easy climbing causes zero pain but sometimes I will feel slight pain after the session for about an hour is that ok?
Not to contradict the video but I’m pretty sure the body has both receptors for pain ‘nociceptors’ and dedicated nerve fibres ‘a delta’ which send the signal to the spinal cord. I understand that the signals change when going from acute to chronic. But these receptors and nerve fibres specifically for pain do exist in the body. So I’m a little confused when it suggested there arnt?
A delta fibers are stimulated by mechanical and thermal sensation. It is those two stimuli that can be perceived as pain. I'm saying there are literally no receptors called pain receptors. None that are just there with the sole purpose to make you say owe.
@@HoopersBeta This part of the video also didn't sit right with me. There's an entire wikipedia page on nociceptors (en.m.wikipedia.org/wiki/Nociceptor) which are dedicated to making us say "Ow" if a certain stimulus threshold is passed, they are literally termed "pain receptors". These are different from other mechanical/thermal receptors because "Only when the high threshold has been reached by either chemical, thermal, or mechanical environments are the nociceptors triggered." If you are interested in a scientific review check out www.cell.com/current-biology/comments/S0960-9822(17)30069-6#%20 which of course also introduces nociceptors with, "Nociception, the sensory mechanism that allows animals to sense and avoid potentially tissue-damaging stimuli, is critical for survival. This process relies on nociceptors, which are specialized neurons that detect and respond to potentially damaging forms of energy..."
the brain recalibrates according to how you react to the pain. if your doing exposure and triggering pain..don't survive through the process or whiteknuckle through it. you might also get waves of fear. these are all alarms that need to ring..so sit in the fear and the pain and do nothing. don't resist the fear or pain. don't react in a way that shows you don't like it. embrace the pain and ask for more. this tells the brain that the perceived danger isn't real and turns off the alarms with repetition. when people sooth or freak out or put braces on..it tells the brain that the perceived danger is correct and keeps the alarms going.
Hi, great video as always, I have a question about training with slight pain ( 1-3 on a scale of ten like mentioned ). When I climb or put the injured finger to use I don’t feel increments of pain while putting more load on the finger, but rather a sudden sharp pain when reaching a certain point or with sudden movements. Any input on the matter would be much appreciated, and again great video per usual 👍.
This is quite an old video, but I wanted to ask anyway hoping on a response. I have been retraining with farmers crimps for a few weeks. Multiple times I didn't have any pain after doing the sets, but the next day my pulleys were sore. Does this mean that I am doing too much or should I just rest a bit longer before doing the next session? Would really appreciate a response! Cheers. Ps. I love your videos!
This is terrific for any tendon issues in the hands. Can this help with non climbing tendon issues, say like tendonosis due to years of repetitive use of a particular finger tendon, say the index finger knuckle?
Very helpful video! I injured my A2 about 7 weeks ago and could not crimp at all while climbing. So I stuck to open hand while climbing and rehab hangs. I was hanging on the 30mm for the first few weeks and it felt good. Then I didn't feel any pain while hanging on the 30 mm so, I thought it would be good to go down an edge. I then started using the 25mm and while I did not feel pain over a 3 threshold and no pain after, the next day my finger was sore. That happened a few times and after a full day of rest my finger didn't feel sore anymore. I'm wondering why that is? and how to keep progressing my hangs to avoid that.
Thanks so much for this info, I've started a routine based on this. Should I consider adding some extensor activation to inhibit tension in the flexor side as I feel like there's a lot of tightness there?
How do you test for an A1 pulley injury on the ring finger? I can do weighted half crimps on the tension block and no pain, but holding a jug hits directly on the A1 area and causes me pain
ive gotten finger injuries in both middle fingers on both hands about 2years+ ago. have rested for long times before climbing again, with my most recent rest period being 2 months. basically i have been resting and climbing, resting and climbing, and its been 2 years but my finger still seems to hurt edit: is there an alternative excersise to the farmer crimps? ( e.g hangboard? )
You can safely load the fingers through hangboarding but only if you can modulate the weight you apply to the fingers. I hope you watched the video in it's entirety because I believe it could help you!
Does this only apply to when you're climbing? I had a mild pulley tweak maybe 3 months ago but it's still tender to touch when im not climbing. Tender only on maximal blanching pressure with palpation. But climbing is fine/pain free lol.
Great video, thank you. I am about a year post injury (moderate strain I guess, no rupture) of A2 pulley in my ring finger. What should I do when I have 0 pain during climbing but I feel pain the next day after a hard bouldering session? (About 2 on the scale I guess)
@@martinn2829 that's most likely just the pain science aspect with the hyperalgesia so you should be fine if there's no pain when climbing. Don't push too hard too quickly but you should be healing.
A question I am always left with is when you refer to counting how long pain lasts after load, is it pain without any aggravation? Like when I get off a climb my injured pulley does not hurt on its own, but will be more sensitive when I press on the pulley with my other hand. It feels inflamed as it only hurts when pressing hard before climbing but after a session it hurts (2-3/10 pain level) with softer presses.
I believe i ruptured a pulley while deadlifting. I was losing my grip on the bar and and felt/heard a pop in my left ring finger. Only feel pain when i press/load weight at the base of the finger and the location of the A2 pulley. No swelling or redness. It's been about a week and ive abstained from any weight lifting, as pretty much everything requires a loaded grip (i.e. even just picking up plates to load on a barbell for bench press, which is almost exclusively a PUSH exercise). Im not sure of recovery timelines, so every day after last week, ive been testing the pain by simply picking up weights, going heavier progressively. How long do i need to completely rest before working out again? 6-8 weeks as the video says?
Hi, I just wanted to clarify the pain after the farmers crimps part of the vid. So I can do these without feeling much pain at all, however if I actually press my thumb into the A2 there is still quite a bit of pain. Should I continue with the program if this is the case? I have seen a physio who confirms there is no actual tendon damage, however there is alot of scar tissue from past injuries Thanks :)
Yeah I would keep it going just be aware of it. That pain from pressing into it is just a small part of the puzzle. Not one to overlook and should be considered, but not a hard stop as it is likely just responding to the external pressure and creating a higher level of pain than is normal or equitable to the level of injury.
What about chronic pulley injuries? I have examined my fingers and i most certainly have a pulley strain. The thing is, the pain started 8 months ago and i only started rehab about 1,5 months ago. Not only there is a rock solid small inflamation on the A2 region but i find it much harder to progress weight on that finger compared to oder recent injured fingers - wich logically doesn’t have that inflamation. I have come to 15kg feeling 2-3 pain without warming up but progress now is almost nonexistent. Should i go back to climbing? Rest more? I am struggling at the end of the rehab where my finger is already 75%, but doesn’t get much better. I would aprecciate some orientation in relation to my situation. Thank you!
Sir DJ Dr Hoops, thanks for all the amazing content, it´s really helpful and I wish I had access to all this knowledge when I started my vicious spiral into the world of injuries a few years ago. But regarding this video, I have a question. I´m assuming I have an overuse injury from training with too high frequency/too little rest (no acute injury, just slow building up of pulley soreness over a few weeks). I notice near to no pain during and after the climbing, even when I full crimp. But afterward, almost constantly, the middle finger around my A2 pulley feels sore when I palpate it. It´s usually mild, relative to how rough I have been on it during the previous sessions, but it´s still enough for me to doubt every single move I make with my right hand and not dare training on a fingerboard. In this video you talk about the pain (during the exercise) being actually positive in low intensity for healing, does that also apply to this soreness post session? Is it ok to train and have a mildly sore pulley afterwards as long as there is enough time for it to heal between? Or is this a different type of soreness/pain and should it be avoided altogether?
Just a summary/follow-up question, should one rather listen to the pain that occurs during an exercise, or the soreness afterewards? Or are they both as relevant?
I have a chronic injury from pulling my index finger (stupid I know, I did it during two different panic attacks), and I don't know what to do about it. It got stiff in the middle joint and after a while the extensor tendon got tight in a way that when I make a fist, I feel my finger's mid-joint pull on it and the tendon feels really tight over the knuckle. It's been about 6 years after the incident and the doctor now ordered me an MRI-test to see the soft-tissues. He said however that this happened because "the tendon's support muscles got weaker". I think he's wrong, the middle of my finger feels abnormally stiff also when it's straight, as if some tissue has hardened inside. what do you think?
Very interesting video! I have personally been dealing with a collateral joint/ligament injury (in both the middle joints, middle fingers) for the last 2 years or so. I've done almost every form of rehab I can think of. In the video, you use the Farmers Crimp for tendon/pulley injuries, do you think that this rehab could be applied to a collateral ligament injury?
When an injury lasts that long, my immediate response is two fold. 1) does pain science apply to this case and 2) what are they doing to constantly re-aggravate the injury? You may need to do a deeper look into your activities of daily living, work, climbing style, etc. Oh and 3rd, you may need to get the injury re-evaluated (or evaluated for the first time) to make sure it actually is a collateral ligament injury and not something else.
Thanks, you just helped me figure out what the name of my finger issue is (I think). Do you have the same/similar symptoms as me? - pain in fingers when pushing sideways on them - ability to crack fingers sideways - feeling of ligaments kinda slipping painfully if you move them a certain way, and associated crack sound and feeling - some pain during climbing on really crimpy stuff but usually pain is a bit after climbing - some pain when you bend your knuckles tightly as if to do tendon glides kinda Have you found anything that helps?
@@adampnewsome The only things I would say I have similar to you would be your last two points. However, now my fingers have made quite some progress over the last half year or so in the rehab I've been doing, so it is hard for me to tell if they had more of what you had in the past. The main thing that has helped the most recently is doing a hangboard protocol by Dr. Eva Lopez. en-eva-lopez.blogspot.com/2018/07/fingerboard-training-guide-iii-periodization-samples-of-maxhangs-training-programs-.html After that, I find that light finger stretching, massage, and blood flow control help reduce the pain and increase the mobility of the joint. Plus, rice bucket training helps more of the same in that essence. However these things do not result in healing the injury/getting it strong enough to climb again. I would recommend documenting the finger's progress. I've been doing so for the last year, and it's provided great affirmation and insight into the rehab I've been doing. At the very least, I would highly recommend looking into starting the hangboard routine if your fingers have been chronically injured (and it's a similar injury to what I have.) The fingers need to be loaded appropriately to get back to climbing shape, otherwise, they will never be strong enough for climbing.
@@Rees8269 great, thanks for all the helpful info. I've been considering starting hangboarding - I have an appt with my physio next week and I'll ask if he recommends it. The other things sound helpful as well 🤞🏼
Hey, like so many others here, I have a question. I now have the second A4 injury this year on my right hand, it's slowly getting there, I have climbing sessions without pain in the pulleys. However, my DIP hurts more when doing rehab protocols than the pulleys and they are also the bigger issue when climbing. I had an MRI because of my first pulley injury and they found nothing. Do you have an idea what might be the issue and how to deal with it?
If the MRI was a while ago and the swelling is new then the MRI wouldn't tell you too much, but... It could be that you lost range of motion in your fingers after the injuries and began developing some synovitis? I hate to just jump to that when I hear DIP swelling but without an evaluation it's harder to determine if there is another cause of the injury like a collateral ligament injury, volar plate injury, or others. We do have a video about synovitis / finger swelling. Check that out and see if it helps answer any of your questions! th-cam.com/video/h-nOPJsBZz8/w-d-xo.html
No hangs with arms overhead or in a similar fashion to the farmer crimp / carry? With arms overhead / on a hangboard the only challenge is being objective and knowing how much weight/force you're producing every time.
A few weeks ago, I hyperextended my ring finger distal phalange while crimping, and now I have joint pain, weakness, and hypermobiliy that is preventing me from crimping with that hand. I'm wondering, could this same rehabilitation technique be applied to a joint injury like this?
Thank you for the video. I have a pulley injury on my second toe and it's been stuck in a slightly curled position ever since I stubbed it. The ROM is maybe half of what it used to be. Can I break it into it's normal ROM?
Awesome question! It can be applied in many different areas, from an FDP injury, to Runners Knee / patellafemoral pain syndrome. It is, of course, case by case. TFCC injuries aren't as applicable as often times the problem is the person continues to re-aggravate the injury with their activity or day to day motions.
I had a car wreck, my finger gotten broken from impact. I had surgery but they said rn eh couldn’t fix it due to it being broken in 3 different spots, I gotten the pins removed. Still can’t move my finger. Any suggestions ? I have pain. & I also have carpal tunnel.
Quality content guys. Keep it up. Had a question hopefully you can help. I get release pain when I come off or move though pinches but not other holds. The pain is deep in forearm around halfway down my arm and feels like it’s between the radius and ulnar. Any feedback would be greatly appreciated. Thanks
Google "flexor pollicis longus" and see if this matches the area of discomfort. part of the muscle body runs right between the radius and ulna. likely just a muscle working really hard on those pinches which could use some training.
recently ruptured my A4 and am wondering at what point in the recovery process i should start to use PPP. After a few weeks of ROM exercises or right away?
Hey my one of my middle finger on my right hand is pointing to the right due to some poorly performed gripper training I did. It was months ago and I just rested it, but every time I try to go do it again, the finger aches again and points to the right, as in being angled to the right where there is blatantly more distance between that middle finger and the index finger compared to the distance between the left hand's middle and index fingers. I already paid way too much just to have it checked by physiotherapists who gave general advice but nothing specific so hopefully you know what I could do, I probably didn't give enough details but I figure you can ask and I'll explain it as best as possible. Would appreciate some method for this. Thanks
With this protocol it should come to a point where it doesn't hurt at all?? After how long do tendons get to the level "pre-injury"? Do tendons get stronger after an injury?
Yes of course :) Your hands / fingers / body should certainly heal and get to the point of not having pain. Tendons, depending on the level of injury, typically take about 12-16 weeks to heal. Getting to "pre-injury" also depends on the severity and how much strength you have lost. Yes, you can be even stronger after injury if you are patient and work on good protocols to safely get stronger.
Hi, it is great to see such content on "Pain science" and progressive load for recovery. A good supplement to the video on A2 Pulley Injuries, which I unfortunately have at the moment... :(. First real injury over more than 10 years of climbing... I have a question/clarification regarding the pain level protocol and monitoring: How should the pain level be monitored? During the load and timed after the load is clearly stated, but how do we let our body tell us? Meaning should we touch/move/apply some sort of pressure to the sensitive part or just without any touch/movement/pressure? Eg. for fingers and A2 pulleys. Thanks !
Awesome! Yeah after the A2 video we felt we needed a follow up on that to help bridge the gap even better. Sorry to hear about your injury though, that's a bummer.
Good question regarding the monitoring. I think the foundation will be just how the force is causing your body to react. If it's not causing any pain it's great, if it is, listen to it and see how it unfolds. If it starts to go into those yellow areas (longer duration, more than a 3/10 pain) then I think it's OK to supplement with touch/movement to assess how it is doing. That way you can make a more educated assessment on "should I do more or less". Does that answer your question?
@@HoopersBeta Hi, Yes perfect :) thanks again. I am doing progressive loading for few weeks now, listening to my body, monitoring pain and inflammatory reaction for, hopefully, optimal recovery. Hard to ensure the right balance though. Yet, I see great progress and pain, while applying pressure, is low and disappear completely after 2 days rest. Again, thanks for the great content ! If you would need any input for future content and I could help, I would be happy to do so :)
@@charlesfourcade825 hi charles, i was interesed to know on how your injury is doing now (1month ish later?) i just hurt my a2 pulley yesterday and dont actually know how bad it is but i hope it will recover fast!
Hi @@kunlaialps, it is slow but still going in the good direction. I injured my A2 mid of July actually. Back then I could not put any load without pain on half crimp grip (open hand was never an issue). 4 months after I can now do series of repeater of half crimp on 8mm edge or one arm lock off on 20mm edge with 8kg help with pulley system (pain level at 3). Before injury I was doing it with 5kg added weight so it is still not fully recovered. I re-started outdoor climbing and Moon Board about 1 month ago. Everything is closed now though... I hope this help. We can exchange further if you want.
@@charlesfourcade825Hi Charles. I hope you’re well. I just wondered, when you had your A2 pulley injury, how long were you not climbing at all for? When you had pain crimping, did you still climb open hand? Thanks.
This makes so much sense now. Came back to climbing after almost 1 year of lockdown and an old popped pulley was still sore after said year of rest time, but now after a couple weeks of climbing the pain is almost gone!
Nice! What a wonderful example of this :) Thanks for sharing!
Hey Urik? What did you do to rehab this? As I’ve got the same issue. But I can’t get the 4/10 pain to go. Trying to rehab it through density hangs. Most my pain comes when I involve some rotation to my crimp position. So trying to add a little rotation into my Fingerboard rehab in order to ‘re learn the brain’.
@hoopersbeta would love your help here!
Thank you so much for this video. I started following this advice (more or less) in february and today I declare my finger officially healed. Today I climbed my orginal level, whitout tape, with small edges and most importantly without pain.
That’s great to hear, way to go!
I’m SO happy this is being talked about. I wish I would’ve known this with my chronic back pain three years ago.
Glad you found it useful! But, sorry that the information was available to you for your back pain! Hopefully you're recovering/recovered from that!
Thank you Dr Hooper. You are a true man of the people offering this information for free. Long may you send!
We are all about the sending! Thanks for your support.
Injured my finger (i think A4?) in a bike crash 6 days ago. Splinted it for 2 days and WOW i was in pain when i took it off. 4 days of very light use and my finger has partial range of motion back. Good to know that retraining with slight pain is actually a good thing.
Man, this channel is so good. You do such a great job with injury recovery and prevention, but also with general training and strength. A wonderful combination of tasteful (most of the time) humor and brilliant (all of the time) material! Crush on bruuuutheerr!
Thank you for the comment! Much appreciated :) We'll keep it going with hopefully the same/similar recipe :)
I've seen a number of videos covering rehab of finger injuries and this is on another level, so good, thank you!
Your Videos are top notch! Thanks for putting in the effort :).
In med school we learned about nociceptors which is a specific system developed to avoid tissue damage and are dedicated to different kinds of pain like monomodal vs. polymodal efferent signals. An example might be a monomodal function of thermal damage with information carried by the Thermal nociceptive receptors... these fire at 40-43 degrees Celsius and form a tetramer that allows the influx of calcium to signal imminent thermal tissue damage. Likewise- mechanoreceptors which are less understood- are clearly functioning (we feel pain) and they can be cultured... the molecular cellular signaling in vivo has not been worked out. So I take issue with "there are no pain nerves" as a sweeping statement. I do agree with the statement, "we have not identified the Calcium channel moiety that is stimulated by an excess of mechanical force within the unmyelinated penetrating nociceptive fibers," but that doesn't matter to the argument here. The argument here (as I understand it) is that we feel pain even when there is no ongoing tissue damage or a behavior that we should exhibit to prevent further tissue damage. In this case, I completely agree and would point to a whole body of literature on central vs. peripheral pain, the mechanisms of chronic pain- and how to learn to live within the envelope of this pain and still fulfill your physical demands. What might be missing also from this message is age- If you wake up at my age without pain? you're dead... so get used to it now. If you use your body (I run 50 miles/week)... then it will hurt. And the hurt is just your body telling you that living is happening. 30 somethings talking about pain (even elite athletes)... just haven't woken up at 70.
Liked this about 5 seconds in, thanks for the insight Dr. Hooper!
I’ve never climbed, but dislocated a couple of fingers falling. These guidelines and info are perfect!
I'm not a climber at all (I'm an arm wrestler) but all of this advice completely applies to my wrist/hand tendon soreness
Happy that it was able to help you as well!
Thanks for this, I badly injured my finger when my bull attacked me (yeah, I'm not a climber), my finger was under his halter when he tossed me over his head. It's been two months tonight since the attack.
This video has really helped, I've just tried some of the exercise and my finger is feeling better already!
Whoa! That's gnarly! Thanks for sharing and I'm glad the video is helpful!
Thanks Dr for the incredible insights, really glad that someone is creating such content to help educated recreational climbers like us!
Our pleasure! Thanks for watching.
Thanks for the video! Really helpful to understand how injuries work and how to treat them
I developed CRPS when the docs told me to rest my wrist for 6 months cause pain wasn’t going away. The pain went away when I pushed through it in PT to restore function. When you immobilize or baby a part of the body and are convinced that you are injured, it will signal your brain to send pain signals
Thanks for sharing your experience, but sorry you went through that! Hoping that you're doing well now!
ive been looking for this video for so long!! Thnak you, this is so helpful!
Lol i'm massaging my finger right now, wondering about this!
Thank you for reading my mind and putting this out!
This is great content... probably the best I've seen in free vlog format. Just wanted to note that the case study involves an A4 pulley injury and the pain science conversation used a tendon injury as the example. Different tissues respond differently to load.
Thanks a lot! I realize that I shouldn´t worry too much about a little bit of pain.
This is all lines up with my tricep tendon issues (i suspect tendonitis). Developed bad pain in it, likely from overuse at the gym so i took a big break from the gym due to the injury and other circumstances.
When I came back to it a year later i still had the exact same pain, even with low loads. I decided to just try working through it while being more cautious with my form and weight increases, and after a handful of months its almost completely faded away.
Not much of a climber, but coming from a basketball player, still very interesting content. We also sprain our fingers all the time, and it always takes months to heal.
Do you get MRIs to determine the grade of tear? And how do you treat the sprain? Cast or taping?
wow, a rare instance where "meh, it doesn't hurt much, it's probably fine" is actually the correct attitude! love to hear it, was worried I'd have to completely avoid climbing for a while 🙌
Love the protocol you're describing! Very consistent with the net of what I've read and the protocols I use in my personal training (and a recent pulley rehab)
Just a comment, please don't say you're "getting deep into understanding pain science" --because you aren't talking about hypotheses, experiments, testing, etc... i.e. Science, AT ALL.
You're presenting your personal (and likely accurate because you're well read) interpretation of recent research and the presumed multitude of anecdotal cases you've experienced. You are NOT presenting comprehensive support for your personal opinions -- your background, the papers you've read, data, comprehensive explanations of your personal anecdotes, etc... insufficient support to help your viewers understand how to interpret the potential accuracy or error of your personal conclusions. You are presenting some papers to support your point of view (which generally I agree with) but you are NOT presenting a comprehensive review of the literature on this subject which may or may not include conclusions that conflict with your interpretation. It's easy to cherry-pick papers to support wrong conclusions.
I don't think it's sufficient to present expert opinions on this topic anymore -- there are plenty of resources like Dave McCleod's excellent books which have given consistent and good advice on this topic for years. I'd love to seem more videos explaining the actual science (experiments, scans, tests, hypotheses that fail, etc...) rather than simple conclusions. This rings doubly true for teaching people how to learn scientifically (through personal experimentation) about their body and become better able to interpret the spectacular amount of data generated by their own senses -- i.e. the generalization that includes "pain science".
So fun dumb stuff: the only way i was able to regain my tendon range in my thumb i cut once was stretching it just to its limits and trying to match the positioning to the healthier thumb. Eventually it caught up to confort level and i believe both thumbs are back on par.
It was over a year since that injury, 1 month to actually heal the cut, 3 months of forcing its range ever further, the remainder to ease into trusting it more
What if I feel almost no pain (left ring finger pulley) while climbing, but then after a session or the next day the pain/stiffness/swelling feeling sets in. Does this mean I still need to climb easier / shorter sessions?
2 years later and not a doctor but this is exactly my issue for a very long time and all I can really tell you from my reading and looking around is that I think that's more of a finger joint capsulitis/synovitis issue and not an acute tendon or pulley injury most content is aimed at. If you ever figured out some way to keep increasing results without injury let me know lmao.
Well, if you are overweight - losing weight reduces load, so helps a lot.
Thanks for sharing your expertise!
I know this is an old video, but thought I would comment anyway on how I haven't seen much on your channel dedicated to toe health. I did see your ankle health video. But it seems that big toe injuries are quite common in rock climbing. So I would be really curious to see you cover this topic if it ever interested you. Thanks for all the knowledge. Cheers
Loved this, super thorough! However, i was wondering if you could suggest more exercises in addition to the farmer crimp you mentioned to progressively load more? Thanks!
Thanks for the awesome content, Cooper. Always come here for my climbing training and rehab advice.
I'm current'y rehabing to me what seems to be a minor A4 pulley injury. I never actually "injured" it, but over the last month of climbing hard outdoors, it's sore when I warm up, I feel less confident with that finger/hand while climbing (even if I don't experience pain per se after warming up), and the next few day it feels swollen and 3/10 pain even just light crimping on a door frame, for example.
When I do the farmer crimp protocol, I can actually work up to high loads (almost as high as my other, non-injured hand) with 0 - 2 /10 pain that dissipates within 10 seconds. However, the next morning, it fees swollen and sore (again 3-4/10 with the lightest crimping). Is this morning pain and swelling just a sign of tissue adaption? Do you think as long as I'm not producing more than 3/10 pain lasting < 10 secs while farming crimping that I'm safe, regardless of the morning after pain? Thanks so much!!
- Dunavan
Hoop with the inside scoop! thanks man!
Perfect !
I hope this will help me with my trigger finger?
I hurt my index finger about 6 years ago, once and then another time after 2 weeks and the finger has been more stiff than normal ever since. The middle joint feels especially jank and the extensor tendon feels as if has become shorter/tighter. I've done physical therapy but it doesn't help. Will it ever heal or am I doomed?
Epic video! Thanks guys
5 star video!
******* :) Thanks!
Hello, thanks for the engaging and informative video. I am dealing with my first finger injury as a climber. My middle and ring fingers on my dominant hand are slightly swollen around the pip joints. The fingers often feel stiff and slightly weak when flexing against resistance. The range of motion is good and the fingers can be completely flexed and extended without pain if unloaded. There was no acute injury they just started to feel weaker and stiff in my last couple sessions so I have stopped climbing for a few days to assess. Does this sound like an injury to the pulley system or does it sound like more of a joint capsule thing?
Do I sound like a good candidate for farmers crimps or should I wait until the swelling and stiffness has gone down? Also would finger extensions with a powerfingers help?
So I'm pretty sure I injured my middle finger A3 pulley by overload of my tendon on the heaviest part of deadlift. I was using an outward grip on my right hand and as the load was too high on my last rep, I think I really caused a lot of injury to this pulley whilst trying my best to hold onto the bar. I think this injury is connected to my distal bicep tendon which has also been hurting significant which I believe got injured in the same exercise. Funny that the only content I can find on this type of injury on youtube is coming from climbers who deal with this probably more often than most.
Hi, thanks for a very informative video! Do you have an understanding of how long to wait and rest after an acute injury before beginning this kind of rehab? Can I get right into very low pain stressing of the injured finger if no swelling or resting pain, or should one wait to begin this rehabbing?
Thank you!
Incredible video. Again.
I think it's even worse with wrist and elbow injuries because with fingers it's easy (easier) to avoid certain activities to make sure that you are loading them just right for recovery while with wrists/elbows there are also those everyday tasks that you cannot avoid and cannot fully control (like you cannot avoid lifting your baby and you cannot control how many times per day you have to lift them - or sometimes you have to deal with firewood and it just has to be stacked in one weekend, etc.). So it's much harder to figure out the amount of exercise you should be doing to balance it with daily unavoidable activities.
Interesting video. I presume a similar protocol could be used for golfers elbow rehab?
Wow awesome video here, is there any possibility of doing something like this for elbow injuries? Would really REALLY appreciate it!!!
Please do a similar video but for fractures!
Great content, thank you!
Awesome video!!
Glad you enjoyed it!
10 years ago i felt a pop in my middle finger and just started climbing again since my 9 year old daughter showed interest and after a few weeks that finger swells up and gets stiff for a couple days after every climb
Sorry to hear that you're having issues after coming back to climbing! Volume? Intensity? If those are too high that can cause it. Similarly, over gripping?
@@HoopersBeta I am thinking volume and intensity, once I started working on v5 and 6 it started hurting again. Of course I let my ego take over knowing that it was too much for just a month back. Sticking to slopers, jugs, and anything that's comfy and open hand with light training in-between. Knowing a little discomfort and even a little pain that only sticks around for 5-10 seconds is ok was a big game changer for me and after just a couple weeks I am noticing some small changes in the right direction.
Hello, nice video! I would have wanted some information about whether isometric/eccentric/concentric movement affects and how does it do so on the tissue loading or rehabilitation factors. This particular 'farmer's exercise' is as i see it an isometric movement, which should be carried out on the early stage of rehabilitation, right?
Thanks for the awesome video! This is such an important (and difficult!) part of injury treatment. How would you interpret pain reappearing a while after the assessment is done? For example no pain right after loading, but 4 of 10 pain 2/30/60 minutes after loading?
You'll need to be cautious on your loading if your pain takes that long to respond to. Monitor your signs and symptoms after you have completed the loading and be sure to write down as many factors as possible to minimize those symptoms. You don't want a 4/10 pain 30/60 minutes after.
Great video as always, what alternative exercise(s) could you recommend for one who cannot replicate your rock-ring + sling setup?
I was really surprised myself that my third digit DIP lateral ligament injury only got worse when I was forced on a COVID + surgery 2-month break.
Active recovery, such an optic topic!
Hopefully I'll get a response. I had a partial (maybe complete) a4 rupture on my ring finger in almost 5 months ago. I've done your retraining protocol from the A2 pulley injury video and it went somewhat well. Currently, I still have pain, but I'm at a lost on how to proceed. I still H-tape and do my farmer crimps at least twice a week. I can do up to 35lbs without H-taping, but I need to H-tape once going higher. With the H-tape, I can do up to ~60lbs for 4 reps. Any tips on returning to full confidence?
Thanks Doc.
This helps a lot thank you! I have been dealing with a chronic A2 pulley injury for over 6 months and it's been driving me crazy. I have a question though. While I don't feel much pain on the hangboard or when climbing (unless I go too hard), I have gotten into the habit of pressing on where the pulley hurts. Thus, I may feel a little pain while climbing and no pain when I stop, but I press on the tendon and its still really sore. The other day I was setting and after forerunning, while my finger only hurt a little while climbing, I could tell that pressing on it felt worse after that day. This is just a long way of asking, if it hurts more to press on the area, does that indicate anything about the injury?
I have the same problem.
I don't tend to put much merit into pain with palpation, other than to say it may not be at 100%, yet :) It could be well on it's way, heck it could even be 99% there! That pain on palpation is adding an external pressure over the tissue typically in the opposite fashion of which it became injured (most A2 pulley injuries occurr from bowstringing or pulling away from the bone, not pressing into it) Thus, it is not a great way of determining extent of injury. That pain upon palpation could be mostly neurological or that protective response and not a great indicator of the true status of the underlying tissue. Hope this helps!
@@HoopersBeta thank you so much! I feel like it’s easy to fixate when it hurts to touch, but in reality I have little to no pain without palpating it. Thanks again for the reply :)
I am a guitarist, not a climber....and somehow found this video. I’ve sliced a few fingers before, in the kitchen or opening stuff… still waiting on my middle fingertip to heal from a minor knife cut (still a pain to deal with cus it takes forever to heal) And all these people all over the forums and online recommend to use super glue and I think it’s the dumbest freaking thing in the world because fingertips are so sensitive and have several nerves which feel pain very easily. Use liquid bandage instead it’s not as harmful and is labeled as a first aid but it still didn’t make much of a difference in my healing. Do you have any therapy recommendations to help
boost fingertip healing???
Had a few questions I hope you could answer.
I had an a2 pulley strain about a month ago. I am doing a rehab routine to retrain the finger with light loading on farmer crimps. The initial sets have some pain in the 2-3 range, but in later sets this pain is down to 0-1 range. What is the explanation for this?
That being said after the routine when I press on the injured area it is painful. The pain could even be going into the 3-5 range when doing this. Is this fine or should I reduce the weight and intensity?
Also is there a difference between how the pain should be monitored when loading the finger versus pressing on the injured part of the pulley?
So good, thank you so much
Thanks for the video, it’s very helpful!
Do you have any tips for doing farmer crimps with no dedicated equipment?
Replacing the weights is easy enough, but what can I use to replace the hold?
I was thinking even a backpack with water bottles to control the weight, and using the upper lace as a hold.
Would that work?
I injured my hands from defending karate kicks with my hands, even wearing fighting gloves. For more than 2 months I've felt weakness when squeezing my hand and almost a pain, as if the hand was warm inside. Especially when waking up.
I had an MRI but it only showed some water inside the fingers and in a joint that hurts when I bend the finger. No arthritis or anything. The doctor said that finger injuries take time to heal but he didn't tell me anything else, not even about physiotherapy, medication, if I should stop or restart the activity. What do you think? I try to distract myself from it but the symptoms are there.
I’m about a year post injury and have been getting back to climbing, I have been doing this same thing on a hang board twice per week 3-5 reps for 10 seconds each, the pain is always at a 1 for less than 10 seconds after the hang. However easy climbing causes zero pain but sometimes I will feel slight pain after the session for about an hour is that ok?
Yes
Really useful video thank you
Glad it was helpful!
Great content! I subbed
Congratulations on that really nice content! I got a kick question, should my finguer be suported by h taping while doing the farmer crimps?
Not to contradict the video but I’m pretty sure the body has both receptors for pain ‘nociceptors’ and dedicated nerve fibres ‘a delta’ which send the signal to the spinal cord. I understand that the signals change when going from acute to chronic. But these receptors and nerve fibres specifically for pain do exist in the body. So I’m a little confused when it suggested there arnt?
A delta fibers are stimulated by mechanical and thermal sensation. It is those two stimuli that can be perceived as pain. I'm saying there are literally no receptors called pain receptors. None that are just there with the sole purpose to make you say owe.
@@HoopersBeta This part of the video also didn't sit right with me. There's an entire wikipedia page on nociceptors (en.m.wikipedia.org/wiki/Nociceptor) which are dedicated to making us say "Ow" if a certain stimulus threshold is passed, they are literally termed "pain receptors". These are different from other mechanical/thermal receptors because "Only when the high threshold has been reached by either chemical, thermal, or mechanical environments are the nociceptors triggered." If you are interested in a scientific review check out www.cell.com/current-biology/comments/S0960-9822(17)30069-6#%20 which of course also introduces nociceptors with, "Nociception, the sensory mechanism that allows animals to sense and avoid potentially tissue-damaging stimuli, is critical for survival. This process relies on nociceptors, which are specialized neurons that detect and respond to potentially damaging forms of energy..."
@@neuromodel wiki link is corrupt due to bracket FYI
en.m.wikipedia.org/wiki/Nociceptor
the brain recalibrates according to how you react to the pain. if your doing exposure and triggering pain..don't survive through the process or whiteknuckle through it. you might also get waves of fear. these are all alarms that need to ring..so sit in the fear and the pain and do nothing. don't resist the fear or pain. don't react in a way that shows you don't like it. embrace the pain and ask for more. this tells the brain that the perceived danger isn't real and turns off the alarms with repetition. when people sooth or freak out or put braces on..it tells the brain that the perceived danger is correct and keeps the alarms going.
Hi, great video as always, I have a question about training with slight pain ( 1-3 on a scale of ten like mentioned ). When I climb or put the injured finger to use I don’t feel increments of pain while putting more load on the finger, but rather a sudden sharp pain when reaching a certain point or with sudden movements. Any input on the matter would be much appreciated, and again great video per usual 👍.
Hi,
is this also true for other areas, like running with a burning kind of pain in the soft tissue around the knee?
@hooper's beta - How long after an injury is it okay to start the pain protocol?
This is quite an old video, but I wanted to ask anyway hoping on a response. I have been retraining with farmers crimps for a few weeks. Multiple times I didn't have any pain after doing the sets, but the next day my pulleys were sore. Does this mean that I am doing too much or should I just rest a bit longer before doing the next session? Would really appreciate a response! Cheers. Ps. I love your videos!
This is terrific for any tendon issues in the hands. Can this help with non climbing tendon issues, say like tendonosis due to years of repetitive use of a particular finger tendon, say the index finger knuckle?
Very helpful video! I injured my A2 about 7 weeks ago and could not crimp at all while climbing. So I stuck to open hand while climbing and rehab hangs. I was hanging on the 30mm for the first few weeks and it felt good. Then I didn't feel any pain while hanging on the 30 mm so, I thought it would be good to go down an edge. I then started using the 25mm and while I did not feel pain over a 3 threshold and no pain after, the next day my finger was sore. That happened a few times and after a full day of rest my finger didn't feel sore anymore. I'm wondering why that is? and how to keep progressing my hangs to avoid that.
Awesome vid, thanks Hooper. Any thoughts on rehab with 30s sub max hangs?
Thanks so much for this info, I've started a routine based on this. Should I consider adding some extensor activation to inhibit tension in the flexor side as I feel like there's a lot of tightness there?
How do you test for an A1 pulley injury on the ring finger? I can do weighted half crimps on the tension block and no pain, but holding a jug hits directly on the A1 area and causes me pain
ive gotten finger injuries in both middle fingers on both hands about 2years+ ago. have rested for long times before climbing again, with my most recent rest period being 2 months. basically i have been resting and climbing, resting and climbing, and its been 2 years but my finger still seems to hurt
edit: is there an alternative excersise to the farmer crimps? ( e.g hangboard? )
You can safely load the fingers through hangboarding but only if you can modulate the weight you apply to the fingers. I hope you watched the video in it's entirety because I believe it could help you!
Does this only apply to when you're climbing? I had a mild pulley tweak maybe 3 months ago but it's still tender to touch when im not climbing. Tender only on maximal blanching pressure with palpation. But climbing is fine/pain free lol.
Great video, thank you.
I am about a year post injury (moderate strain I guess, no rupture) of A2 pulley in my ring finger. What should I do when I have 0 pain during climbing but I feel pain the next day after a hard bouldering session? (About 2 on the scale I guess)
Is it painful the next day as you press on it or just at rest?
Hooper's Beta Only when I press on it.
@@martinn2829 that's most likely just the pain science aspect with the hyperalgesia so you should be fine if there's no pain when climbing. Don't push too hard too quickly but you should be healing.
Hooper's Beta good to hear :) thank you so much for your replies and videos.
A question I am always left with is when you refer to counting how long pain lasts after load, is it pain without any aggravation? Like when I get off a climb my injured pulley does not hurt on its own, but will be more sensitive when I press on the pulley with my other hand. It feels inflamed as it only hurts when pressing hard before climbing but after a session it hurts (2-3/10 pain level) with softer presses.
I believe i ruptured a pulley while deadlifting. I was losing my grip on the bar and and felt/heard a pop in my left ring finger. Only feel pain when i press/load weight at the base of the finger and the location of the A2 pulley. No swelling or redness. It's been about a week and ive abstained from any weight lifting, as pretty much everything requires a loaded grip (i.e. even just picking up plates to load on a barbell for bench press, which is almost exclusively a PUSH exercise). Im not sure of recovery timelines, so every day after last week, ive been testing the pain by simply picking up weights, going heavier progressively.
How long do i need to completely rest before working out again? 6-8 weeks as the video says?
Hi, I just wanted to clarify the pain after the farmers crimps part of the vid. So I can do these without feeling much pain at all, however if I actually press my thumb into the A2 there is still quite a bit of pain. Should I continue with the program if this is the case? I have seen a physio who confirms there is no actual tendon damage, however there is alot of scar tissue from past injuries
Thanks :)
Yeah I would keep it going just be aware of it. That pain from pressing into it is just a small part of the puzzle. Not one to overlook and should be considered, but not a hard stop as it is likely just responding to the external pressure and creating a higher level of pain than is normal or equitable to the level of injury.
What about chronic pulley injuries? I have examined my fingers and i most certainly have a pulley strain. The thing is, the pain started 8 months ago and i only started rehab about 1,5 months ago. Not only there is a rock solid small inflamation on the A2 region but i find it much harder to progress weight on that finger compared to oder recent injured fingers - wich logically doesn’t have that inflamation. I have come to 15kg feeling 2-3 pain without warming up but progress now is almost nonexistent. Should i go back to climbing? Rest more? I am struggling at the end of the rehab where my finger is already 75%, but doesn’t get much better. I would aprecciate some orientation in relation to my situation. Thank you!
Sir DJ Dr Hoops, thanks for all the amazing content, it´s really helpful and I wish I had access to all this knowledge when I started my vicious spiral into the world of injuries a few years ago. But regarding this video, I have a question.
I´m assuming I have an overuse injury from training with too high frequency/too little rest (no acute injury, just slow building up of pulley soreness over a few weeks). I notice near to no pain during and after the climbing, even when I full crimp. But afterward, almost constantly, the middle finger around my A2 pulley feels sore when I palpate it. It´s usually mild, relative to how rough I have been on it during the previous sessions, but it´s still enough for me to doubt every single move I make with my right hand and not dare training on a fingerboard. In this video you talk about the pain (during the exercise) being actually positive in low intensity for healing, does that also apply to this soreness post session? Is it ok to train and have a mildly sore pulley afterwards as long as there is enough time for it to heal between? Or is this a different type of soreness/pain and should it be avoided altogether?
Just a summary/follow-up question, should one rather listen to the pain that occurs during an exercise, or the soreness afterewards? Or are they both as relevant?
I have a chronic injury from pulling my index finger (stupid I know, I did it during two different panic attacks), and I don't know what to do about it. It got stiff in the middle joint and after a while the extensor tendon got tight in a way that when I make a fist, I feel my finger's mid-joint pull on it and the tendon feels really tight over the knuckle. It's been about 6 years after the incident and the doctor now ordered me an MRI-test to see the soft-tissues. He said however that this happened because "the tendon's support muscles got weaker". I think he's wrong, the middle of my finger feels abnormally stiff also when it's straight, as if some tissue has hardened inside. what do you think?
best outro ever=D
Haha yess!!! Thanks for sticking in to the end!
Do you teach continuing education for PT? you give a lot of quality info!
Thank you! I do have some teaching experience but I have significantly reduced that recently to focus more energy here :)
Very interesting video! I have personally been dealing with a collateral joint/ligament injury (in both the middle joints, middle fingers) for the last 2 years or so. I've done almost every form of rehab I can think of. In the video, you use the Farmers Crimp for tendon/pulley injuries, do you think that this rehab could be applied to a collateral ligament injury?
When an injury lasts that long, my immediate response is two fold. 1) does pain science apply to this case and 2) what are they doing to constantly re-aggravate the injury? You may need to do a deeper look into your activities of daily living, work, climbing style, etc.
Oh and 3rd, you may need to get the injury re-evaluated (or evaluated for the first time) to make sure it actually is a collateral ligament injury and not something else.
Thanks, you just helped me figure out what the name of my finger issue is (I think). Do you have the same/similar symptoms as me?
- pain in fingers when pushing sideways on them
- ability to crack fingers sideways
- feeling of ligaments kinda slipping painfully if you move them a certain way, and associated crack sound and feeling
- some pain during climbing on really crimpy stuff but usually pain is a bit after climbing
- some pain when you bend your knuckles tightly as if to do tendon glides kinda
Have you found anything that helps?
@@adampnewsome The only things I would say I have similar to you would be your last two points. However, now my fingers have made quite some progress over the last half year or so in the rehab I've been doing, so it is hard for me to tell if they had more of what you had in the past.
The main thing that has helped the most recently is doing a hangboard protocol by Dr. Eva Lopez. en-eva-lopez.blogspot.com/2018/07/fingerboard-training-guide-iii-periodization-samples-of-maxhangs-training-programs-.html
After that, I find that light finger stretching, massage, and blood flow control help reduce the pain and increase the mobility of the joint. Plus, rice bucket training helps more of the same in that essence. However these things do not result in healing the injury/getting it strong enough to climb again.
I would recommend documenting the finger's progress. I've been doing so for the last year, and it's provided great affirmation and insight into the rehab I've been doing.
At the very least, I would highly recommend looking into starting the hangboard routine if your fingers have been chronically injured (and it's a similar injury to what I have.) The fingers need to be loaded appropriately to get back to climbing shape, otherwise, they will never be strong enough for climbing.
@@Rees8269 great, thanks for all the helpful info. I've been considering starting hangboarding - I have an appt with my physio next week and I'll ask if he recommends it. The other things sound helpful as well 🤞🏼
@@adampnewsome what did you find out. I'm having a similar issue for the last 6 months.
Hey, like so many others here, I have a question.
I now have the second A4 injury this year on my right hand, it's slowly getting there, I have climbing sessions without pain in the pulleys. However, my DIP hurts more when doing rehab protocols than the pulleys and they are also the bigger issue when climbing.
I had an MRI because of my first pulley injury and they found nothing.
Do you have an idea what might be the issue and how to deal with it?
If the MRI was a while ago and the swelling is new then the MRI wouldn't tell you too much, but...
It could be that you lost range of motion in your fingers after the injuries and began developing some synovitis? I hate to just jump to that when I hear DIP swelling but without an evaluation it's harder to determine if there is another cause of the injury like a collateral ligament injury, volar plate injury, or others.
We do have a video about synovitis / finger swelling. Check that out and see if it helps answer any of your questions!
th-cam.com/video/h-nOPJsBZz8/w-d-xo.html
@@HoopersBeta Thanks for your answer. I checked out your link and will try the tendon glides and rest. Keep up the great work!
Excellent video! Do you reckon that "No Hangs" can be a safe and suitable exercise to supplement farmer crimps?
No hangs with arms overhead or in a similar fashion to the farmer crimp / carry? With arms overhead / on a hangboard the only challenge is being objective and knowing how much weight/force you're producing every time.
A few weeks ago, I hyperextended my ring finger distal phalange while crimping, and now I have joint pain, weakness, and hypermobiliy that is preventing me from crimping with that hand. I'm wondering, could this same rehabilitation technique be applied to a joint injury like this?
Thank you for the video. I have a pulley injury on my second toe and it's been stuck in a slightly curled position ever since I stubbed it. The ROM is maybe half of what it used to be. Can I break it into it's normal ROM?
How applicable is this for other tendon injuries? Like a TFCC injury for example
Awesome question! It can be applied in many different areas, from an FDP injury, to Runners Knee / patellafemoral pain syndrome. It is, of course, case by case. TFCC injuries aren't as applicable as often times the problem is the person continues to re-aggravate the injury with their activity or day to day motions.
I had a car wreck, my finger gotten broken from impact. I had surgery but they said rn eh couldn’t fix it due to it being broken in 3 different spots, I gotten the pins removed. Still can’t move my finger. Any suggestions ? I have pain. & I also have carpal tunnel.
😥sending you love and healing sis
Quality content guys. Keep it up. Had a question hopefully you can help. I get release pain when I come off or move though pinches but not other holds. The pain is deep in forearm around halfway down my arm and feels like it’s between the radius and ulnar. Any feedback would be greatly appreciated. Thanks
Google "flexor pollicis longus" and see if this matches the area of discomfort. part of the muscle body runs right between the radius and ulna. likely just a muscle working really hard on those pinches which could use some training.
I see comments on tendons but not much about ligaments... why ?
After how many days we should start doing this after a finger injury. A weight fell over my finger
Yes
recently ruptured my A4 and am wondering at what point in the recovery process i should start to use PPP. After a few weeks of ROM exercises or right away?
Hi, with the training protocol you present in the video, can i climb during the rehab period o just 4-5 times a week the exercises but no climbing?
Hey my one of my middle finger on my right hand is pointing to the right due to some poorly performed gripper training I did. It was months ago and I just rested it, but every time I try to go do it again, the finger aches again and points to the right, as in being angled to the right where there is blatantly more distance between that middle finger and the index finger compared to the distance between the left hand's middle and index fingers.
I already paid way too much just to have it checked by physiotherapists who gave general advice but nothing specific so hopefully you know what I could do, I probably didn't give enough details but I figure you can ask and I'll explain it as best as possible. Would appreciate some method for this.
Thanks
I dont feel any pain in my finger when rehabbing, only discomfort. How do I know when to add more load to my finger?
With this protocol it should come to a point where it doesn't hurt at all?? After how long do tendons get to the level "pre-injury"? Do tendons get stronger after an injury?
Yes of course :) Your hands / fingers / body should certainly heal and get to the point of not having pain. Tendons, depending on the level of injury, typically take about 12-16 weeks to heal. Getting to "pre-injury" also depends on the severity and how much strength you have lost. Yes, you can be even stronger after injury if you are patient and work on good protocols to safely get stronger.