An Injured Climber – How to do a contrast bath

Alright, alright.   So I’m injured, or more exactly, I’m getting over being injured.  I hurt my finger in a competition at Planet Granite last November, and because it wasn’t bad, I kept climbing on it, thinking that I could climb my way through (pssst.. the Modern Language Association has changed rules allowing sentences to end with prepositions!  Cool! And, yes, I’m a dork.).  I mean, as long as I wasn’t re-hurting my finger, climbing should have just kept making it stronger, right?  But, no, it just kept getting worse.  It started aching all the time.  I would even wake up in the middle of the night from the throbbing in my knuckle.  I tried laying off the climbing for a while, but it didn’t help.  If anything my finger got worse.  I think it may have to do with the fact that I often spend 10+ hours typing for work (e.g., writing research articles), so even if I wasn’t climbing, I wasn’t really resting my fingers.  So I started trying to figure out every approach in the book besides rest that could help heal my finger.  I tried common climber remedies to no avail.  I tried Eastern medicine (acupuncture and herbs), because it has worked for acute injuries in the past. It didn’t work, however, this time.  So I changed things up and did something I have never done before:  I took my ass down to my peeps at Stanford to see a hand doctor and to start up hand therapy.   I’ve learned a bunch of amazing and sometimes surprising things from them, and I am going to share them in a series of blog posts here.

In this blog post, I want to talk about bathing your fingers in water.  Everyone asked me if I was icing my fingers when I was injured, but it really isn’t that simple.  There are multiple ways to bathe your fingers in water and they have different purposes and different levels of effectiveness.   So I am going to break it down here, give you the potential purpose, and my opinion of each approach.  More importantly, I will share with you how to do a contrast bath on your fingers – without a doubt the best therapy I have ever found for a finger injury.  Read on if you’re interested.

The primary reason people use ice baths, etc., is to decreased inflammation.  Inflammation leads to scarring, and further tightening of tendons.  Inflammation, except for in the period immediately after an injury, is bad.  The problem with my finger, according to the experts down in hand therapy, was that it was chronically inflamed (most likely if you have an injury, inflammation is also your problem). Hence, my major goal with the baths was to reduce the swelling, giving me both pain relief and also increasing the rate of healing in my fingers.

Other goals with water baths can be to increase blood flow or to increase heat, in the eastern sense, in the fingers.  I’ll get to that.

1.  Ice water.   Just soak your fingers in a bucket of ice water.   This seems to be a potential approach for dealing with swelling immediately after climbing – when the swelling/inflammation response is just starting and you want to nip it in the bud before it gets out of control.  To do it, simply soak your fingers in a bucket of cold water loaded with ice, and it will close the capillaries down.  This method is similar to that used after spraining an ankle (i.e, R.I.C.E.).

Review – I would only do this immediately after an injury.  It may be possible to use it immediately after a hard climbing session, but even then, I don’t think it compares to a contrast bath (see below).

2.  Hot water.  Soak your fingers in hot water.  This can be done to make aching/stiff fingers feel limber.  You can use it before exercise to get your hurt finger moving again.   I was also told to do this once by an acupuncturist because she had diagnosed me with a “heat deficiency.”  I’m still not really sure what that means, but I do know that my efforts to follow these instructions made my fingers hurt more than before.

Review.  If you have a chronically inflamed finger, do not use hot water on its own.  I think it makes fingers feel worse.  I would not even use it as a warm up, when you can use a contrast bath instead (coming up!).

3.    Cool water.  Put cold tap water and may 1 or 2, but no more, ice cubes into that water;  soak your hands for 25 minutes or so.  This is a technique popularized by the famous British climber, Dave MacLeod (he has a great blog on training, injuries, etc., that is worth checking out: http://onlineclimbingcoach.blogspot.com/).  I have had countless climbers recommend this technique to me.  Apparently, the aim of it is to increase blood flow in the fingers, because blood flow brings nutrition to the hurt tendons, thereby leading to increased recovery.  If I remember this correctly, the idea is that the cool water will initially close blood vessels, but that it will then open them up so that the finger doesn’t get to cold.  (Check out MacLeod’s blog for more details, if your interested.)

Review.  I recommend against using this technique for two reasons.  First, most people’s issue is probably with chronic inflammation, and if that is your problem, you don’t want to increase blood flow (if that is even what this technique accomplishes), but instead you want to reduce blood flow into the fingers.  Second, I have tried this technique a bunch over the years, and I have never noticed a thing!   It hasn’t helped me with pain relief, with recovery, or with healing an injury.  You may have a different experience, but in my opinion, it is a waste of time and good climbing skin.

4.  Contrast baths.  Baam! And we have arrived!  Contrast baths f’n’ rock.  I can’t recommend them enough.  I was taught how to do contrast baths in hand therapy, and everything explained here comes directly from those sessions.

To do it, first off, fill up two buckets, pots, whatever; one with hot water and one with cold water.  The hot water should be around 100 degrees or slightly warmer.  Although I like to get it hotter – basically hot enough that the first few times you dip your fingers into the water, you have to quickly pull them out because it is painfully hot.  Your fingers adjust to the heat quick, so they should be fine after those first few dips or after 30 seconds or so (if they aren’t, the water is probably too hot – don’t burn yourself!!).   The cold water doesn’t need to be that cold.  The difference in temperature between the two buckets of water must be 30 degrees. So, just use cold tap water – or maybe add in a handful of ice cubes (should make the ice water about 66 degrees or slightly cooler).  I like to make the difference in temperature a bit more extreme at the start so that the difference in the temperature remains over 30 degrees for the whole process, even as the cold water warms up and the hot water cools off.

Okay, so now that you have your two buckets of water, dip your fingers in the hot bucket for one minute, then into the cold bucket for another minute.  Continue like that, switching every minute, for 10 to 12 minutes.  Always start with the hot water and end with the cold water. And pay attention to the time.  It is much more effective if you switch on the minute (Stanford hand therapy also emphasizes the importance of this timing).  I feel like the end result is the most effective if my fingers tingle a lot throughout the contrast bath (if they aren’t tingling, usually it is because the difference in water temp is not large enough).  My hands tingle when I have done the contrast bath down in therapy, so that seems like a good thing to aim for.

If you do this only once per day, do it immediately before bed so that your fingers aren’t swollen through the night.  I often do it a couple/few times on days that I climb (at least, I do these days because I am still trying to fully recover from my injury).

Review – contrast baths are a life saver!  I plan on continuing to use them after my finger is fully healed, in part, because they dramatically help with recovery from climbing.  So much so, that I plan on using contrast baths even while on climbing trips, because, although you take a hit to your skin by soaking your fingers in water (albeit not a huge one), you recover much faster with a contrast bath.   Have a finger injury?  Try it.  In my opinion, forget about all the other types of baths out there (unless you are aiming for some other very specific effect).

Lastly, I would like to note that you should take all of this advice at your own risk. I would suggest that if you have a finger injury (and insurance), that you see a hand doctor and do hand therapy.  It is a cool experience!

Next up.. either some photos from my europe climbing trip or a video of hand exercises that I have been doing.

Anson