Symptoms vs. Structure Around Finger Rehab
Here’s a great example of why we can’t let symptoms govern all of our decisions on the progression of finger rehab.
This client had a classic A2 pulley injury. As you can see from the left two ultrasound images below, the tendon bone distance is significant demonstrating a partial rupture of the pulley. We can tell it is more one-sided due to the rotation of the tendon on the bottom left image.
Note: it’s not mandatory to have the ultrasound images. Physicians who work with climbers should understand this process. It’s just way cool to document the progress.
Under my guidance, this client has been loading on a fingerboard, climbing with many modifications, recovering and re-fueling on a pace consistent with other pulley injuries I have managed.
lack of symptoms doesn’t necessarily mean it’s healed
What’s important to note is how much better their finger feels! That is good, but also risky.
If the presence of pain is not the best indicator of tissue injury, the opposite is also true. The absence of symptom does not represent full healing. This is especially true with connective tissue.
Based on the symptoms, imaging, and psychology of the athlete, this pulley is healing well. But it’s not ready for the high intensity, high-velocity, and high-volume loading this athlete is capable of.
So, we update the plan with slight progressions in difficulty and stay patient.
Key takeaways:
Absence of pain does not equal health.
Persistence of pain does not mean it’s not healing.
Connective responds slowly, so you have to be patient. ASIDE FROM LOADING AND RECOVERING THERE IS NO METHOD TO MAKE THIS HAPPEN FASTER!
Not loading at all (under loading) often times is more stressful for athletes. There are always things you can do!
Get help from a professional.