Physical Therapy for PIP Joint Synovitis in Climber

Shared by eshlow on Jun 9, 2019 (Written on Mar 11, 2018)
What is your story about?
I'm a physical therapist and climber with PIP joint synovitis in the middle fingers of both hands. I've run the gamut of physical therapy approaches for treating the condition, and have found it to be difficult to resolve. I'm still in the process of recovering, but so far have found finger rolls to be the single most effective rehab exercise.
What symptoms did you experience and how did they progress over time?
I injured my left middle finger PIP around mid Summer of 2017. Injured my right middle finger PIP early Winter of 2018. I forget how the left finger came on, but the right finger came on after too much volume + full crimping a bit too much.
What treatment approaches have you tried?
I'm a physical therapist so I've tried almost every different type of rehab method without much help. The main things that help mine are:
  • Less climbing (e.g. avoid aggravating exercises)
  • 3 finger drag / open hand hangs on hangboard
  • Finger rolls
  • Full range of motion exercises
  • Resting for 7-10 days usually resolves pain and irritation completely... but I can't reasonably do this because it comes back immediately and my hand strength and technique goes to crapper
Things that transiently help decrease pain and improve function but have not made a long term difference:
  • Contrast baths ...
Has any one exercise stood out in effectiveness?
Finger rolls have proved to be the most effective thing for improving my PIP swelling/pain, probably because they're non-aggravating (hard half crimp and full crimp aggravate mine the most) and they're good at remodeling the tissue with the open finger type of movement. What I've been doing is working up to 1-2 max hangs and then do finger rolls. Since I normally would've been doing 5-6 sets of max hangs or so, I just replaced the few max sets with the finger rolls so it's not a huge increase of volume and I still get the stimulus of having at least one max hang. Good results thus far and ha ...(more)
Where are you now in terms of progress?
At the moment, I'm down to fairly minimal aggravation when doing hard climbs to light soreness the next day (from very achy or painful when climbing hard + still feels aggravated to bend and open the next day). Still a bit limited PIP extension though. I'm also cutting my climbing down to extremely low volume, trying to maintain my strength, and do more open hand and finger roll stuff with full range of motion exercises to resolve it. Might take a couple months to get fully healthy I'm thinking though.
What recommendations do you have for climbers facing hand injuries?
I wrote a detailed blog post dedicated to just this subject, which you can read here: This is another useful resourced I'd recommend: Also, FWIW, if you do actually have synovitis, NSAIDs should help significantly because the anti-inflams will counteract the inflammation "-itis." If NSAIDs do not help, you do not have synovitis. If they help, that also does not mean you have synovitis but could mean you have it. Getting a di ...(more)