About Jared Vagy, Doctor of Physical Therapy

Dr. Jared Vagy is a physical therapist, and he’s a climber who’s incredibly motivated to help other climbers heal their bodies. In this interview, we talk about how to heal common finger injuries in climbers. It’s the longest interview I’ve ever done! It’s super in-depth and he describes exact protocols to use on finger injuries, so I hope it helps you out.

In my first interview with Dr. Vagy on the podcast 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. In our second interview he talked about how to heal shoulder impingement using his new Rock Rehab Pyramid protocol. In our third interview, we talked about rotator cuff injuries and neck strain.

Jared recently wrote a paperback book all about healing climbing injuries called Climb Injury-Free. In it, he describes his 4-step pyramid to healing injuries:

In the book he discusses injuries of all kinds, but in this interview we focus on finger pulley sprains and finger injuries in general.

We just released his new Finger Pulley Sprain protocol on TrainingBeta yesterday:

• Finger Pulley Sprain Protocol

Here are his other three protocols if you’re interested in learning more about them:

• Rotator Cuff Strain
• Neck Strain
• Shoulder Impingement

You can see a description of all of the protocols (which he’s made available for $10 each) at www.trainingbeta.com/rock-rehab.

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.

Dr. Jared Vagy Interview Details

• How finger injuries happen
• What the different finger injuries are
• How to figure out what injury you have
• When to start climbing again
• How to heal the finger injury
• How to avoid finger injuries in the future

Rock Rehab Protocol Links 

• NEW Finger Pulley Sprain
• Shoulder Impingement
• Rotator Cuff Strain
• Neck Strain

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

Training Programs for You

Do you want a well-laid-out, easy-to-follow training program that will get you stronger quickly? Here’s what we have to offer on TrainingBeta. Something for everyone…

• Personal Training Online:  www.trainingbeta.com/mercedes
• For Boulderers: Bouldering Training Program for boulderers of all abilities
• For Route Climbers: Route Climbing Training Program for route climbers of all abilities
• Finger Strength : www.trainingbeta.com/fingers
• All of our training programs: Training Programs Page

Please Review The Podcast on iTunes

Please give the podcast an honest review on iTunes here to help the show reach more curious climbers around the world.

Transcript

Neely Quinn: Welcome to the TrainingBeta podcast where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and I’ve been away from the podcast for a little while now. That’s because we’ve had a lot of exciting things happening in the past month and a half or two months. Well, three months really.

We went to the Red River Gorge which was amazing as always. We spent 10 days there and climbed eight out of those 10 days which is unheard of for us. We climbed on a ton of moderates, checked out new areas, and just had a really good time. I love that place.

Then we came home and it was a mad dash to finish our house that we bought and are renovating to make it liveable. Then we moved in and now we’ve just been trying to finish up the electrical and things that you need to have in a house.

We’ve been really busy but now I’m back and podcasting and I’ll try to be more regular about it again. Today on the podcast I have my friend, Dr. Jared Vagy, on again. He’s been on the show a few times now. He’s a physical therapist. He’s very passionate about what he does. He’s a climber and he understands the injuries that climbers get because that’s what he does, too.

Today we picked the body part of fingers because so many climbers have finger injuries. He has an entire protocol for what to do for finger injuries and in particular, pulley injuries because that’s pretty common for climbers to get. Sometimes you hear a popping noise and sometimes you don’t but he’ll get way into the details of what it feels like, how to do a little bit of self diagnosis, and then exactly what to do after you sustain an injury.

I don’t know if you know this but Jared has put several protocols up on the site, on TrainingBeta, for different injuries. He has protocols for neck strain, for rotator cuff injuries, and for shoulder impingement. Yesterday we just put another protocol up on the site that’s just for pulley sprain because it’s so common and people need to know what to do.

If you go to www.trainingbeta.com/rock-rehab, because his protocol is called the Rock Rehab Pyramid, you’ll find all of those protocols. He’s made them extremely affordable. They’re $10 each and you can buy all four of them now for $25. He’s trying to make it really accessible for people to heal themselves and then prevent further injury. If you want to go check those out, www.trainingbeta.com/rock-rehab. If you want to just check out the pulley one you can go to www.trainingbeta.com/pulley.

Without further adieu, here is Dr. Jared Vagy. I’ll talk to you on the other side. Enjoy.

Neely Quinn: Welcome back to the show, Jared. Thanks very much for talking to me today.

Dr. Jared Vagy: Yeah, definitely. Glad to be back on.

Neely Quinn: What’s been going on with you?

Dr. Jared Vagy: Just keeping busy like usual. A couple new updates in my life: I’m on the teaching faculty at the University of Southern California and we are developing a hybrid program for physical therapy learning which is a combination of in-person and online. I spent about 30 days in the studio over the past summer filming over 700 physical therapy techniques and co-developing the orthopedic curriculum for the Doctor of Physical Therapy students. That’s been using a lot of time but it’s been really fun to be part of this process. It’s the first program in the country to do it at this level and it’s also the top Doctor of Physical Therapy program in the country as well so it’s a new endeavor that we’re embarking on.

Neely Quinn: Wow. That’s exciting.

Dr. Jared Vagy: Yeah, it’s fun and I learned a lot of not-physical therapy things in the studio. This is a huge production. There’s five different cameras when you’re doing a technique. There’s about 13 people in the room and everyone has a different job. One person’s job is just to take your lunch order, which is pretty interesting. There’s hair, there’s makeup, it’s like a whole ordeal. It’s been fun going through that process.

The reason I bring that up is I was actually able to build in a patient case of a rock climber into the curriculum which is something I’m pretty excited and psyched on. There is a patient case of a climber. Neely, can you guess at all what the injury is in the patient case?

Neely Quinn: Shoulder?

Dr. Jared Vagy: Shoulder, and guess what type of injury.

Neely Quinn: A labrum?

Dr. Jared Vagy: Yeah, it’s a labral injury or actually a SLAP tear in a rock climber. I was able to change it from a CrossFit athlete to a climber and that was actually something kind of cool.

Neely Quinn: Nice. Sneaking us in there.

Dr. Jared Vagy: Yeah, sneaking it in the content. That’s been fun.

Neely Quinn: When you say ‘hybrid program’ you mean partly online and partly in the classroom. Is that what you mean?

Dr. Jared Vagy: Partly online, partly in the classroom. They come in for these immersions where we go over skill practice, they have asynchronous content where they watch these 700 videos of lectures and techniques, and then each week we also meet online to go through content review and so forth.

Physical therapy is a clinical field and USC has been at the forefront. They were the first program to introduce a doctorate in physical therapy. They’re now the first program to, at this scale and at this quality, introduce a hybrid program that’s a combination online and in-person.

We have students from all over the country and they’ll get a lot of airline miles for continually flying in but it’s a big test in seeing if we can take this clinical profession and kind of merge it with the future of technology. So far it’s been going great and there’s been a ton of energy and time and resources from everybody on the faculty coming together to say, “How can we do this better?” Whatever we show – we’re in the studio filming 30 days – this content is going to be out there for at least 10-15 years before it gets updated so we had to go back and look at all of the research and say, “Okay, which of these techniques are valid? Which ones should we teach?”

It’s definitely a time consuming yet rewarding process and we will see how it goes. As you know, I work with a lot of climbers remotely and I’m a specialist in movement and all those things you can do online. You don’t have to necessarily be in-person so it’s definitely exciting. It’s a new avenue and I’m excited as well to get a new generation of physical therapists that have the skills to assess injury digitally as well.

Neely Quinn: Yeah, it seems like a perfect fit for you because you have these online programs. You’ve had these online programs for awhile now and you’re all about making really high quality videos. It’s kind of cool to see that universities are validating, in a way, what you’ve been doing all along which means you can do it without being in the clinic which a lot of people don’t really think is possible.

Dr. Jared Vagy: Yeah, part of it is learning the content and then technique practice. They have community partners that are assigned so they schedule with these partners and practice their techniques. They submit videos of them doing the techniques, they take pictures of them, they have reflection assignments to make sure they’re getting as much in-person practice time, and then in the end, implementation is 100% correct.

The leader of the division, the dean and the chair, Doctor Gordon, had an amazing vision to expand this and it’s scary. It’s something that I think is a little bit ahead of the times and I almost equate it to online dating 10 years ago. If you were like, ‘Oh yeah, I met my wife through online dating,’ someone is going to roll their eyes and be like, ‘Oof, yeah, you’re a loser.’

Neely Quinn: Yeah but that’s not valid.

Dr. Jared Vagy: Nowadays anyone you talk to, at least the majority of my friends and colleagues, at least a percentage of them met their partner online and they’re in a great environment and they would not have met them without it. Technology is changing and I just feel very lucky to be a climber, to know rock climbing, to know it’s a movement-based sport, and to know that the profession of physical therapy is branching into a medium that may allow you to be a movement expert and maybe not have to necessarily have to have your hands on the patient and be able to determine diagnoses. But don’t get me wrong – when I do online assessments I have people submit footage of them doing techniques on themselves and so forth so you’re a little bit limited but we take it as we go.

Anyway, that’s the update with where my life has been the past summer. I’m bummed I missed some of this year’s rock climbing season in the high Sierras but we always have next year.

Then the book has another print run sold out. It’s been sold out of stock for about two months. I have to get better at timing these waves but new copies are coming in October so by the time your listeners are hearing this there will be some fresh copies of Climb Injury Free in stock. If anyone has injuries they’ll be able to go by those step-by-step protocols. On your webpage, too, by the time they’re listening to this the pulley sprain or finger injury protocol should be up as well as some updates for the shoulder protocol. Exciting new things coming out.

Neely Quinn: You’re like the most productive person ever. [laughs] It’s amazing.

Dr. Jared Vagy: We were talking earlier about how one of these days I’m going to sit on the deck and take a deep breath and just relax for about 5-6 minutes, but definitely not in this next calendar year.

Neely Quinn: Okay, cool. Congrats on all of that. I’m glad your book is selling out. It sucks because it means a lot of climbers are injured, which is why they’re listening to us today. What are we talking about today?

Dr. Jared Vagy: I want to talk about finger injuries and talk a little bit about how every climber I talk to – I get a lot of emails, I get a lot of phone calls, I get a lot of people asking for assessments and everyone is saying they have a pulley injury. They’re like, ‘Oh, Doctor Vagy my fourth digit at the level of A2 pulley, I believe that I sprained it when I was doing a crimp move after hangboarding for five days straight instead of taking a day off,’ and so on and so forth.

Everyone is getting so specific into it that I feel like almost every climber that has a finger injury has an A2 pulley injury, or at least that’s what they are saying, but then I see them in the clinic and it’s actually something much different. Or even the reason for their injury isn’t necessarily focused on the hand.

I wanted to take a little bit of time to step back and to talk about finger injuries but also to say there’s more injuries that can occur in the finger than just this pulley sprain or this A2 pulley sprain.

For those of you who don’t know what that is, you basically have these five annular pulleys and four cruciform pulleys that press your finger tendons down to the bone and keep them from bowstringing. The analogy you can think of is maybe the eyelets on a fishing rod keeping the fishing line in line or even a rope through a carabiner and the carabiner is keeping the rope in line. Those are your pulleys.

I get that diagnosis all the time and I first want to take a step back and almost paint the picture. If you’ve ever had a finger injury and you’re listening now, or you’ve had a friend that has had a finger injury, or you just want to learn more about them, I want to go through the process of first: what I do outside of the hand in an assessment? And then pull it back into the fingers and talk about the different types of injuries, not just the pulley sprain, that you may actually have. That’s kind of what I was thinking for a game plan for this session.

Neely Quinn: Sounds great. Where do we begin?

Dr. Jared Vagy: Alright, so first of all I’m always asking questions. I’m going to ask you a question first, Neely. Imagine someone has a finger injury. Have you had any recent finger injuries?

Neely Quinn: I have a little thing on my ring finger, on the side of my finger.

Dr. Jared Vagy: So you have a little thing on the side of your ring finger. Imagine that someone is coming in and they have that injury. What do you think is the first thing that I check? The hint is going to be that it’s not in the fingers. What do you think is the first thing that I check?

Neely Quinn: I mean, I’ve also had injuries that have stemmed from neck stuff that are just nerve pain so I don’t know, maybe your neck?

Dr. Jared Vagy: Yeah, the first thing is rule out any contributing factors. It’s unlikely that if you have an isolated pain right in one finger that it’s coming from your neck but that may be possible that it’s a pinched nerve in the neck radiating down the arm and manifesting into that. You clear or you screen the neck or the cervical regions. Great.

We went through that, we overpressed them – it’s called a Spurling’s Test – and there are a cluster of tests you do. It’s called the Wainner’s Cluster and there are four different tests. If they are negative for those four tests then the neck is ruled out of the picture. What’s next? Now we know it’s not from the neck.

Neely Quinn: So then the trap and the shoulder area?

Dr. Jared Vagy: Yeah, so what you’re picturing is kind of moving down from the neck to the shoulders and I guess next would be the elbow, the wrist, and so forth.

I start way further back. I first have the patient just perform a grip and I’ll put them in a half crimp position. There’s a bunch of different ways that you can test this. I have this awesome unit, a Tendec Unit [spelling?] from Norway that measures force production. There’s inverted scales where you can have someone on the hangboard and it measures how much weight they take away from the scale, there’s hand grip dynamometers that you can put people in a half crimp grip – there’s a variety of different ways. Also, Tension puts out a custom wood grip that has different pockets and you can hang weights on them. Grip Pull [spelling?] also has one. It’s limitless, the amount of things that you can test with.

I have the patient grip in a half crimp grip with a dynamometer with their elbows at their side. Can you imagine that, Neely? They’re basically sitting, elbows are at their side, elbows are bent to about 90° almost like you’re shaking someone’s hand, and they squeeze.

Neely Quinn: Okay.

Dr. Jared Vagy: They’ll have two in their hand. I just don’t have one, they’re doing two at one time. I look to see the force reproduction or force generation and I look to see if there’s any pain. Then what I do is I put them in a squat position, I put their arms over their head, and I have them in that same half crimp position and they squeeze. I check the force reading and then I check to see if they have any pain. Then, I put them on a step with their heel right off the step so it’s a little bit hard to balance. Squatting down, hands over head, squeezing.

In those three scenarios what do you think we notice is a trend, especially with newer climbers that train their fingers quite religiously?

Neely Quinn: Newer climbers that train their fingers religiously? Like on a hangboard?

Dr. Jared Vagy: I’ll say in two categories: a trend with newer climbers and a trend with people that will exclusively train their fingers – eh, I’ll just say newer climbers. Let’s just make it easier. So with a newer climber, what do you think we would notice?

Neely Quinn: I don’t know. I have no idea. I’m kind of lost.

Dr. Jared Vagy: Imagine they’re gripping seated, then they’re gripping with their hands over head, and then they’re gripping with their hands overhead with their heels off of a step. Each level of that is now simulating closer and closer to what you need to do on the climbing wall.

Neely Quinn: Oh, right. So the people who train on a hangboard are mostly probably going to show symptoms when their hand is overhead? I’m not sure.

Dr. Jared Vagy: You’re close. Let’s think first of the beginner climber. Your beginner climber is going to be better at sitting than they are with hands over their head. It’s going to be even harder and they may even generate more pain when they’re squatting with their heels off of the stair and their hands are over their head, trying to grip, because now there’s this added level of instability. Without their feet able to stabilize they have to stabilize throughout their knees, their shoulders, and elbows and so forth.

What I’ll notice is a drop with newer climbers and oftentimes they may not even have pain when they squeeze a half crimp seated. The pain comes on when you simulate climbing a little bit more when they’re squatting down, when their heels are off the edge. Does that part make sense?

Neely Quinn: Yeah, that part makes sense because their bodies aren’t as trained as older climbers.

Dr. Jared Vagy: Exactly, or more experienced climbers. Don’t call me old, Neely. [laughs]

Neely Quinn: No, not old. [laughs]

Dr. Jared Vagy: I think we’re in the same age bracket.

Then you look at people that hangboard all of the time. Where do you think they’re strong?

Neely Quinn: They’re probably strong in that position.

Dr. Jared Vagy: They’re actually strong in the squatting position but not in the squatting with their heels off the edge.

Neely Quinn: Why?

Dr. Jared Vagy: When you’re hangboarding you’re not using your legs. You’re not using your proprioception from your feet. You’re just training your fingers with your elbows extended and your arms overhead. It’s interesting to see. Maybe I’ll have someone squat down that hangboards and they can crush the dynamometer when they’re standing, squatting, hands over their head, then I’ll put them in a single-leg squat with their heel off of the edge of a step, have them squeeze, pain comes on, grip drops down.

This is just an isolated scenario but then what do we do with that information? Let’s say that I have someone who initiated a hangboard program, they’ve injured their finger, it’s pain-free when they grip overhead or at their side but when their heels are off the edge or they’re in a single-leg squat, pain starts to come on. What do I start thinking? I need to screen their balance and their stability and then the strength of the muscles in their foot and ankle. Does that make sense?

Neely Quinn: Yeah.

Dr. Jared Vagy: Potentially, if they’re stronger in their foot and ankle, they don’t have to work as hard with their gripping. The one muscle that is the workhorse for climbers, and especially delicate climbers that use the inside edge of their foot, is called flexor hallucis longus. That’s the big toe muscle, the muscle that presses your big toe down. If you imagine you’re on the rock wall and you’re using the inside edge of your foot, when the big toe presses down that creates all of the stability in your foot.

Then, we get into later stages of training and they’ve built up stability throughout their body. I’ll actually take a resistance band, put it underneath their big toe, loop it all the way up to the dynamometer and have them gripping when the resistance band is underneath their toe. If their toe loses strength the resistance band pops up and it hits them in the face.

Anyway, it’s something for the listeners. If you’re having trouble following that step-by-step, I’m going to slow it down for a moment. I think the important thing with the message with that is you have to take a step back and think about yourself. If you have a finger injury, it may not be just what’s going on at the fingers, it may be from a different region of the body.

Neely Quinn: Okay, so let me just recap for a second here. You’re saying that because you’re testing strength, you’re not testing pain levels, right?

Dr. Jared Vagy: I’m testing both. I’m testing pain from a scale of 0-10 and then I’m also testing force production. Each time they squeeze I’m asking the patient what they feel.

Neely Quinn: Do you find that those things are correlated? Like, more pain with less strength?

Dr. Jared Vagy: Pain inhibits strength. One of the trickiest things is if you have a painful finger it’s unlikely you’re going to hit maximum strength because pain is going to block you from doing that. I oftentimes find a correlation between pain generation and force output. Sometimes it’s not truly strength because if you eliminate the swelling, the inflammation, the pain itself, well strength goes back to normal.

Neely Quinn: Okay. So you’re saying that you’re testing their strength just so that in the future, they will balance out their strength in all of these different positions so that they’re less prone to injury?

Dr. Jared Vagy: Correct, from a training standpoint. The real test is I’ll have someone in a single-leg squat off the edge of a stair, they’re squeezing the dynamometer. They’ll say they feel pain 3 out of 10. I come in, I stabilize their knee, and their pain goes away.

Neely Quinn: In their finger?

Dr. Jared Vagy: In their finger. This is a common finding. You’re like, ‘Woah, wait a second. You stabilize someone’s body and their finger pain went away? What’s going on with that?’

Neely Quinn: Yeah. That’s crazy.

Dr. Jared Vagy: They’re working so hard in their lower body to try and keep their balance. You can imagine their knees going side to side and they’re trying to grip this dynamometer at the same time. We just stabilized the whole lower section and now they can truly be rooted and they can squeeze without having to work as hard.

Then that becomes the buy-in. I said, “Oh, well I just stabilized your knee and your finger pain went away. What do you think we need to do?” They have some balance or stability exercises in addition to their hand program.

Neely Quinn: That’s really interesting.

Dr. Jared Vagy: And it’s fun stuff. In climbing, the whole body is connected. This is why I love climbing so much. I’ve worked with a little bit less than a dozen different Olympic sports and climbing – I mean, I am a climber so I’m biased, but climbing is the most fun to analyze movement, to tweak, to go in and to make these changes.

That’s a macro example and some of you following probably caught a little of that, some of you probably caught all of it, but I think the idea is that you have to take a step back. That was a huge step back. That was like looking at the whole body and how it reacts.

What if we go in a little bit closer and we look at what Neely was talking about? The next thing down the line is then the shoulder or the shoulder blade.

A lot of climbers come in, they’re doing rehab programs for their fingers but they’re not doing much for their shoulder. How do we know if we need to train someone’s shoulder in order to take stress off of their fingers?

Neely Quinn: I don’t know. I’m sure you do tests on how stable their shoulder is or how strong it is.

Dr. Jared Vagy: Exactly. You test how strong/how stable they are and you do it 1) in the open kinetic chain with their arm just going in the air, 2) in the closed kinetic chain with them almost in a plank push-up position or a bear position, and then 3) you test them in a little bit more dynamic position related to climbing. I don’t want to go all in depth to that but a big component is – there was a research study that was put out a couple years ago. Someone with outside elbow pain, or lateral elbow pain, and all the therapist did in this case study was stabilize the shoulder blade and the scapula. Within six weeks the patient’s elbow pain was gone.

Neely Quinn: Nice. That’s awesome.

Dr. Jared Vagy: This was a case study published in JOSPT, which is the physical therapy journal of sports, and this is something I think a lot of people don’t think about. We’re just so focused on the fingers.

Neely Quinn: It’s true. We just want to know what our finger protocol is.

Dr. Jared Vagy: Yeah, you look at any finger protocol, including the ones that I put out, and it talks…

Neely Quinn: Yeah, what’s wrong with you, Jared? [laughs]

Dr. Jared Vagy: Yeah, I know. It talks a lot about the fingers itself but we also need to take a step back and know that there’s much more. Then that takes us to the elbow and then it takes us to the wrist.

I can tell you that the majority of patients that come in with some type of finger-related injury, I screen their wrist ability and how strong their wrist is, resisting motions into palm going downwards, palm going upwards – that’s pronation and supination – testing how strong their wrist is with multiple directions pushing back and forth, and a lot of climbers have fingers that are much stronger than their wrists.

What does this tell us about injury in the fingers if we have an unstable wrist? Everyone look down right now at your wrist. Crimp like you’re going to a half crimp, in the air, a fake one, and if you imagine the wrist joint being unstable and kind of moving around a lot, think about how much stress that can put on the fingers. That’s something that people completely forget to train when they’re trying to prevent or rehabilitate their finger injuries.

Neely Quinn: I feel like that’s part of what handstands do for you, too. I’ve been doing handstands for months now and it definitely trains your wrists. You can injure yourself with handstands, too, doing them.

Dr. Jared Vagy: Oh for sure. Neely, I think handstands train your wrists really well. I think the one challenge with them is it trains your wrists to stabilize in extension, which is your wrist cocked back, which is not the most common position unless you’re climbing a route called Mantle Marathon and you have to mantle 50 times with yourself in extension. That’s not as common a position but I think it’s a really good start.

The question is: can we train wrist stability with the wrist neutral? Neutral or even flexed slightly because that’s how we’re simulating our climbing. I’ll oftentimes give patients exercises for wrist stability while they’re holding isometrically their fingers in a strength exercise, if that makes sense.

Imagine a rubber band around all the fingers. The fingers are holding isometrically, which just means holding the rubber band resistance away or outwards, and then another rubber band that’s at the level of the wrist and the patient is rotating their wrist back and forth. Now they have wrist stability in addition to finger stability.

Neely Quinn: That’s a lot of rubber bands. What do you mean, “rubber bands on the wrist?”

Dr. Jared Vagy: Sorry, a Theraband on the wrist and then rubber band on the fingers.

Neely Quinn: Oh, so the Theraband is creating pressure downward?

Dr. Jared Vagy: Yeah, I guess to imagine this, everyone that is not driving right now or operating some heavy machinery, if you were to stand up and have your elbows at your side and have your elbows bent to 90° and your palms facing each other. Can you kind of imagine that? You’re in an ‘L’ and you take a Theraband and you loop it around, not necessarily the wrist, but around the hand right below the fingers but above the thumb. Can you picture that?

Neely Quinn: Yeah.

Dr. Jared Vagy: So you have a Theraband that’s looped, you’re pressing out on it, and it’s wrapped around the back of your hand.

Neely Quinn: Both hands or just one hand?

Dr. Jared Vagy: Both hands. You’re basically just pressing out on a Theraband, turning on your rotator cuff. Then imagine that you have a resistance band in your fingers, so in each hand you’re pressing your fingers out into a resistance band – sorry, into a rubber band. You almost have this clawed position and you have a rubber band around each finger and you’re pressing out, then you do these little circles of your wrist as you press out into the resistance or the Theraband.

Neely Quinn: That would be hard.

Dr. Jared Vagy: What you’re doing is you’re strengthening all of the muscles surrounding the wrist joint at the same time you’re stabilizing through your fingers.

Neely Quinn: Okay.

Dr. Jared Vagy: Now, there are easier ways to do this. Throw your hand in a rice bucket and move your wrist as you extend your fingers, right? That’s a simpler way to do that. The only challenge with the rice bucket is it’s good to start but you can’t get your arms or hands into a climbing position. The position we talked about earlier with your elbows bent to 90° and elbows at your side, how do you advance that? You can start straightening your arms and then bringing your arms overhead. Now you’re closer to a climbing position.

Neely Quinn: So tell me again, is this going to be useful for a person who has a finger injury or who is this going to be useful for? Is this just prophylactic for later?

Dr. Jared Vagy: Basically, if someone comes in and let’s say they have a finger injury and I’m screening their different joints, the finger rehab protocol is pretty straightforward. If you have a pulley sprain or a flexor tendon strain then you mobilize it, you increase selective strength, you reload it, you return to climbing. That’s straightforward.

These are the things that I start to notice if I test someone’s wrist and their wrist is unstable and they came in with that injury. Maybe their wrist being unstable is the reason their fingers are working too hard. I need to give them this exercise or else they’ll re-injure it again. Does that make sense? Or if they return to climbing and they have more strain on their fingers because their wrist isn’t as stable.

Let’s say I have someone perform a flag while they’re gripping a dynamometer. I have them with their heels off the edge of a step while they’re gripping a dynamometer and their pain comes on. Let’s say that same example I said earlier: I stabilize their knee joint and their pain goes away or even their grip gets stronger. This becomes something we add to their finger program to make it so they don’t injure themselves again or so they can get a little bit stronger when they’re climbing.

Neely Quinn: Okay, got it.

Dr. Jared Vagy: You can be as complex as you want or you can be really simple. Just train your wrist strength. You don’t have to loop your second rubber band around the fingers, you can just have one resistance band around the back of the hand, going in circles, just improving your wrist. You can take a hammer or a wine bottle, you can rotate it back and forth to stabilize your wrist. There’s plenty of other ways. I just tend to very specific and anal and OCD so I tend to pick things that are very related to climbing but you can do something that’s just a general stabilizer.

Neely Quinn: Okay, so that’s wrist. I have a question about that because Seth, my husband, has this injury right now. He heard a pop when he was in a pocket and his two fingers – his middle and ring – they both hurt. It’s because it’s coming from the wrist. They think he pulled something like a pulley in his wrist. Do you want to say to say anything about that because it goes up into his fingers but it definitely originates in the wrist?

Dr. Jared Vagy: Yeah, you actually could not have presented a better segue from functional training or functional assessment into the specifics of injury. One of the things I wanted to talk about on this podcast related to what you’re mentioning is everyone comes in and they say, “Oh, I sprained two pulley ligaments. My A2 in my middle and my A2 in my ring. I also feel it a little in my wrist and I feel it in my forearm.” If that comes to mind, you then have to be thinking, ‘Wait – the likelihood of injuring two pulley ligaments versus just one structure that attaches to all those areas is much lower,’ if that makes sense. That becomes our differential diagnosis.

What I want to talk about on the podcast is: we have our pulley sprain, which I talked about earlier, our five annular and four cruciform pulleys. The eyelets of a fishing rod or the rope through the carabiner. We also have one other very common climbing injury that is not talked about enough and plenty of climbers have this, they just don’t know it and they mislabel it. That’s likely what you’re mentioning with Seth with his injury.

Neely Quinn: Okay, what’s that called?

Dr. Jared Vagy: It’s called a flexor tendon strain. If you imagine this, you look down at your palm facing up and your forearm. The muscles that go from your forearm attach all the way down and they turn into tendons as they get to the level of your wrist. Two of those tendons – one’s called flexor digitorum superficialis – that goes all the way up as a tendon and it stops right at your second knuckle. That is called your PIP joint. The other one, flexor digitorum profundus, goes all the way and attaches to the tip.

Neely Quinn: On which fingers?

Dr. Jared Vagy: This is the same exact muscle attaching to every single finger.

Neely Quinn: Oh woah, okay.

Dr. Jared Vagy: You can almost imagine it’s a general muscle and then once it hits the wrist it fans out to all of your fingers, all four fingers, and your thumb has a different muscle.

Neely Quinn: Okay.

Dr. Jared Vagy: With that, oftentimes what happens is someone will have a flexor tendon strain and the area of the most congestion – do you have much traffic in Colorado or not much?

Neely Quinn: It’s heinous here.

Dr. Jared Vagy: In LA the 405 freeway or the 5, those are these really bottlenecked traffic congested freeways. Think about high levels of traffic of all these tendons running through your wrist. That’s the area where they have the least amount of movement or room to move or glide. Oftentimes what will happen with a flexor tendon strain is you’ll feel it at the level of the base of the finger, if it’s the flexor digitorum superficialis because that’s one muscle, or you’ll feel it all the way up your finger if it’s the profundus. You’re also going to feel it in another area. You may feel it in your wrist, you may feel it in your palm, you may feel it in your forearm.

If you feel pain in your finger but you also feel pain in an adjacent area, it’s unlikely that your primary diagnosis is a pulley sprain. It may be something else such as what we’re talking about, a flexor tendon strain.

Neely Quinn: So it’s basically from the bottleneck in your wrist, from your flexor tendon.

Dr. Jared Vagy: It’s from the bottleneck in the wrist but part of this is also that you’re just straining a tendon. If you think about any type of soft tissue injury, the tendon is where the muscle connects into the bone. If the pulley – the eyelets on the fishing rod or the rope through the carabiner – held, you just messed up your fishing rod or you messed up your rope. You got a core shot to your rope or hopefully not a core shot but just a sheath shot.

Neely Quinn: That’s a thing? A sheath shot to your tendon?

Dr. Jared Vagy: You fray the sheath of the rope versus a core shot.

Neely Quinn: That’s really apt.

Dr. Jared Vagy: In my past I’ve done a lot of big wall climbing and I get a lot of sheath injuries to the rope just due to the friction of it rubbing against stuff if you don’t protect it with duct tape. You have an injury to the rope in your finger which is the tendon.

The rehab for that is different. It’s not the same or components of it are not the same as a pulley sprain. It’s important to recognize that because if it’s misdiagnosed you may be doing some of the wrong exercises.

Neely Quinn: So can you just describe it briefly? Mostly so I can tell Seth later. [laughs]

Dr. Jared Vagy: The tenets of rehabilitation for finger injuries – first of all, in general, this is for both pulley and tendon strain and then I’ll diverge and talk about the tendon strains themselves. In general, our fingers are far away from our heart and all the tissue, or a majority of the tissue, in our fingers is tendinous or ligamentous which is white tissue. Red tissue gets blood flow, white tissue does not, so being far away from our heart and being white tissue means you need to increase circulation.

Neely, what strategies do you use if you want to get circulation going in your fingers? What do you do?

Neely Quinn: I jump around and swing my arms around or just move my fingers.

Dr. Jared Vagy: Yeah. Jump around, swing arms around, that’s a great way to pump blood there. What if you have a desk job or you’re at school and you can’t really do that because people are going to look at you funny?

Neely Quinn: I don’t know, maybe squeeze something? I don’t have that problem so I’m not sure what I would do. [laughs]

Dr. Jared Vagy: Yeah, you could squeeze something or you could even squeeze your finger. You can put some sunscreen or lotion on your finger and make a hole with the opposite finger and rub the finger in and out.

Neely Quinn: Oh, or use an acupressure ring.

Dr. Jared Vagy: Yeah, use an acupressure ring to fidget back and forth or just slide a wire mesh ring back and forth to increase circulation. There’s plenty of ways. Have you heard of voodoo floss?

Neely Quinn: Yes, I have.

Dr. Jared Vagy: It’s a really thick Theraband so either buy that or get a bicycle tube tire and cut it. Just be very safe with this. Anyway, wrap it around your finger so it’s taut at the edge of your finger and then it goes a little bit looser and it goes towards the base. Keep that on for a minute as you move your finger back and forth and the pressure will compress your finger. Then you release it and there’s a quick rush of blood to the finger as well.

Neely Quinn: Right. You basically mummify your finger.

Dr. Jared Vagy: Yeah, you mummify your finger and you make sure that it’s only on for a minute so you don’t overcompress it. If you’re doing that do it in the safety of your own home and be aware that you want to make sure that your capillaries refill and everything. You mummify your finger, you release it, and you have a quick flow of blood to it. Sometimes we even do that through one finger and then up the entire arm. Release it and there’s a quick flush of blood to the whole hand.

There’s so many different ways. Tyler Nelson the chiropractor, I think he’s been on your show a couple of times or he’s had some articles up, he’s big on blood flow restriction therapy.

Neely Quinn: Yeah, that’s what Seth did. He did that three times a day for the first two weeks and it made it 50-60% better.

Dr. Jared Vagy: It’s the concept that you’re flushing blood to the area. It’s a brilliant concept. You just need to find the best way to do it. There are so many different ways but for any finger injury, that’s rule number one: just getting blood flow to the region. I could probably spend an entire podcast mentioning every single type of way that you can increase blood flow but anyway – we’re talking about pulley sprains or flexor tendon strains. That’s for both of them, just to get the blood going.

That increases blood flow and we move onto mobility. Mobility is just maintaining or gaining back your range of motion. Then we move onto strength and strength is where it differs a little bit with how you treat a tendon strain versus how you treat a pulley sprain.

Have you heard the concept ‘eccentric training?’

Neely Quinn: Yeah.

Dr. Jared Vagy: Eccentric training is basically where you’ll take a resistance – let’s say for the biceps. Concentric is doing a bicep curl with a weight. Eccentric is you’re slowing letting it down. Eccentric training is the term for allowing a muscle or tendon to lengthen but controlling that motion.

When we talk about tendon injuries there’s research that supports – a lot of this research is into tendons in the foot and ankle which are very similar to tendons in the fingers. They’re far away from the heart, they’re long tendinous units. There was a model that was developed by a faculty member, a colleague over at USC, called the EdUReP model. It is that you educate the patient and then you unload the tissues and then you reload the tendons. One of the big take homes from this article was that eccentric loading of tendinous injuries improves strength and decreases pain.

Now we’re getting into something where if you have a pulley sprain, which is that single area of the eyelets on a fishing rod or rope through a carabiner, versus a tendon strain which is a tendon, a tendinous muscle connecting to bone, you need to differentiate your treatment. In the tendon injuries you need to build in some type of eccentric exercise. All that becomes is you can assist curling your fingers ups and then maybe with a weight or dumbbell in your hand you can slowly straighten those fingers out which is going to be controlling that motion. Or you can take a Theraband and put it around the tip of your finger and kind of curl your finger inwards and then slowly let the finger extend straight.

Neely Quinn: Okay.

Dr. Jared Vagy: There’s different ways that you can train this eccentric control that is a big difference between how you treat a pulley sprain and then how you treat a flexor tendon strain.

Neely Quinn: Yeah, because you wouldn’t want to do that for a pulley sprain?

Dr. Jared Vagy: You can, it just won’t help you. In the end, you can take and do any finger exercise that any physical therapist has recommended or any medical practitioner and you’re probably going to be doing exercises all day and you’ll overload your tissues. Or, you can pick the four most important exercises for that injury, do them consistently and do them diligently, and the likelihood of you getting through the injury quickly is actually quite high.

Neely Quinn: So, I may have missed this but is a rice bucket good for the flexor tendon?

Dr. Jared Vagy: It’s not so good for flexor tendons because you cannot control the eccentric force. If you think about this, if you put your palm on the table and let’s say you take a rubber band and you loop it around the tip of your ring finger and you pull that rubber band away from you – does that make sense?

Neely Quinn: Like out to the side?

Dr. Jared Vagy: No, away from the finger so it’s almost like straightening the finger.

Neely Quinn: Okay, yeah.

Dr. Jared Vagy: So then you press the tip of your finger into that rubber band and now you’re resisting the finger flexing. You’re flexing against that resistance. Then, if you slowly let your finger straighten while controlling that motion, that’s going to be eccentric control. You’re slowly allowing the finger to straighten while you’re still letting out slack in the band.

Neely Quinn: It’s interesting because this is the exact opposite of climbing and nobody ever talks about doing that.

Dr. Jared Vagy: The exact opposite. Why do you think climbers always injure themselves flexing? We overuse our ability to flex the muscles. You nailed it. This is the exact opposite of anything you would think about when you climb.

Neely Quinn: You should invent a thing that is a tool for that.

Dr. Jared Vagy: Alright, I’ll add that to the list. [laughs]

Neely Quinn: Okay, well I’ll do it. [laughs]

Dr. Jared Vagy: You invent it. You can take the idea. The thing that’s pretty cool about it is it sometimes just takes one exercise, really, to change the game. I’ll have people flying in from all over the US that come and do evals. We find this one thing that wasn’t addressed. I see people after they’ve seen two, three, four medical practitioners and we find the one thing that makes all the difference. It was just one component that wasn’t touched upon.

For finger flexor strains, I think the take home would be make sure you do your eccentric finger exercises and there’s plenty of different ways to do this. Neely is going to invent an apparatus to help you with that.

Neely Quinn: Stay tuned.

Dr. Jared Vagy: Stay tuned for the next episode.

Neely Quinn: So that was our foray into flexor tendons which is not what we were supposed to be talking about so should we talk about pulleys now?

Dr. Jared Vagy: Yeah. For pulleys or pulley sprains, and those are so common with climbers as I mentioned before, just make sure that that is actually the diagnosis. To be able to differentiate that one way is a real-time ultrasound. There’s not that many people that have access to that and there’s not that many trained medical professionals that can read it so you’re going to have to rely on a clinical assessment, typically. Sometimes people will get an MRI but a clinical assessment is a really good starting point. A clinical assessment just means the person is in front of you, in person, and you’re testing some things.

Neely Quinn: Wait. Can we stay here for just one second? This whole thing, and I think I’m not the only person who has this – Seth for some reason has this whole understanding of what the body looks like under our skin and obviously you do, too. I’m always like, ‘What is a pulley? Where are these things?’

If you were to get an MRI of a pulley sprain could you just describe briefly what it would look like?

Dr. Jared Vagy: Yeah, so first of all an MRI or an ultrasound?

Neely Quinn: Whatever is better.

Dr. Jared Vagy: Okay. Let’s say you’re doing a real-time or a diagnostic ultrasound on the pulley. What you’re going to do is you’re going to sit down and have your hand facing upwards. The therapist or the medical professional or the MD is going to put some ultrasound gel or cream on it and then they’re going to go over the region of your finger and they’re going to look for several different things. You basically get this black and white, grainy image. Imagine the finger tendons are quite small, and the pulleys as well, but you get this black and white, grainy image as they pass over, almost like you have X-ray vision.

What you do is you have the patient go through a series of different things. They go through tendon glides and let’s say they go through a tendon glide – all that is is moving their fingers back and forth so basically going into a claw and then straightening their hand. When they do that, if you notice an area of what’s called ‘signal intensity,’ the area that’s lit up that is not a consistent color to the other adjacent tissues and is in a region of the finger that moves back and forth, up and down when they go through that position, you can guess that that’s a structure that lengthens and shortens and moves back and forth which would be your flexor tendons.

If you have them do that and you see an area right over the base of the finger that maintains a single intensity, so a whiter than normal look, as you go through that and it doesn’t move at all and it has an area of that finger that is looking a little bit whiter than the other fingers then that’s a stationary structure and an area of the pulley so you can hypothesize that that’s a pulley sprain.

Then you take screenshots or image shots of that and you can compare and track it over time.

Neely Quinn: So there’s some abnormality with those off-colored structures that are the pulleys?

Dr. Jared Vagy: Correct. It’s black, white, and shades of grey.

Neely Quinn: Okay, but basically if you were to look at it as if you could just see it underneath your skin would it just look frayed? Would it look inflamed?

Dr. Jared Vagy: I see, so if we were like a superhero who can see through things? Which one?

Neely Quinn: I have no idea. Superman?

Dr. Jared Vagy: Superman was going to be my guess as well. Oh man, I have to brush up on my superhero knowledge. So if you were to look in at what’s truly going on rather than what an image is showing you would see fraying and you would see some of what’s called ‘micro tearing.’ If you think of a climbing rope and you get a grade two pulley sprain, imagine this climbing rope is looped around your finger – make-believe the climbing rope is your pulley – then you have a half core shot to the rope. If you have a grade three then you’ve basically core shot the rope and it’s gone.

Neely Quinn: Oh.

Dr. Jared Vagy: You basically just imagine a rope that is frayed and the different levels of fraying would be your pulley sprain.

Neely Quinn: It’s so funny that the rope is so perfect as an example.

Dr. Jared Vagy: I love working with climbers because coming from a big wall climbing background there’s so many different cool climbing analogies that you can relate. Most of the climbers I see are sport climbers or boulderers and a large portion of youth climbers as well, but every now and then a big wall climber comes in and I get to bust out some different terminology.

That would be to answer your question about what you would see on an image and then what you would see if you were Superman or whatever superhero can see through things.

Neely Quinn: Okay, thank you for that. I appreciate it.

Moving along: pulleys.

Dr. Jared Vagy: Pulleys. We went through flexor tendon strains and pulleys together through a mobility category and in the strength category we diverged a little bit. That’s when we started talking about flexor tendon strains and how you need to eccentrically train them.

Now, for both pulley sprain and flexor tendon strain we need to also build strength in our antagonistic muscles. This is probably not an uncommon term. Sorry for the double negatives but it’s something that most climbers have heard. ‘Antagonistic muscle strength.’ What is that? It’s the muscles or tendons that antagonize normal climbing movement.

When I deal with climbers that have any type of hand injury on the front of their hand we always want to train the muscles, tendons, and the strength of the muscles and tendons in the back of their hand. Where pulley sprains become quite interesting is when climbers start to develop them repeatedly on certain fingers. Do you have any idea what the most common finger is for a pulley sprain, Neely?

Neely Quinn: Isn’t it your ring finger?

Dr. Jared Vagy: Yeah, your ring finger is your most common area. Part of it is because of the size differential between your pinky finger and your ringer finger. It doesn’t have much stabilization or support. Part of it is if you look at your wrist and you deviate – almost have your elbows bent and your hands towards the ground – your wrists to the side and then deviate them inwards so you’re kind of chopping back and forth, you’ll notice that your wrist deviates more towards your pinky. Does that make sense?

Neely Quinn: Yeah.

Dr. Jared Vagy: You kind of chop your hand back and forth. We have much more range of motion towards that pinky side than we do towards our thumb side. Our hand tends to go – it’s called ulnar deviation – in that position which will then load that ring finger more versus our pointer finger. Another thing is it’s just a weaker tendon because it has a shorter lever arm compared to the other fingers.

That’s a common injury so one thing I always look at is people’s ability to differentiate their fingers. Basically, to turn on selectively the strength of their finger extensors or the muscles in the back of that ring finger. This is kind of a cool exercise. Neely, go ahead and place your palms together and go into almost a prayer position where your elbows are out and your palms are pressing together and your fingertips are up towards the sky. Your thumbs are maybe at the level of your chest. Are you in that position now?

Neely Quinn: Yeah.

Dr. Jared Vagy: Now Neely, just lift your ring finger. Lift both fingers away while maintaining that position.

Neely Quinn: Okay.

Dr. Jared Vagy: Are you able to do that?

Neely Quinn: Yeah.

Dr. Jared Vagy: While your palms are touching, elbows out to the side, fingertips to the sky?

Neely Quinn: Do you want me to send you video proof?

Dr. Jared Vagy: Have you ever had a finger injury?

Neely Quinn: Yeah.

Dr. Jared Vagy: Which finger?

Neely Quinn: I think both of them.

Dr. Jared Vagy: Now what I want you to do is we’ll take it to another step. You don’t have to do this now but you’re in a plank position and you try to lift each finger selectively off the ground, while in a plank position. Then you start to straighten the wrist to get it closer and closer to neutral.

One thing that I notice, and it’s an interesting finding, is the anthropometrics of the fingers – which just means the length of them or the size of them. Everyone has different lengths or sizes of their fingers so if you have a shorter pinky finger or a shorter middle finger then that may put your ring finger more under stress just genetically, looking at that, but the other thing is the ability to differentiate each finger separately and turning on those extensors. That would be the example of like what we just did with that prayer pose, lifting each finger away from each other, or even if you put your hands down on the table and selectively lift each finger and be able to do that against resistance. Oftentimes people will find the hardest one to lift on its own is that ring finger.

Neely Quinn: So is that a good exercise to do?

Dr. Jared Vagy: That’s a great exercise. There’s one trick to it. Remember when you were talking about handstands that were strengthening or stabilizing your wrists?

Neely Quinn: Yeah.

Dr. Jared Vagy: This is one where it’s good to start with that wrist fully cocked back. It’s almost impossible to lift your finger up off the table. You put your hand on the table, you put your elbow right on top of it so your wrist is cocked back and that really challenges those extensors but it’s not so functional to climbing because your wrist is cocked back so far. You can start bringing your elbow closer and closer to your hand and then add resistance to your finger to selectively turn it on.

Neely Quinn: Okay, that makes sense. The angles make so much difference.

Dr. Jared Vagy: Yeah. If you imagine – if anyone’s listening now, put your hand on the table or on the ground and just bring your elbow up so basically it’s right over your palm then try and lift one of your fingers. Good luck. You’re in a tough position and your joint is at an end range and those tendons and muscles are shortened. Then you can start dialing back how much you have your elbow over your hand to make it easier and easier.

Neely Quinn: I wonder if I can do these things because I’ve played the piano since I was five? I came into climbing with strong fingers.

Dr. Jared Vagy: That’s so funny because I was about to say that I always – well, I wouldn’t say always, but I routinely ask patients, “Did you ever play piano?” or “Do you have a history in some type of instrument where you built this dexterous ability to move each finger independently?”

Neely Quinn: That’s so funny.

Dr. Jared Vagy: The people that have these motor patterns, where they can selectively control each finger much much better, have a decreased likelihood of a finger injury.

Neely Quinn: Interesting. Cool.

Dr. Jared Vagy: For all of you youth climbers who are listening to this, diversify your skills. Play the piano, become a Renaissance man or woman, but anyway…

Here’s the thing: how I present stuff is I’ll always present it first a little complicated, right? A little bit very, very specific. Then I’ll ease off a little bit and say, “Alright. If you don’t want to do it that way let’s do it a little bit easier way.” Here’s the easier way to do it: can you think, Neely, maybe of a way, if you wanted, to selectively turn on your ring finger? The muscles in the back of your ring finger. How can you do that? You only want that ring finger and you want the muscles in the back that extend your finger back.

Neely Quinn: Push on all of the other ones or something?

Dr. Jared Vagy: Okay, I like that. So kind of push on all the other ones and keep them down and then you can only turn on that one finger? That’s good. You can take some tape and tape the other ones down and then you can lift one finger. That’s a good idea.

Another thing you can actually try is you know the moulding on the top of the door? I used to, before hangboards were popular, use that as my hangboard. You can hang from a moulding and try and actually lift one finger at a time when you’re hanging. It’s extremely difficult to selectively turn on one finger extensor while the other ones are flexing. Do that under a mild to moderate load in the safety of your own home.

Anyway, what I was going to say is if you want to selectively turn on one finger what you can do is instead of doing finger flex, where you take rubber bands and you put them around the tips of your fingers and you kind of flick your fingers outwards and that strengthens all of your fingers at once, if you just loop that around a single finger and you pull downwards, then you can target that one finger.

Neely Quinn: Okay, so this is something that a person with a pulley strain should do?

Dr. Jared Vagy: Yeah, someone with a pulley sprain, if you have it on one finger and if you want to save the time, you can selectively turn on the extensors in that one finger. The reason why I like this is because the strength of our fingers is based on how you train it in specific isometric positions. Meaning, if you train just grip strength, like to squeeze and shake someone’s hand, you’re going to get really strong at giving a good handshake. If you train grip strength in a half crimp, you’re going to get really strong at half crimps. You’re not going to be as strong in a full crimp position but you’ll get what you train.

If you take a rubber band and you loop it around the tip of your finger, just one finger, the ring finger for now, and then you position your hand in a half crimp or even a closed crimp or an open hand and you hold that isometrically, now you’re getting very, very specific. You’re mirroring the position of your hand when you climb and you’re targeting that single finger extensor muscle in the back of the hand.

Neely Quinn: Oh, so you’re just in a crimp position and then making that one finger go out of it?

Dr. Jared Vagy: Yep. You’re in a crimp position and that one finger is pulling out of it but just a hair, just enough to turn on the muscles and feel the burn in the back of the finger.

Neely Quinn: Yeah, that makes sense.

Dr. Jared Vagy: Now the coolest thing is: can you do that in a half crimp with three fingers at once? What you can actually do is you can take a carabiner and you can girth hitch three rubber bands to the carabiner and then you can attach each of the rubber bands to your finger, go into a half crimp and pull down on the carabiner.

Neely Quinn: I’m going to need a photo for that. I hardly even know what a girth hitch is! I’m not a trad climber. [laughs]

Dr. Jared Vagy: Sorry, you attach to a carabiner three rubber bands. Imagine a carabiner and there’s three rubber bands sticking out of it, right? Attach each of those rubber bands to the tip of your finger. Your hand is in a half crimp position, you pull down on the carabiner to flex your fingers and your fingers extend against them.

You know what we’ll do, Neely? That’s actually one of the new exercises I’m going to put up on your webpage. I haven’t put that one up yet. Let’s give that as a free video for everyone to check out.

Neely Quinn: Okay.

Dr. Jared Vagy: We can have that so people that are listening to this right now can go to Neely’s site. Neely, just remind me to put that one up. It’s kind of a cool exercise with rubber bands and a carabiner. We can make that a free video for everyone that’s listening to check out and find an additional way to train their fingers.

Neely Quinn: Okay, and it can be a girth hitch tutorial as well.

Dr. Jared Vagy: Oh yeah. Anyone who is a sport climber or boulderer who wants to get into the coolest form of climbing, which is trad climbing, then you can learn how to girth hitch a rubber band. Eventually you can girth hitch chickenheads as you are climbing sketchy, runout terrain.

Neely Quinn: [laughs] Okay. We’ll put that up there. How often are people doing these exercises?

Dr. Jared Vagy: Here’s the thing: when I develop a rehab program, climbers are doing 4-5 exercises total. It’s so dialed into the specific things that you need that you’re not wasting your time spending hours a day.

As a general rule, any type of blood flow exercise that we were talking about earlier in this podcast you can do as much as you want. Neely, when you’re sitting at your desk you can bring your arms in circles and flick your fingers and wrists and all of that as much as you want during the day to increase blood flow. Seth can put the blood flow restriction cuffs on him up to two times a day. Actually, you have to cap that one but anyway, you can do the voodoo floss that we talked about earlier, you can do the acupressure rings. There’s not too much of a limit for blood flow.

For mobility categories it’s similar. You can’t really overdo it on the quantity of stretching but maybe the intensity of stretching you can. You can do those everyday, sometimes even up to three times a day.

But when you get into strength exercises, those ones you want to do every other day because for that you need time, at least 24-48 hours, for the muscles to recover.

Neely Quinn: Wait – can you say that again? I know I could just pause and rewind but how many times a day and how many days a week?

Dr. Jared Vagy: If you’re doing any type of blood flow, trying to get more blood flow to the area, do that as much as you want. You can’t go wrong with that unless, potentially, with blood flow restriction you’re causing issues in changing your blood pressure and so forth. Be aware of that but that’s outside of what we need to talk about on here. For increasing blood flow, do that as much as you want.

For mobility, do mobility everyday. You can even do it up to three times a day. You just want to make sure that you don’t go too aggressive in the actual exercise but the quantity you can do everyday and up to three times a day.

For strength training you need at least 24-48 hours for the muscles to recover. I’ll oftentimes recommend doing that every other day.

Neely Quinn: Okay, and how many times a day?

Dr. Jared Vagy: Just once.

Now if we’re talking about something where you’re not fatiguing – what is a strength exercise? What is an endurance exercise? What is a power exercise? This is all where you’re fatiguing after a certain number of reps. If you’re doing an exercise – let’s say you’re doing these rubber band flicks or these half crimp positions where you’re turning on those extensors in the back of your hand. You’re not getting tired, you’re just doing it and feeling the muscle turn on, then that you can do as much as you want. You can do that up to three times a day as long as you’re not fatiguing at the end of the exercise.

I used to say, “Oh my god.” I worked in China with the Chinese National Team for track and field and the dosage of therapy there is insane. I would see an athlete that, when I was there, he was number three in the long jump so third best long jumper in the world. He strains his hamstring right before World Championships and they scheduled physical therapy. In the States you would see this patient for maybe an hour and a half a day max, right? I was seeing him for three sessions of an hour and a half.

You’re like, ‘How, for four and a half hours a day, can you go through specific exercises?’ You just have to modify them and you can’t do all of them to a high level or a high intensity. You have to choose and select which ones you go through. That really changed the paradigm for me of how much you can do an exercise, as long as you’re not doing it to fatigue. Most people do not have the time to do four and a half hours of exercises so by going by a simple rule: blood flow as much as you want, mobility training up to three times a day, strength training every other day – that kind of allows people to fit it within their schedules.

Neely Quinn: So you said 4-5 exercises total. Could you give me an example protocol?

Dr. Jared Vagy: Yeah. Maybe let’s do one for a pulley sprain. First thing is you have to decide whether you want to tape or not. It depends on what side of the fence you are on for that. That’s even it’s own podcast, to tape or not to tape, and then to use circumferential, to use figure-8, use H-tape – I’m not going to go into that but that can be a potential unloading technique that you can do for when you return to the wall. I’m not going to add that to the number of 4-5 but I’ll just put that as a preface to unloading injuries.

That brings us to mobility. First thing for mobility is you need at least one exercise that increases blood flow. We’ve talked twice, I think, in this podcast about all the different ways you can increase blood flow to your finger. That becomes an exercise. Neely, which ones do you remember for increasing blood flow?

Neely Quinn: The mummifying your finger one, the BFR/blood flow restriction, and the acupressure rings.

Dr. Jared Vagy: You’ve got it. You just need one of those. If you want to get an A+ in rehabbing your finger you can do all of them if you want but you just need one of those. One thing to increase blood flow to a region that has white tissue that is far from the heart. That’s exercise one.

Exercise two: you need to gain mobility back. Anytime after a pulley sprain we oftentimes lose our motion, lose our mobility, and some of it’s from pain/inflammation or tissue damage. Some of it is because the joint is just stiff because of some of the scar tissue that eventually starts to generate and build up so early mobility is important. Doing something that’s called ‘tendon glides’ I’ll oftentimes recommend.

Tendon glides are where you basically take the tips of your finger and press them into the palm. Continue pressing them deeply until you come up into a clawed position and then straighten your fingers. You almost brush the tips of your finger against the palm to get that full range of motion in the opposite position that we commonly climb. Does that one make sense, Neely? Or do you want me to talk through that one one more time?

Neely Quinn: Yeah, for sure. We actually have an Instagram video on TrainingBeta of a girl doing those. I’m sure you probably have a video, too.

Dr. Jared Vagy: Yeah. Check out the TrainingBeta Instagram for tendon glides. I think on the Climbing Doctor Instagram we’ve got one of Jonathan doing that, too. I like doing the reverse. Basically you start with your fingers palming your palm and then you fully extend them. Check those out. That would be a second exercise. Now you’re increasing mobility and the bonus is that strengthens a little bit the extensors in the back of your fingers.

The third exercise is now we need to start thinking about the strengthening that we talked about earlier. One is that I like to do a global strengthener. A global strengthener can be those finger flicks against the band that we were talking about earlier. You have a rubber band against the backs or tips of your fingers and you’re pressing out against it, turning on your extensors. Or, if you want to be more specific, you can have a single rubber band across that one finger that is bothering you in a climbing specific position. It depends on how much time you want to invest, how specific you want to be, but one exercise to strengthen those extensors.

Now the trick with that is actually how long do you hold the position for? Think about you have a rubber band around your fingers. How long do you think you would hold that position for doing finger flicks or doing those extensor training exercises?

Neely Quinn: I don’t know. A minute?

Dr. Jared Vagy: Here’s where it becomes tricky. You have to think about when we climb, how long are we holding onto holds? If you’re bouldering maybe you hold onto a hold for about five seconds. If you’re sport climbing maybe a little bit longer, maybe six seconds. Trad climbing maybe 10 seconds. You kind of want to mirror how long you hold onto the holds with how long you do these exercises for.

Neely Quinn: You mean like each flick would be five seconds?

Dr. Jared Vagy: Correct. You would flick and hold for five seconds if you’re a boulderer. If you’re a really slow, sustained, methodical boulderer then flick and hold for longer because that’s your climbing style. The closer that you can train your finger extensors to turn on in the same type of quick impulse and static hold that you do when you’re climbing, the better they’re going to work when you return to the wall.

Neely Quinn: Okay, cool. So those are the extensor exercises and then we need to do the other ones.

Dr. Jared Vagy: This is where it’s super important and also the time frame is really important. You have to train your finger flexors again and if you have a pulley sprain I recommend what’s called ‘progressive deadhangs’ and we’ll talk about that in a moment, or if you have a flexor tendon strain where you do that eccentric activity that we talked about earlier.

Neely Quinn: Okay.

Dr. Jared Vagy: With a pulley sprain, progressive deadhangs. Basically you can do this with a hangboard or you can do this with a finger on a carabiner with a weight at your side. Just imagine a hangboard and you need to start retraining your finger flexors. There’s a protocol that you can utilize to start to almost hangboard with a decreased load to start to habituate your finger to those stimuli that you’ll feel on the rock wall. I’ve been experimenting with different protocols for the past four or five years. I have different sets and I’ve been compiling data on it. I know Esther Smith has a killer protocol out there as well and she’s put a lot of thought and research and time into this as well.

In the end, all climbers need to do is slowly and progressively start to load their injury. There’s a couple different protocols out there. I have one in my book and there will be one as well, Neely, on your site with these new programs that I’ve put out. I also encourage you to check out Esther Smith’s protocol as well. It’s really well thought out and she’s a great physical therapist.

Either way, you have to have some progressive load to these finger flexors. That’s that final stage but you have to do this at the right time and you have to start it after eight weeks after your injury. If you do it too soon you can hurt yourself.

Neely Quinn: Eight weeks? That’s a much longer time than what Esther would say, I think.

Dr. Jared Vagy: Yeah, it’s two months before you start truly loading the fingers on a hangboard. That’s for a grade two sprain. A grade one sprain you can get in much sooner but a grade two sprain you have to allow that time because strength gains don’t occur until a 6-8 week stage. You have to allow that time to fully get strength in your fingers, at least in my opinion, before you can start reloading and remodeling them.

Neely Quinn: Okay, I want to take back what I said about what Esther would say. I don’t want to say what Esther would say so just delete what I said. [laughs]

Dr. Jared Vagy: I haven’t looked too in depth at what she has but what I can say is there is so many different thoughts and philosophies on how to rehab, how to treat, and in the end all of us are looking at the research, we’re doing things in clinical trials, we’re testing our patients, and we’re determining what works the best. Whether you listen to this and you look at different protocols and different examples of finger strengthening and training, just take the information out there and try it on yourself.

My programs tend to be slightly more conservative than other physical therapists as well but in eight weeks you know for sure that you’re not going to be hurting yourself when you load on the fingerboard. Those are just my two cents.

Neely Quinn: What would be physical signs that you’re doing it too early or that you’re doing it at the right time?

Dr. Jared Vagy: One is your timeline. Basing it on your timeline you know that you’re at the right level. The other thing is knowing that what you feel in your finger, the pain that is being generated, may or may not be harmful. Hurt may not equal harm.

There is a great article and I always reference this. Will Bateman, a physical therapist up in Vancouver, put an article up on www.theclimbingdoctor.com. You guys can check it out on the blog site. It’s called ‘Clarifying the Role of Pain in Injuries.’

He talks specifically about the fingers and how when you feel a sensation loading your fingers – let’s say eight weeks after an injury – this may not be a harmful sensation. This may actually be just a warning sign that’s coming from your brain that is saying, “Be careful when you load it,” but your tissues may already be healed. It’s hard to take what’s called ‘subjective reports’ or what a patient or a person reports to truly determine if that is a level of pain that should allow them to move forward with loading the finger or not. With that being said, we do our best.

What I do is I scale it from 0-10 and if it’s a 3/10 pain or discomfort, that’s about the level of discomfort that you want to have when you’re starting to progressively load the finger as long as you’ve waited your eight weeks. We know the stages of tissue healing that you’ve gone through and now we know that you have this level of perceived pain that we can start to habituate your system to fight out of.

Neely Quinn: Okay, so then what do they do on the hangboard?

Dr. Jared Vagy: First you go on the hangboard and you find this level of 3/10 pain and you get to a level where you have a little bit of that stimulus, so it’s just enough for your brain to recognize symptoms but for you to be able to train through. You find that level and you hang on that and it becomes your baseline measurement. You do different levels of hangs.

When I start my protocol, actually the first four weeks of the protocol are 30-second hangs. Can you imagine 30-second hangs on a hangboard? Why do you think that’s the first four weeks of the protocol? Normally we do repeaters. We do 7-second holds. Why is it 30 seconds?

Neely Quinn: I mean, I’m assuming the intensity is really low because you’re taking a lot of weight off.

Dr. Jared Vagy: Exactly. You take a lot of weight off, you hang at a low intensity so the longer you hang the more you have to take weight off, right? You get to that level where you’re training some endurance and some fingers, you’ve given enough time for the brain to habituate to that stimulus, and then from there, after those four weeks, you start to load a little more aggressively with more and more weight going from different grips into open hand, half crimp, two finger pockets, varied positions, etc.

Neely Quinn: What are you starting on? What grip are you starting on?

Dr. Jared Vagy: You’re starting just in an open hand grip.

Neely Quinn: Okay.

Dr. Jared Vagy: From there, in that open hand grip at that four weeks, then you build the next four weeks into a half crimp grip so now you’re spreading and distributing the load. It’s a higher amount of activity from your finger flexors and you do your typical hangs. You do four sets of 7-second hangs, you get that pain that’s reproducing, you get to that 3/10, you can take weight off if you need to unload, you can put weight back on. You want to stay at that level of 3/10 throughout your training and eventually, at the 24 week stage with a grade two sprain, you’re back to a high level of fingerboarding with open hand, half crimped, two finger pockets, varied. It’s a protocol that just goes step-by-step.

There’s lots of these out there. I’m in the lab all the time and I’m writing all this data down with patients and playing around with what works and in the end, you just need to stick with a consistent program of progressive load to the fingers that’s safe and controlled. You’re going to be just fine coming out on the other end of your pulley sprain. If you miss this step, that’s where we get a lot of re-injury. People oftentimes quit. They do six weeks of progressive loading on the fingerboard or 6-8 weeks or something like that. They’re feeling better and they don’t go through the full 24 weeks and then that leads to re-injury.

Neely Quinn: How often should they be doing this, approximately?

Dr. Jared Vagy: The first round is really endurance. You’re at 8-12 weeks and you’re doing this three times per week. Then you build into just about twice a week. You can vary this as your non-rehab days and you’re not really hanging that much. They’re 7-second holds, four times. You have a two minute rest in between and you’re just allowing your body to habituate to a painful load. Change that stimuli and potentially you’re strengthening and remodeling the tissues in the fingers to mirror the positions that you would be in when you’re climbing which would be open and half crimp, two finger pocket, varied positions as you start getting deeper into it.

Neely Quinn: And you said the 30-second hangs are lasting for 4-12 weeks?

Dr. Jared Vagy: Four weeks total.

Neely Quinn: Just four weeks then after that you’re doing four sets of 7-second hangs for 4-20 weeks, basically?

Dr. Jared Vagy: Yep. From week 8-12 you’re doing 4×30-second hangs. From week 12-24 you’re doing 4×7-second hangs which is more what we do when we climb, right? You’re doing repeaters on the hangboard or you’re holding a hold when we climb on the climbing wall for somewhere between 5-9 seconds. We’re starting to simulate that climbing environment. The only thing is our first four weeks is a much lower load, a much longer duration, to habituate your nervous system to turn on these muscles and tendons.

Neely Quinn: Okay, so that was 8-12, 12-16, and 16- do you just alternate then?

Dr. Jared Vagy: The difference between 12-15 weeks, 16-20, and 20-24 is from 12-15 weeks you start integrating your half crimp. From 16-20 weeks you integrate your half crimp as well as two finger pockets. From 20-24 you integrate your half crimp, two finger pockets, as well as additional varied holds that are climbing specific. You can do pinches, you can vary it a little bit as well. You’re building up to a level where you’re utilizing your fingers in all these different ways. We’re not trying to kill you, we’re not trying to build strength, we’re just trying to get the fingers to start to load in a safe environment with a low level of pain so that the tissues can start to adapt.

Neely Quinn: How often would you say to increase the load?

Dr. Jared Vagy: How often to increase the load is basically the next week, you do that hang test if you want to again and if your symptoms are 0/10, they’re no longer that 3/10 that’s coming on, then you can increase the load. A 2.5 or 5-pound weight and you can put a little bit more so you can get that 3/10 discomfort when you get on the hangboard. You’ve hit that level – okay, great. Now we can maintain at that. The next week, stay at the same level if you still have the 3/10 pain or you can add more weight if the pain goes away.

Neely Quinn: Okay.

Dr. Jared Vagy: The tough paradigm is you’re training a finger protocol but with some discomfort. Discomfort is a subjective component that, as a medical community, we’re not entirely sure whether this is a warning sign from our body or if it’s safe. Does that make sense? Our finger pulls. Are the tissues intact and it’s just a warning sign telling our brain that there’s pain? Or is it a fake warning sign and our brain is just trying to protect our fingers and it’s generating pain?

The question I then have for you, Neely, is how do you think, in the clinic, I determine whether it’s a true warning sign or whether it’s a fake warning sign which is called ‘centralized pain?’

Neely Quinn: I think it has to do with how long the pain lasts.

Dr. Jared Vagy: So one is the duration of pain. Correct. If the pain or soreness lasts more than 30 minutes after you go through this protocol then you probably irritated some tissues. You probably flared them up and that’s a little too much. That’s part of a protocol. You need to make sure to cap the duration of time. That’s one thing.

The other thing is you can get a little bit tricky with it. One thing that I do – Neely, what hand did you have your injury on? Was it right or left or both?

Neely Quinn: Left.

Dr. Jared Vagy: So take your left hand and take a mirror and you split the mirror down your body so that the mirror is facing your right hand. Does that make sense? You can look at the mirror. The mirror is splitting your body. You can see your right hand and in the mirror you see your “left hand” but it’s really your right hand. Does that make sense? The mirror is halfway down your body, your right hand is right in that mirror and then you can see a fake left hand but really it’s your right one.

Neely Quinn: Okay.

Dr. Jared Vagy: I put the patient in that position, I have them go into a half crimp, and I’ll put them in a little device that loads them. They go into the half crimp, they load in that position as much as they can maximally, and I see if that generates pain in their opposite hand.

Neely Quinn: What?

Dr. Jared Vagy: What? Isn’t that crazy?

Neely Quinn: It’s like your brain is just so used to having the pain that it generates it.

Dr. Jared Vagy: 100%. There’s a whole side of physical therapy or these medical professions and there’s a school of thought – if you look it up it’s called Graded Motor Imagery – and there’s the three stages to identifying, training, and treating what’s called ‘centralized pain,’ or pain that doesn’t really exist. It’s in your head but it’s not really the tissues. It’s a trip. You can’t believe how many times I’ve done this.

A climber is going to go in, they’re going to crimp on their right hand, let’s say in this case for you, and they’re going to maximally crimp and keep going and kick in and keep going and they start feeling this weird, subtle pain in that left hand. It’s because they’re looking in the mirror and their brain is imagining that’s happening on their left hand and that same warning sign is traveling up from the left hand to the brain and saying, “This is pain.” That’s a way we can start to differentiate whether pain is being generated in the brain or whether it’s truly pain that you need to be aware of.

Now, if I do that on a patient and they feel pain in their left hand I’m going to say, “Oh, alright. Go ahead and do that deadhang protocol and if you want, 4/10 pain is fine. Whatever pain that we reproduced when you were pulling on the half crimp on your right hand, that level of pain in your left hand is totally fine. That’s fake pain. That’s not tissue damage so go ahead and do your protocol and be safe with it.”

There’s plenty of other ways to assess that. I’m just giving a single example.

Neely Quinn: First of all, this is the longest podcast episode ever.

Dr. Jared Vagy: Are we at like two hours right now?

Neely Quinn: We’re at an hour and a half but I have a follow-up question to that because sometimes I get worked on by this guy, Brent Apgar, who is a chiropractor and he does dry needling. He also uses the E-stim and he talks about this all the time, how he’s trying to zap your brain or create a different stimuli for your brain so that your brain stops creating that pain. It’s trying to disrupt it. Would you say that for a finger injury, that kind of thing could work?

Dr. Jared Vagy: What you’re talking about is called ‘the gating response.’ Think about a gate to your house. What the gating response is is – I’m going to try to give an analogy. I’ll try not to give an analogy. I’ll try and just talk about the pain science. We’ve done too many rope analogies on this podcast.

Imagine right now you have a pain stimulus and our pain fibers – we have A-delta and beta cells, or pain fibers – that generate the pain sensation from our finger to our brain. One of them is slow and really intense, the slow burn, this C fiber. Sorry – we have A-delta, beta, and C fibers. Anyway, we have a slow burn pain that’s really powerful but it’s super slow. Then we have this fast or quick sensation. What the theory is – this is called the ‘gating theory’ – is that our faster sensation is beating the pain to the spinal cord and to the pain. What you feel is the electrodes instead of pain. Does that make sense?

Neely Quinn: Yeah, that makes sense.

Dr. Jared Vagy: We have pain, which is this large, slow fiber and then we have this fast sensation fiber. We’re shooting electricity. You’ll see a TENS unit, like you’ll put on the arm, give a sensation and you’ll feel that sensation instead of pain because that sensation is beating the pain signal to your spinal cord. It’s a brilliant way to trick people into not feeling pain, to allow muscles to relax and get into full function but sometimes, if overused, you can imagine how you can get yourself in trouble.

If you put on a TENS unit and you put electrodes on and you put them on your wrists and your fingers and you’re hangboarding, you’re not going to feel any pain. You’re going to feel a bunch of tingling in your arms and you may load to a level where you fail at the tissue level, generate true pain, because you pushed past it because it’s like you’re on a bunch of pain meds.

You just have to be mindful but from a manual therapy technique, if someone is doing hands-on therapy, that is awesome. When I’m in Colorado I’ll go see him because I really like what he’s thinking. You try and shut off one area of the brain, change the stimuli, and then work on another area when you release it.

Neely Quinn: It’s confusing because I use acupuncture a lot and it’s helped me a ton but every acupuncturist I’ve ever seen is like, ‘You can’t really do much with finger injuries with acupuncture,’ but Brent Apgar uses dry needling with the E-stim. Do you think that would work on a finger?

Dr. Jared Vagy: Yeah, and then you get into dry needling. First of all it’s challenging because when I travel with some of the teams, with some the Olympic or World Championship events, there are physical therapists – which is my field. I’m a Doctor of Physical Therapy – that dry needle and get such amazing results out of it. In the state of California it’s actually against our practice act to inject or to needle so it’s something I have less experience doing.

Neely Quinn: Oh, you can’t.

Dr. Jared Vagy: I just usually refer out but it’s a powerful technique to either inhibit muscles or tendons but it is outside my scope of practice so I really can’t speak to personal experience with utilizing it.

Neely Quinn: Okay, that’s fair. Should we try to wrap up?

Dr. Jared Vagy: Let’s go for another hour and a half.

Neely Quinn: [laughs]

Dr. Jared Vagy: Of course. I think the big thing, Neely, as we’re going through this podcast is climbers are so darn lucky. There are so many talented physical therapists, chiropractors, acupuncturists, any other medical profession I haven’t mentioned – massage therapists – that are climbers themselves that are treating patients. When I started doing this there wasn’t that many people out there doing that and I’m psyched. I’m psyched that there are so many people out spreading the word. I’m excited there’s so much good information going to climbers. I really think you’ve done an amazing job with your podcast, too. When I first went on your podcast what was I, number seven or something? Fourteen?

Neely Quinn: You were early on.

Dr. Jared Vagy: Now you have this mass of followers. People come up and they’re like, ‘Oh, I heard you on TrainingBeta,’ and I’m like, ‘Oh yeah. Neely is awesome.’ I think it’s pretty amazing how the field and the work of climbing and the work of people working in climbing as coaches and trainers and medical professionals has really advanced. The culmination is Tokyo for the Olympics. Whether you stand on the side of thinking the format sucks or whether you’re excited that we just got into a mainstream event, climbing is going to keep on growing and I’m just so psyched to have the opportunity to be on these different platforms to kind of speak my mind. I do have my biases, as you know, but hopefully people got a lot out of this episode and they didn’t fall asleep after an hour and forty minutes.

Neely Quinn: Well, I think your background as a professor and a teacher is really helpful because you keep me listening. I mean, I didn’t fall asleep so hopefully they didn’t. I really appreciate your wisdom and your enthusiasm for all of this. I know that people will get something out of this so thank you.

Dr. Jared Vagy: Awesome. Climb on and I’m looking forward to the next one.

Neely Quinn: Alright, have a good one.

Dr. Jared Vagy: Take care.

Neely Quinn: Alright, I hope you enjoyed that interview with Doctor Dr. Jared Vagy. I always enjoy talking to him. I always come away feeling like I’ve gone through an oral exam or something. I feel like he’s a good teacher that way. He makes you think about things and find answers for yourself. You can find him online at www.theclimbingdoctor.com and then @theclimbingdoctor on Instagram and Facebook. He’s pretty active over on Instagram with helpful videos and photos and tips and tricks.

Again, if you want to check out the protocols, including the pulley one, you can go to www.trainingbeta.com/rock-rehab. The pulley one in particular is at www.trainingbeta.com/pulley. I hope that’s helpful for you if you have an injury, especially a finger injury right now. If you do I’m really sorry to hear about it and I hope you get better soon.

A few things going on over at TrainingBeta: one is that we started a few months ago this series on the blog called ‘How I Trained For.’ It’s different athletes. Some of them are well known and some of them are not and it’s athletes talking about how they trained for a specific route or a specific boulder or a specific trip and exactly what changed because of that training. Usually, they’re success stories so it’s pretty cool to see people figure it out for themselves or with a trainer and execute and then have success. If you want to check out those stories you can go to the blog on TrainingBeta.

Other than that, we’re still offering online training with Matt Pincus. He’s been having a lot of success with clients all over the world and he designs four-week training plans for them. These are people who want more personal attention and more individualized programs set up for them. You can find that at www.trainingbeta.com/matt.

I’m taking a few new nutrition clients right now and you can find more information about that at www.trainingbeta.com/nutrition.

On the topic of nutrition I do want to throw my two cents in there about injuries, basically. I think that a lot of people can do a lot of good with not only these protocols for helping heal injuries but also changing their diets up a little bit to encourage healing, or at least take away some of the inflammation that you might have going that’s excessive in your body.

Some of the things that I recommend for people when they have injuries is just the low-hanging fruit is collagen. I take Vital Proteins collagen, the marine one, but there’s also a beef one and that has more collagen per scoop in it. It’s a little bit pricey but it really affected me after my second surgery. I wasn’t sure I was a believer  but at six or seven months I still was having a ton of pain and I really wasn’t able to climb much. Maybe it was even eight months. I started taking collagen and it helped me turn a corner and it was like after a week I started noticing a difference.

I highly recommend it. There’s been a lot of research done on it talking about how it actually does help injuries. It goes to the injury site because, basically, collagen is what a lot of our tissue is made up of so our hair, our skin, our tendons, our connective tissue. If we take it, it seems weird that we could take it and it could affect those things but it does. I highly recommend that.

The other low-hanging fruit thing that you can do is take out foods that you are sensitive to. That can be sort of a process to figure that out but if you have a sneaking suspicion that you are sensitive to gluten, like if you have bloating from it or you have bloating all the time, or if you have diarrhea or constipation or you have skin issues or any sort of inflammation or immune system response that you’re dealing with on a regular basis, it could very well be food that you’re eating. The first thing that I have people test is always gluten. It’s almost always gluten because most of the time it does make a difference for people. I know that you hear ‘Gluten this, gluten that,’ but it is actually a thing.

Even if you don’t think you have a sensitivity to it it might be worth it for you to take it out for a week and just see. ‘Does my finger feel better? Do my shoulders feel better? Do I feel a little less creaky?’ It might happen and a lot of times for my athletes, that does happen. They might recover better. I’m not saying to take out grains or go low carb or anything like that, just substitute everything you eat with gluten in it with a gluten-free option or do rice instead of bread. There are super simple solutions everywhere and at most restaurants, too, so it’s just an easy thing to do.

The other food sensitivities would be dairy, nuts and seeds, soy. Those are other things that are pretty common. The nuts and seeds thing I have seen quite a few clients and myself have effects on their joints. They’re just really hard to digest so sometimes your immune system won’t like it that you’re having nuts and seeds.

Those are the two low-hanging fruit things. Definitely eat enough protein, try to make it 20-25% of your diet. You can go into MyFitnessPal and figure that out. Eating enough protein will help us repair any damage that we’ve done to our bodies.

Those three things I guess I would say are the most important. Taking collagen, figuring out food sensitivities, and eating enough protein will probably help you with your injuries or at least help you heal from them faster. I hope that’s helpful and I wish you the best if you do have an injury.

You can always contact us at info@trainingbeta.com with any questions that you have. Thanks for listening all the way to the end and I’ll talk to you next week. Take care.

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