Notes
https://podcasts.apple.com/us/podcast/jacked-athlete-podcast/id1462537296?i=1000704121310
Jake (02:27)
I say this on every show, but my fascination with the patellar tendon came because I had such bad patellar tendon pain that was resistant to the medical route. Why did you get this interest in the finger tendons?
Tyler Nelson (02:43)
I mean I’ve just been a rock climber since I was in college and so there’s no doubt that people who start rock climbing or get into rock climbing know that it matters how strong your fingers are and so mostly from a training standpoint like rock climbing is is relatively new in terms of its sports science very new and so they’re coming out of graduate school you know I did my master’s degree at the University of Missouri like very you know that’s where Brian Mann was with doing the
VBT stuff like.
lots of science stuff and lots of pushing the boundaries of strength conditioning. So I had that exposure in graduate school and was very interested in isometric testing and different styles of isometric testing and velocity-based training. But those things hadn’t really been applied that much to rock climbing. It’s very, we made the training look like the sport with the tools that we had, which to me never made a ton of sense. Not that it was wrong, it was just like a little bit more precise way of doing it. So that’s really what got me interested in
fingers specifically and I always loved anatomy and have been a super geek like that. So always had that kind of interest, but really that pushed my clinical interest there as well because I would just talk with clients all the time that had finger injuries and you can’t really understand finger injuries unless you understand training and training habits.
Jake (04:01)
So I’ll spend a lot of my time at LA Fitness basketball courts and everyone’s knees hurt, know, patellar tendons, quad tendons, it’s just so common. When you’re at these climbing gyms, how common are these finger injuries? Does everyone have them?
Tyler Nelson (04:21)
You know, just like any athlete, rock climbers are very motivated. They like to try hard. They tend to have really good compliance, tend to be overly compliant. So it’s really over training, which is a common across the board kind of athletic thing. And especially when people are adults and they start climbing, it’s a totally new challenge. It’s totally exciting. It’s very just multifunctional kind of multi-joint movements, easy to get addicted to.
you know, your tendon build, right, it’s maybe easier to start jogging because you’ve been walking your whole life. But it’s not necessarily easy to start climbing because you haven’t been loading your fingers in the same way. And so…
Even easy climbing is considered risky for the most common overuse injury, is tennis and vitus. know, our new climbers get different injuries than experienced climbers, but it’s pretty common. I it’s definitely, I gave a presentation at the Climbing Wall Association here in Salt Lake yesterday, and I forget the exact number, but I think it’s like 93 % of climbers will have some sort of overuse injury, and the most common is finger injuries.
Jake (05:23)
Okay, you said tenosynovitis. guess maybe it’s best to start to someone who doesn’t know about these type of things. are maybe the anatomy, how these things, how this thing functions, what’s going on with the finger tendon.
Tyler Nelson (05:38)
Yeah, so people aren’t as familiar with the anatomy. The muscles, the extrinsic muscles, they live in the forearm. And then maybe midway down the forearm, they turn into tendons. And then there’s essentially eight tendons, two on top of each other, that pass to digits two through five. So index through pinky finger, and then the thumb has its own flexor tendons. And so the ones that get most commonly injured are…
middle two finger tendons of climbers. So the middle finger and the ring finger and primarily because they’re the longest. And so as you like as the tendons pass through the wrist and they go into the hand almost or right at the point where the first knuckle is the first joint is they have a sheath that surrounds them.
So this is called the tendon sheath and both tendons that go to each finger goes in that tendon sheath and then that tendon sheath runs the length of the finger all the way out to the tip of the tendon. So it’s like a fibroosus tunnel that the tendon runs through. And at certain locations, both before the joint, at the joint and after each joint, there’s thicker portions of that tendon sheath which are called the annular pulleys.
and then next to those are another kind of cruciform pulleys which make an X shape and those tissues are responsible for keeping the tendon close to the bone so we can get better leverage on the finger.
Jake (06:58)
This whole, this tendon sheath in the human body, what, the Achilles has one? Do other tendons have them?
Tyler Nelson (07:06)
think all tendons will have a tendon sheath to some degree. I think this one’s pretty unique and I mean, they definitely all do. This one’s unique in the sense that it’s supported by additional tissues to help protect it and to help give more leverage.
on the tendon. Obviously the tendon sheath is responsible for providing nutrients, removing waste, etc. Having an anti-inflammatory response. The thing that’s really unique about the climber and or the finger tendons and particularly climbers and jujitsu athletes, I surprisingly talked to and have quite a few clients that are jujitsu athletes because they also are gripping very high intensity with the gi. And then the other maybe non-climbing group that I work with is people that ride motocross because they also get really pumped with their fingers.
But the thing that’s really unique about the flexor tendons of the finger is that they’re kind of made like a fishing pole. The fishing pole is a really easy analogy where when you cast your pole and then you catch a fish and you pull back on it, it bends the pole. And so the wire or so the line going through the guy wires, that’s kind of what happens when you put tension on the pulleys as a climber.
And so the other thing that happens when we climb is we grab onto things, but it’s not like a constant steady position. There’s some sliding that happens back and forth along the undersurface of the pulley and the tendon sheath, is very similar to other tendons. You get the compression, the shearing, but you get the tensile load, but then you also get irritation to that sheath underneath it.
Jake (08:40)
This distinction of energy storage tendons like patellar and Achilles versus positional, the finger tendons are in this positional camp.
Tyler Nelson (08:51)
What was the last part? I didn’t catch that.
Jake (08:53)
they’re there.
So like they have this distinction of energy storage tendons where like they they strain a lot, they extend a lot, then they recoil like the Achilles and patellar versus the positional tendons that are kind of just set up to, I guess, relay that what’s happening at the muscle to the to the bone. These finger tendons, there’s not really a whole energy storage component. Is it is it mostly like positional? Do they not really extend a whole lot?
Tyler Nelson (09:17)
I I’m sure they do, like that’s not something that’s really been addressed in the climbing literature certainly, but like the pulleys actually will. So the pulleys provide like this sling upon which you can generate force, specifically at the PIP joint. So the PIP joint of people listening maybe aren’t familiar with that term. If your hand, if your fingers are straight and you flex your fingers at the second joint, that’s the PIP joint as if you’re making like a 90 degree angle.
across that joint is the sling of the pulleys where there’s an A2 and an A3 and an A4. And so the majority of the stress goes through that sling. And so when climbers do dynamic moves, which we can talk about the ridiculous forces climbers can put on their fingers, but when climbers do a dynamic move, there’s definitely a big elastic stretch that goes to the annular pulleys, which certainly would create like more recoil and efficiency for energy storage. And so I don’t know that there’s a lot of like stretch to the tendon as much
as there would be stretch of the pulleys.
Jake (10:17)
And you had said, I guess off-air I was like, what is another tendon that goes, like you just talked about the anatomy and how complex and all these tissues that are surrounding it. Are the finger tendons like in their own world of the complexity? Is there not other tendons that are kind of built like this?
Tyler Nelson (10:37)
mean the other one that comes to mind is maybe the proximal bicep tendon as it goes through the inner tubercular groove. Like that has a, you know, it’s intracenovial or extracapsular, extracenovial intracapsular. So there is a membrane that goes on the proximal part of that.
The bicep tendon also has the ligament that goes across it and then the subscap of course helps support it but that thing ruptures you know with a lot of repetitive stress. That’s one that comes to mind and maybe like the UCL and the elbow although the pulleys will have acute they’re kind of like chronically overloaded and then they’ll have an acute moment where there’s a big eccentric load to that joint angle and that’s responsible for popping the pulleys away from the bone so I don’t know that the
UCL on the elbow and someone like an athlete with Tommy John surgery, I don’t know that they fully rupture in that mechanism. I think it’s from my understanding a more degenerative slow process where they get tears or they get thicker and the tunnel gets smaller so the nerve gets irritated. That definitely happens in climbers fingers and so one of the
you know, most common pathologies of the tennisinitis comes from lot of repetitive stretch to the pulleys. And then with that stretch, you get compression of the tendon sheath, you get ischemia, and as a consequence, get hypertrophy. And so the tunnel can get a little smaller as the tendon gets a little bigger. And so that creates more, you know, kind of space closure there, which can be a problem for a lot of use.
Jake (12:05)
So in terms of the chronic tendon pain, we go to patellar tendon, it’s just like regular tendinopathy, Achilles tendon, regular tendinopathy, mid portion, insertional. When you talk about the chronic injury to the finger tendons, the big one’s the tenosynovitis, right?
Tyler Nelson (12:26)
I’ve seen a few physios report like bigger cross-sectional area at the attachment of the FTP tendon. they’re like the FTP tendon essentially curves over the top of a tissue called the volar plate which is a ligament which is bigger in climbers because they get a lot of leverage but the attachment into the bone of that tendon
cross-sectional area like another tendon with a tendinopathy would have. Not well documented, not well reported in the climbing literature, but there’s just no way that the flexor tendons wouldn’t have those similar chronic repetitive overuse injuries. Both because the one thing that’s really unique about the climber’s hand is like kind of the compressive tendinopathy of the Achilles.
Like we actually grab on to really small holds with the end of that tendon and so holds that are maybe 15 millimeters or 1.5 centimeters long, imagine grabbing onto that with the end of your fingertip and being able to hang with one arm. Like that’s the kinds of loads that climbers can put on these tendons. And so there’s no way that those things don’t happen. They’re just not well reported and not well documented.
Jake (13:40)
So what’s the typical tenosynovitis? What’s the typical story of someone that’s presenting with it? Is it like a typical case of too much too soon, a change in load, or what’s going on?
Tyler Nelson (13:54)
like too much too soon definitely is a problem for beginners so if someone begins climbing they essentially wrap their fingers around a large hole so climbers will call it a jug so it’s kind of the equivalent of like grabbing over the top of a barbell
but sometimes they have a little bit more end cuts so they’re really positive. And so if you’re not used to that kind of stress and you grab onto a jug and it’s super fun, you do that for hours and you get psyched and you buy a membership and you do that three days a week for a month and your fingers are not used to that, they will get sore. And a lot of that soreness comes from that new compression of the tendon on the tendon sheath, but also the pushing back of the hold against that tendon sheath. So the sheath kind of gets pinned between the tendon
and the hold, and then there’s some sliding that happens along the tendon. And so that’ll create an inflammatory response within the tendon sheath that is usually easy to detect on an ultrasound with like more fluid. You can use a Doppler, but that definitely is like a membrane irritation that will present with morning stiffness, that will present with pain when you close your hand, know, kind of the typical acute stages of a tendon pathology. And then,
For experienced climbers, comes, maybe they do jug climbing, but experienced climbers are doing more aggressive finger positions where that PIP joint is flexed more, so it’s more acutely bent, and they get a lot of pressure inside the pulleys. And so, kind of a different mechanism, but same essential therapeutic, like guess, pathologic response or symptoms.
Jake (15:27)
So you, don’t know how much you’ve looked into the structure of it. said you, I guess you said you’re doing ultrasounds on these things. When I think of like the patellar tendon, Achilles tendonopathy, it’s like you can have, you have that inter-facicular gel that’s surrounding the collagen fascicles and it’s like you can get overload of the gel, overload of the collagen fascicles, and I’d probably pick up that degeneration on a scan.
But if you’re just getting this tenosynovitis, is it only like, is it getting deep into the collagen and into this gel matrix or is it localized to the outer, the outside of the tendon?
Tyler Nelson (16:03)
mean, we’ve seen there’s some papers and you need to get an MRI to see those, but there’s some papers documenting that. And those are not climbing papers. Those are papers in the general public where they get different kinds of tennis endovitis, like an inflammatory tennis endovitis, or they get like pyogenic stuff. So it’s like a little bit different, but I would say for rock climbers that definitely will happen and does happen. It’s just something that doesn’t really get talked about a lot.
kind of gets the downside of climbing being relatively new and healthcare providers that specialize in rock climbing being new is there’s a lot of over diagnosis of a poly injury where in order to like stress the tendon sheath that much you have to load the polys pretty intensely and a lot of volume as well and so they kind of go hand in hand and so when people have those injuries and they press over the area where they’re sore it looks and feels and smells like a two poly injury so they’re
I think over time we will learn a whole lot more about flexor tendons, the tendons themselves. But right now we just don’t have tons of information on whether those things happen, but I would say they most certainly do. I don’t see why they wouldn’t.
Jake (17:07)
So when it comes to the rehab, I guess in the tendon world with the big tendons is like the isometrics and the slow heavy strength and then like a slow introduction back into the dynamic sport. What’s the rehab look like for this tenosynovitis?
Tyler Nelson (17:26)
think those are, I mean, as far as anyone is aware and best practice would be borrowing that information from, you know, the elbow tendon literature, lower extremity, which certainly has way more than the elbow does. So we borrow that re that research and we apply those same methodologies. The one thing, so like obviously the isometrics, long duration isometrics, I’m a big fan of the thing that climbers need to be more aware of or that practitioners do is the fingers aren’t the same length. And so
One of the more nuanced kind of, I guess, thought processes that we need to have is climbers like to use like a flat 20 millimeter edge for their training. It’s very classically used, but that doesn’t load the fingers evenly. And so because of that, if we only do rehabilitation on a board that has that width, the whole length, then we overload the middle two fingers and we don’t get low to the outside two fingers. So when doing the rehabilitation,
I like to use circular objects, kind like the size of an American softball or American baseball to squeeze and lift loads with. And I also like to use something called a fingerboard with a rounded jug over the top. So imagine like a two inch diameter wooden dowel where you can drape the fingers over the top so we can make the loads more intense on the fingers but not put as much direct pressure at any location or not flex the joints.
know, kind of asymmetrically finger to finger. certainly the heavy stuff is, from my experience, has worked very well for rehabilitating tendons. But again, you got to like back off the sport, get the approximate load, work back into the sport just like we would in other activities.
Jake (19:07)
That compression, there was a recent paper on achilles, achilles, insertional achilles. Yeah, where they did rehab with deep dorsiflexion versus like not deep. And I guess there were benefits from avoiding the compression in the long run. If that’s what the tendon was getting. For you, you talked about this compression you get when your finger is gripping something. If you’re rehabbing someone, are you removing the compression or what are you doing?
Tyler Nelson (19:32)
Yeah, as best you can. It’s essentially not possible to remove all of it because the way that climbers train and the way that we climb is you have to have some form of compression against the rock to get up the wall. So I’m a big fan of Greg’s work we’ve had on the podcast and like I’m totally with the calm, you know, let shit calm down and then build it back up. Totally reasonable.
And so with like, imagine grabbing like doing regular, I guess a deadlift is a good example. So most people that you probably work with or see in a normal gym, they deadlift with straps, just kind of natural. And that’s because they don’t have strong enough hands to actually lift the load. But for rock climbers, they’re the very opposite. When they learned to deadlift, they don’t even think about wearing straps because they always can grab the load. So think about how heavy that load is on the fingers. And then in addition to that, they do their normal climbing, which has
a big load or the same probably maybe not the same but
you know, similar types of loads off the wall. And so it’s really just like, that’s a form of compression, the deadlifting that we got to get away from. So in the rehab context, I have my athletes wear straps for deadlifting, wear straps for doing pull-ups or change the tool they’re using, and then use more rounded structures to start loading the fingers. And then we need to start progressing them with more joint flexion at the fingers. And then eventually getting back to like climbing and jumping and doing more.
on a
Jake (20:57)
Is it difficult for you to take away the sport for these climbers? Do they?
Tyler Nelson (21:02)
I don’t know,
I don’t take away the sport as much as maybe you would think. I definitely, you know, it’s kind of like other, like every sport, right? Like a tendon pathology is usually a performance limit or yeah, a power limit or not a performance limiter. Like a lot of athletes around the world are participating in their sport with some sort of tendon injury, but their power is lower. They don’t have the same power output.
So for most climbers, they’re climbing regularly and they are very transient, which means they can travel and go to places. And so as long as we can, we definitely have to drop the volume in a big way, but with the hand, we can be more thoughtful about the finger positions that we have them use with their climbing and that alone in conjunction with some other strength training practices for most people is helpful. In some cases with tennis and avitis, they need to stop climbing for three or four weeks with poly ruptures, same thing.
initially weeks off and then just a gentle slow load back in but just like other athletes they’re they can be resistant.
Jake (22:03)
Okay, so we were talking on this whole on tennis and avitis. I want to keep going on the rehab and kind of things you’re doing, but is the rehab very similar for these poly injuries? Because off air you were saying a lot of them are well, non-operative and you can just rehab conservatively. What is the big, is there a big difference with a poly injury versus the tennis and avitis in terms of the rehab?
Tyler Nelson (22:25)
In terms of rehabilitation, probably not tons of differences. I think with it depends on which pulley. So there’s two pulleys that get ruptured commonly and the first one is the A2 pulley. So the pulley that lives between the first two joints closest to the palm is the A2 pulley. And then the pulley that lives between the middle, the end two joints of the finger is the A4 pulley. So if it’s an A4 pulley,
those we can load relatively quickly and those get back pretty quickly. If it’s an A2 pulley, when you bend your finger to 90 degrees, the A2 pulley is responsible for most of that load, most of that torque. And that’s also the position that is irritated with tenosynovitis. So I would say an A2 pulley and tenosynovitis not hugely different in terms of management. The one thing that you wouldn’t do for tenosynovitis that you might do for a pulley is to wear a protective ring on the finger.
for the initial maybe four to six weeks to keep the tendon close to the bone when the tissue is healing. So that’s something that climbers have traditionally done to try and keep the range of motion of the PIP joint as it is by wearing a pulley protective splint.
Jake (23:37)
You said earlier the volume, so think it was Jill Cook said this a long time ago and I’ve used it so frequently about trying to get these tendons to settle down like someone who’s staying active and she said her big frequency, intensity and volume kind of in that order, take a day away so it can recover, then you decrease the intensity and then you start looking at the volume. But you said one of the big things is the volume.
that these people are. So like, is that the big player for you to try to get this thing to settle down?
Tyler Nelson (24:08)
Yeah, they gotta drop the ball in. Because climbing is so unique in the sense that most of the climbers that I’ll talk to, get injured. are warming up doing easier climbing, so they’re grabbing big holds. And then in conjunction with their climbing session, they’re using a fingerboard to do training, which is stressful to that joint. And then they’re also doing weightlifting on the side a lot of times. And then a lot of them like to do mountain biking and other sports. And so it’s just a lot of repetitive use of those joints. some of the mechanical papers…
create a parallel between the PIP joint and the knee joint, because there’s ligaments on the side, there’s a tendon on the front, there’s tendons on the back, and there’s not a meniscus homolog in the middle, it’s kind of the same kind of joint, but if you just look at the size of those joints, it’s just very obvious that there’s no way that joint’s gonna tolerate the same kind of.
load that other sport loads will tolerate. And so another thing that happens in climbing is people come from other sports and they are very familiar with the training practices and the frequency. And if they don’t have that same slow build of tolerance, which they don’t, if they’re new, like that’s so much load for that joint. It’s really hard to, you just have to be patient and build that tolerance, right? It’s not like going from soccer to track and field, right? It’s like totally different avenue with the hands.
Jake (25:23)
What is your, is there a general recommendation you have for like someone who’s not, has never done climbing or they’ve taken a lot of time off? How, like how many days a week, how much time do they need to give this thing? What type of things can you do so you don’t run into an issue?
Tyler Nelson (25:38)
So I think most of the time it’s going to be some sort of power loss. So likely you’re very familiar with using power as a metric to understand quality drop in a rep or.
know, power out fatigue with a session. So when people get new to climbing, it’s so exciting because you progress very quickly, but it’s still relatively hard on the hands. And so what I typically say is like a couple of days a week is probably fine for someone that’s new to climbing. So you go on a Monday, you go back on a Thursday or a Friday, and then you do that again. And you can have that slow build, but each session that you go,
If you’re new, try and focus on learning skills and putting more weight through your feet and actually putting less load on your fingers. If we look at the research, the small amount that’s been done on rock climbers on a climbing wall that has actual measurement devices on the holds, high level climbers apply less force on their fingers than people that are not as high level. And so the problem with being a beginner is you don’t put pressure through your feet and you just pull on your upper body.
So you get a lot of strong athletes that will come into a climbing gym and they have strong muscles, but they don’t have the adaptation in their fingers and they’ll just push it way too long. And so if you’re new to climbing and you want to experience the sport, come in and do it until you’re tired. But you’ll know when you’re tired, like don’t push into that too hard and then leave and then rest plenty of days. Make sure your tendons feel normal again, go back and do it again. You gotta do that and be patient for a couple of years.
Jake (27:09)
What type of frequency is common with high level rock climbers? Can they do it daily or no?
Tyler Nelson (27:16)
High level rock climbers will definitely have double sessions. A lot of my like athletes that are in competition.
setting, trying to get on USA team or in the World Cup circuit, we’ll do double sessions. They’ll do something powerful, high intensity in the morning, short, and then something longer duration, more slabby, technical in the evening. And so the climbing style of the climbing style has changed quite a bit over the years. It’s not all finger strength grabbing down on the smallest holds. It’s very much like parkour dynamic. It’s very much more athletic than it used to be. So athletes now can get away with that because it’s not so savage on the fingers.
But it’s not uncommon for athletes to have two like back-to-back sessions and then rest day and then know repeat that but those are high level climbers right and as you know from other research those athletes genetically have more of an ability to tolerate stress on their connective tissues but they also have all the developmental changes that they’ve gained throughout their life you know so they have the capacity to do that where I would not have the capacity most people would not.
Jake (28:18)
As far as the build, it’s usually like really skinnier, lighter athletes. How much does body weight affect the load on these tendons?
Tyler Nelson (28:27)
Body weight is a big deal for sure and so the strength to weight ratio is the most important metric for the fingers in a climber. So your absolute strength.
obviously matters, but your body mass that you have to hold on also matters. But that’s been a problem in climbing. Climbing definitely has had the same problems that other sports has, like gymnastics and dancing with people having bad habits with their eating and having bad relationships with food. So that’s definitely a problem that happens in climbing. But there’s no doubt that it matters. But the review papers that have come out recently
definitely support the idea that athletes should improve their strength to weight ratio by getting stronger, not by getting skinnier. So it matters, but most climbers also have a positive ape index, which means their arms are wider than they are tall. And a lot of climbers also have a short torso. So if you have long arms, a short torso, and really flexible hips, you can get your body in positions on the wall that tend to be very efficient for rock climbing.
Jake (29:27)
When we talking tendon adaptation, I saw a paper years ago with horses and they looked, I guess they looked at the size and probably the stiffness and it’s like if a horse was kept in in the stall for all day, its tendon was like really much smaller after many months, much smaller than the horse that was out at the pasture. And then I kind of other, other pieces of research too, like badminton had like a lifetime badminton or lifetime fencers had a
1.25 times bigger and stiffer patellar tendon on the lead leg. And so I’m kind of convinced that it’s just like a lifetime of loading is the best way to get this tendon adaptations. You talk about how strong these rock climbers finger tendons are. it from anything special with like heavy strength training or is it just the volume of a lifetime of loading?
Tyler Nelson (30:16)
really good question because in the climbing world everyone wants to attribute the gains or that people can perform on the wall with strength training with heavy strength training on a fingerboard but I would argue that most of that is developmental over years and so just like in other tendons the ligaments in the joint will get developmentally larger if kids grow up climbing and so just like in every other sport
climbers now that were kids 10 years ago, 20 years ago, now that are adults, they’re like doing all these phenomenal things with the sport and just taking it to new levels. And certainly that’s a training precision.
adaptation as well, but there’s no doubt that that’s developmental in conjunction with just like selection bias of you know, the athletes are just more people rock climbing so we get a better pool of athletes to choose from but then also it’s just like the repetitive loading and there’s a couple climbing papers where Volker and their group in Germany and other
switzer measure athletes as they adapt and they grow demonstrating that the ligaments that the tendon passes over are thicker and youth climbers as they grow same thing with the tendon so the tendon cross-sectional area will be larger and a kid that starts climbing when they’re an adult than someone like myself that started as an adult so I would say a big part developmental.
Jake (31:35)
When we talk about the pain, guess it’s always easier if someone has had a history of a tendon pain and then they take all this time off and they go back to the sport too soon and it just flares up. Is that something that happens? I’m thinking of seasons. Do people have seasons where they go to rock climb because it’s cold outside and then in the summer they’re not doing it? Do these tendons take a while when you take time off? Do they take a while to reacclimate to the sport?
Tyler Nelson (32:03)
That’s a great question too. The problem with climbing now is you can climb year round. so climbing gyms are so popular in big cities that most people don’t have a season anymore. For people that focus on climbing outside, they have a season, but they don’t stop their season when the season’s over because they can just go inside. So the problem now is it’s just like a constant season for people that are really psyched about rock climbing. But…
Other side of that is like should athletes treat rock climbing periodization wise as if there were seasons and they do a peak and they back off and they do a peak? Absolutely. Not everyone does that. know, people maybe aren’t understanding that as well, but that’s becoming popular now.
So that’s a big part of why climbers get hurt so much because the weather gets bad outside and the weather is very fidgety like the humidity the temperature outside the rock style like it’s very fickle in that sense so people go off of a season but they’re still feeling strong and pretty psyched and they’ll just continue to do that you know until they get injured and then when they get injured then they need to take the time off and then they need to reload and so it’s just like any other tissue you know if you under load it you’re just as risky of making it
Pathologic as you are if you’re overloading it. So you always got to like find that middle ground for athletes
Jake (33:22)
Something I think we talked when we had a phone call a few weeks ago. You said one of the big issues, I think you did, you can correct me if I’m wrong, one of the big issues with the rehab is just under loading because the typical physio or physical therapist might not realize the strength that this athlete has. Is that something that you see pretty common?
Tyler Nelson (33:41)
yeah, all the time. And it’s obviously not anyone’s, no one’s intending to do that. They just don’t know what climbers do. It’s really common for youth athletes to have finger injuries and go to an orthopedic doctor who misdiagnoses them just because the types of injuries that youth athletes get in their fingers, they just don’t know. Once they do, they’ll never miss it again.
but it’s something that’s so novel and unique to rock climbing that they just never see that. With the tendon strength stuff, especially for like high level climbers, like I talk to them every single day, someone that maybe has seen someone else or I talked to a guy yesterday that dislocated his finger, had X-ray and MRI, no torn tissue, and it was three months later and he was going to PT and the PT had him doing air ball squeezes. So literally just like pretending he was squeezing a ball with his fingers in the air, but actually applying a load.
And then he was doing that in conjunction with like tending glides, which is essentially just opening your fingers and closing them and like, that’s it. Right. And so like to make his joints stiffen up again or to make his joint capable of load, like that’s that there’s absolutely no sense that that would do anything to the tissue. Right. And so that’s one dramatic example. But if someone also has like a like a capsuleitis inside the joint, also like under loading the joint, just like other tissues, like you have to give it the
stimulus or it’s just not going to get better.
Jake (35:04)
Okay, so from the outside for me, I look at when people are on these walls doing rock climbing and I’m like, you’re getting so much finger training. What is the point of like the, what do you call it? The board or like when you’re doing specific strength training, what is the point of adding more on top of it?
Tyler Nelson (35:21)
So it’s just like a runner doing strength training. We know that other athletes that do sports, soccer, running, et cetera, football, they do strength training in certain parts of the season more than other parts of the season. But the justification for it is for gaining voluntary activation, maybe gaining a little bit of muscle hypertrophy in the off season, definitely making connective tissue stiffness changes, where it’s kind of in a weird space now, climbing is, because
before things like system boards were created, which are like fixed wall, like training boards that are the same everywhere they go. Before those were made, there was only like a hang board that you could hang on and then something called a campus board, which is like something that you climb without your feet and you just like swing around up on your fingers. So those were the tools originally that gave people that stiffness adaptation. But now there’s these new training boards that all the gyms have. And so now it’s like people are doing a lot of the training board stuff.
and they’re doing a lot of the heavy dynamic stuff also can be a little bit of a problem. So I always try and think about strength training for climbers just like any other athlete. We do it because it’s protective, but we do it because it has a different adaptation to the tendon and the pulleys as far as we know. And we want to do a small amount of it just like other strength training to make sure we can practice our sport more.
Jake (36:43)
So when I look at tendon adaptation for like the Achilles patellar, it really depends on getting a big pull from the calf muscles so the tendon will strain or a big pull from the quads to get the patellar tendon to strain and then the strain is gonna lead to the adaptation. With the finger pullies, is a lot of it about getting that muscle, like a big muscle activation or is there anything special going on with like the joint positions?
Tyler Nelson (37:10)
The definitely matter and the pulley positions definitely matter, but there’s no doubt that you have to get a big muscle load as well, I would imagine, just like any other tendon. the joint angles, like if you’re in an open, it’s called an open position, imagine for your listeners, you could do like, put your pinky, you know, grab your pinky with your thumb and then the other three fingers are open. Bend your finger joints a little bit on the other three fingers, that’s called a three finger drag. So a lot of climbers will climb in that position.
and they’ll train in that position. But that’s not a very muscular position. That’s an equivalent of like a long muscle length, but it doesn’t really load the annular pulleys for better torque. Whereas if you bend your fingers to 90 degrees, all four of them like we did before, that’s the stronger position for most climbers because it creates more wrist extension and a little bit more length.
in the muscle to generate torque. And so that’s the typical position that’s very common to train with, which is the more muscular position. And I mean, in terms of intensity, like imagine hanging on like a two centimeter or 20 millimeter edge in that position with one hand with your whole body weight. Like it’s kind of ridiculous how strong climbers fingers can be as they adapt over many years of training. So definitely a big muscle stress, I think is a big part of that stiffness adaptation.
Jake (38:28)
Okay, I think we had talked about this on our call, because I, my little bit of finger, looking at a finger tendons just to try to understand tendons, I came across that Keith Barwerky did with the Eberhangs, and I don’t know the synopsis of that, but I think it was like more frequent, lighter loads was leading to similar tendon adaptations and like really heavy stuff. I don’t know, what, if that’s right, what have you made of that? Is that something where like, is it pretty popular now in the climbing world or?
Tyler Nelson (38:56)
It’s definitely popular in the climbing world for reasons that would say are unjustified, just like you probably, I don’t know, all the episodes you’ve done, certainly someone’s probably brought up that work. And the citations they use are the same, using synthetic tendons or using rat tendons. So the same justification for it.
But with that evidence, they try and pair something that is this low intensity. They try and estimate 40 % MVC. So they say, do this loading at 40 % MVC. And they do a loading cycle where they do 10 seconds of loading, and then they do 20 seconds of rest. And then they do that six times per grip. But they try and do 40 % with four fingers, three fingers, two fingers, two fingers, three fingers. So it’s like.
the load changes all the time. And so the outcomes that they came up with, they make the argument that that low intensity load increased strength, like I think 3.2%, which
My argument to that would be that’s just normal variation day to day with someone’s strength testing. And then they compare that to max weighted hang. So another protocol that climbers commonly use is add weight to their body and hang on their fingers in that half current position. And then that group increased 3.2%. Again, another variation. And so another day to day variation. So those aren’t huge strength numbers to like, you know, kind of like.
be that enthusiastic about, but also this data is all retrospective. And so it’s all individual reported on a training app that climbers use. And so the methodology is messy, the sample size is messy, the intervention’s messy. just like, but it got really popular because of YouTube. so like everyone else is maybe familiar with in this space is like.
Professional athlete post something on YouTube. It gets a million views everyone does it, you know, so it’s like one of those things where it’s gonna be hard to Turn back that momentum at this point. So I’m not really sure that that’s the point but to me it makes very little sense
Jake (40:58)
Mm-hmm. Yeah. You said you have this ultrasound. What are you looking at with your ultrasound?
Tyler Nelson (41:07)
So the Ultrasound have a small like little probe, like a little hockey stick probe. It is for sure the best.
objective assessment tool for a climber’s finger for a finger injury. So you can measure the bone tendon distance of a normal A2 pulley, you can measure pulley strains, you can measure the percentage of the pulley that’s strained, you can measure tennis and avitis, you can do dynamic scan. So the ultrasound definitely is the gold standard for most injuries in rock climbers. For stress fractures in kids, x-rays are the standard and then
non-conclusive x-rays, MRI is the next best choice. And then MRI is also helpful in some instances for like bone marrow edema, the bones and other pathologies. But for the most part, we can do a really good job doing a full diagnostic scan with an ultrasound machine because those tissues are superficial. They’re very easy to see. Once you understand the anatomy, they’re pretty easy to perform. And it just gives us better recommendations for athletes in terms of timeline.
Jake (42:10)
Another thing I’ve seen you is you have that scale. don’t know what is it called? That scale you pull on. Yeah, so what kind of what do you what are you using that for?
Tyler Nelson (42:22)
So like I’ve had, it was cool. There’s a paper that just came out in March of 2025 that I posted about and we did a podcast about that paper and I brought up these videos because this paper supports this seated position, bent elbow testing position for rock climbers. And so I’ve been doing that since 2018, 2017. And so I brought up all these old videos and showed people. So I’ve had a couple different versions of that. It’s just a strain gauge. It’s just a…
strain gauge that can be tensed and can be compressed and gives a force readout. And so this one is made by a I forget where they’re from, sorry Tindak if I don’t remember where y’all are from, but an awesome company that really cares and they have a good app.
Like it’s essentially just a power meter, it’s a force meter, right? So it measures peak force, it can measure rate of force in whatever timeframe you choose. You can measure capacity, you can measure. So essentially it’s like the equivalent of other isometric tools that Alphite will use, like a force plate, except you can actually hook it overhead. You can hook it out in front of you, so you can use more dynamic positions with it.
Jake (43:29)
When you’re training like this Max Overcome or even those hangs, the weighted hangs, are you ever worried about the poly rupture or not? That’s kind of what I would think from the outside of like, when does it rupture? it just like you’re doing, you’re putting so much load on it or does the thing have to be like pathological in the first place or what’s going on?
Tyler Nelson (43:53)
It’s going to be a little bit pathological and the analogy is like the roots on a tree is a really good analogy. So the pulleys, you know, go over the top of the tendon and then they come into the bone. But the pulleys dense regular connective tissue as it goes into the bone, it spreads out like the roots on a tree. And so with a lot of consistent inflammatory response with loading a lot of
know, asymmetric rotation of the pulley. It’s kind of like a big storm in one direction and it can just kind of like slowly pull the roots away. And then you have the big mechanism where it pops. It’s actually not common to have a pulley rupture with testing or training. I mean, it definitely can happen, but the mechanical factor that creates the greatest increased risk of pulley rupture is when you’re at that 90 degree position and you’re applying a lot of force and you open the joint really fast. So it’s a rapid eccentric load.
that if the tendon is up against the pulleys, it’s very locked in place. And then when you quickly open the finger, it is still locked in place, it pops away from the bone. So we can almost think about it as like a safety net for the flexor tendons because it is not common for rock climbers during rock climbing to tear the flexor tendons away from the bone. That is something that has happened, but it’s not a common injury in climbers. You know, I listened to a podcast with Volker recently and
He’s maybe seen five of those in his career, I think. So it’s not a common injury, is definitely the mechanism is like pulling the pulleys away from the bone before the tendon.
Jake (45:24)
When, so all these other tendons, they have adjuncts with rehab like shockwave, PRP, stem cells, all those injections. Are there any for the finger tendons?
Tyler Nelson (45:36)
It depends on the tissue. For poly ruptures, I don’t think there’s a whole lot people can do. Like doing PRP injections, think those are a waste of time, they’re not really helpful. I think Volker and other people like to use shockwave therapy for certain types of injuries, but I don’t personally think that those are really that valuable. I don’t do those for my clients. You know, it’s still going to be kind of the same thing of…
what’s really gonna be better help for the tendon because there’s not much calcification than anyone can see in a flexor tendon that would warrant any sort of shockwave intervention. So it’s really just like giving the tissue enough time to calm down, make sure all the nutritional needs are met, and then we’re just gonna keep reloading the tendon. Not stop loading in most cases, but continually load and adapt and get back to higher power output loads and then more volume eventually over time. But I don’t use those interventions in my clinic.
think in a lot of cases they’re unnecessary for people to get better. The one thing that I will do periodically if people have PIP joint pain is I’ll definitely order steroid injections and people can do PRP injections there but steroid definitely works better for the capsule to calm down and sometimes people need that in the tendon sheath as well but I usually refer out for those because I don’t do those in my office.
Jake (46:54)
the maybe a couple more run out of time the the thumb tendons what’s going on with the thumb I had a girl reach out rock climber that had a thumb I forgot the exact name you probably know it but I just referenced that she should talk to you because I don’t know much about what’s going on with that tendon but yeah what kind of issues happen with the thumb tendon
Tyler Nelson (47:14)
I think like to quare veins is that what she had? mentioned that? So like the other thing that happens with the finger strength training world in the climbing community is it’s very like other sports very ego driven and so you’ll see people grab on to like a piece of wood that has that two centimeter or 20 millimeter edge with that 90 degree bend and they’ll be dead lifting it off the ground and so they’ll be using body weight or a little bit above body
Jake (47:17)
Yeah, yeah.
Tyler Nelson (47:44)
loads in my opinion that are way too heavy for the finger flexors that are not very muscular that are risky but for some reason rock climbing has excluded the thumb if you’re using a half crimp position like most of the old papers would say this was a four finger load no thumb included and so climbers like don’t know what to do with their thumb if they’re lifting something off the ground one of the things that I commonly see is the thumb will go across the fingers across the palm of the hand
And it’s a huge like compressive load to the, you know, backside to the extensor tendons of the thumb. And that’s, you know, partly the reason that people get to quere veins is just a lot of repetitive use. And so I think it’s largely from that climbers will be doing a lot of like thumb across the fingers when they’re grabbing onto pockets or four fingers. That’s one of the mechanisms. And then it’s hard to say without knowing that.
athlete but they maybe went somewhere like Kalymnos which is a common climbing destination that has a lot of big holds so they’re doing a lot of pinching with the thumb and the fingers and so if your thumb is not used to that much pinching because that’s kind of a unique style it’ll just add a lot of volume to that tissue and ultimately you can create some sort of tendon irritation.
Jake (48:55)
What do you, you said earlier, kind of the finger-tie in the world is maybe kind of behind, I mean probably behind in terms of like Achilles and patella. What do you think needs to happen to get a better understanding of what’s going on?
Tyler Nelson (49:09)
I mean, there’s more people that are interested in this and it’s changing all the time. I do lots of teaching. I’m going to Germany in May and then I’m going to Luxembourg in France in June to teach and I’ve done lots of teaching in Canada over last six years. so just people that are interested in it. And there’s a lot of climbers that are now coming out, PTs and like Kairos and medical doctors that are psyched about this stuff and gonna be doing more. So it’s really just like people being interested in.
and caring and as with anything the research will just get better and people will be more interested and everyone benefits.
Jake (49:47)
Alright, Tyler, tell everyone where to find you online and I don’t know if you do stuff in person too.
Tyler Nelson (49:53)
Yeah, I mean, I definitely do people that live in Salt Lake. have an office next to the bouldering project. mostly for upper extremity injuries, so shoulders, elbows, and fingers and wrists. And I do diagnostic ultrasound. like.
Clinically, appointments for me usually consist of conversations like this for an hour, and then we’ll do a diagnostic ultrasound if it’s indicated, do some quick orthopedic testing, and then write you a program, and then stay in touch via text, and then modify the program. So I’m a big fan of doing programming and communication and modification over time for my clients. So I do in-person consults, but I do a lot of remote consults as well. So I have clients on…
every continent and lots of people overseas and so if people are somewhere where they want advice and they need help and they can’t find someone locally like you know I have zoom link contacts and ways that people can just book online on my website probably the easiest way to find me is on Instagram as probably my largest platform that I use and my handle is C4HP and then in the bio
are links to rehabilitation services courses that I teach. We have a YouTube channel with some finger training stuff on there so those are the best ways to find me.
Jake (51:07)
Great. All right, man. Thanks for coming on.
Tyler Nelson (51:10)
Yeah, yeah, thanks man. Appreciate it.
Jake (51:14)
Please stop. There we go.
