Why your FINGER INJURY WON'T HEAL and HOW TO FIX IT (Pain is Good)

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// Timestamps //
Intro & Video Overview (00:00)
Part 1: Care Study with Marcel (00:58)
Part 2: Neurological Effects of Injury with Dr. James Lee (02:19)
Summary of the Neurological Effects of Injury (04:42)
Part 3: Physical Effects of Injury (05:15)
Part 4: Rehab with the Proper Pain Protocol (06:37)
Farmer Crimps Reps & Frequency (09:16)
When Do I Increase the Weight? (09:44)
Outro & Bloopers (10:11)

Show Notes: Intro
I’m just going to come right out and say it, this is a complicated and deep subject, BUT we’re going to break it down into digestible pieces in this video because it’s such a massively important topic for climbers. We’re going to find out how to FINALLY fix that lingering hand or finger injury you got months ago from climbing that “just won’t heal”. We will go deep into understanding pain science and how to USE that knowledge to rehab our injuries. We will go into a Proper Pain Protocol to help guide your process. AND, we are making this episode extra special by bringing in not 1, but 2 special guests.

For our two interviews, we will have a pain science discussion with Dr. James Lee, a physical therapist in Chicago who has been treating climbers there for years (and is of course, also a rock climber). And, we will have an interview with our friend Marcel, who is a rock climber himself who found himself in a similar situation uttering those same words to me while climbing one day: “I hurt my A4 a year ago, and it still hasn’t healed”.

We are going to start off with an interview with Marcel, but before we call him up, let’s give a little more background. Marcel is an awesome dude and a strong climber who experienced an A4 pulley injury about a year ago. In his words: “I was climbing at Tramway, it was cold, and of course i spent all of 10 minutes "warming up". I got through the slopey crux and grabbed a huge incut crimp with my left hand and as soon as I put my weight on it I heard a loud pop and my finger instantly went tingly and funny feeling. surprisingly no pain but suddenly I lost all power with that finger. It was never diagnosed but I believe a a4 injury on the middle finger.”

Now, it’s been long enough since the injury so the tissue should be healed at this time. But he is still experiencing discomfort. We will talk to him about his rehab process and check in on how he has been doing

For the rest of the show notes, please check out the website!

Disclaimer:
As always, exercises are to be performed assuming your own risk and should not be done if you feel you are at risk for injury. See a medical professional if you have concerns before starting new exercises.

[charlesfourcade]

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 !

[urik]

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!

[lieketv]

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.

[dannymarsh]

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!

[Dave-obwk]

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.

[jonbonhoagie]

Thank you Dr Hooper. You are a true man of the people offering this information for free. Long may you send!

[haushunny]

I’m SO happy this is being talked about. I wish I would’ve known this with my chronic back pain three years ago.

[dinkelhacker]

Your Videos are top notch! Thanks for putting in the effort :).

[frictitiousclimbing]

Liked this about 5 seconds in, thanks for the insight Dr. Hooper!

[legestrom]

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.

[the-nomad]

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!

[garronfish]

I've seen a number of videos covering rehab of finger injuries and this is on another level, so good, thank you!

[firstmkb]

I’ve never climbed, but dislocated a couple of fingers falling. These guidelines and info are perfect!

[junkfire]

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 🙌

[muakutu]

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

[omeradanyodla]

Thanks for the video! Really helpful to understand how injuries work and how to treat them

[melvinchua]

Thanks Dr for the incredible insights, really glad that someone is creating such content to help educated recreational climbers like us!

[professorbellorum]

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".

[matthewberke]

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.

[Literemmett]

ive been looking for this video for so long!! Thnak you, this is so helpful!