Road back to 8a (Rehab part 2)

As many of you will know I suffered a full rupture of my A2 pulley whilst on a bouldering trip in South Africa last July. When the injury happened I was in the best form of my life and I was absolutely devastated with the set back. On returning home I set myself a goal which was to be climbing at a reasonable level within 6 months. With this in mind I booked a trip to El Chorro for January.

I am writing this blog sitting outside our Finca in El Chorro having just climbed my first 8a, Mar de Ortigas, since the injury.

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It has taken me 188 days to get back to this level. In my previous blog here I documented the first part of my rehab. Below I will try to explain what I have been doing between then and now.

The next step after completing my finger curls was to build finger strength progressively on the fingerboard. I started with partial body weight hangs on big holds in an open handed grip. The way I did this was to stand on a set of bathroom scales whilst doing my hangs. At first I only took 30% of my body weight, then 40%, then 50% and so on until I could comfortably do my sets of hangs without standing on the scales at all.  I did repeaters i.e 7 seconds of hanging 3 seconds of rest, repeat for 6 reps. This was one set. My sessions consisted of 3 sets with 5 minutes rest between sets.

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When I felt strong and comfortable open handed I worked through the same routine but in a half crimp position. It was really motivating to see progression through these sessions and my finger had less pain and stiffness as well as feeling stronger after each session. I must add that I had my finger taped using the H taping method for my fingerboard sessions.

Now this all sounds very scientific and structure but I must admit that I was really missing climbing movement so I added one session a week on the circuits into my rehab. I started off by doing the easiest circuit at the wall using only massive holds. Each week I increased the number of moves I did until I was doing over 1000 moves in a 2 hour session still on the very biggest holds. I climbed very carefully and precisely making sure to place my feet perfectly so they didn’t slip. The last thing I wanted to do was shock load my finger. I actually really enjoyed these easy climbing sessions. They gave me time to concentrate on perfect climbing movement and to iron out some flaws in my technique. After a month of this my climbing felt really fluid and efficient and, dare I say it, better technically than it had ever been before.

I supplemented the fingerboard sessions and circuit sessions with general conditioning and core work often on the TRX.

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As my finger strength increased I started to increase the difficulty of the circuits. I made sure I was well warmed up by doing a few hundred moves on the easy circuits before moving onto something harder. At first this meant making my own 40ish move circuits up to avoid any small crimps. Eventually I could climb the set climbs but I had to open hand the small edges, getting my “pinkie” finger on wherever possible. I was still trying to do about 1000 moves per session.

The thing I would say about this and any stage of the rehab would be to really “listen” to the injury. If there is pain or anything more than mild discomfort reduce the intensity or stop altogether and go and do something else for a while, like surfing.

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6 weeks before my planned trip to El Chorro I started to really up the intensity of my rehab, in fact you could almost call it training. Having done so many moves on the circuits I had given myself a really good endurance base. I also Route Set for a living, part of this job involves testing the routes or boulder problems I have set (to make sure they work at the given grade and are nice to climb) and this testing was all the strength/power training that I needed so all I had left to work on was my power endurance and recovery.

The style of climbing in El Chorro is generally long, steep and pumpy. You often have to move efficiently through hard sections, getting pumped, before finding a nice rest, perhaps a knee bar, where you have to recover as best you can.

My favourite way to train for this is again on the circuit boards. I do a kind of interval training which involves warming up thoroughly before alternating between a hard circuit where you get pumped and an easy circuit where you can recover fully. Alternatively you can do a hard pumpy circuit then try and recover on a good hold or rest position before repeating the hard circuit.

I soon began to see improvements in my climbing and  after several weeks I could comfortably do laps on the 8a circuit at Bloc

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Admittedly I had set this circuit to suit me. It has no crimps and mainly  consists of big wide moves on pinches and slopers, just like El Chorro.

So here we are, in El Chorro. The rehab and training seems to have paid off and I am really happy with the level of climbing I have been able to return to. I am confident that I will be able to return to my previous form and maybe even surpass it. The thing I have learnt through this process is that many people who push themselves in sport encounter injury along the way. It is the how you deal with your injury that dictates the outcome. Be positive, use your time and energy constructively to work through your rehab and perhaps you will be able to reach new heights in your chosen activity.

I will let you all know how my week in El Chorro pans out.

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I must also thank my sponsors, Mammut UK and La Sportiva for their continued support.

A2 Pulley Rupture (Rehab part 1)

This summer I had a 5 week bouldering trip to the Rocklands in South Africa booked. It promised to be the trip of a life time.

I had prepared well with my training. I was feeling fit, strong and healthy. For the first 6 days of climbing I was on great form, ticking off hard classics quickly. I had high hopes for the trip, until this happened:

In the video you can hear several different loud cracks and pops. On the first hold I move to you can hear a faint crack and then whilst swapping hands on the fiddly match there are two loud popping sounds. I now believe that the first crack was a partial tear of my A2 pulley and then whilst bumping around on the match with with poor feet the pulley ruptured fully.

Initially I had no pain in the finger and there wasn’t much swelling. There was just a strange fuzzy tingling feeling and the finger had absolutely no strength.

It was a 40 minute walk back to the car, during this time I kept my hand raised above my head, the cold wind helped to keep the swelling down. Arriving back at the house I iced the finger to keep the swelling away.

The icing technique I use is the one suggested by Dave Mcleod. I put 5 to 10 ice cubes in a bowl of cold water and leave my hand in the bowl for 10 to 15 minutes. At first my hand goes white but after about 10 minutes it it starts to flush with blood. You can tell when this happens because you will feel a nice warm throb in your hand. It will also be a nice pink colour. I believe this a trained response and you get quicker at flushing the blood to your hand the more you do it.

At first we thought I may have just dislocated my joint. I theorised that the two pops could be the joint dislocation and relocating and I hoped it would heal up fast.

I went to the local hospital in Clanwilliam to see a doctor. He sent me for an X-ray.

Xray

Xray

The Xray showed that there was no damage to the bones in my finger but couldn’t give me any information about the pulleys. He just vaguely told me to rest and not climb for “a while”.

Finger pulley system

Finger pulley system

Pulleys are ligaments that hold the finger flexor tendons (FDP and FDS) onto our finger bones. There are 5 pulleys, A1-A5.

The pulleys experience extremely high loads during rock climbing, especially when crimping. and I suspected I had done damage to one of these.

From previous pulley strains I have suffered I know that when pressure is applied to the palm side of the suspected injured pulley there is localised pain/discomfort.

Testing for pulley strain

Testing for pulley strain

With this injury I had no pain just a dull sensation where the A2 pulley should be.

Not satisfied with the local doctors vague advice I decided I was in need of an MRI scan to give me a proper diagnosis for the injury. Fortunately I had travel insurance for the trip which was provided by Sports Cover Direct. They organised and paid for my scan without any hassle at Durbanville Mediclinic in Cape Town.

The results of the MRI scan were conclusive:

MRI scan showing bowstring of the tendon

MRI scan showing bowstring of the tendon

MRI scan showing cross section of the fingers. Note bowstring of tendon and remains of A2 pulley

MRI scan showing cross section of the fingers. Note bowstring of tendon and remains of A2 pulley

This scan shows the palm side of the hand. The tendon in the ring finger is more visible because if is bowstringing away from the bone

This scan shows the palm side of the hand. The tendon in the ring finger is more visible because if is bowstringing away from the bone

I had suffered a full rupture of the A2 pulley in my right ring finger.

Whilst I knew a full rupture meant having a substantial amount of time off climbing my head was still full of questions:

“How long will I need off climbing?”

“Will my fingers ever recover back to full strength?”

“Will I need surgery on the injury?”

“What rehab should I do to maximise my recovery?”

When I returned home I booked an appointment with a hand surgeon. I wanted to know if surgery was needed or if a conservative approach to rehab could be taken.

The surgeons recommendation was that surgery was not needed for a single pulley rupture and that conservative rehab would be the best option. He referred me to Dr Schoffls paper on finger injuries which gives a nice timeline of the rehab process.

Table for scoring pulley injuries

Dr Schoffls table for scoring pulley injuries

Table showing recommended rehab schedule

Dr Schoffls table showing recommended rehab schedule

I had a grade III injury so a non surgical rehab was recommended. I was overjoyed with his news and I booked in to see Nina Leonfelner. Nina is a physiotherapist who has worked with climbers that have suffered  from pulley ruptures in the past.

She built me a rehab program taking Dr Schoffls tables into consideration.

So for the first three weeks after my injury I had rested and iced the injury twice a day. I used tape as protection whenever I had to do anything physical with my hand. I also did some very gentle mobilisation of my fingers.The idea of this was to stop scar tissue building up and attaching to the tendons which could lead to a poor range of movement in future.  These mobility exercises included:

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For the following month I did some very light resistance exercises to promote healing of the damaged tissue. These included using the rice bucket, squeezy balls, putty.

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I also did a lot of antagonistic forearm work these included wrist curls and lots of work with the powerfingers.

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I had a  30 minute routine using these that I would do three to five times a week.

After this stage of the rehab my finger was feeling much stronger and my finger had almost  returned to full range of movement. It was time to move onto the next stage.

The mid stage rehab that I was given was a bit more intensive. It revolved around doing weighted finger curls. The idea is to start with multiple fingers with a low weight. I then increased the weight until I reached about 5kg’s without any discomfort. I then reduced the number of fingers being used and started back at a low weight until finally, after about a month, I could finger curl 4-5kg’s on one finger without any pain.

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This is the rehab stage that I am currently working on. I am really happy to be seeing real gains in my finger strenght and feel confident that I am well on the way to making a full recovery. Nina tells me there is one more rehab stage to complete before I can get back to the climbing properly.

You can find the next stage of my rehab here.

In the mean time check out this great article written by Robin O’Leary and Nina Leonfelner on ukclimbing.