TBP 299: Dr. Jared Vagy on Finger Capsulitis (What It Is and How to Treat It)

Date: October 22nd, 2025

Dr. Jared Vagy is a physical therapist and a climber who’s incredibly motivated to help other climbers heal their bodies. In this interview, we talk about capsulitis, which is a common finger injury that climbers get. He describes what capsulitis is, how it happens, how to avoid it, and how to treat it if you have it.

Supporting Resources from Episode

• Peer reviewed case study on capsulitis
• How to use a finger trap for capsulitis
• Jared’s book Climb Injury-Free. Order his book here.
• Database of medical providers on Jared’s website

Other Interviews with Dr. Vagy

1. Interview #1: We talked in general about how to heal injuries, but since that time he has gotten way more specific about the steps we need to take to address them.
2. Interview #2: He talked about how to heal shoulder impingement.
3. Interview #3: We talked about rotator cuff injuries and neck strain.
4. Interview #4: We discussed finger pulley sprains.
5. Interview #5: We discussed elbow injuries.
6. Interview #6: We talked about hip injuries.
7. Interview #7: Finger Injuries and Protocols

Jared Vagy Professional Credentials

Dr. Vagy is an authority on climbing related injuries. He has published numerous articles on injury prevention and delivers lectures and seminars on the topic. He received his Doctorate in Physical Therapy (DPT) from the University of Southern California, ranked the number one DPT Program in the nation for the last decade by US News and World Report.

He is now a professor at the University in the DPT Program. As a Doctor of Physical Therapy in clinical practice, he went on to complete a one-year residency program in orthopedics and a one-year fellowship program in movement science. He is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist.

Rock Rehab Protocol Links

Dr. Vagy has created 6 injury protocols using his Rock Rehab Pyramid method that are available on TrainingBeta. You can find out more about his methods by clicking on any of the links below. You can see a description of all of the protocols (which we’ve made available for $15 each) at www.trainingbeta.com/rock-rehab.

• Inside Elbow Pain
• Outside Elbow Pain
• Finger Pulley Sprain
• Shoulder Impingement
• Rotator Cuff Strain
• Neck Strain

Dr. Jared Vagy Links

• • Jared’s book, Climb Injury Free
  • Website: www.theclimbingdoctor.com
  • Instagram: @theclimbingdoctor

 

 

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Transcript

00:00:01.42
Neely Quinn
right. Welcome back to the show, Jared. Thanks so much for talking to me.

00:00:05.12
Jared Vagy
I know, Neely, it’s been a while. I’m not sure the last time, but maybe two years, something like that.

00:00:10.83
Neely Quinn
Has it been?

00:00:11.23
Jared Vagy
Two plus, maybe…

00:00:12.58
Neely Quinn
Gosh, I don’t know, but that does seem right. Things just time just flies and it’s crazy, but we’re back now. And for anybody who hasn’t heard the many, many episodes you’ve been on before, can you tell us who you are and what you’ve been up to?

00:00:31.08
Jared Vagy
My name’s Jared Vagie. I’m a doctor of physical therapy, an associate professor at the University of Southern California, and the author of the book, Climb Injury Free. And I work a lot with climbers. I have a ah platform called The Climbing Doctor, which we have educational content for climbers to prevent and rehabilitate injuries.

00:00:52.90
Jared Vagy
And I love climbing, love treating injuries, love teaching climbers how to not get hurt and really enjoy sharing that information. And recently I’ve been doing a ton of research and that has ah been a really quote unquote fun process, maybe a type three fun process.

00:01:12.01
Neely Quinn
I love that.

00:01:12.23
Jared Vagy
yeah yeah And yeah, I’m excited to be on the show.

00:01:16.23
Neely Quinn
Cool. Yeah. What’s the research been on?

00:01:19.35
Jared Vagy
Lots of different studies. We just put out a study on, there’s a knee injury in rock climber, or knee injury where you tear the ligaments in the knee it called ACL injury. And there was no available protocols for climbers after this injury and surgery to get back on the wall.

00:01:36.36
Jared Vagy
So we actually put out two studies, a review study, and then a case study of a climber who went through a protocol, successfully returned after surgery.

00:01:47.26
Jared Vagy
And it has all these kind of timelines, checklists, and protocols. And a lot of the research that I’m doing right now on climbing injuries is practical research. Like I really want information that’s open access that climbers can then use and utilize to rehab their own injuries.

00:02:03.53
Jared Vagy
And we’ll talk about later on this topic we’re talking about today. i also put out a study on this as well. And so this is, yeah, this is something I’m quite passionate about.

00:02:15.65
Neely Quinn
Yeah. Wow. That’s so cool that you made a whole protocol with research about ACL. So many people have ACL injuries.

00:02:24.52
Jared Vagy
I mean, so many athletes have ACL injuries, but you don’t see it that much in climbers, but you see it a lot in climbers that cross over to different sports. Like, yeah, I climb, but I tore my ACL skiing or I climb and, but I really want to return back to climbing. And it’s this, site oh my God, it takes so long. This research study took a year to develop the protocol, a year to write the paper and eight months to eventually get it published.

00:02:54.20
Jared Vagy
so this is a slow churning process and it is all, you know, sweat equity.

00:02:55.00
Neely Quinn
Oh my gosh.

00:02:58.85
Neely Quinn
Yeah.

00:03:01.81
Jared Vagy
It’s volunteer time. It’s like doing things that are good for climbers and the community. But definitely, definitely has to be something you’re super passionate about.

00:03:12.63
Neely Quinn
Yeah. You definitely have that spirit about you, like an altruistic spirit where you really, we really can feel that you just want to help us as climbers.

00:03:22.78
Neely Quinn
So thank you.

00:03:23.73
Jared Vagy
Yeah. And it’s fun and that type three kind of way.

00:03:27.67
Neely Quinn
and Yeah, right.

00:03:27.97
Jared Vagy
um

00:03:28.66
Neely Quinn
Cool.

00:03:28.97
Jared Vagy
But yeah, on the other side of how things are going, like from the non-research perspective, one of my books just got translated to Chinese. so I’m going to Taiwan to do like a book tour, which I’m really excited about.

00:03:42.85
Neely Quinn
cool

00:03:43.25
Jared Vagy
And then I’m writing a new book that comes out May, 2026 on on movement patterns with climbing and then how to break down those movements into mobility and strength exercises.

00:03:57.02
Jared Vagy
So there’s always different things that I’m working on that whatever I’m passionate at the moment.

00:04:00.78
Neely Quinn
I don’t know how you have the time. And then you’re here talking to me.

00:04:05.90
Jared Vagy
Which is great. I enjoy it.

00:04:09.02
Neely Quinn
All right. Well, so what are we talking about today?

00:04:11.94
Jared Vagy
ah This is the most common finger injury that I see in rock climbers. And it is called capsulitis or synovitis.

00:04:24.78
Jared Vagy
And it’s an inflammation of the knuckle joint in rock climbers. And I want to do this podcast because i used to see so many climbers with pulley injuries. And now climbers can just look online. They can find the majority of treatment. And if it doesn’t work, then okay, they come in and see me or they come and see some medical provider. But there isn’t that much good information on swollen knuckles when climbing or capsulitis synovitis.

00:04:51.62
Jared Vagy
And it’s something that can easily be prevented from getting worse. And i feel like I need to speak to that and maybe how climbers can catch it in the early stages and make sure it doesn’t affect them later.

00:05:07.61
Neely Quinn
Cool. Yeah. So I think that there are probably a lot of people who have no idea what this is. And I mean, I’m not even aware of really what it is. I’ve just heard my friends say that they have it. So what is it?

00:05:19.95
Jared Vagy
And you don’t have it? Do you don’t have any swollen knuckles in your finger that are affecting climbing? Okay.

00:05:24.62
Neely Quinn
No, not. I mean, not yet. I always like to say that.

00:05:29.65
Jared Vagy
Not yet.

00:05:30.13
Neely Quinn
Not yet.

00:05:31.89
Jared Vagy
Dot, dot, dot, dot.

00:05:32.87
Neely Quinn
Yeah. Yeah.

00:05:33.38
Jared Vagy
um So maybe I’ll break down like a one minute finger anatomy. We have our hand, we have our fingers, we have three main joints in each of our fingers.

00:05:45.66
Jared Vagy
We have our first knuckle joint, the one that you kind of, if you punch a wall, that’s the one that hits the wall first. We have our second knuckle joint in the middle. It’s called our PIP joint. We have our third knuckle joint, which is our DIP joint.

00:05:59.55
Jared Vagy
On the front of our hand, we have tendons that run over the front of the fingers. There’s two main tendons, the profundus and the superficialis. I’m not going to go in depth in those. And then we have pulleys that anchor down those tendons.

00:06:16.41
Jared Vagy
So the main thing I’m going to talk about is the joint itself. So if you look at your hand, so Nealey, look at your hand right now and go ahead and just like close your fingers, ah maybe like into a crimp, just maybe like into a half crimp.

00:06:29.60
Neely Quinn
Okay.

00:06:29.71
Jared Vagy
And which joint bends the most if you’re like making like a pseudo half crimp?

00:06:37.16
Neely Quinn
Uh, well, it’s the, is, I don’t know. is that the second joint?

00:06:43.62
Jared Vagy
Yeah, it’s the one right in the middle, right?

00:06:44.38
Neely Quinn
Yeah.

00:06:45.66
Jared Vagy
It’s called a PIP joint.

00:06:45.82
Neely Quinn
Yeah.

00:06:46.90
Jared Vagy
It’s not that knuckle that connects to your hand. And it’s not the edge of your finger, that final joint. It’s the one tray in the middle. And if you do like a half crimp, it’s what, around 90 plus degrees, right?

00:06:58.69
Jared Vagy
Almost like a right angle of like a bend.

00:07:00.64
Neely Quinn
Mm-hmm.

00:07:01.99
Jared Vagy
So that is the most commonly affected joint that becomes swollen or inflamed while climbing. And the joint itself has a synovial lining.

00:07:13.81
Jared Vagy
So like a very thin ah lining that allows it to lubricate itself. And then there’s a capsule that is fibrotic that surrounds the joint.

00:07:25.34
Jared Vagy
And that almost, imagine, it encases it. And so capsulitis and avitis is when that becomes inflamed. And it’s very simple. It becomes inflamed from crimping.

00:07:36.59
Jared Vagy
That’s like the main aspect because it goes through so much range of motion and it has such high forces in the crimping position. And it starts as a kind of mild ache in the joint.

00:07:50.69
Jared Vagy
Most climbers don’t even recognize it. They kind of shake it off. And then over a couple weeks, a couple more weeks, a couple months, ah kind of slowly creeps in. The joint becomes a little bit more stiff.

00:08:02.84
Jared Vagy
Oftentimes it becomes a bit harder to move and then it becomes painful. But climbers can still climb on it. It becomes more painful. They could still climb on it. And then eventually they go and see someone to figure out what’s going on. So that’s kind of the process of it. And typically climbers will see someone to address it after it’s already, you know, in a later stage of the condition.

00:08:25.89
Neely Quinn
And so it’s hurting them at that point when they’re climbing and after?

00:08:32.00
Jared Vagy
It’s typically when they’re climbing, when they’re crimping pretty hard on something, almost like a closed crimp, because you can imagine that stresses the joint a little bit more. And then afterwards is, is yeah, of course, when it when it starts to kind of become irritated. And sometimes in the later stages, I see this quite common,

00:08:51.78
Jared Vagy
bothers them when you first start climbing, you know, kind of stiffness in that area. And then you have to start moving the fingers a little bit, work it out, and then it feels okay, maybe in the middle of your climbing session.

00:09:03.12
Jared Vagy
um So it’s something that’s, it’s quite interesting because it’s a bit self-limiting. Like a lot of climbers will climb on it and just be like, ah, it’s just like a little bit of a stiff finger. I’m not going to worry about it.

00:09:15.15
Jared Vagy
And it’s not like a pulley injury or some traumatic injury that can shut you down from climbing, you can climb really hard ah with capsulitis. The issue is the next day, it’s going to feel a little sore. The day after when you warm up, it’ll be a bit sore, but you can continue to climb. And that’s why I think it’s important to educate climbers about this early on, because there’s some stages of the injury. And if you kind of stop it in the early stage, then you’re able to obviously prevent it from getting worse.

00:09:45.35
Neely Quinn
Okay. I’m going maybe jump ahead here, but if a person wanted to be diagnosed, how would you go about doing that?

00:09:56.57
Jared Vagy
Yeah, so there’s the simple way. If you’re a rock climber and you have a single finger and it’s your PIP joint, that middle one that we’re talking about, that’s inflamed or maybe one or two different fingers,

00:10:11.50
Jared Vagy
and you overpress it, you like press it into bending a little bit harder than it’s like full range of motion. And you extend it a little bit further, kind of straighten the finger as much as possible.

00:10:26.04
Jared Vagy
And if one of those cause discomfort, it likely is capsulitis. Now, if we wanna get more in depth into how do you actually diagnose it, there’s a series of different tests.

00:10:32.83
Neely Quinn
Mm-hmm.

00:10:39.02
Jared Vagy
We’re actually running a research study right now on using diagnostic ultrasound to grade the severity of capsulitis.

00:10:50.11
Jared Vagy
um But if a climber also comes in and they close their finger as much as possible, it’s painful. And then I distract the surfaces from each other, almost like pull them apart and it feels better.

00:11:04.12
Jared Vagy
That’s another diagnostic way I can rule that in. And there’s a series of other components, but typically it’s a clinical classification until we publish this study um with some ultrasound evidence. And you can pretty much clinically classify if you have a swollen knuckle joint that’s larger than the others, most often in the longer finger, and it’s painful to bend, you very likely fit into this category. It’s it’s not a rocket science diagnosis.

00:11:34.19
Neely Quinn
Okay. Because in all of my experience with injuries, like the um MRI has always been the gold standard, but that’s not the case with this.

00:11:42.47
Jared Vagy
No, it’s with this one, we’re we’re actually mr MRI is First all, it’s not needed in this condition. it can show some inflammatory processes, you know, localized in the joint, but ultrasound, which is i really easily accessible by clinicians, um is what we’re using for this research study to grade the amount or severity of this condition.

00:12:09.57
Jared Vagy
And yeah MRI is definitely not necessary for this.

00:12:09.75
Neely Quinn
and

00:12:14.65
Neely Quinn
Okay. And at its very worst, what if, if somebody had this and they just kept climbing really hard and they never stopped and did anything about it, what’s the worst that would happen to them?

00:12:28.40
Jared Vagy
The joint will become more stiff. So it’ll be like harder to bend the finger and the pain levels will increase, but they can likely still climb hard.

00:12:41.65
Neely Quinn
Okay. okay

00:12:42.54
Jared Vagy
as long as they warm it up appropriately. And that’s why it’s crazy because it’s a diagnosis. I think one of the most important things when climbers come in to see me is to let them know it’s okay to climb on this. This is not going to shut you down, but you have to be really smart and you have to be able to manage the injury when it flares up.

00:13:02.09
Jared Vagy
And I think that’s really the key. So someone can be cruxing And like trying like projecting something really hard with this condition, and they’ll be okay. But then they’re gonna be shut down for like two, three, four days after, because it’s going to be uncomfortable until they can start to loosen up, get their range back, and then they can go back at it.

00:13:21.97
Jared Vagy
um When The joint becomes inflamed though. There’s this capsule that surrounds the joint. There’s a synovium, but if it becomes chronic, it becomes a cycle and it just keeps laying down more and more tissue.

00:13:41.43
Jared Vagy
And you’ll see the knuckle becomes huge. It becomes giant. And that’s starting to become more in the category of it becomes harder and harder to treat once you get bony changes.

00:13:54.81
Jared Vagy
And once you get kind of these larger called hypertrophied knuckles, um, so. It can come on through just climbing, especially crimping. Crimping is the the culprit, full crimping and half crimping.

00:14:12.08
Jared Vagy
it can come on through trauma. So imagine someone’s climbing, they do a side pull and they their finger slips or whatever it is, and they like twist their finger.

00:14:22.83
Jared Vagy
We call it like a collateral ligament injury. And the finger just gets a bit of a strain, gets loose. Well, that heals up. But the finger is now a little bit loose and that looseness while crimping can start to creep up and create a little bit of that swelling, little bit of that inflammation as well. So there’s, I don’t want to you know, fear monger climbers into this condition, but the the the great thing to know is it’s so easily preventable once you have early signs of this like knuckle stiffness.

00:14:56.54
Neely Quinn
Okay. One question on that. You know how sometimes you stick your fingers into like a horizontal crack and then you’re you kind of dynamically try to move out of that crack and your fingers get stuck momentarily?

00:15:12.06
Jared Vagy
Yeah.

00:15:12.46
Neely Quinn
And I feel like, is that the kind of trauma that could potentially cause this later?

00:15:20.02
Jared Vagy
So like you’re in a horizontal crack. you’re trying to move up on it and you kind of like jam your fingers upward, right?

00:15:25.70
Neely Quinn
Yes, yes, yes.

00:15:26.44
Jared Vagy
as As you’re moving upwards. Yeah, any type of like over extension injury, that would be like a hyper extension injury. Or imagine you’re like in a side pull or like a finger lock. I know you probably don’t crack climb that much, but like in a crack, you’re like torsioning your fingers.

00:15:42.59
Jared Vagy
So anything that like torsions or bends mechanically that causes what we call macro trauma, like a quick incidence of trauma to the finger, could potentially loosen the finger and then through micro trauma, crimping, crimping, crimping all the time, can can bring it on.

00:15:59.52
Neely Quinn
Okay, and one last clarifying question on this. i I had like a very minor finger injury recently, and I went to my hand specialist. She’s great.

00:16:10.31
Neely Quinn
And she looked at all my fingers and she was like, oh, you got arthritis there, arthritis there, arthritis there. and it’s because I have these like… Tiny little and no knobs on my first, ah the third knuckle or joint, the final one.

00:16:25.30
Jared Vagy
Yes. The final one, the final one.

00:16:28.71
Neely Quinn
Yeah, exactly.

00:16:29.11
Jared Vagy
Yeah.

00:16:29.90
Neely Quinn
And so I just want people to be able to like differentiate between what might be arthritis and this.

00:16:37.57
Jared Vagy
Yeah, that’s a really good question. So one, Herbert and nodes, those are basically when you crimp and you close crimp, that last digit hyperextends.

00:16:49.07
Jared Vagy
Can you imagine that? Like it goes goes like backwards.

00:16:49.96
Neely Quinn
Yeah.

00:16:52.34
Jared Vagy
And so when that goes backwards over time, there’s something called Wolf’s Law. When bones touch bones, they like to grow. And so by doing that crimp over time and those bones are touching each other, the bone decides to lay some extra bone.

00:17:08.99
Neely Quinn
Hmm.

00:17:09.02
Jared Vagy
And those are called osteophytes or bone spurs. And some people develop them, some don’t. There is a genetic component potentially linked to it. um And so that’s fairly common to have bone spurs on the edges of the fingers, especially that DIP joint, that final joint.

00:17:25.06
Jared Vagy
That is a different condition. That is not joint capsulitis. Those are nodes. Those are bone spurs. Those are ah joint-related changes.

00:17:34.00
Neely Quinn
Okay. So it it’s not even arthritis what I have.

00:17:34.42
Jared Vagy
Now, yeah.

00:17:36.94
Neely Quinn
It’s these.

00:17:37.24
Jared Vagy
Well, now, so yeah, so it’s so then arthritis is a little different.

00:17:37.78
Neely Quinn
No.

00:17:41.20
Jared Vagy
You may have a combination of both.

00:17:43.15
Neely Quinn
Hmm.

00:17:43.69
Jared Vagy
Arthritis is typically all the fingers and not just the fingers. You also may feel it in your toes, you know, and it is a condition of the joint itself, Artha’s joint and itis’s inflammation ah that’s a bit more systemic.

00:18:01.00
Jared Vagy
that meaning you can have it on multiple joints. And climbers, there’s been research studies and literature, climbers that climb hard and climb, even youth climbers over time, have arthritis. And they have arthritis in, you know, multiple joints in their fingers.

00:18:16.24
Jared Vagy
And there is a bit of a medical debate of if if capsulitis is really just a clinical term for arthritis, but in a single finger in a rock climber.

00:18:28.51
Jared Vagy
And that is a discussion to be held at a different point.

00:18:28.53
Neely Quinn
oh

00:18:30.79
Jared Vagy
But I think the easiest way to differentiate it If you have a bunch of joints that are stiff and creaky and it’s not isolated to one of them and it’s most uncomfortable like first thing in the morning and just general gripping, that would be more arthritis related changes.

00:18:49.92
Jared Vagy
If you have a node or a spur you know on the on a joint, that would you know be more a bone spur, what’s called an osteophyte. And then if you have a single finger or maybe one or two fingers or one or two joints that are just much bigger than the other joints, that would be more your capsulitis or synovitis.

00:19:09.68
Neely Quinn
Okay. That was very well done. Thank you for that.

00:19:14.65
Jared Vagy
Yeah, yeah, and here’s the crazy thing. When you’re trying to think of what fingers are affected, so Neely, if you look down at your hand, and then now have you guess, guess which finger is oftentimes most affected by capsulitis and why?

00:19:32.03
Neely Quinn
Well, you kind of said it was the longest, so I’m assuming that’s the middle. And it seems like that’s the one that’s bent the most when you’re crimping.

00:19:41.55
Jared Vagy
Yeah, you.

00:19:42.61
Neely Quinn
Yeah, wow.

00:19:43.39
Jared Vagy
Nailed it. Yeah, there you go. Yeah, one one for one. like the question It’s going to get harder. The questions are going to get harder. Yeah, that’s the professor instinct jumping in.

00:19:52.14
Neely Quinn
Yeah. well

00:19:53.14
Jared Vagy
Yeah, you’re like, really? Are we doing this on the podcast? But yeah, so we’re, um yeah, it’s the the middle finger joint is most common, that PIP, that middle joint. And that’s the finger that gets the most amount of bend during a crimp.

00:20:08.46
Jared Vagy
Now here’s the next level. Neely, look at your hands and look at your second digit, so like your pointer finger, and your ring finger, and kind of line those up. Like stick them next to your middle finger they’re like nice and like you’re just all your fingers are together.

00:20:26.61
Jared Vagy
Are those the same length or is one longer than the other? This is your point. And everyone listening obviously do the same. It’s your second finger and your fourth finger. Are they the same length or is one longer than the other?

00:20:39.83
Neely Quinn
My ring is longer than the other. Mm-hmm.

00:20:42.77
Jared Vagy
Okay. So you’re, that means your pointer is shorter. Okay. So that’s what’s called a 2d 4d ratio. It’s our second digit and our fourth digit.

00:20:55.08
Jared Vagy
And you have a negative ratio, which is ah a shorter pointer finger. Correct.

00:21:01.81
Neely Quinn
Mm-hmm.

00:21:02.60
Jared Vagy
Okay. So once you imagine this, imagine you’re crimping now with a shorter pointer finger and it’s a flat edge, you’re just on a fingerboard. you aren’t able to bend that pointer finger as much because it’s shorter.

00:21:17.10
Jared Vagy
So what it does is it chisels straight. You’re almost like you’re on a crimp and it chisels straight to match the middle finger instead of bending.

00:21:27.28
Jared Vagy
Does that make sense?

00:21:27.38
Neely Quinn
Yeah, totally.

00:21:29.42
Jared Vagy
And what that does is that then puts some more stress into the middle finger, in the joint, that PIP joint in the middle finger, because your pointer finger is now straight, straighter, not as bent.

00:21:41.08
Jared Vagy
And so these are like

00:21:41.11
Neely Quinn
and it’s not And it’s not doing as much? Like the pointer isn’t doing as much work then? Mm-hmm.

00:21:46.67
Jared Vagy
Yeah, or the middle joint in the pointer isn’t going through as much load because it’s now straighter than bent because it’s a little shorter.

00:21:51.10
Neely Quinn
Yeah.

00:21:54.96
Neely Quinn
Yeah.

00:21:55.05
Jared Vagy
And so there’s all these like little individual differences when I’m assessing climbers that are super fascinating and play a large role. And that’s actually one of the things that I find that climbers with a shorter pointer finger than ring finger will actually have a little bit more of a predisposition that point.

00:22:14.45
Neely Quinn
ah

00:22:15.50
Jared Vagy
middle finger capsulitis.

00:22:17.70
Neely Quinn
I didn’t even know that you could have a longer pointer than your ring finger. Whoa.

00:22:22.34
Jared Vagy
Oh, it’s a big deal. It’s like this in literature. They do all these research studies of like hormones in the uterus and yeah know so forth that lead to different lengths of fingers. And everyone has a different ratio.

00:22:34.47
Jared Vagy
Some people have the same length.

00:22:34.77
Neely Quinn
oh

00:22:36.70
Jared Vagy
They’re second and fourth. Some, their second is shorter. Some, their second is longer. And we won’t even get into pinkies, but there’s a whole discussion on pinkies and what they do. All

00:22:47.00
Neely Quinn
Okay. Fascinating. All right. So what else do you want to cover?

00:22:53.28
Jared Vagy
All right. So we’ve gone over the anatomy. I think everyone listening can check on that. We’ve gone over ah a short explanation, ah you know kind of minor explanation of what capsulitis is, and we differentiated it from arthritis, and we differentiated it from you know a bone spur or an osteophyte.

00:23:14.14
Jared Vagy
I talked a little bit about how macro trauma, so like you were talking about like a horizontal crack, ah you like leverage up and your fingers hyperextend or even like a side pull going to the side. Some type of large amount of trauma could lead to capsulitis developing over time or it could just develop over lots and lots of crimping.

00:23:33.06
Jared Vagy
And then we talked about the most common joint that’s affected. so And I guess we talked a little bit about some of the ultrasound evidence of the study that we’re doing and clinically what I would do to make assessments of the joint.

00:23:46.51
Jared Vagy
But I think what people really want to hear is how to actually treat it. I mean, I have to imagine that that is what, you know, we’re, you know, we’re into the podcast now. People are right, let’s, let’s get to the the meat of this.

00:23:57.14
Jared Vagy
So probably talk about how to treat this condition.

00:23:59.40
Neely Quinn
Yeah.

00:24:00.68
Jared Vagy
All

00:24:00.78
Neely Quinn
Cool. Yeah. They’re on the edges of their seats. Let them, let them have it.

00:24:03.71
Jared Vagy
right. Well, maybe, Neely, this can also, add this doesn’t work perfect for your for your injury. But let’s imagine, Neely, that you have a swollen middle finger ah PIP joint.

00:24:17.31
Neely Quinn
Okay.

00:24:17.60
Jared Vagy
um And it’s stiff and you’re climbing tomorrow and you’re trying to send your project. um And you’re like, all right. I don’t know if I’m able to do this. My joint and finger is actually quite stiff. I have some localized pain. It’s a little bit inflamed.

00:24:34.61
Jared Vagy
In the short term, what would you do to try and get your finger ready to to climb the next day? That’d be where I’d start.

00:24:43.41
Neely Quinn
I mean, what would I do ah is probably different because I think a lot of people would say i would take ibuprofen, but I don’t take like that kind of stuff i because I can’t.

00:24:55.54
Neely Quinn
And so I would probably ice it That was helpful for me. i would like rub it with a ah like a massage tool and I would put some homeopathic cream on it.

00:25:09.00
Jared Vagy
Yeah, I think that you’re in a similar philosophy that I have at the moment. So this isn’t a time to debate whether it’s good to reduce inflammation or not.

00:25:23.84
Jared Vagy
We have a joint that’s not bending and we have a short-term project. We need to reduce inflammation locally to allow it to bend. And whatever Whatever method we go about doing that, I think is quite appropriate.

00:25:37.74
Jared Vagy
And it works really, really well for these conditions in the short term. I’ll kind of keep that you know in mind. So I break this into four categories. The first category is unloading, like taking all the stress off of the joint.

00:25:53.38
Jared Vagy
And we’ll talk about that um in a moment. The second one is mobility. So improving the finger’s ability to bend. The third is strengthening. And the fourth is movement. And this is the same pyramid that I’ve presented in my book.

00:26:09.51
Jared Vagy
And it’s also the pyramid, we’ll link this in the show notes, I had a climber go through this protocol, and we’ll share with everyone the exact protocol step by step.

00:26:21.68
Jared Vagy
A climber that was in their early stage of capsulitis, and it cleared up all of their symptoms.

00:26:23.87
Neely Quinn
Okay.

00:26:27.32
Jared Vagy
They returned back to climbing quite strong. But just know if you’re in the moderate stage or the late stage, it doesn’t work as easy as that. This is more like early stage trying to trying to prevent it. um But I think we’ll start with unloading, which is similar to icing or anti-inflammatories.

00:26:45.47
Jared Vagy
But yes, icing for the joint is really, really effective. And there’s a bunch of ways. Nealey, how do you ice your joint? like What do you do if you wanted like if you had a finger joint that was affected?

00:26:57.35
Neely Quinn
Well, I’m a super baby about cold. I have very, like very little tolerance for it, but I would just take a bowl of water and put some ice in it and then soak it for as long as I could and then rest, and like take it out and then soak it for as long as I could.

00:27:14.58
Jared Vagy
that’s That’s honestly the one of the best ways to do it because the fingers are difficult surfaces and the joints to really wrap around with an ice pack.

00:27:25.96
Jared Vagy
And so putting your hand in a jug or a large bowl, putting ice around, and then what I find is actively moving the fingers.

00:27:35.15
Neely Quinn
o

00:27:35.50
Jared Vagy
This is an inflamed joint and your goal is really to improve range of motion. So not only does the ice reduce local inflammation, but it also numbs your hands so you don’t feel pain.

00:27:46.91
Jared Vagy
And so that gating mechanism allows you to start to build through a little bit of range of motion.

00:27:46.99
Neely Quinn
Yeah.

00:27:52.76
Jared Vagy
So I have climbers just wiggle their fingers and it’s just for five minutes. And i say just for five minutes.

00:27:56.51
Neely Quinn
Mm.

00:27:58.68
Jared Vagy
If anyone’s tried this with ice, It is really, really hard to sustain. um The one drawback to that is it’s a pain in the butt to set up.

00:28:14.14
Jared Vagy
It’s just such a hassle to put ice and fill up water and find the jug and then dry your hand and and Am i making anything up or is this just a whole process? Like, I feel like if I were to ice my hands, it’s not as much the icing part. It’s a setup and cleanup that just takes time.

00:28:32.74
Neely Quinn
Wow. i I mean, I’m going to disagree. i would just like made it a part of my routine. I would put it in a bowl. I would go sit out in my backyard and look at my garden and it was actually kind of, I don’t know, soothing.

00:28:47.65
Jared Vagy
Great. So that for those of you listening that find it quite soothing to go through the whole process, because I I’m like a, know, I’m very OCD.

00:28:48.63
Neely Quinn
yeah

00:28:57.05
Jared Vagy
I’m very like, if I like spill a little bit of water, then I have to like, wipe the water up. And then I’m like, Oh, how many ice cubes do I do? And I check the temperature. And it’s just like, I don’t know, it just for me, it became like a hassle.

00:29:08.69
Neely Quinn
learning so much about you.

00:29:08.90
Jared Vagy
So yeah, exactly. um

00:29:14.10
Neely Quinn
okay so you don’t like that part.

00:29:14.28
Jared Vagy
And then I was like,

00:29:15.54
Neely Quinn
Is there some sort of alternative?

00:29:16.24
Jared Vagy
no this is a it’s just No, it’s a personal preference.

00:29:19.18
Neely Quinn
Okay.

00:29:19.20
Jared Vagy
like Some people love it. Obviously, you love it. So if people love the you know the ice bath for the hand, then go for it.

00:29:21.60
Neely Quinn
Yeah, I loved it.

00:29:28.40
Jared Vagy
I think that’s the best way, honestly, because the water circulates around. You can even ah you know take your other hand and splash around the water so it doesn’t you know you don’t get numb and you can keep the circulation going.

00:29:41.96
Neely Quinn
wow

00:29:41.98
Jared Vagy
But um you can also, there’s like little things you can put on your fingers. I mean, like Penguin Fingers is a brand. i think there’s a couple other ones, but they’re like ice packs for your finger ah that you just throw in the freezer and you just grab them and then you put them on your finger and you don’t have to clean up the…

00:30:00.06
Jared Vagy
the dripping water. um But I’ve found a lot of issues with those that climbers will put these like, just imagine like a finger ice pack, right? You slide your finger right through it. um Climbers will put those on and then they’ll get like frost burn of their skin ah because they just left it on too long and they, you know had direct ice on their finger or ice gel

00:30:14.41
Neely Quinn
Oh,

00:30:23.15
Jared Vagy
And so if anyone does use like a finger ice pack, my recommendation is to put tape around your finger or put a, you know, a plastic glove on or something, ah because I’ve seen so many quote unquote like freezer burns on the skin from climbers like trying to ice their fingers.

00:30:41.55
Neely Quinn
Climbers are so intense. They’re like, more is better. More has to be better.

00:30:45.20
Jared Vagy
Yeah.

00:30:46.35
Neely Quinn
This is fine.

00:30:46.55
Jared Vagy
Yeah. Yeah. I’ve seen ah decent number of rehab injuries, um you know, in addition in addition to like training and climbing injuries.

00:30:55.22
Neely Quinn
We’ll do a whole episode on that.

00:30:57.18
Jared Vagy
Yeah. I have some really funny ones, um but I don’t know if funny is the right word. i have some very interesting ones that can be prevented with some education to climbers.

00:31:05.66
Neely Quinn
Yes. How professional of you.

00:31:07.65
Jared Vagy
Yeah. So, okay. So we talked about unloading so you can decrease inflammation locally. There’s also other ways that you can compress the joint.

00:31:19.43
Jared Vagy
Now, synovitis or capsulitis isn’t like movable fluid. It’s not like, you know, like you, don’t know, you injure your knee or your ankle and it like swells up and you can like push your finger into it and it kind of bounces back.

00:31:36.46
Jared Vagy
that type of fluid is quite, you know, quite easy to decrease the volume of um through some massage and through some, you know, mobilization of those tissues and then through some icing and compression.

00:31:50.04
Jared Vagy
But the joint itself, you’re you’re not going to see too many changes. Climbers in the later stages of this condition will still have a large joint. It’s not like the joint’s going to decrease or go down, but compressing the joint actually works really well, ah especially to improve pain-free motion.

00:32:10.60
Jared Vagy
And there’s this type of tape ah called Coban tape. It’s They sometimes give this, you know, when you, I don’t know, when you get a shot and they like give you that cool bandaid, like the SpongeBob bandaid, and then they like wrap that area or no, let’s say you’re giving, your you’re, you’re giving blood, right.

00:32:35.46
Neely Quinn
oh yeah.

00:32:35.55
Jared Vagy
And you have a, you have an injection and they, you know, they,

00:32:35.64
Neely Quinn
Mm-hmm.

00:32:40.23
Jared Vagy
you know wrap that area with like this like flexible gauze type tape. in So that’s called Coban tape. um It’s like very inexpensive. It’s very porous. It’s very flexible.

00:32:54.79
Jared Vagy
If climbers take that and they wrap it around their finger, and especially around the joint, and then they just move their finger back and forth, they just like like almost like you’re grabbing things. You just move it actively.

00:33:06.95
Jared Vagy
that tape acts as a compressive force and your joint moving back and forth that can help pump out some of that localized fluid in that area.

00:33:18.15
Neely Quinn
Nice.

00:33:18.54
Jared Vagy
So ah Coban tape active motion, don’t know if that’s the right terminology, but that’s a really nice way to pump out some of the kind of gross swelling in that area. And it just has to be some type of elastic tape, if that makes sense.

00:33:34.09
Neely Quinn
Yeah, yeah, that makes sense. Okay, those are great ideas.

00:33:39.28
Jared Vagy
All right, so that’s going to be to kind of unload that area to get some mobilization or mobility. i like your idea of um doing some massage you had mentioned, some localized massage.

00:33:53.12
Jared Vagy
um I often use like a tool, like a People can get these. I’m not really into beauty care, but I’ve seen these advertised, you know, those face plates that people take and they’ll rub, rub their face.

00:34:06.30
Neely Quinn
Yeah.

00:34:07.78
Jared Vagy
how How would you describe that? It’d be like a

00:34:10.73
Neely Quinn
I feel like they definitely have a name, but, and and you get them in sets in like velvet bags. They’re really nice.

00:34:17.60
Jared Vagy
Yeah, these like jade face plates that are like, you know, people that want to um scrape their face to, ah actually not sure the the mechanisms for the face or the skin tissues, but i can tell you the mechanisms for the finger tissues.

00:34:33.23
Neely Quinn
Yeah.

00:34:33.64
Jared Vagy
But if they if people want to use that ah in their beauty care for their face, actually those same things work really well for the fingers. And they’re only a couple dollars and maybe like $6 or something like that.

00:34:44.79
Jared Vagy
And i like using jade tools um and actually take that, you put in the freezer. And so you now have this tool. It’s cold. It’s in the freezer. And then you just scrape the finger back and forth.

00:34:58.05
Jared Vagy
And you’re scraping away any local tissue adhesions. And it’s slightly an abstract concept. um But mostly what you’re doing is the adhesions.

00:35:12.34
Jared Vagy
ah Right above the joint is our skin and kind of fatty tissues. And you’re just making all the tissues that are above the joint glide a little bit more easily.

00:35:23.92
Jared Vagy
So when you bend your fingers, it doesn’t cause pain or discomfort. So that’s another method that climbers will sometimes use. And a little bit of this is anecdotal, meaning, well, does that really work?

00:35:38.77
Jared Vagy
Does that really, you know, change adhesions? Does wrapping the finger really get rid of inflammation? If you have capsulitis, you will know whether or not this works for you.

00:35:50.65
Jared Vagy
Why? Because you test it first. You close your hand and say, ow, does that hurt? You then do the treatment. You either wrap it or you scrape it. And you see which one allows you to bend your fingers further with less pain. And the one that works is the one that I recommend to you. That’s basically the the recipe.

00:36:10.40
Neely Quinn
Nice.

00:36:10.69
Jared Vagy
So um so yeah yeah, go for it

00:36:12.29
Neely Quinn
And can i ask a specific question about these things? Like if you’re doing the co-band tape or the massage, again, I think that a lot of climbers were like more is better, but is there any sort of prescription for how long or how much?

00:36:28.97
Jared Vagy
So in the research study that I did, it was three sets of 45 seconds.

00:36:34.50
Neely Quinn
No.

00:36:36.08
Jared Vagy
It’s not that much, right?

00:36:37.20
Neely Quinn
No.

00:36:38.69
Jared Vagy
And… and It’s not like you’re scraping your finger so you rip all the skin off it. You’re scraping your finger like you’re brushing your teeth.

00:36:51.56
Jared Vagy
Like you’re doing self-care for your finger, essentially. And it’s not like when we brush our teeth at night, you don’t brush your teeth so hard. You try to make your gums bleed.

00:37:03.04
Jared Vagy
Like that’s not the the goal of brushing your teeth.

00:37:04.75
Neely Quinn
It’s a really good analogy.

00:37:06.35
Jared Vagy
Right.

00:37:07.39
Neely Quinn
Yeah.

00:37:07.53
Jared Vagy
So i brush my teeth every night, every day, three times a day. also floss. I love flossing. That’s like one of my favorite things to do.

00:37:13.35
Neely Quinn
Wow. Of course you do. Yeah. i mean

00:37:15.03
Jared Vagy
Yeah. It’s like, i you like flossing too?

00:37:19.41
Neely Quinn
No. Yeah. I don’t, I don’t mind flossing. I don’t love it. ah hit You just seem like the kind of guy who would love doing something that’s very good for you.

00:37:24.22
Jared Vagy
okay.

00:37:28.45
Jared Vagy
Yeah, I’m like all into flossing. I’m like an after lunch flosser. um but um But anyway, yeah, you’re not brushing your teeth for your gums to bleed. You’re brushing your teeth nice and gently so you can maintain good oral hygiene. And this is like the big take home thing for climbers too, is doing some gentle, subtle things on your fingers daily is actually quite good you know for finger longevity.

00:37:51.42
Neely Quinn
Yeah, like even for if even if you don’t have injuries. This is reminding me of these things I just got. They’re called fascia blasters, which I know is a hilarious name, but I swear they work.

00:38:05.12
Neely Quinn
They’re just these plastic molded, they look like… They’re handheld massage things, but you don’t even press that hard. And I have this glute, this old glute injury, and it really makes it feel better.

00:38:18.97
Neely Quinn
But it also works better when I use oil umma or lotion, which I would assume you would recommend for people to use with these jade tools or whatever they’re using too.

00:38:30.83
Jared Vagy
Yeah, 100%. And it typically works better if you use some type of lubricant that has friction. So chapstick is one of the best things you can use. We all have it and we have like old chapstick, right, that we can use and utilize.

00:38:45.92
Jared Vagy
um Or you can use Vaseline, you know, but some type of ointment that has a little bit of friction. So you’re not giving yourself quote unquote massage, you’re creating friction to the skin and the tissues surrounding it.

00:38:58.41
Neely Quinn
Okay, great. So those are mobility. Was there more on the mobility side?

00:39:05.08
Jared Vagy
There’s one more, which is actually quite important. So these are like the scraping and the wrapping. Those, some climbers will try them and it just doesn’t work.

00:39:16.19
Jared Vagy
It just doesn’t change their finger motion. Some will try it and they have significantly more range with no pain. So those are quote unquote optional decisions, right?

00:39:26.71
Jared Vagy
If you have capsulitis to improve your motion. But ah less optional decision is treating the joint itself because that’s what’s actually causing the discomfort, the inflammation through the joint and the joint capsule and and the synovium around it.

00:39:41.99
Jared Vagy
And so have you ever seen like finger traps, like when you were a little kid, like those, like, how would you describe it?

00:39:47.47
Neely Quinn
Yeah.

00:39:50.45
Jared Vagy
I’m not going to try to describe it, but how would you describe it? You know, you stick your finger in each side.

00:39:55.22
Neely Quinn
Yeah. And then you try to pull them apart and the more you pull the tighter they get. Right.

00:39:59.72
Jared Vagy
Yeah. They’re like woven. Yeah. yeah Woven finger traps.

00:40:04.30
Neely Quinn
Yeah. Yeah.

00:40:05.54
Jared Vagy
Okay. I think we’re good on that. I’m not, I’m not going to, they actually have medical ones that are actually quite expensive ah that they use for surgery. um And so it’s like a finger trap for surgery.

00:40:16.48
Neely Quinn
Oh,

00:40:16.67
Jared Vagy
That’s woven nylon. I have a set of them. I forget how they They’re expensive. And like I use those for treatment. um But for like six cents, you can buy an actual like, you know, disposable finger trap or you can go to the dentist to get your teeth cleaned and go in the treasure chest.

00:40:30.04
Neely Quinn
it

00:40:37.40
Jared Vagy
And usually there’s a couple um finger traps there.

00:40:40.91
Neely Quinn
Dirtbag hacks.

00:40:40.97
Jared Vagy
I’m actually taking… dirtby Yeah, exactly. I’m actually taking singing lessons. And so I get these like gold stars when I sing. This is probably too much information. but um And so they actually have that singing lessons.

00:40:51.28
Neely Quinn
I love it.

00:40:53.11
Jared Vagy
They have this like box, you know, this chest of a bunch of different gifts.

00:40:58.03
Neely Quinn
Wow, you just come home every time with a new children’s toy?

00:40:58.09
Jared Vagy
And so…

00:41:02.05
Jared Vagy
Yeah, like, the the I’m looking through all these like, I’m like, oh, what would be a good rehab tool for climbers?

00:41:07.59
Neely Quinn
ah Yeah.

00:41:08.04
Jared Vagy
And trying to find, um that’s but that’s basically me at the craft store looking for good rehab tools. But anyway, let’s let’s get back on track, Neely. um

00:41:15.37
Neely Quinn
yeah

00:41:16.55
Jared Vagy
So anyway, so you could take these finger traps and you can put them around your finger. You slide them up right to the joint. So it’s like right above the affected joint. For you, Neely, I know you have, no, this wouldn’t work for you. Never mind.

00:41:31.32
Jared Vagy
But for if someone had capsulitis, it’s harder on that last joint. You know, that DIP, that like final joint in your finger.

00:41:37.94
Neely Quinn
Mm-hmm.

00:41:38.07
Jared Vagy
It’s hard to get the finger trap around it.

00:41:38.08
Neely Quinn
Mm-hmm.

00:41:39.91
Jared Vagy
But if someone has capsulitis on the middle finger joint, the PIP, the most common one, you get the finger trap right up to it. You can take your fingers and drape it. like over the edge of a table so the knuckle is bent almost to 90 degrees. And then you just gently pull on the trap.

00:41:57.53
Jared Vagy
Gentle is the key term to distract those tissues. And you can hold the position or you can oscillate back and forth. And that’s a method to treat the joint itself.

00:42:11.53
Neely Quinn
oscillate back and forth you mean like tractioning non-tractioning tractioning non-tractioning okay okay

00:42:15.67
Jared Vagy
you You got it. So like if I was treating a climber’s finger joint, I would do this with my hands. I would go up. I would put that in an open position.

00:42:26.14
Jared Vagy
i would pull it or distract it to take the joint surfaces away from each other. And then I would gently move traction, no traction, traction, no traction.

00:42:37.33
Jared Vagy
at different intensities for 45 seconds and the literature is at two hertz which is to the beat of row row row your boat um so that’s the if anyone knows that uh that song so yeah and i’m not i’m not deep enough in my singing lessons to be confident singing that song right now but um yeah i know i’m working on it

00:42:52.89
Neely Quinn
No, but I don’t think anybody knows that.

00:43:00.53
Neely Quinn
Oh, okay.

00:43:03.02
Jared Vagy
Um, but, uh, but yeah, row, row, row your boat would be the tune that you would have in your head as you’re tractioning that joint.

00:43:09.17
Neely Quinn
Okay. And when you say 45 seconds, you said like three sets of 45 seconds. Is this every day for these things?

00:43:16.98
Jared Vagy
Yeah, this is daily for the mobility work.

00:43:19.45
Neely Quinn
Okay, cool. Those are really good ideas. Like I would never think about doing though any of those things.

00:43:26.38
Jared Vagy
Yeah, I think they’re well now everyone listening to this podcast will know. um And they’ll also they will also have, ah you know, in the show notes, I have these like wonderful pictures with, you know, letter A, B, C, D, e like it walks through this entire process. So I’m hoping that climbers listening to this will have all the resources they need.

00:43:46.91
Neely Quinn
Yeah. Yeah. Okay, cool. So that’s mobility. um and then we have strength strength work. strength work

00:43:56.94
Jared Vagy
Well, we’re not done with, there’s one more thing mobility is just moving. After you do all that stuff, you know, whether it is wrapping the joint, whether it is, you know, using a tool on the joint or whether it is doing, using joint traction, after you do all that, you do want to now move the finger specifically through its range of motion. So that would come next.

00:44:20.00
Jared Vagy
If you don’t do that, in my opinion, you’re kind of wasting your time. But you want to loosen the joint, you want to scrape the joint, you want to wrap the joint, whatever it takes to free up tissue adhesions, restrictions, maybe ice if there’s localized inflammation. And then you do want to actually use that range of motion.

00:44:38.83
Jared Vagy
So you can do tendon glides or even just active range. Just roll your fingers, move your fingers back and forth. Motion is lotion. don’t know if you’ve heard that term.

00:44:48.34
Neely Quinn
Mm-hmm.

00:44:48.37
Jared Vagy
So the more that we move our joint under low loads, the healthier they are. It secretes synovial fluid. And that would be the final stage of mobility.

00:44:58.62
Neely Quinn
Yeah, that makes sense. And yeah, that’s what my hand specialist told me to do too. is She gave me all these exercises, like basically going into a full crimp and then coming out and then full crimp and coming out or then bending all of your fingers down into your palm at the same time and coming out.

00:45:14.47
Neely Quinn
And now I do all these things like as a warmup too, so for all of my climbing days.

00:45:17.97
Jared Vagy
Yeah. Yeah, I think that’s just really good, you know, holistic advice for everyone is the more that you can just continually do that, even if you don’t have this injury, the more you can keep the fingers lubricated in their joints and moving quite nicely.

00:45:34.80
Neely Quinn
Yeah. All right, cool. so now are we done with mobility?

00:45:43.39
Jared Vagy
Yeah, moving on to strength, moving up moving up the pyramid.

00:45:44.93
Neely Quinn
Okay. Cool. How do we strengthen?

00:45:50.44
Jared Vagy
All right. This one is interesting. So knowing the anatomy. So when people have capsulitis, like any guesses where the pain typically is? It can be anywhere in the in the joint, but is it typically typically in the front, the sides, or the back?

00:46:08.34
Neely Quinn
I would guess that it’s on the back and the sides.

00:46:12.18
Jared Vagy
Yeah. So it’s almost like almost all the time in the back of the finger. And then it will leak onto the sides of the capsule, especially since there’s collateral ligaments there as well that are interwoven.

00:46:25.05
Jared Vagy
And so what else is on the back of our finger is we have tendons from the back of our forearm. Well, muscles, the back of our forearm, and then extends into tendons that go along the tops of our fingers.

00:46:40.32
Jared Vagy
So if you like look, if you put your palm like facing the ground, and then you like lift your fingers backwards, like lift your fingers to the sky, you should see in your hand, like these like lines of tendons.

00:46:55.08
Jared Vagy
you see any of those in your hand? Like when you extend your fingers back?

00:46:59.06
Neely Quinn
Yeah.

00:47:00.87
Jared Vagy
Okay, so those are your extensor tendons. And those go directly on top. You have like one specific one for your pointer finger, one specific one for your pinky, and then like a shared one, you know, for all the fingers. But those go directly on top of the joint itself. Okay.

00:47:23.80
Jared Vagy
And so it’s a little bit of a hack. This will work for quite a few climbers. If you take like a rubber band and you thread it through all your fingers and then you press out on it and you hold 30 seconds.

00:47:38.88
Jared Vagy
So you you just like exert your fingers into the band backwards. Does that make sense?

00:47:44.35
Neely Quinn
Oh, like that, that tool that you can buy, like attaches to all of your fingers in a claw position. And then you just spread your fingers out wide.

00:47:51.83
Jared Vagy
yeah

00:47:55.03
Jared Vagy
Exactly. You can use a tool, you can use rubber band, you can even like use your own hand.

00:47:55.73
Neely Quinn
Yeah.

00:48:00.42
Jared Vagy
But if you extend your fingers backwards and you hold that for 30 seconds, there’s been some literature on inhibition, like pain inhibition, which basically shuts off the pain signal from the brain and I usually give climbers that three sets of 30 seconds to do, and then I retest their ability to crimp or bend.

00:48:26.63
Jared Vagy
And it’s not a magic trick. It’s just neuroscience, but oftentimes that will improve your ability to flex the fingers. And so I build in three sets of 30 second holds with a rubber band for the extensor muscles in the backs of the fingers ah to help reduce pain.

00:48:34.10
Neely Quinn
Okay.

00:48:44.14
Jared Vagy
And also there’s a tendon on top of the joint. The more You could build up the you know thickness of that tendon, the strength of the tendon. It could potentially protect the joint as well.

00:48:56.80
Neely Quinn
okay I’m just imagining somebody doing this protocol. If somebody, if they were like, I got to go do my PT, this is just not ever what anybody would expect from a PT session.

00:49:08.47
Jared Vagy
Right. It’s like completely. and a lot of these things, it’s like there’s there’s a lot of medical providers who now treat climbers. When i started doing this, there was nobody. it was like me and like three other people.

00:49:19.23
Jared Vagy
um

00:49:19.27
Neely Quinn
Hmm.

00:49:20.11
Jared Vagy
And so a lot of us are like in silos, like practicing things, trying things, working with thousands of patients and seeing what works. And then now there’s a lot of communication between a lot of us and the process is just speeding up.

00:49:37.01
Jared Vagy
And so someone learns like, oh, here’s a great way of managed capsulitis. And then that progresses on and there’s more and more knowledge. And so i hope by putting out this information, climbers can play with it and maybe find some new tips and tricks.

00:49:52.83
Jared Vagy
But that was a fun magic trick that I kind of um kind of learned over time.

00:49:58.68
Neely Quinn
Yeah. Yeah. That’s really cool actually that you, you all are working together and not gatekeeping the information.

00:50:05.54
Jared Vagy
No, it was like, yeah, early on like one of my big missions was to try to unify as many climbing medical providers as possible.

00:50:06.32
Neely Quinn
and

00:50:14.98
Jared Vagy
And we have this huge group that’s actually spans entire world, you know, multiple, yeah, across multiple continents, you know, dozens of countries. And we get together once a quarter and we just talk climbing PT and we nerd out.

00:50:32.71
Neely Quinn
That’s amazing.

00:50:32.84
Jared Vagy
And yeah, it’s really…

00:50:34.39
Neely Quinn
Wait, you should record one of those and we should put it on the podcast. People would die to hear it be a fly on the wall.

00:50:40.57
Jared Vagy
would love it Let me see the numbers. Okay, we have 271 members in 207 cities in 31 countries.

00:50:49.60
Neely Quinn
Wow.

00:50:49.95
Jared Vagy
So yeah.

00:50:50.47
Neely Quinn
I am so impressed. What do you call yourselves?

00:50:52.44
Jared Vagy
Yeah. ah The rock climbing special interest group. And so it’s the rock, it’s a rock rehab community.

00:50:57.63
Neely Quinn
Wow. and

00:51:02.40
Neely Quinn
That’s amazing. Right.

00:51:03.40
Jared Vagy
And here’s the cool point part. cool part um People that are interested in finding a medical provider in their area, i list everyone like on my webpage, theclimbingdoctor.com, that’s in the group.

00:51:17.99
Jared Vagy
And if someone is in… you know, Salzburg or someone’s like wherever they are, they can hopefully find somebody, you know, that is in their geographic area that’s in person. Now, I cannot vet everyone in the group is the thing that I say, right?

00:51:30.52
Neely Quinn
right

00:51:31.79
Jared Vagy
These all I know is these are people that are medical providers that work with climbers and are psyched on climbing.

00:51:32.12
Neely Quinn
yeah

00:51:39.93
Neely Quinn
Yeah. I’ll, I’ll find that link and I’ll put it in the show notes.

00:51:43.47
Jared Vagy
Yeah, that’ll that’ll be great.

00:51:44.84
Neely Quinn
Yeah. All right.

00:51:46.73
Jared Vagy
But I do want to put that stipulation because yeah.

00:51:48.44
Neely Quinn
Yes. I hear you. You cannot. Yeah. You are not liable for their actions.

00:51:53.82
Jared Vagy
For their treatments. Yeah.

00:51:54.86
Neely Quinn
Yeah.

00:51:55.32
Jared Vagy
So, um, where are we?

00:51:58.65
Neely Quinn
Uh, holding the extensors, the extensor hold.

00:52:00.94
Jared Vagy
Yeah.

00:52:01.83
Neely Quinn
Yeah.

00:52:02.40
Jared Vagy
Okay. So we got the extensor hold. And then the other aspect, which is really fascinating. Remember I talked about that 2D-4D ratio when you were kind of looking down at your fingers and climbers are like chisel a finger forward.

00:52:11.68
Neely Quinn
Mm-hmm.

00:52:16.45
Jared Vagy
um A lot of these injuries also come on from asymmetric gripping. and especially fingerboarding. So fingerboarding on like a flat edge and having finger orientations that are not symmetric. Maybe the finger is jutting out to the side or because of finger length, you are pushing one finger forward more or maybe one finger hurts, your ring finger hurts. And so you’re rotating your hand a little bit one way and you do that for four months. Your ring finger feels better, but you don’t change your pattern. Like all these things come up on fingerboard training.

00:52:54.44
Jared Vagy
And so anytime a climber comes in with this condition, I will always look at how their fingers look on the fingerboard, if that’s part of their training, and also how they grip climbing holds when they climb.

00:53:05.07
Neely Quinn
oh Yeah, I imagine if you were to work with somebody remotely, you’d want even a video of that.

00:53:12.21
Jared Vagy
Yeah. And yeah.

00:53:12.82
Neely Quinn
like yeah, and people could maybe even look at their own videos of themselves.

00:53:19.11
Jared Vagy
You’d be surprised how many people are like blown away when I met when i video their fingers on a fingerboard. They’re like, whoa, wait, what ah what what’s going on? Like all my fingers look great on my left hand. Why is my right pointer finger like spread out to the side?

00:53:37.16
Jared Vagy
And that’s right next to my injured middle finger, you know, and things like that where like climbers don’t even realize why, because our hands are over our head.

00:53:40.25
Neely Quinn
the

00:53:44.81
Jared Vagy
And we’re not looking at our fingers when we hang. So yeah, anyone with this condition, I would really advocate, like take a look at how you grip. and you could do every like mobility technique in the world to unload the tissues.

00:54:01.23
Jared Vagy
But if your crimp pattern is causing asymmetric stresses, that may be a challenge.

00:54:07.57
Neely Quinn
Okay, and before I forget, question about hangboarding. ah do you find that this injury or finger injuries in general are happening more often to people who are hanging?

00:54:20.37
Jared Vagy
I think hanging, but also using a lot of the boards like moon board, kilter board, like really crimping heavily angulated terrain, if I were to put that nicely.

00:54:31.92
Neely Quinn
Mm-hmm. Well, and I feel like on boards, when you’re going dynamically for crimps, sometimes you land with your fingers in just like a weird way and you keep going like that. And then you’re like, ouch, that hurt.

00:54:46.11
Jared Vagy
Yeah, I mean, it’s the two main things I notice utilizing boards, whether it is, you know, an angulated board training board, or whether it’s a fingerboard for training.

00:55:00.51
Jared Vagy
Let’s put those in the same category. And then the other is just volume and intensity of crimping. That’s like, if you can control those parameters, you can likely get this under control.

00:55:13.75
Neely Quinn
and Okay.

00:55:13.91
Jared Vagy
But it’s really hard to tell someone not to move, not to moon board when, it’s you know, it’s like, really, what are you going to do?

00:55:14.11
Neely Quinn
yeah

00:55:17.14
Neely Quinn
Right, right. Exactly.

00:55:20.15
Jared Vagy
um So we’ll talk a little about that when we talk about climbing movement.

00:55:20.28
Neely Quinn
Yeah. But the

00:55:23.59
Jared Vagy
Yeah.

00:55:24.18
Neely Quinn
The other thing is like when you said the way that you grip can be kind of funky and, and affect injuries. So like, it’s very hard to retrain yourself to crimp differently, especially when you’re climbing, like much less on the board.

00:55:41.35
Neely Quinn
But so how do you.

00:55:42.79
Jared Vagy
Yeah, if if you’re if you’ve been climbing for 12 years, let’s say, right? Good luck changing that pattern.

00:55:48.73
Neely Quinn
Yeah.

00:55:49.47
Jared Vagy
Like that’s not going to happen when you’re climbing. When you’re fingerboarding, I’ve had some good success with pointing it out because you’re in a very stable, controllable environment.

00:56:02.29
Jared Vagy
And if the fingerboard doesn’t work, I’ll have climbers take a block and put it down by their sides like a portable fingerboard and look in the mirror and maybe hang a ah loading pin with some weight.

00:56:13.59
Jared Vagy
And then they can really look at their fingers and control. um But the majority of these conditions really come down to quite a bit of being able to equally weight.

00:56:25.99
Jared Vagy
Well, sorry, the majority of these conditions that are associated with asymmetric gripping come down to climbers not being able to equally weight the pads of their fingers well, if that makes sense.

00:56:37.14
Neely Quinn
Yeah.

00:56:37.85
Jared Vagy
Like if you had a sit, yeah, go for it.

00:56:37.86
Neely Quinn
with Yeah, go ahead.

00:56:40.66
Jared Vagy
No, you go for it.

00:56:41.13
Neely Quinn
Well, yeah. And then that’s where that like uneven hangboard comes in ah asymmetrical or whatever it’s called.

00:56:46.42
Jared Vagy
Exactly. Yeah. So it’s called like an unleveled edge and I’m sure you’ve had, you know, maybe even Tyler’s been on the podcast talking about the unleveled edge and, um, you know, it’s, uh, it’s a trend in climbing, which is quite effective to change the loads through different fingers when you climb.

00:57:08.04
Jared Vagy
And maybe, do you want to describe that nearly like what unleveled edges and like just simplest terms?

00:57:11.70
Neely Quinn
i have Well, instead of just a flat edge, it is a wooden edge, but it’s it’s more it’s just rounded in a way so that you’re your index finger is bending as much as your middle finger, right?

00:57:28.30
Jared Vagy
Yeah. And there’s way exactly. So instead of a flat edge, it’s a rounded edge. And there’s um some that are commercially made. And then I have a bunch of them like custom made for like different finger type and orientations.

00:57:40.86
Jared Vagy
And it’s actually kind of cool because a climber will be on a fingerboard or doing a block, you know, block pull, and they’ll have pain. And I’ll measure, let’s say, you know, however many kilograms of force they’re outputting.

00:57:53.55
Jared Vagy
And then they’ll say, ow, that hurts. That’s six out of 10 pain. I’ll be like, okay, do that same exact thing on the same edge depth, but I’ll give them a rounded edge or an unleveled edge.

00:58:08.09
Jared Vagy
And now they can pull the same amount of weight and their pain is Two out of 10, right? Because they’ve now essentially unloaded that affected finger. um So there’s a lot of different ones out there.

00:58:20.84
Jared Vagy
There’s some that think on like Etsy, you can find ones where you like send in the length of your fingers and then they’ll custom 3D print one based on like the length of you know, each finger, each joint.

00:58:36.43
Jared Vagy
And it’s like, there’s, it’s a whole aspect. I’m sure and don’t want to promote specific products, but if someone wants to do a Reddit deep dive, there’ll be, there’ll be more than enough information on unleveled edges, training the fingers.

00:58:44.93
Neely Quinn
isn’t

00:58:48.68
Neely Quinn
Okay. Cool. So, so yeah, like with, with other finger injuries, often the treatment involves hanging.

00:58:59.65
Neely Quinn
Is that what you have people do?

00:58:59.78
Jared Vagy
Mm-hmm.

00:59:03.87
Jared Vagy
The challenge with this one is we’re not progressively loading with hanging. If you injure a pulley, yes, your treatment is I’m progressively loading. I’m making the load more and more so that I can habituate those tissues.

00:59:18.87
Jared Vagy
This is actually, no I’m changing the movement coordination of how you grip. is more of the rehabilitation program. And so the loads actually are maintained quite low because if you train more and more, you’re now probably, you know, making the joint more injurious. So it’s actually quite low loads.

00:59:40.09
Jared Vagy
I have climbers on thirty second loads with these. That’s quite a long time to be loading. On a fingerboard, it’s quite hard, like overhead, just because you’re sustaining like a hanging position, but like with a block from the side, it just gives you enough time to coordinate your fingers to be in a really symmetric position. And then obviously from there, i decrease the time that climbers, you know, are loading and we can match that to the specific climber of 10 seconds 15 seconds on whatever their load protocols they want to use. But typically start climbers on really long durations. And that’s mostly just so they can coordinate the positions with minimal joint stresses.

01:00:24.45
Neely Quinn
And what’s the effort level there?

01:00:27.79
Jared Vagy
Well, when they’re failing, they’re probably, no one they’re not failing at all on it. Effort level doesn’t matter as much as pain onset, but probably say an RPE, which is like the intensity, would probably be at like 6.5.

01:00:40.26
Jared Vagy
It’s like pretty low.

01:00:41.74
Neely Quinn
Oh, okay.

01:00:42.19
Jared Vagy
like pretty low

01:00:43.90
Neely Quinn
I thought it was going lower actually. So that’s still like, they’re trying.

01:00:48.14
Jared Vagy
If it’s lower than that, no one’s going to do it. So, right.

01:00:53.48
Neely Quinn
Yeah. Okay.

01:00:54.76
Jared Vagy
So you have to have a little bit of motor coordination and then you have to have a little bit of load, but there shouldn’t be pain with it. That’s really the key.

01:01:01.81
Neely Quinn
Okay. So just to clarify, you’re saying that you have people use sometimes flat edges, but if if it’s available to them, these unleveled edges at their sides, not above. So they’re not hanging.

01:01:13.92
Neely Quinn
And if they, in the early stages, and they’re doing this for 30 seconds, 30 seconds at a time for how many sets and how often.

01:01:13.96
Jared Vagy
In the early stages.

01:01:23.19
Jared Vagy
Yeah, so three times a week is usually what I dose it at. And then just four sets.

01:01:30.37
Neely Quinn
Okay. Well…

01:01:33.13
Jared Vagy
The goal is not to overload the tissues.

01:01:33.27
Neely Quinn
well

01:01:35.73
Jared Vagy
It’s quite or not even to progressively load the tissues. The goal is to change the coordination of the fingers when they load into a half crimp. And obviously, if you have a block with your hand by your side,

01:01:49.45
Jared Vagy
You’re eventually going to progress that overhead, right? Because now, you know, the finger orientation, you have to make that more climbing specific. And then you have to dial down the, the amount of time because no one wants to hang on a fingerboard for 30 seconds. And that’s not very functional to climbing.

01:02:05.45
Jared Vagy
And then you get that closer and closer to more functional while it still is pain-free and that’s the eventual progression, but there is not a one size fits all with that. That’s basically on a climber to climber basis of how to make that progression.

01:02:18.19
Neely Quinn
This is where I’m just like completely lost in my own healing of any injuries. I’m like, when, when this kind of stuff becomes an art rather than a science, I’m like, I don’t know.

01:02:29.90
Neely Quinn
I don’t know what to do, but but so many people are really good at it, you know?

01:02:30.77
Jared Vagy
Yeah. So this is.

01:02:34.81
Jared Vagy
Yeah. And this is where it’s like, all right, like follow this protocol because it works for most people, like 70, 80 percent of people figure out on your own. But if you’re having trouble with those last stages, that’s when it’s really effective to see a medical provider that works with climbers.

01:02:51.48
Neely Quinn
Mm-hmm.

01:02:51.76
Jared Vagy
Because then they can load test you. They can figure out your exact sets reps. They can set you up on a program. And then the art component is more of a science. But when you’re talking about like people listening to this podcast, no, the hardest part is that final part.

01:03:08.29
Jared Vagy
And I think… maybe even harder to that is the final stage, which is climbing, like integrating all this into movement patterns climbing.

01:03:19.55
Jared Vagy
Because right now, all we’re talking about is the fingers. But I can tell you a lot of capsulitis comes from not just the fingers that comes from your inability to rotate your hip while in a drop knee or shoulder stability from the scapula and those components.

01:03:35.87
Jared Vagy
um So that’s as we get higher up in the pyramid, I think things get a little bit harder to individualize.

01:03:42.56
Neely Quinn
Yeah. And with these sets and reps, are you wanting people to do these on their climbing days before as a warmup after rest days? What?

01:03:55.50
Jared Vagy
my role or My rule typically is within six hours of climbing. Oh,

01:04:02.17
Neely Quinn
So within, not after six hours.

01:04:04.24
Jared Vagy
sorry. No, sorry. I misspoke that. Outside of six hours. So if you climb at 10 a.m., you have to wait six hours before you do some type of activity.

01:04:09.10
Neely Quinn
Okay. Okay.

01:04:15.20
Jared Vagy
And some of that’s related to college and loading principles, um but that’s typically what I’ll what i’ll build in.

01:04:21.00
Neely Quinn
Okay, that makes sense. Okay, what else with strength?

01:04:27.56
Jared Vagy
There are some components of these little muscles in the hand, they’re called interossei. They allow you to squeeze your fingers tightly together and spread your fingers apart.

01:04:41.53
Jared Vagy
So your palmar interossei, squeeze your fingers together, your dorsal interossei, pull them apart. But you can imagine if you’re crimping and your fingers are maybe slightly rotating or sliding to the side, if we improve the strength and coordination of these muscles, then it can stabilize your fingers better during gripping.

01:05:06.00
Neely Quinn
Okay.

01:05:06.83
Jared Vagy
Does that make sense? So imagine like you’re crimping and like your pointer finger is like splaying all the way, you know, towards your thumb, right?

01:05:07.56
Neely Quinn
Yeah, that makes sense.

01:05:16.78
Jared Vagy
And so if you can strengthen the muscle that gets your pointer finger closer to your middle finger, you know, away from the thumb, closer to middle finger. So all those fingers are now stable.

01:05:29.33
Jared Vagy
Then you may have less stress on your joints when you climb because you now have one mitt versus a bunch of individual fingers that are in different positions.

01:05:38.13
Neely Quinn
Yeah, imagine you do that with a rubber band too.

01:05:41.70
Jared Vagy
You could do that with a rubber band, but it’s actually the squeezing inwards that I find is the hard part to train.

01:05:45.16
Neely Quinn
oh

01:05:48.72
Jared Vagy
And with that, ah I get a little creative. I talked a little bit earlier. I like going to the arts and crafts store. And so i was going around and I saw these little pom poms. Have you seen those? like Not the cheerleading pom poms, but like they’re like cotton balls, but they’re colorful and really small.

01:06:07.80
Neely Quinn
hmm.

01:06:08.59
Jared Vagy
Have you seen those?

01:06:09.32
Neely Quinn
Yeah.

01:06:10.24
Jared Vagy
Yeah. So I got a bunch of pom poms, all different colors. And if you put those in between the fingers, they’re really soft and have just enough resistance to make it difficult to press.

01:06:17.06
Neely Quinn
Oh.

01:06:24.76
Jared Vagy
And so you basically take your hand into like an L. So you’re like mimicking a half crimp and then you squeeze those pom poms like close together.

01:06:35.51
Neely Quinn
This is so funny.

01:06:35.79
Jared Vagy
And yeah, it’s funny. And for some reason, climbers freaking love these. Like everyone, like pot, they’re different colors. They’re exciting. It always puts a smile on your face, but it is really hard to do.

01:06:45.94
Jared Vagy
Like these are really small muscles in the fingers.

01:06:46.15
Neely Quinn
Yeah.

01:06:49.89
Jared Vagy
And so I’ll give climbers that if there’s a strength deficit in the inner OCI muscles I talked about. And for climbers that are like super psyched and super hardcore, I’ll actually have them squeeze pom poms while they’re fingerboarding.

01:07:02.64
Jared Vagy
So they’re now like squeezing that pom pom as they’re loading their fingers symmetrically.

01:07:07.48
Neely Quinn
Well, that’s like some Pilates stuff right there.

01:07:10.27
Jared Vagy
Yeah, that’s like you’re doing something on plyo machine and then you grab like a ball and you squeeze it between you.

01:07:14.16
Neely Quinn
You’re like, ah.

01:07:14.91
Jared Vagy
yeah so So some climbers are like, yes, give it all. I want like the you know want to put it all together. And some are like, no, this like pom-pom squeeze is hard enough. I think this is like… And it’s interesting. It’s like not hard in a way that you’re…

01:07:29.74
Jared Vagy
you know, you’re fatiguing on like a dead hang. It’s like hard in a way that your hand is like shaking because these are little muscles that you don’t normally use and you’re really squeezing them. You’re maximally contracting them.

01:07:46.05
Neely Quinn
Yeah, that’s so interesting. You were not joking about going to a craft store.

01:07:54.32
Jared Vagy
yeah no it’s i’m still trying to figure out how to use pipe cleaners those haven’t like ah you know they’re a little too aggravating for the fingers so because the wire

01:08:03.53
Neely Quinn
Yeah.

01:08:06.55
Neely Quinn
So that’s how you strengthen the inner Aussie. Is there anything else?

01:08:12.58
Jared Vagy
think strength were good think we got movement like returning back to the wall and looking at the whole body with movement

01:08:15.63
Neely Quinn
Okay, then what else did you want to cover?

01:08:25.58
Neely Quinn
And do you want Yeah, do want to…

01:08:25.64
Jared Vagy
And that’s, yeah, that’s the hard part. Like that’s really like when when I see climbers, I have them, you know, if I’m operating out of a climbing gym, i have access to that, then I’m going to watch them climb.

01:08:38.35
Jared Vagy
If they’re submitting video footage, they’re submitting videos. Like I need to see how they move on the climbing wall. And oftentimes, as I kind of spoke earlier,

01:08:50.47
Jared Vagy
it’s not an issue with the fingers as much as it’s, oh, is there a wrist muscle that we have muscles that load our wrist towards our thumb side and some towards our pinky? And maybe the wrist muscles that ah deviate our wrist towards the thumb are a little bit weaker.

01:09:08.69
Jared Vagy
And so that’s why the climber is loading their pinky side a little bit more when they grip. Or we look down the chain at the scapula or the shoulder, or maybe the shoulder is not engaging well.

01:09:19.53
Jared Vagy
Or we look down at their hip mobility and we put the whole picture together. And so I think that’s the harder part is figuring out like the movement patterns on the wall that are contributing to it.

01:09:30.18
Jared Vagy
And then obviously there is a coaching component to volume intensity and hold selection. that if it’s in its acute phase, this injury is really bothering a climber, there has to be some type of plan or program to kind of ramp down to allow the injury to get a little bit better so they can ramp back up and continue to project.

01:09:51.95
Jared Vagy
So I think the last stage, I don’t have to go too in depth into that because that’s where it’s in the hands of typically a medical provider or a coach that can then program for the climber or it’s in the hands of the climber to just be smart about load, volume, and intensity.

01:10:10.50
Neely Quinn
So to be clear, you are not suggesting that people should just climb at their normal level while they’re trying to rehab this.

01:10:19.95
Jared Vagy
When a climber comes to see me, let’s just say they walk in the door and let’s say they have a moderate stage. We have mild, let’s say moderate and severe, and we’re still working on grading criteria for this and figuring that out with ultrasound diagnostics. But I’ll just use just a global term, mild, moderate, severe, and they’re in a moderate stage and they haven’t tried anything yet.

01:10:41.83
Jared Vagy
I tell them, listen, can you take two weeks, decrease your climbing volume and intensity and the amount of time that you crimp? And we go a little bit more specifically into making that you know customized for the climber and really focus this next two weeks on your unloading and mobility.

01:11:01.29
Jared Vagy
and see how much headway you can get into really managing this condition and getting under wraps. And then, yeah, ramp back up and get to that stage. um If they’ve already done that, if they’ve already unloaded, if they’ve already worked on mobility,

01:11:17.22
Jared Vagy
No, then we’re really just trying to manage it. And that is then going to be where I have a discussion of you’re going to have ups and downs. you’re going have some days where you need to take a few days off. You’re gonna have some days when it feels better.

01:11:30.67
Jared Vagy
All I’m doing is giving you the tools and then it’s up to you to figure out how to use or utilize them.

01:11:36.12
Neely Quinn
Mm hmm. OK. I mean, that’s fair. People are going to want a really concrete answer to that question. And I think you did the best that you could like without actually seeing each and every individual because everybody’s so different.

01:11:50.32
Jared Vagy
Yeah. And there, yeah, that’s really on a case by case basis, but um hopefully that gives a little guidance.

01:11:58.50
Neely Quinn
hmm.

01:11:58.64
Jared Vagy
Now, I can say if someone comes in, they’ve already done all this.

01:11:58.84
Neely Quinn
Yeah.

01:12:02.83
Jared Vagy
They said, you know, Dr. Vagie, looked at your protocol. I did everything, you know, in your article. I listened to the training-based podcast. um And then I do my assessments.

01:12:14.36
Jared Vagy
That’s always great. I’m on the spot now, right? And I have to find, you know, if there’s any other contributing factors. Usually I get lucky and I find things. I find multiple things. But if I don’t find anything and they have tried everything, that’s really the case. But if it does happen, then that’s where you may need to go outside of conservative management. And maybe they need to see an orthopedist to do an injection of a corticosteroid into the joint to decrease some of that inflammation.

01:12:42.16
Neely Quinn
Yeah.

01:12:42.28
Jared Vagy
And typically they’ll do two injections and the climber will then have much less inflammation. They’ll feel much better typically. And then you have to start and ramp things up from there.

01:12:54.42
Jared Vagy
So there is a level of when conservative management, such as physical therapy takes its kind of you’ve capped out on what you can do.

01:12:55.14
Neely Quinn
yeah

01:13:04.87
Jared Vagy
And then you have to look at other options. And that’s why we have medical management teams and access to orthopedists who can help on on those types of conditions.

01:13:13.87
Neely Quinn
Yeah. And is there any research for PRP on this kind of thing?

01:13:20.56
Jared Vagy
Not on this condition, no. And anecdotally, you know speaking with some orthopedists and people in my network who who treat this, there’s some conditions orthopedic or PRP works quite well anecdotally for the fingers, ah but joint capsulitis doesn’t seem to be one of them.

01:13:40.38
Jared Vagy
um It seems to also be a quite expensive way because it’s typically out of pocket um versus ah versus an anti-inflammatory localized.

01:13:40.44
Neely Quinn
Okay.

01:13:43.53
Neely Quinn
It’s so expensive. Yeah.

01:13:50.12
Jared Vagy
But no, we don’t have any literature on that, so I can’t speak specifically to um to that.

01:13:50.16
Neely Quinn
Okay.

01:13:55.54
Neely Quinn
Okay. And people I just realized that people probably, some people don’t know it’s platelet rich plasma therapy. They like take your blood, spin it, get the platelets and then inject them into a site.

01:14:07.92
Neely Quinn
Um, so anyway, thanks for that. Um, is there anything else?

01:14:13.07
Jared Vagy
think that’s everything. I mean, I think that’s hopefully enough for people listening to to get a head start on this. And then you’ll have all the resources to share with your community. You’ll have the case study that I that i put together that has step-by-step processes. They’ll be able to listen to this to follow along.

01:14:34.90
Jared Vagy
And think that’s everything that climbers need to at least get a head start on this condition.

01:14:42.60
Neely Quinn
Okay, well, as always, you came very prepared. You’re super good at explaining things. I think that’s one of your greatest gifts probably is and it’s like why you’re probably a very good professor too.

01:14:56.98
Neely Quinn
And we as a calming community so appreciate you just freely giving this information away. So thank you.

01:15:04.32
Jared Vagy
Yeah, absolutely. And um yeah, it was a pleasure and I’m glad to have talked through it and excited, hopefully, that climbers can take this and and manage it and and keep climbing as hard as possible.

01:15:14.88
Neely Quinn
Yeah, me too. I think you’re going to help a lot of people here. So thanks.

 

 

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