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We’ve all heard of a pulley injury—the most common and most feared finger injury for climbers. But the second most common, capsulitis, can be just as disruptive to climbing and training.
Capsulitis, a type of synovitis, is the chronic inflammation of the membrane that lines the fingers’ joint capsules. It’s a particular type of synovitis that causes stiffness and pain, and it accounts for 6 to 10 percent of all climbing injuries. To understand how to identify, prevent and treat capsulitis, we talked to Dr. Tyler Nelson, founder of Camp4 Human Performance, a rehabilitation and training program aimed at climbers.
Check out the video below to watch Nelson explain capsulitis, or keep reading for more information.
What is capsulitis and how is it different from other finger injuries?
Throughout our bodies, we have synovial joints: Think our knees, hips, shoulders and, yes, fingers. “Any joint that has a capsule with fluid in it and cartilage on both sides of the joint is a synovial joint,” Nelson explains. Synovitis is a broad term that refers to inflammation of any of these joint capsules. What climbers often experience in their fingers is capsulitis, or intra-articular synovitis, which leads to swelling, pain and stiffness.
Compared to other climbing injuries, capsulitis often is less dramatic and can be harder to diagnose. Often, people with an A2 or A4 pulley tear will report hearing a distinctive “pop” at the moment they sustained the injury. Capsulitis is a chronic condition that develops over time. Since it’s the result of inflammation, and a tendon or pulley rupturing, there won’t be the same “tell-tale” moment of trauma that there is with tears. Lumbrical tears, which often occur with pockets, will usually present pain in the palm, while capsulitis will present pain in the joint of the finger.
Tenosynovitis, also common among climbers, refers to inflammation of the sheath that protects and lines tendons. Both tenosynovitis and capsulitis are similar in that they’re inflammatory responses, but a distinguishing factor is range of motion. Capsulitis will frequently mean that climbers can’t fully flex or extend the injured finger.
Causes of Capsulitis
Repetitive, excessive stress on the fingers from full or half crimping on small holds is the number one cause of capsulitis. Crimping places a high degree of compression and force across our joints, and when done repeatedly or at a high intensity, it can produce inflammation. In an effort to recover, our body will produce extra synovial fluid to compensate.
Nelson most commonly sees clients with capsulitis in the middle two fingers. “If you think about a crimping position on a flat edge, the middle fingers get stressed and bent the most,” he explains. “If we load [the finger joint] again, it stays inflamed,” Nelson says. That negative feedback loop will lead to the joint membrane getting larger due to the chronic pressure, resulting in swelling.
How to Prevent Capsulitis
To reduce the likelihood of capsulitis, Nelson advises managing load = and varying climbing grips. Instead of full and half crimp grips, Nelson recommends that his clients use a three-finger drag so they can use it to generate force without putting too much stress on the fingers.
The campus board can be particularly risky for finger health. “The campus board requires you to half crimp a lot of stuff. It’s high pressure with a lot of high force,” Nelson says. Reducing climbing volume and avoiding climbing on back-to-back days can also help give your fingers adequate time to recover.
Identifying and Treating Capsulitis
If you start to notice symptoms in your fingers like persistent soreness, swelling, and stiffness, especially when flexing, consider cutting volume or reducing training.
“[Climbers with capsulitis] need to back off climbing for three weeks, sometimes six weeks, depending on how bad it is, and then they need progressive loading,” says Dr. Nelson, “and then slowly rebuild tolerance back in the joint.” He understands that climbers have a hard time staying off the wall, so he encourages active rest; if you’re going to climb, keep it a low volume, and stay away from jugs and crimps. Climbing on jugs or performing pull-ups can worsen capsulitis due to the compressive pressure these activities put on the joints.
When reintroducing load back to the fingers, Nelson prefers that his clients with capsulitis use an unlevel edge rather than a traditional, flat-edged fingerboard, which stresses and bends the middle two fingers, further aggravating capsulitis. By comparison, the unlevel edge matches the height of the edge to the length of the finger, leading to a more even load on the fingers. He also likes the Ninja Balls from Atomik because they allow climbers to strength train by squeezing, instead of flexing, their fingers.
Nelson says that typical recovery time for capsulitis can be 8 to 10 weeks, but if clients keep their climbing volume too high, they can experience flare ups again. The specialist frequently sees clients’ capsulitis reemerge when they’re hitting training hard for an upcoming comp or an outdoors trip.
“They just need to understand [what] things to do that are going to put less pressure on the joint,” says Nelson, “and be patient as hell.” It’s important to keep a long-term view and understand that recovery is a marathon, not a sprint. “It’s gonna look a little different for every person, but you have to be patient and stick with it for a couple of months, and you’ll make meaningful progress,” he says.
Tyler Nelson is a Doctor of Chiropractic and Certified Strength and Conditioning Specialist with a Master’s Degree in exercise science. With Camp4 Human Performance, Nelson seeks to apply the science of rehabilitation and training to climbers. For more information, visit camp4humanperformance.com.
