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Capsulitis & Synovitis from Rock Climbing

Capsulitis or synovitis from rock climbing is a treacherous injury that often doesn’t hurt enough for you to stop rock climbing sufficiently after injuring your finger. After 2 to 3 weeks the inflammation in your finger is gone and pain will have subsided too.

So, what do you do?

You get back to climbing and you hurt your finger. And there starts a vicious cycle of hurting your finger, waiting for it to pass, and then hurting it again.

If you’re here right after you hurt your finger that’s great. Are you in the vicious cycle described above?

That’s fine too. I describe a rehab plan for both situations to get you back to climbing as soon as possible.

Let’s get right to it!

1. Finger Joint Anatomy

Before we dive into the specifics of capsulitis it’s good that you have a basic understanding of finger joint anatomy. Most of you know where the pulley ligaments are in the fingers, but there’s more to this fascinating piece of natural engineering.

We’ll only look at the finger because the classic synovitis from rock climbing is in the interphalangeal joints.

Each finger starts at the metacarpophalangeal joint (MCPJ) with the first phalanx. Then after that, there’s the middle and the last phalanx which are connected by the proximal interphalangeal joint (PIPJ) and the distal interphalangeal joint (DIPJ).

Each of these joints is kept together by a capsule. It’s technically a capsule ligament complex (CLC) which means that the capsule and the ligaments holding both joint surfaces together are a single piece of tissue. The difference is that this complex piece of tissue can be thicker at certain points, which indicates a ligament, and thinner at others. Also, on the dorsal side of the PIPJ, the finger extensor tendon is fused with the joint capsule.

The joint capsule is built up out of 2 layers, the “membrana fibrosa” or the fibrous layer, and the “membrana synovialis” or the synovial layer. The first is the part that provides stability and the latter produces the synovial fluid.

The synovium is responsible for nourishing the cartilage which covers each of the joint surfaces. Besides that, the synovium also works as a lubricant to help joint surfaces move smoothly.

anatomy of finger with rock climbing synovitis sites

It depends on how you load your fingers how the fibers of the CLC will develop. So, the more you climb the better this system will be able to resist climbing-specific movements.

2. What is a Capsulitis?

Capsulitis, also called synovitis, is when an inflammation of the synovium occurs.

In rock climbers, this is due to an overload of the CLC. Here are a couple of possible overload mechanisms:

  • Climbing a lot on pockets
  • Climbing a single type of route or problem only (again you’re more likely to overload on pockets but also crimps. Slopers less)
  • Pulling at an angle
  • Deficits up the chain; for example, you lack shoulder stability and therefore have to compensate for rotation in the shoulder with inefficient finger positioning.

In general sheer and rotational forces are more likely to irritate the capsule and the synovium. These forces can cause friction between the joint surfaces and because there is no muscle in the interphalangeal joints that rotates or causes sheer movement, and therefore cannot provide stability in these directions, the entire force has to be stopped by the CLC. Also, when the distal interphalangeal (DIP) joint is hyperextended while crimping, only a part of the cartilage has to carry the entire load. This can irritate the cartilage which in turn irritates the synovium.

pressure points of cartilage while crimping
Image adapted from: Crowley TP. The flexor tendon pulley system and rock climbing. J Hand Microsurg. 2012 Jun;4(1):25-9.

3. What are the Symptoms of a Rock Climbers’ Capsulitis?

The onset of a rock climber’s synovitis is often sudden, usually with no acute incident. You will just have a swollen and irritated finger joint after climbing.

All signs of inflammation are present in finger capsulitis:

  • Redness
  • Swelling
  • Heat
  • Pain (often a dull kind of pain)
  • Reduced function (mobility, strength, and or stability of the joint)

The swelling and redness are easy to spot outside your IP joint. The pain you feel with or without moving and the heat you must feel by comparing to the joint on the other side.

Besides that, you might feel like your finger is “squashy”, unstable, weak, you can’t pull as hard, or certain ways of using it might cause increased pain. All of these are symptoms of reduced function.

So how do you know you have synovitis for sure?

  1. You need to have the symptoms above.
  2. The symptoms are located in an interphalangeal or metacarpophalangeal joint. If they are not exactly in a joint it might also be tenosynovitis or a (chronic) pulley injury.
  3. There was no acute pop, tear, or strong sheer movement whereafter the symptoms started instantly. If this was the case a capsule tear might be a possible other diagnosis.

Other possible symptoms but not necessary:

  • Climbing with an open grip hurts.
  • Climbing with a crimp grip hurts.
  • Increased pain in end-range extension and/or flexion.
infographic finger synovitis (capsulitis) from rock climbing

Now before we move on to how you can best heal your synovitis, I’d like to discuss osteoarthritis with you.

4. Synovitis and Osteoarthritis

Synovitis can be a symptom of an activated symptomatic osteoarthritis. Osteoarthritis is a progressive degeneration of the cartilage occurring when the water-retaining proteins, proteoglycans, lose their capacity to hold water. This dehydrates the cartilage and makes it more porous. This in turn increases the chance of damage.

Cartilage isn’t innervated nor does it have blood supply. This means that you don’t feel damage when it occurs, nor does it have the capacity to regenerate. So broken is broken.

But you know what?

Tissue damage does not equal pain. This means that you can have horrible osteoarthritis but no symptoms. It also means that you can have no tissue damage but a lot of pain. As is often the case in back and shoulder pain.

Yet, if your osteoarthritis is “activated”, which means that you’re experiencing symptoms, it can be painful. The question is now if these symptoms are caused by the osteoarthritis itself or by the synovitis caused by it.

The bottom line is, that if you have osteoarthritis together with your synovitis it can influence the progression of your rehabilitation. Where normal capsulitis, if treated right, should be gone in up to 5 months, with underlying osteoarthritis it might take longer. And you can experience more ups and downs in your rehab.

So how do you know if osteoarthritis might be an underlying cause of your finger capsulitis?

3 things make it more likely that osteoarthritis plays a role in your synovitis:

  1. You’re 35+
  2. You’re a rock climber – yes, I know this sounds dumb but heavy use of joints is a risk factor.
  3. Osteophytes on the edge of your IP joints. These are bony deformations that occur in response to cartilage damage. The best way to see if you have them is to feel around all your finger joints to get a feeling of how they should feel and then compare it to your painful IP joint.

And then finally, to get a definitive answer to the osteoarthritis question in your fingers you should get an ultrasound image of the joint.

Now that you have all the necessary background information about your capsulitis from rock climbing let’s dive into your rehab.

5. What is the Fastest Way to Heal Finger Capsulitis from Rock Climbing?

The fastest way to heal finger capsulitis from rock climbing is by responding to your joint pain immediately. Synovitis will follow a stereotypical (meaning each new synovitis follows the same process) healing process with distinct healing phases.

In the initial days during the inflammatory phase, you need to rest for 2-3 days and start loading lightly with pain-free movements. During the proliferation phase, you should increase the pain-free loading of the finger progressively. Then, after 21 days your capsule will build back the original tissue strength, which you should again, stimulate with progressive loading. This final phase is tricky because your capsule is still not at its original strength, but you will have less to no pain anymore.

So be careful! When your pain is gone it doesn’t mean your injury is gone.

Below is an overview of each of the healing phases a capsulitis goes through.

  Capsule (Membrana Synovialis) InjuryInflammation Phase Proliferation Phase Remodulation/Maturation Phase
0-5 Days2-21 Days21 Days- 5 to 7 Months
 Damaged tissue is taken away and fresh building materials are brought to the sight of injury. Your body heals the injured site with temporary capsule tissue. The temporary tissue is changed into the final original capsule tissue.

Here’s what you should do in each of the healing phases to recover as fast as possible.

If you’ve been struggling with a capsulitis for longer than a month already you should be very strict in following these phases. Every time you hurt your finger you’re restarting the process. So, be a bit more on the conservative side when it comes to the time indications mentioned below.

5.1 Inflammation Phase 0-5 Days

Take a day or 2 of full rest. And apply a light compression bandage around the joint that’s hurting. This will stimulate blood circulation and help to reduce the swelling. Taking 1 gram (DHA & EPA combined) of Omega 3 oil for 10-14 days can help to modulate the inflammatory response.

After 2 days of rest start the following passive movement protocol.

Do 3×15 repetitions 3x/day of passive flexion-extension of the injured IP joint. These movements should be entirely pain-free. So make them as small as necessary to not feel pain.

Also, do 3×15 repetitions 3x/day of active flexion and extension of the injured IP joint. This again should be pain-free.

And finally do 2x30xoscillating 3x/day tiny tractions of your injured IP joint as shown in the video below. Your finger should be slightly bent, and you should lightly pull repeatedly in the direction of the phalangeal bone that’s bent. This is a technique that directly works on the mobility of the joint capsule. Besides that, it can help to reduce pain and refresh the synovium. Doing this should also not hurt at all.

5.2 Proliferation Phase 2-21 Days

From day 5-7, you can continue with all the exercises above but now you’re allowed to feel a discomfort of 2-3/10 while doing so. The goal in this phase is to get your full active range of motion back. If your discomfort level allows for it, you can force your finger a little in end ranges.

But again, only when you can do so with a pain of 2-3/10. No more. And the pain should subside within an hour after doing exercises.

It’s normal when you still see signs of inflammation in this phase. Because the inflammation builds up over 5 days and winds down over the following 5. So, if your inflammation is still the same after 2-3 weeks post-injury, you’re either loading the finger too much or something else is going on. This “something else” could be the involvement of the cartilage that irritates.

After 3-4 weeks your finger should be pain-free in your everyday life.

Other things you can start during the proliferation phase:

From 2 weeks post-injury start hanging on jugs on your hang board. Every other day 3×10 seconds with a 2-minute break between sets. You’re allowed to feel your finger as mentioned above. The hangs should be submaximal and shouldn’t feel too hard at all.

If the pressure on the joint is hurting, you can tape it for cushioning. A simple circular stretchy tape should be sufficient.

Besides that, you can also do dumbbell rolls. Which is a dumbbell wrist flexion in which you extend your fingers all the way. This strengthens the forearm and finger flexor while on the roll-out also causing traction on the IP joints. Apply the <2-3/10 pain rule for this exercise too. Do 3×20 with a weight that allows you to do just that number of repetitions.

Then, restart your antagonist training of the lower arm and finger. Do finger extension in a theraband, dumbbell wrist extension, and also dumbbell supination all 3×15 repetitions.

And anything else that doesn’t hurt you can continue doing. So run, bike, jump, train your legs, core, and any upper body with movements that don’t aggravate your finger. The better you continue to train in the presence of your injury the fitter you’ll be when you’ve healed your injury.

5.3 Remodulation/Maturation Phase 21 Days – 5 to 7 Months

You can progress to this phase if you have no pain in your finger anymore, not in your everyday life or during any unloaded movements. You should have full active range of motion as you have on the other side in the same joint.

If that’s the case, you can progress to the following exercises:

  • Dumbbell rollouts: continue with 3x20x a weight you can just do that number of repetitions with
  • Hangboard
    • 3×10 jug; week 4
    • 3×10 open grip: Week 5
    • 3×10 half crimp: Week 6
    • 3×10 full crimp: Week 7
  • Return to Climbing
    • on jugs in week 6
    • on open grip in week 7
    • with half crimp week 8
    • with full crimp week 9

Progress slowly to your redpoint grade until week 12-20 post-injury. Be mindful of how your finger feels and take at least 2 weeks per grade increase. So if you’ve climbed up to 7a this is how your progression looks like:

  • week 6: routes that have jugs only
  • weeks 7, 8, and 9 train your grip types on 6a/+
  • week 10-11: 6b
  • week 12-13: 6b+
  • week 14-15: 6c
  • week 16-17: 6c+
  • week 18-19: 7a.

If your redpoint grade is higher or lower, adjust the grade progression accordingly.

6. Important Take-Away’s

Capsulitis is a gnarly injury and often causes discomfort longer than the 5 months that are necessary for the healing of this injury. I think this often has to do with progressing the loading of the finger too fast.

Thus, be rather conservative in your approach when rehabilitating this injury. Progress your climbing slowly and keep doing complementary exercises to acquire the strongest joint tissue possible.

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