PIP and DIP Joint Synovitis in Rock Climbers – I’m calling you out!
Every year, countless climbers take unnecessary breaks from climbing. Tears fill their eyes as they sit on their couch, watching climbing youtube videos, hoping that their joints will heal.
But now there’s something you can do. For only a few cents per day. Only a few little pennies, you can support a climber in need. No more tears. No more suffering. No more days sitting at home when there are perfect conditions for sending.
Or… read up and get your shit together.
At Rock Rehab, finger joint synovitis is one of the most common things we see with climbers. This condition can be very difficult to manage without professional help. And, to be real with you, most of the pain and swelling is self inflicted. Many climbing injuries have a clear mechanism and a clear path of recovery. Finger joint synovitis tends to be caused by repetitive stress, training errors, and, most commonly, an unwillingness to make significant changes to how you’re climbing or training.
Synovitis is not going to go away unless you make some changes to the amount you’re climbing, to the way you’re training, or to your technique. The longer you put off taking care of this, the longer the recovery process is going to be. We’ve seen some pretty bad cases but full recovery is almost always possible. At Rock Rehab, we don’t judge people for being too psyched and delaying treatment. But we will be honest with you about what is best and realistic for you to achieve your climbing goals.
It’s only in severe circumstances that you’ll need to completely stop climbing. Treatment for synovitis most commonly involves dialing down your climbing volume, but not down to zero.
If you’re looking for a resource that tells you that “you don’t have to change your training plan and can still climb as hard as you want while healing your synovitis”... keep looking. I’m sure there are plenty of articles out there that will tell you what you want to hear.
For the rest of us who actually want to get this shit taken care of… keep reading.
What Is Interphalangeal Joint Synovitis?
Interphalangeal joint synovitis is inflammation of the synovial membrane that lines the finger joints. The synovium normally produces fluid that lubricates and nourishes the joint. When this membrane becomes irritated or inflamed – often due to repetitive stress from climbing – it can produce excess fluid, causing swelling, pain, and limited mobility in the affected joint.
In climbers, this condition typically affects the PIP joints (the middle knuckles) and DIP joints (the end knuckles) of the fingers, with the middle and ring fingers being most commonly affected.
Prevalence in Climbers
It’s common. Chances are that if it isn’t happening to you, it’s happening to someone you know. According to a study published in the Journal of Sports Medicine, finger injuries account for approximately 25-40% of all climbing-related injuries, with synovitis representing about 20-30% of these finger issues.
A survey conducted across several climbing gyms found that nearly 60% of advanced climbers (climbing V5/5.12 and above) reported experiencing symptoms consistent with finger joint synovitis at some point in their climbing career.
Synovitis tends to be more prevalent in:
Boulderers (due to higher intensity crimping)
Sport climbers working at their limit
Climbers with more than 5 years of experience
Those who regularly climb 3+ times per week
Sound familiar? If you feel called-out, it’s because you are. But just chill. None of these mean you are CERTAIN TO develop synovitis.
At Rock Rehab we strongly believe that you can climb your hardest for a long time as long as you’re being smart about training, are doing the right injury prevention program, and have the right guidance from a PT who knows their shit about climbing.
How Physical Therapists Diagnose Synovitis
Suspect you might have finger joint synovitis? When you visit one of our rock climbing specialist physical therapist at Rock Rehab, the diagnostic process typically includes:
Detailed History: Your PT will ask about your climbing volume, style, recent changes in training, and the specific finger positions that cause pain.
Physical Examination: Key diagnostic indicators include:
Visible swelling around the PIP or DIP joint
Tenderness with palpation directly over the joint (as opposed to the areas where pulleys are located)
Pain with compression on the joint
Decreased range of motion
Feeling of stiffness, especially in the morning, especially the morning after a climbing session
Differential Diagnosis: Your PT will need to rule out other common finger conditions, including:
Pulley sprains
Collateral ligament sprains
Tenosynovitis (inflammation of the tendon sheath)
Climbing-Specific Testing: Your PT will ask you to demonstrate different grip positions to identify which ones provoke symptoms. Small crimps, finger buckets, and jugs are the most common hold types that will cause synovitis. But any hold type can be contributing to your symptoms if you’re using poor technique and have weakness in your fingers or upper body.
The hallmark sign that often distinguishes synovitis from other finger injuries is pain primarily with joint compression rather than with resistance to finger flexion (which would suggest a pulley issue).
Treatment Approaches
Effective management of interphalangeal joint synovitis typically requires a comprehensive but straight-forward approach:
Calm shit down
Build shit up
Phase 1: Calm Shit Down
This phase focuses on reducing pain, controlling inflammation, and improving mobility:
Relative Rest: Reduce or modify climbing to avoid painful grip positions and hold types
Ice or heat: 10-15 minutes 2-3 times daily to reduce pain. Pick whichever helps the pain and stiffness the most.
Taping: Specific joint support taping techniques, such as H-taping, can sometimes help to reduce pain while climbing. Try it. If it works, keep using it while you calm shit down.
Gentle Range of Motion: To prevent stiffness without aggravating the condition
Joint Mobilizations: Gentle manual therapy techniques to improve joint mobility
Phase 2: Build Shit Up
Once pain and inflammation are under control, focus shifts to strengthening and return to climbing:
Progressive Loading: Carefully structured finger strengthening with attention to load management
Technique Modifications: It will be helpful to assess how you’re crimping or pinching, then making changes to your technique to reduce joint irritation and optimize performance.
Graded Exposure: Progressive reintroduction to climbing, starting with easier grades and more joint-friendly hold types such as open crimping, slopers, and larger jugs. Then progressing to using smaller holds, full crimping, finger buckets, and pockets.
Volume Management: Careful tracking of climbing volume to avoid re-aggravation
The key factors affecting return timeline include:
Severity of initial inflammation
How early treatment was sought
Adherence to rehabilitation protocols
Individual healing factors
Previous history of finger issues
Prevention Strategies
To reduce the risk of developing synovitis:
Implement proper warm-up protocols before hard climbing
Gradually increase climbing volume and intensity (no more than 20% per week)
Vary climbing styles to avoid overuse of specific grip positions
Strengthen antagonist (finger extensor) muscles
Maintain good finger mobility when not climbing
Consider regular "deload" weeks in your training cycle
When to Seek Professional Help
While mild synovitis might resolve with self-management, consult a climbing-savvy physical therapist if:
Pain persists beyond 2-3 weeks
Swelling is significant or worsening
Range of motion becomes increasingly limited
The condition interferes with daily activities
You're unsure about safe return to climbing protocols
Remember that early intervention leads to faster recovery and reduced risk of chronic issues. A physical therapist who understands the demands of climbing will be your number one homie, like that friend who is always down to belay you, however cold or windy it is. We’ll get you back on the wall safely and efficiently.
If you’re one of those people with swollen finger joints that you’ve been avoiding taking care of for months… Props to you for reading the whole article. Now, are you ready to make a change? 6 months from now, you will thank yourself.
At Rock Rehab, we don’t judge people for delaying treatment. But we will be honest with you about what is best and realistic for you to achieve your climbing goals. Come see for yourself by scheduling an appointment in Santa Fe, New Mexico.
