Collateral Ligament Injury from Rock Climbing (Causes & Fix)

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🔬 RESEARCH CITATIONS
- Complications of Proximal Interphalangeal Joint Injuries: Prevention and Treatment: bit.ly/3YzUNBa
- The Collateral Ligament of the Digits of the Hand: Anatomy, Physiology, Biomechanics, Injury, and Treatment. bit.ly/3S48jKE
- Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. bit.ly/3YUqJQA
⌛ TIMESTAMPS
00:00 Intro/Overview
00:17 Collateral Ligament Anatomy
00:54 Causes of Injury
02:07 Symptoms, Testing, & Diagnosis
04:01 Ruling Out Other Injuries (Differential Diagnosis)
06:26 Rehab/Treatment Options
06:34 Can You Still Climb? (Tape?)
07:31 Active Range of Motion
08:17 Exercise and BFR
08:48 Manual Therapy / Massage
09:06 Joint Mobilization
09:50 Rice Bucket?
10:13 Ice and Heat?
10:56 Patience (and Surgery?)
11:21 Prognosis
📝 SHOW NOTES
Episode 130
www.hoopersbeta.com/library/c...
⚠️ DISCLAIMER
As always, exercises and rehab programs 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 a new training or recovery program.
#trainclimbsendrepeat #climbingtraining #doctorofphysicaltherapy

[@paulgaras2606]

Not at all interested in bypassing medical professionals here but it would be really nice to have a mega guide on fingers similar to the one you did on training recently. I have numerous mild pains at various places in my fingers that usually go away after a few days (or even after training) and it would be nice to have a reference for what’s going on and what I need to be watchful for.

[@JonahBoretsky]

I went to a hand specialist for this about a year ago and their response was basically there's not much we can do. They suggested I either rest, or continue climbing through it and avoid positions that aggravated it. I rested a few months but still had the pain and just decided to start climbing again. Pain is still there 1.5 years later but I barely think about it anymore and it's not nearly as bad as it was. This video would have been really helpful, as it was really difficult to find any information out there about it. I'll definitely try the workouts and see if they help to further improve it! Thanks, glad I'm not the only one that's experienced it!

[@tallbetaclimbing]

Thanks for this great video ! I'll add a few things, as I already had this injury two times, on the two middle fingers : Yes it was from sidepulls, especially when losing feet on them. The initial phase of healing is just fine, but the PIP tend to stay swollen even when the ligament is healed, and it often evolves into a synovitis. Both injured sides evolved to a synovitis (maybe I was climbing too much during rehab ?), that took more than a year to resolve for the first one because of a lack a knowledge on the synovitis, and that was only a minor problem on the other side because I knew how to handle it. I've had two other friends (both V9+ climbers) for whom it evolved this way too, so I think it's fair to warn people : this injury might evolve to synovitis ! Since I'm a doctor too (but in Oncology) I checked my textbooks, and it says that this collateral ligament injury can takes up to 8 to 12 months to feel perfectly fine : I suspect that it's because of the underlying synovitis. I had an ultrasound and an MRI to confirm the Synovitis : the ultrasound just showed that the ligament had thickened because of the healing process but no sign of synovitis. The MRI showed that the synovitis was dry (no oedema) but the joint was flashing like crazy !!

[@NestorMandela]

I suffered from it and ask you about it in another video a few months ago. Now you deliver like a pro. I love your channel!

[@HoopersBeta]

Glad we could deliver! Sorry it took some time :)

[@pavelbelik6174]

Top notch content Hooper! Getting better with every video!!

[@HoopersBeta]

Thank you! We appreciate the kind words.

[@FunnyFish2121]

It's been unbelievably hard to find anything on this topic, a much needed video! Would you say that the basics are the same for the thumb IP joint as well? Been having problems with it for like half a year now, seen two professionals and it's getting better but the progress is frustratingly slow😔

[@HoopersBeta]

Yeah that's fair. Sorry to hear of the slow progress! The thumb is tough because well, we use it sooo much with our daily activities and its function is a bit more advanced. Hope you're able to make a full recovery!

[@user-wx6xi7ef6l]

Guys thank you so much for this video!🙏🙏🙏 I have been searching for 2 weeks this information. There is almost no info in youtube about this injury.

[@cyclic_infinity]

Always appreciate having you as a self-diagnostic source Dr. Hooper! You've helped with my diagnosis and rehab of A2 ring finger pulley injuries on both hands, and deciding when seeing a medical professional is warranted. Turns out I had pretty extreme ulnar wrist weakness, and have since childhood, but with that resolved through some PT I finally have a new injury. I seem to be a dealing with a Grade I left-hand middle finger PIP ulnar collateral ligament injury, based on the procedures outlined here. For climbing safely going forward, and as a clarification on this video, I am curious about the relationship of ulnar/radial deviation and varus/valgus forces; as the ulnar collateral ligament is the injured one, it seems I need to minimize Valgus force. My gym uses traversal routes for bouldering very often due to space limitations, which likely contributed to this injury, and I'm uncertain how left-leading versus right-leading routes might impact this injury. I'll mostly be switching over to vertical top-rope routes for a few sessions in any case, but this could be useful for future injury prevention and rehabbing. It seems to me that left-leading traversal climbs would tend to have more radial deviation of the left wrist, and thence more varus than valgus force on the left middle PIP and should be safer, but I am not quite confident I'm interpreting the information correctly.

[@derekhowell181]

Great video. I've had to learn pretty much all of this on my own after the last year of dealing with this injury on and off. Glad theres a video for people!

[@HoopersBeta]

Thanks for the comment! You (and everyone else) are never alone with these injuries though. While there still aren't enough, there are more and more healthcare professionals learning about climbing injuries and we are all stoked to help!

[@rockstarjazzcat]

Good timing on this. Thanks!

[@HoopersBeta]

Our pleasure!

[@jamesonklein9363]

I know you mentioned you’re not a huge fan of ice/heat but I’ve found it rapidly improves my recovery. My injury is actually from disc golf (finger ripping off the disc instead of off a hold) but it has improved my range of motion rapidly.

[@user-wx6xi7ef6l]

Thanks to you i have decreaced pain in my finger. And climbing become more comfortable. Thank you guys once again

[@HoopersBeta]

Love to hear that! Thanks for sharing :)

[@wm6549]

Excellent video. Thank you!

[@paulmrodriguez]

Thank you I needed this

[@ozamram]

Great stuff as always! Please do synovitis next!

[@HoopersBeta]

We could certainly use an updated video on that!

[@ivanpaskalev9863]

Daaamn This channel is awesome

[@themightyquinn1343]

I had this injury a few weeks ago, and had no idea what was happening. I knew it wasn't a pulley, and it probably wasn't overuse, but I couldn't find anything that described what it actually was. I ended up just playing it safe and stopped climbing until the pain went away, while doing some mobility exercises. Thank you so much for putting this together! Glad to hear I was on the right track, and happy to report everything's back to normal.

[@HoopersBeta]

Thanks for sharing! Stoked that everything is back to normal for you :)

[@oliviercourtens5540]

Thanks a lot for this

[@MP-bx3uj]

!! I injured one of mine earlier this year and couldn’t figure out why it wasn’t exactly a pulley issue! Thank you for explaining it!

[@HoopersBeta]

Our pleasure! Happy it helped :)

[@Luca-cw9kg]

Hey Hooper's Beta, thanks for the great video! I'm currently studying to be a physiotherapist myself and while clinical evidence is still laking these video's help me learn a great amount about climbing injuries. In the video you mention joint synovitis as a differential diagnosis, are you planning on making a separate video about this injury?

[@HoopersBeta]

Glad you find these helpful! It's fun to know that they can be useful as educational and not just for specific rehab. We have a video on synovitis but it might be time to update it!

[@slapthesloper]

Awesome timing just had an audible pop in my pinky crimping hard outdoors and ended up self diagnosing a LcL injury and my a2 pulley. Rewatching my joint flex on the video and hearing the pop gives me shivers still 😬

[@HoopersBeta]

Yikes! Yeah I'm sure that's some gnarly footage! Sorry to hear of your injury.

[@deusexmachina1090]

I love you man, just so valuable content ❤

[@HoopersBeta]

Thank you! We are stoked you love our content, that's what we are here for.

[@MeticulousSpline]

I have really crooked middle fingers, I have to deal with grade II on the concave side pretty much every time I climb hard. Grip position doesn't seem to matter much, although hard crimps give the most risk. I'm just glad that the methods of dealing with it that I figured out over the years are pretty much point for point what you recommend. Taking collagen seems to have improved things tremendously too, but I'm inclined to think that's mostly a placebo.

[@virendradatt9817]

I found your video extremely informative and useful. Being a right handed golfer and have pain in middle joint of left hand ring finger. I feel pain whenever i swing the club and consequently am unable to hit the ball firmly. Grateful if you can guide me towards a solution.

[@user-sh5ni9yu9c]

Thank you so much sir 😊🙏

[@jhonasaugusto1]

Omg thanks for talking about this topic! I can't bend my finger without a nerve catching.

[@jpuigclimbing3961]

Awesome Channel!!! To get rid completely of pain, before getting back to serius climbing, it helped me weighted hangs... Or so I thought... Any insights?

[@stefanopaoli717]

Thanks. Very useful for me too.

[@HoopersBeta]

Happy to hear that!

[@InterwovenElements]

Thanks for putting this video together. Very clear and concise information. Props for the flossing on your sponsor table xD

[@HoopersBeta]

Haha thank you. Glad you enjoyed the vid!

[@shanpieee]

thanks ❤

[@HoopersBeta]

Welcome!

[@ScratchRick]

Any tips you can give me as a youth climber to avoid big injuries (or things that may cause problems later)?

[@altaris2000]

Thank you for this. I thought I hurt my A4 pulley a few weeks ago, but certain things just didn't seem to match up, like it hurting more on one side, and not in the center of my finger. Now that I see this I am leaning much more towards the DIP joint. It also lines up with the fact that I had some really hard sidepull type crimps that night too. And yes, I am know I am stubborn with going to see a dr :)

[@HoopersBeta]

Thanks for sharing and glad this video found you! Hoping you a strong recovery!

[@matthewontherocks]

What things have you learned the most from the climbing side of things compared to the PHD side of things in retrospect to the ability to teach/understand the subject? MSc Health Econ climber here, try to be as analytical as I can towards my training but it's interesting the link between the theory and the practice from my experience

[@danielamolina8892]

Hi Dr. Hooper, Great video! Are these finger injuries similar to pain/tenderness in the toes? Specifically on the distal interphalangeal joint of the big toe? Thanks!!

[@neekobody]

Amazing video… Patience seems to be key. Unfortunately I got injured 4 weeks ago on 2 joints… + a broken bone on P3 (last phalange): is that going to make recovery faster in your opinion?

[@KietTheViet]

Thank you for this video! Interestingly, when my right middle finger is fully extended there is no sideways bend in my DIP joint, but when I close my hand there is a clear sideways bend in my middle finger towards the direction of the index finger (a little less than 20 degrees). There is little to no instability when I do the lateral stress test. As far as other symptoms, I have all the symptoms of synovitis as well (swelling around the entire joint, pain on the top of the joint, reduced ROM). Would this be a separate issue or are these symptoms also indicative of collateral ligament injury? I'm paranoid that my finger will "heal in that position".

[@middle-agedclimber]

Holy shit, impeccable timing. Exactly how I recently f..d up my middle finger (got locked in a slot). Thank you!

[@HoopersBeta]

Sorry for the injury but glad we have good timing for you and your injury! Wishing you a strong recovery!

[@hoshvilson6902]

What are your thoughts on using something like diclofenac for something like this or synovitis? I know we wouldn't want to use that when inflammation is required for the healing process in a pulley strain, but what about wanting to reduce the inflammation, like with synovitis? Curious of your thoughts on this.

[@jaredandress4304]

I'm curious as to what your thoughts are on red light therapy? Or if you can do some scientific digging on the topic? I use a rubylux red light bulb on my hands/wrists after all my climbing sessions. I belive it helps me! 😊

[@carbonking53]

After receiving treatment for three months for what my orthopedic hand specialist thought was an A4 pulley injury I am thinking he missed the diagnosis. My MRI showed no pulley damage but he was not buying it and said it was a pulley injury. After weeks of treatment the swelling eased off and there is noticeable lump in the pip collateral ligament area on the injured finger. I looked at my MRI at home again and granted I'm not a doctor but somethng looks off in that very area of my MRI. I think I may get a second opinion because my current doctor is to focused on what he thinks is the issue to even listen to my concern and observation on the MRI.

[@Allen_lena]

Thanks for the video. This help me discard synovitis as my issue, and find out what is the cause of my grade 1 sprain. I'll focus on not over-reaching laterally with this hand (my project had a way to big move to the side that is the possible culprit), and I will focus on recovery. Thankfully my baseline pain is usually around a 1, so I'll work on rehabing it over a few weeks. I wanted to ask about taping: would the X taping method, putting the X on top of the affected side help more than just taping in a circle? Or is buddy taping the way to go?

[@jpmonlevad]

Was surprised you did not mention the use of corticosteroids injection as a potential intervention in some specific cases. Would there be any situation that you'd recommend it?

[@humbertolopez2627]

Can you make a video about pain on top the finger? Specifically caused by slipper in the middle finger A2 area but not under the finger, on top the finger. Thanks I have been having that injury go no and coming for past couple of months

[@WyandWombat]

You know, I think I actually had an injury like this for the past 6 months. It's really difficult to find any info on this and I eventually got a hint towards collateral ligament from a book specific to climbing injuries that I bought. The book says this is often overlooked, but I got pretty much the same issues that are described there (and in your video) and crucially, the main cause of those kind of injuries the book gives is small pockets or monos. And that's exactly what I did when I got this issue: A deep lock off on a very shallow 2 finger pocket on a 7c+ route. It's a really weird injury that fits none of the descriptions of your typical finger injuries and I even could continue climbing for the past 6 months. Weighted hangboarding, moonboarding, no problem, no pain. It's just the occasional weird load on the finger that causes sharp pain and I have a difficult time fully flexing the affected finger. Finally made a doctors appointment with an orthopedist who specialices in climbing injuries. It's three more weeks but I guess that doesn't matter all that much given that I had this for half a year now. Apparently that book is also available in english where it's got the title "one move too many". But beware: The pictures are quite gnarly :D

[@GavynnStrasshofer]

What happened with the specialist?

[@florianb.l.8274]

Thanks for the video ! I injured my right index finger while climbing almost 4 months ago. It’s really hard not to use it much so I guess it’s long to heal. The pain and the swelling are still there… I have an IRM on July to see if nothing is broken. Finger crossed !

[@HoopersBeta]

Sorry to hear of the finger issue but yes, it certainly can be hard to not use it!

[@rest0ck]

I've got my collateral ligament on the mcp joint injured. Does everything here apply to that one as well? It's been 4 months now and it still hurts

[@jychoo1424]

My pain is at the right hand pinky, but it is not on the joint itself, rather its in between the PIP and DIP joint, and I feel tenderness at the right side and bottom of the area. I have not found any more videos or resources regarding pain in this area and this video is the closest I have come so far. Am I having this exact injury or do I need to seek more professional help ?

[@christopherwells4768]

Timely.

[@sandrasun9179]

Hi doctor Hooper, unrelated question from this video, would you have any advice or video content on recovery lower back pain presumably from repeated bouldering falls?

[@HoopersBeta]

We haven't made a video on lower back pain yet as the source can vary and so making a specific video is quite challenging.

[@TheTonVeron]

Prefect timing. Ive been moonboarding a lot and have noticed a nagging pain on the side of my PIP joint in my ring finger. It's worse when i full crimp but being on the side made me consider the collateral ligaments, but it was super hard to find info about.

[@HoopersBeta]

Definitely do your differential between collateral ligaments and joint synovitis if it's worse with full crimping.

[@TheTonVeron]

@@HoopersBeta i think it was a combination of both. The pain on the side seems to be mostly gone now, but there's still a bit of pain if i press on the bottom of the joint.

[@MusclePiggers]

Does anyone else experience pain on the thumb side of their wrist/ hand when climbing? Thinking it might be something like mother's thumb - except the only thing I'm carrying is my own body weight on plastic rocks 😅

[@craigbritton1089]

My 69 year old fingers will not touch either of those lines when drawn on my palm. No real pain unless I try and force them down. Just tight and very irregular lineup of the fingertips Any recommendations or advice/ warnings. I had two broken fingers as a kid. And a dislocation and tendon/ nerve tear when a two finger first knuckle jam broke and one finger tried to stay. It started growing back together before the surgery was approved.

[@alexgalays910]

Seems a bit like the Knee's LCL

[@arcusang9685]

Finallyyyyyy

[@TheAbd1233]

Hi, Hopper thanks a lot for this video. I just had this injury in my dip joint 2 weeks ago and was very confused as all the tests for other finger injuries were negative. Currently, I have no pain unless I climb a lot 2 h +. Just want check in my case if I climb too much I get pain on one side of the joint and my fingers move in a jerky manner (click into position) is that expected?

[@HoopersBeta]

That high volume could simply be triggering your symptoms but you'll want to perform some differential diagnosis regarding joint synovitis as well.

[@TheAbd1233]

@@HoopersBeta thanks for the advice.

[@pavelbelik6174]

Hi Hooper, great vid! One addition from my experience with this issue. It is worth checking the position of your fingers when loading them on different types of olds, esp crimps. I started to have serious pain in my middlefinger only then to notice that Im loading the finger sideways (pushing more with the outter half of the finger). It is also worth observing the position of your wrist relative to the fingers, from writing on computers we tend to keep the deviated position which affects finger loading as well. Only after I started paying attention to these 2 factors (both in and out of the gym) my finger healed.

[@HoopersBeta]

Good share! Glad that you were able to figure those factors out and get your finger healthy again!

[@duduc998]

RIP DIP & PIP

[@CarryBrahHighlightReel]

I think I got this from basketball. Jammed my finger. 2 months and it's still not completely healed.

[@HoopersBeta]

Sorry to hear about your injury! Hopefully it heals up strong!

[@w1zar13]

Slowly collecting all the injuries in hooper videos...

[@HoopersBeta]

haha oh no! Well, at least you have information on how to address them all :)

[@davidarmstrong2078]

Rice bucket? That's a new one on me.

[@HoopersBeta]

We’ve got a full-length video on it :)

[@davidarmstrong2078]

@@HoopersBeta That was a quick reply. It took about as long as it took me to watch the video about rice buckets. Seems the idea's odd but not useless.

[@Skadi2k3]

Friction massage of already damaged tissue is not a generally accepted treatment.