Management of Swollen Knuckles for Climbers

by Paige Harrell, PT, DPT, FDN-C

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Are you a rock climber with one or more swollen knuckles? This one is for you!

Over the past couple of weeks, you have ramped up your training intensity. You are feeling strong, however you have noticed some finger stiffness and swelling around the joints. At first, it was no problem, but now it has become a dull, achy pain. You may have a common case of finger joint capsulitis and synovitis. 

What is capsulitis and synovitis of the finger?

As rock climbers, our hands and fingers must overcome significant forces in order to grip and maneuver across rock. When connective tissue has been overloaded, it may become irritated and inflamed. Capsulitis describes the inflammation of the ligaments surrounding the joint and synovitis refers to the inflammation of the synovial membranes. This often presents as a buildup of fluid within the distal interphalangeal joint (DIP) or proximal interphalangeal joint (PIP) with loss of finger range of motion and achiness that continues hours to days after climbing. This condition most often correlates to the utilization of a half or full crimp hand position due to the increased forces placed upon the PIP and DIP joints in these positions. Rather than putting your climbing on pause, try this management plan!

Halfcrimp fullcrimp swollen knuckles for climbers

 

How to manage it?

First, deload! When an injury occurs, it’s important to modify your daily activities that increase your pain and injury-related symptoms such as decreased range of motion. This doesn’t mean stopping all activity! For climbers, this may look like climbing lower grades and increasing rest days between training days. For example, spend two days resting following a day of training. Additionally, use modalities such as ice massage, contrast cold and warm water therapy, and massage around the joint to increase blood flow for improved healing opportunity!

Extended hand swollen knuckles for climbers

Next, mobility! Once inflammation has decreased, it is time to focus on increasing your finger range of motion including flexion at end ranges. Try these exercises to increase circulation and mobility of the DIP and/or PIP joints!

Tendon Gliding 

Self-mobilization Finger Distraction

Your finger is feeling and moving better, so it’s time to strengthen again! Progressive strengthening is important to practice in order to avoid overloading your finger too early on. Begin with frequent low-volume training at moderate intensities and progress toward higher-volume training, aka adding more resistance. Listen to your body and how it responds 24-48 hours post-training. This form of loading will support healthy tissue remodeling and decrease risk for future injury. Try using a hang board for controlled body-weight hangs. Initially utilize open-hand grips as this grip puts less force on the PIP and DIP joints, then progress towards utilizing half and full crimps again as you gain more strength in your fingers. Additionally, consider practicing static climbing while you are returning from an injury as dynamic movements place greater load on your fingers.

Combined demonstr 1 swollen knuckles for climbers

If you are still having difficulty with capsulitis/synovitis and returning to the grades you would like to climb, schedule an appointment with one of our climbing specialized physical therapists and we can provide a more individualized one-on-one approach for you!

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