Climbing Through the Pain: Understanding Stiff, Achy and Swollen Knuckles

Portland climbers, are you tired of dealing with stiff, sore, achy, and swollen fingers? If so, then this article is for you. Most climbers can attest to having dealt with sore finger joints at some point in their careers. Others have had the misfortune of dealing with a significant degree of persistent soreness over weeks, months, and even years. Nowadays, a lot of climbers are familiar with the diagnosis of capsulitis or synovitis. In long-standing cases, there may be significant joint swelling, decreased range of motion, and even boney growth. Swelling and pain can be especially noticeable when we’re subjecting our fingers to more volume than they can tolerate. Interestingly, as much as we may think that the intensity of load is the culprit, it’s often actually excess volume and inadequate recovery between sessions that predicts this injury. Greater volume of easy climbing is not always a good approach for injury.

Ouch…What you need to know about climbing and fingers.

I’m sure you’re well aware of how much physical stress we put through fingers. It’s quite remarkable what these small structures are capable of tolerating! The big and small knuckles of the fingers are most commonly affected by capsulitis/synovitis, with the big joint of the middle finger usually being the most problematic. If you’ve climbed long enough or looked at the hands of well-seasoned climbers, you’ve likely noticed how common large, gnarled, and asymmetrical joints are. This is a well-documented and scientifically researched phenomenon. Climbing has profound effects on tendons, connective tissue, and bone. Over years, the physiologic stress of climbing can cause significant thickening and growth of ligaments and tendons, and even the development of bone spurs that can become irritated with excess volume. The tissues inherently adapt this way to tolerate the demands of our sport. This in and of itself is not inherently problematic. What can be problematic, however, are long standing, inflamed, painful, and swollen joints. If we push our sport too quickly or too often and don’t get adequate rest between sessions, we can subject the fingers to maladaptive changes that can be difficult to treat.

Most chronic finger joint injuries occurs when microtraumas to connective tissue due to repetitive stress are not able to adequately heal between sessions. Although many structures within the finger can be involved, the usual suspects are the ligaments that stabilize the joint and form the joint capsule, as well as the synovial membrane within the joint space. With PIP/DIP joint injury, there can be ligament sprains, chronically irritated synovial tissue that is stuck in a pro-inflammatory cycle that can be hard to kick, and joint instability due to fluid propagation and maladaptive changes.

Why do my fingers feel so stiff? How come rest doesn’t always make them feel better?

The synovium contains special synovial cells that secrete synovial fluid. This fluid is a Non-Newtonian substance that is directly affected by load. With increased force and power, we see increased joint stiffness. Furthermore, increased mechanical stress drives fluid out of the joint, which can create an inflammatory response and cascade where the synovial cells seek to replenish the lost fluid. This is why a lot of high-power climbing such as steep bouldering will promote joint stiffness. Mechanical stress to the joint, however, is what results in fluid and nutrient exchange that is essential for joint health. This is why achy and swollen fingers can often feel worse with decreased climbing and loading.

Why is this happening and what can I do? Schedule an in-person appointment with Dr. G to see what your options are.

The dosage and type of loading is what predicts the injury and is critical for successful rehabilitation and prevention. It’s important to understand what demands we can impose on our bodies without being set back. While it is commonly stated that crimping is the culprit, things aren’t always that simple. A three finger drag, or open grip position is not inherently less risky than a closed position. It’s all about dosage. Over reliance on any one particular grip type can precede chronic repetitive stress injuries of the fingers.

If you’re dealing with pain, swelling, and decreased range of motion that you can’t seem to kick, then it’s important to see a qualified climbing medicine literate healthcare professional who can create an appropriate and effective treatment plan. This is not the type of injury that you want to push aside, and hope will resolve on its own. Seeking treatment as early as possible will surely result in the best outcome.

As a naturopathic doctor, I have many modalities in my toolbox for effectively treating such injuries, some of them being relatively unique to my profession. With that said, the most important aspect of my approach is understanding how and why you got here in order to develop a sustainable long-term plan. This is a nuanced topic, and all starts with a detailed consultation where I can help you get down to the root cause(s) of your injury. I’ve dealt with this injury myself and spent 3-4 years dedicating plenty of free time to study it outside of medical school. I’ve read essentially all of the scientific literature on the topic and have consulted with some of the leading experts in the field of climbing medicine.

My approach:

• Patient education around load management. This is fundamental.
• Diet and lifestyle recommendations. Focus on fundamental determinants of health so the fingers have an environment to recover.
• Finger strength training with an unlevel edge for rehabilitation and to decrease unnecessary stress on the middle two fingers while warming up or training the fingers off the wall.
• Hydrotherapy to move blood and lymph.
• Herbal medicines and supplements as needed for inflammatory support.
• Personalized modifications to climbing.
• Discussion on if a single ultrasound-guided steroid injection is necessary to break the inflammatory cycle depending on how long you’ve had this issue and how it has responded to conservative care and load management.
• Manual therapies to decrease tissue sensitivity.