3 June 2007

Finger injury treatment videocast




[UPDATE] The video I made about healing finger pulley injuries is a bit out of date now and the knowledge has moved on a bit. I have almost finished my climbing injuries book 'Rock 'til you drop'. In that I've written a very detailed discussion on everything to do with pulley injuries. It'll be out soonish.

This is my first ever videocast! In it I talk about the most effective treatment there is for speeding healing of finger pulley injuries; what to do, why it helps and how often to do it. Enjoy!

It’s a bit rough and ready cos it’s my first one and I shot it by ditting my digi camera on a table and did it in one take, but I hope it was OK? I’m going to do these regularly so post some comments with your requests on what you’d like me to talk about. Of course I'll post all my new videocasts on this blog but you can subscribe to my videocast feed here

172 comments:

Anonymous said...

Cheers Dave, I'm watching it again with my hand in a pot of water.

Anonymous said...

Interesting stuff. Could the injury have been avoided in the first place?

Do you have any tips for split tips? How to avoid them when working something sharp and how to improve recovery time? Marigolds in the bath?

Cheers

Ralph said...

Awesome stuff Dave, thanks! I've actually been using this treatment for the past week or so, though not as much as I should have been, and it's healing really well.

As for future topics, if you've any advice for treating elbow injuries (mine presents as golfer's elbow, physio helped for a while until I started to train harder again. Now just trying to manage it as best I can but a bit stuck for ideas!) it would be very much appreciated.

Thanks

Dave MacLeod said...

Hi folks - cool, split tips is on the list of things to videocast about. Elbow injuries is a bit more involved - might do a longer article about that soon as I still need to do much research into this. Man, I want to get sponsored by Human Kinetics so I don't have to keep shelling out!

Could the injury have been prevented - sure - by not climbing hard! In my previous post I blogged about the ENERGIE conference and talked about John MacLean's lecture on sports injury today. The title of his lecture was "Sport for all means injury for all". That says it all. If you push yourself hard, injuries are a reality in the real world. But of course you can minimize them. This pulley tear is my first in about 6 years despite training myself harder than most. So my injury prevalence has been WAY below the average despite training WAY harder than average. So I count that as a major success!! Besides, my rehab strategy is meaning that it is barely affecting my climbing capability at all, I just have to add all the rehab stuff. But hey thats life. Hopefully it will be gone in some weeks...

Flapper said...

Hi Dave,

Great stuff. My partner just did a minor tear to her A1 while on an undercling - so the tip comes at a great time! I'll start using it for recovery.

How about some tips on managing skin? Sometimes mine gets so sore it's almost impossible to train.

Another good idea would be some video footage of specific training concepts - e.g. Complex Training.

Cheers.

Anonymous said...

dave..thank you for all that you do

Anonymous said...

Thanks Dave, very relevant to me right now! I had been icing twice a day but will try the cool water instead. Just one question, how cold should the water be? Straight from the tap or chilled with a few ice cubes?

Thanks again!

Dax said...

Hi Dave,

Really appreciate the effort your putting into all this distribution of knowledge. For me, it's so useful becuase it's coming from someone that has the climbing AND academic background that means I can trust what your saying.

Anyhow, do you have any plans/info to summerise ways to prevent injury in the first place?

Also, bit of a long shot, but how would you adapt this treatment for a shoulder injury? It's got me stumped .. taking a partial cold shower could do it but I'm guessing from your vid that the body needs to decide that the bit of your body your cooling can be heated up .. this might not happen in a shower and u might get the opposite effect on the blood vessels.

Also not particularly water conservation friendly (or enjoyable) .. sitting under a cold, bloody, shower for 30 minutes.

I've got a cold pack but that would be just too cold .. perhaps I could insulate the shoulder from the pack with a cloth or similar?

Enough of my waffling on,

Take it easy,
Dax

Anonymous said...

I second the question asked above of how cold.....ice, tap, etc. Great Video. Thanks.

Angus N Clark said...

Hey Dave,

Cheers one more! Like to emphasis someone elses comment by saying you do such a hugh amount for scottish climbing its awsome! The injury stuff is great especially since your actually someone who knows what they are talking about. Elbows are of interest to me as they seem to be to many. Gravity magazine published a rather good artical a 2 issues ago. I have had problems with my elbows started with a trip to Font and typically climbed through pain with ibuprofin till i couldnt sleep!! since thencouple of years ago it has dogged me now and then. First physio i saw gave me ultrasound which was in the end virtually useless for the tendonitous which had developed. A saw someone a bit later who geve me the best treatment up in Aberdeen. He noted that some people have a curvature of the arm which means they are naturally inclined to develope elbow injuries especially when hanging around on your arms (Bouldering or roof problems) His soultion was massage 2 times a day for ten mins which i could do myself and heating the area for 5 minutes in the evening. Most of all he said to keep climbing (Just not as hard) as otherwise your body will just slip back into tendonitus. This area interests me and i have heard much on the subject, it would be good to see a video clip which although may be long may clear up a few points.... Such as overdeveloped biceps compared to triceps can cause tenitus due to overstretchig the tri...?

Thanks for all you help!!

Angus N Clark

angusnclark@hotmail.com

Dave MacLeod said...

Cheers folks. All good suggestions for future posts - noted!

The water for this treatment should be as cold as needs be to allow the 'Lewis Reaction' of the reversal of vaso-constriction to occur after 5-10 mins. If its too cold you hand will still look white and be biting cold right through. Ideally the water should feel cold but your hand should feel warm by the end of the treatment. In a warm room that might need a couple of ice cubes but maybe not. tine tune it by experience.

Elbows are obviously a burning issue with many - more on this soon, but there are no easy answers. The best solution as with all injury prevention is to have impeccable movement technique and concentraion during climbing at all times.

tufish said...

How to avoid them when working something sharp?
well try not to make to many reps of that very hard move at a time, that causes the rip in your finger. or worse could happen such as injury of your joint, that will really take some time to heal( i have that problem)
excuse may English
bye

Anonymous said...

Thanks Dave! Could you possibly please do another one on shoulder injuries and rehab? It's probably nearly as common as A2 injuries so definately worth blogging?
Thanks a lot!

Anonymous said...

Like others, I'd also love to see rehab advice on shoulder strains and elbow tendonitis when you have some more free time. But back on the topic of finger injuries:

- Is the cold water bath specific to pulley tears, or is it useful for other finger injuries? Will it work well for things like cartilage compression in the joint and/or stiff/swollen knuckles, or do you recommend other types of treatments? I've heard that alternating hot water / ice water treatments are best, but I'm wondering if the cool water treatment is better. Thanks!

Dave MacLeod said...

Application of cold treatment for other injuries -

Sure it will be good for other injuries where soft tissue tears are involved. My experience is that it makes little impact on swollen finger joints, but I've not seen any resarch to support this. Variety in the climbing/training venue and especially grip type is effective for attacking swollen joints.

The word is that cold treatment is more effective than alternating hot/cold. Hot/cold appears to be less effective at inducing vasodilatation in deeper tissues (i.e. the ones we are targeting). That fits with my experience of trying both.

AB said...

I Second, third or fourth (whatever) the appeal on elbow injuries.

I'd like to know how bad technique specifically contributes?

You mention the quality of the video - i think its great and quite fitting. Simple, honest and qualified advice, I don't think we need anything more!

Keep it up,

Anonymous said...

Hi Dave, thank you for sharing this cold water treatment for finger injury.

Is this treatment helpful for detached FDS tendon too? If so, how soon should this treatment started after injury? Thanks.

Andrew Preshaw said...

Hi Dave,

Is there anyway of downloading this video cast so I can watch it at leisure - so to speak?

Thanks, Andy P

JeyOz said...

Thanks Dave ! I recovered at 100% my 2 fingers. I had 2 fingers injured since a couple of month, using special cream to "repair" with no success, and finally I ve seen your video with your advice. And now after a couple of weeks of practice, 2 hands in a pot of cold water, I ve got my fingers back ! I m still doing bouldering with more attention and stretching now.

Anonymous said...

Hi dave cheers for the info.

I've also been told of a treatment whereby you heat the handle of a ceramic cup with a lighter making it quite hot then rolling it across the injured pulley to help increase blood flow. Can't say I've had the opportunity to try this much myself though I've just done a partial A2 tear in my ring finger.

just thought I'd ask for your thoughts on this treatment if you've come across it before.

aoryx said...

Hi Dave, thanks for your great informative videocast. Just a question, can I apply the same concept to tendon strains? Those injuries when you 'pulled' a finger (esp. on pockets) and there's a 'strand' of pain in the forearm. In this case, can an coldpack be used since submerging the forearm in water wouldn't be too practical or do you have other alternatives?

Thanks!

Dave MacLeod said...

There is no available data on whether this treatment works for tendon strains comapred to pulleys. Right now there is only the anecdotal evidence of climbers trying it and reporting good results.

So please let us know how you get on!

Anonymous said...

Very good information! I have a question, in the video you mentioned that it helps to build tissue faster which is great for repairing injuries, however, I was wondering would this also be a good idea to help build soft tissue to prevent injuries and possibly help tendons to become stronger quicker? I am not a medical expert so this is why I am asking if blood flow is increased does this also help in strengthening/preventing injuries to the tendons and soft tissue? Thanks for this great info Dave and happy climbing.

David said...

Thanks for posting. I am trying it now.

I would love to see a video on training power endurance for routes or going through a hangboard session.

Ron said...

Is there any benefit to using ultrasound therapy in helping heal a pulley injury? I have access to a portable ultrasound machine, which would make short, daily low level treatments possible.
Thanks

Dave MacLeod said...

Ultrasound - As far as the research stood a few years ago, opinionsseemed to be divided on the effectiveness of Ultrasound therapy, and there certainly was't any data on it in for pulley injuries. That might have changed a little now. Ultrasound seemed to be very popular with phyisos, but the mechanism of it's proposed effects was poorly understood and was brought into question.

The short answer is - there is no definite answer. But if you have ready access to the treatment you could try it and let us know how you get on!

Joe said...

In your Videocast (and reiterated in the climber artical this month,) it is mentioned that you should wait for a week or so to let swelling go down. If this just because cold water treatment is not effective whilst the injury is still swollen, or is there any evidence that it can actually prolong recovery? Cheers and keep up the fantastic blog

Joe

Dave MacLeod said...

If you use the treatment too early while the injury is still in the acute inflammation phase it will prolong recovery by encouraging excessive bleeding, swelling and it's associated problems.

Øyvind said...

New research shows that ultrasound has little or no effect on most injuries tested. It is also far more expensive than a bowl of cold water.

Bryan O'Sullivan said...

Dave, thanks for the great video, and happy anniversary with the video blogging :-)

I did a number on what feels like the C2 pulley of my right ring finger a week ago. As soon as the swelling goes down, off into the bucket will go the hand.

gabe l said...

i stumbled upont your podcast via google as i was looking for a remedy to get a speedy recovery on my injured finger pulley... but unfortunately, since i'm deaf, and i was wondering whether you'd have the time to put up captioning in the podcast or just give me a transcript of what you just said about the treatment for the finger?

thanks in advance or you could just get a hold of me via email (just use my handle here and email it to gmail)

thanks in advance!

Anonymous said...

Thanks for making/posting this video.

If the goal is to cause vasodilation of the blood vessels & capillaries, what's the advantage of using cool/cold water to achieve this? Wouldn't warm water cause vasodilation w/o the initial constriction thus bringing on increased circulation faster? What advantage does cold water have over warm but not-too-hot-to-cause-swelling water?

Mr. Jig said...

Dave, I rupture my A3 pulley about 2 weeks ago and have begun the cold water treatment. Do you know if I should immobilize my finger or if its ok to keep moving it around.

Thanks a ton

Claire MacLeod said...

Sorry, Dave is on a climbing trip and can't answer just now.

Anonymous said...

Someone asked what's the benefit of using cold to achieve the increased speed in healing. Take a look at the book _Cryotherapy in Sport Injury Management_ by Knight around page 122 (which can be viewed via google books). The author argues that vasodilation alone is not really providing any benefit, and he cites a lot of conflicting literature to support these doubts. His main claim (see summary on p. 125) is that the combination of cold treatment plus light exercise of the affected body part is what accelerates the healing process. And following this line of logic, the benefit of the cold is to reduce pain temporarily so that one can ease into the exercise more rapidly.

Anonymous said...

I've recently received an overuse injury to the ring finger on my plucking hand playing guitar. It sounds like it could be a similar injury, so I'll give your idea a try. Thanks for posting it.

Phil (in Dunfermline)

Fred said...

Hi Dave,

Have just tried the treatment for the first time, fairly sure I got it right in terms of temp. etc but now the tissue around my A2 is really tender... is this normal?

Gary said...

Hi Dave, Thank for your video. I find the cold water treatment you describe works great for me.

Could there be added benefits by leaving your hand in cold water for longer periods. 1-2 hours, overnight while we sleep? Or could this have a negative impact?

Thanks

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Anonymous said...

Hi Dave,

I have an injury on the upper part of my forearm that happened over a month ago while climbing, and it just won't go away. I've tried resting it but it's not getting any better. I'm not sure if it's a muscle or tendon issue. I know your method is aimed at finger pulley injuries but I thought I'd try it on my arm. After the treatment time, my arm feels extremely weak and tight for a while. Is this normal or should I stop using this treatment?

cheers

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Travis said...

What would be the difference between doing the cold bath vs placing your hand in a heating pad for 10 min?

I've been doing the treatments for 5 days now at a variety of different temps (tap water, 1 ice cube, 2-5 ice cubes) and am having problems getting the lewis reaction to occur. I will continue to try as i'm guessing my had will become more used to the sensation and eventually it will occur....

I'm just wondering since I get get a reaction from the heating pad that I think is very similar to what the cold water does, is there any harm in this?

I only do it for maybe 10 minutes and then I remove my hand.

Thank you very much and great website on injuries...very helpful!

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rickymartin said...

Thanks for the clip! One question: would sitting in a sauna or hot tub while doing the cold water treatment be an improvement? (the body trying to dissipate excess heat by increasing blood flow to extremities)

Will Jess & Saskia said...

Hi Dave: I've read in "Therapeutic modalities: the art and the science" (page 220) that CIVD (cold induced vasodilation) is a a bit of fallacy. Cold treatment does work but only in that it allows for painfree active recovery which is big benefit - but that it does not increase blood flow. What's the scoop here and perhaps you could post a few resources? Personally, I've been doing the treatment for an A2 ring finger pulley and I must say it seems to help.

Dave MacLeod said...

I have read this book also and his research. It's possible his conclusion is true, but I have some reservations.

First, his research shed some light on the problems with Lewis' data from 1930. But I think it's really necessary to reproduce Knight's experiment depicted in Fig 13.3 with the initial finger temp being normal (and also slightly elevated) instead of depressed by cold room temperature to see if the reactive temperature increase from cold treatment occurs in these situations.

In my experience with this treatment, general room temperature and body temperature are crucial; if either are too low, the treatment doesn't work and your hand gets progressively colder. Knight notes from his own experiments that there was modest tissue warming, even above the control finger (with no proposed explanation!) but both were depressed below 'normal' finger temp.

The research still fails to explain the skin reddening, strong feeling of tissue warming and visual observation of 'throbbing' veins in the wrist in the later stages of the treatment. Knight suggests it could be explained by more oxygenated blood due to lower tissue metabolism, but this is entirely speculative. There is also doubt on the feeling of warming but the data cited in support uses a very strong tissue cooling, much more so that would happen in this treatment.

So yes, there have been problems reproducing increased blood flow in cold treatment in experimental conditions. It could be because the benefits of the treatment come from sources other than blood flow, or it could be down to methodological problems in the experimental evidence used to refute the blood flow hypothesis.

james franklin said...

Nice video dave, thanks.

I would be interested in how you look after your joints, in diet and training to prevent arthritis. something lots of climbers worry about.

Cheers

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MaxCB said...

Dave - BTW the video is no longer available to view. I can't find it using a google video search either..any help? i'd like to see it.

hi..i have had a tendon strain associated with my ring finger which has kept reoccurring for many years. i dare not say how many. i have, mistakenly it now seems, kept taking periods of 6-9months off climbing and have used ice a lot. but not in such a controlled way as mentioned here.

At the moment i am climbing but my technique has autonomously developed to protect the tendon/s of my right hand by over using my right torso and upper body. This is not a comfortable thing and has developed over many yrs and causes discomfort in everyday life now. But i find that if i consciously relax the right side and shoulder so as to allow hanging off the tendons more i feel the weekness and fear tearing. So my side and underarm contract more to protect the area.

The only way to stop this autonomous habit is to heal the tendons so i can use them fully and so go back to better technique!

Any advice...? very much appreciated by me and my family who have seen me sink in and out of depression because of this 'situation'.

many thanks...Max

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John said...

thanks so much for this treatment. I was actually told by a doctor who had read a little about this that I should stay off it an additional two weeks after it stops hurting completely. It's nice to know that someone out there is looking into the healing process a little more

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Ivor said...

Hi Dave,

I've been doing the cool water therapy for a couple of days now, and it does seem to "direct" more blood towards my hand. I realised that it works much better when i wore a jacket and kept my the rest of my body warm, while having my hand in the bucket. I guess your body's more willing to divert blood away from the other parts that way.

It seems to be working pretty well so far, and Im really optimistic it'll improve this niggling finger of mine. Thanks so much for this!

Cheers!

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hi! I have an undiagnosed finger injury and tried your technique but my hand felt very slooow moving afterward - as if I reduced blood flow for 30 min, rather than promoting circulation. This leads me to 2 questions:

1) what is too cold and what is too warm for the cold bath? (notably, the water warms up during the 30 min.. should I replenish it to keep it cold)

2) should i put it in warm water afterward to warm it up quickly??

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