Finger Pulley Injuries

Fingers are our first contact point on the rock as we climb. There is an amazing amount of force being put on them. Usually this force is increased with the difficulty of a particular climb, unless you are climbing a chimney or tension corner. With so much force and use at play it is no surprise that we can hurt this crucial part of the body that connects us to the wall.

Trying hard on a V6 Photo: Chris Miller
Bouldering by nature puts a lot of force on the fingers  Photo: Chris Miller

Before understanding the injuries, prevention, and rehabilitation, it is important to understand the anatomy and basic function. Each finger except for the thumb is made of three different bones. These bones are connected together with soft tissue at the joints called ligaments. On the top and bottom there are also two sets of extensors and flexor tendons whose acting muscles originate in the forearm. These tendons are connected to the three bones by bands of tissue very similar to ligaments. These bands are what we call and understand as pulleys. When we flex and extend our fingers these pulleys keep the tendons tight in contact with the bone to maximize our mechanical function. It is also important to note that there are bursae sacs throughout these moving points that function to lubricate things as they move.

Basic finger and tendon anatomy
Basic finger and tendon anatomy

When we grab things with our fingers the flexor tendons and pulleys are put under stress to certain degrees. The type of hold we are using greatly affects the forces being put on these structures. It all comes down to angles and physics. An open handed hold can actually help the pulleys support tendons as you hold the hold, while a crimp puts a massive amount of strain on the pulley at the 2nd finger joint. This is mainly because there is an increased angle at the joint and the tendon wants to get pulled straight (see picture below). This puts a massive amount of stress on the pulley and results in the most common pulley type injury. The A2 pulley injury.

Significant load being put on the A2 pulley
Significant load being put on the A2 pulley

There are two ways that injuries to your pulleys and tendons start. It either a chronic injury or an acute. Acutes are sudden and are usually accompanied with a popping sensation while you are cranking on a hold, usually in the crimp position, or having your feet cut. These types of injuries are categorized in severity on a three degree scale. Grade 1: Minimal strain to the tissue, Grade 2: partial rupture or half tear of the pulley or tendon, Grade 3: a complete rupture of tear to the pulley or tendon. Grade 1’s tend to get better very fast where the other two will take as long as 4 weeks to months. In grade 3 tears you can actually have a deformity in the finger because the pulley isn’t attached to the bone anymore.

Typical deformity seen with pulley injuries. It can be caused by swelling, grade 2/3 injury, or combination of both
Typical deformity seen with A2 pulley injuries. It can be caused by swelling, grade 2/3 injury, or combination of both

With a chronic injury the onset will be slow and progressive, even if it suddenly gets worse it’s probably a chronic problem. Overuse, muscle imbalances, and lack of recovery time play a huge part in the progression.
It should be noted that the acute and chronic nature of these injuries have a tendency to be intertwined. For example a sudden acute grade 2 tear of your middle finger A2 pulley could have been brought on by climbing and stressing the tissue too much over the past week. The tissue couldn’t recover and it resulted in the pulley becoming weak and it caused your injury. In another example you got a nagging grade 2 pulley injury by climbing too much. Both injuries have the same cause, but start differently.
So let’s explore the causes of these injuries a bit more closely. The number one factor for us is going to be overuse. Did you know that the body needs 48-72 hours to fully recover following serious training sessions? I don’t know about you, but when I am super motivated to climb hard I push it hard every time I climb. Its important to remember this simple fact about body recovery. It is extremely easy to over train and not allow the body to recover. Ive noticed that my hardest redpoints have happened following periods of prolonged rest. At least 2-3 days since I had climbed last. This is probably because of the recovery period that happened. Its a close balancing act to manage your training and recovering time.

Raul Sauco on the redpoint of Air China 5.13d
Raul Sauco on the redpoint of Air China 5.13d

The second major factor is a muscle imbalance. Think about the amount of time we as climbers spend time holding onto things for dear life. Now how much time do we spend extending our fingers or wrists? Not nearly as much. For this reason we can get way out of balance and create an overactive muscle group. In this case, the finger flexors are called the agonist and the extensors are called antagonist. There becomes a point were the agonist muscle group can overpower the antagonists and muscle dysfunction can result. Simply put the extensor muscles in our arm cannot resist the forces our flexor muscle are creating and increases chance for injury.
Once we get an injury to our fingers it can be hard to get over the condition. So our best line of defense is to try to prevent these injuries from happening in the first place. Prevention is the key here. The following are guidelines that I follow to prevent tendon and pulley injuries.
Proper Warm Up: Be progressive with your climbing day. Don’t jump straight on your project unless you have warmed up those muscles and tendons. This doesn’t mean that you need to climb a bunch of easy routes before your redpoint, but just do something to get going. Do 5-10 minutes of cardiovascular activity and hang on a hangboard to get the blood flowing and tissue ready to be put under extreme forces.
Prevent muscle imbalances: those muscle imbalances by performing activities that counteract the squeezing motions we do while climbing. I simply do this with a rubber band. I put it around my fingers and work my finger extension a few times a week to counteract the flexing motions.

Starting position for finger extension exercise
Starting position for finger extension exercise
Ending position with the fingers extended. Hold for three seconds
Ending position with the fingers extended. Hold for 3-5 seconds, repeat 20-30 times for one set
Wrist extension exercise starting position
Wrist extension exercise starting position
Wrist extended with weighted object.
Wrist extended with weighted object. Hold for 3-5 seconds. Repeat 20-30 times for one set
Wrist rotation starting position
Wrist rotation starting position
Secondary postion wrist rotation exercise
Secondary position wrist rotation exercise
Wrist rotation starting position
Back to starting position
Third position wrist rotation exercise
Third position wrist rotation exercise and back to starting position. Repeat 20-30 times for one set

Hydration and Diet: Believe it or not hydration and diet plays a huge part in our overall function. Joints, tendons, and soft tissue move better with healthy hydration. So make sure you are eating a balanced diet and getting enough nutrients.
Stretching: Make sure you maintain a stretching program. Not only for your finger flexor muscles, but also throughout your body.
Limit your crimping: Being mindful of the holds you are using. Try to open hand holds rather than crimp technique.

Example of crimping a hold versus using an open hand technique. Which takes stress off the finger pulleys
Example of crimping a hold versus using an open hand technique. Which takes stress off the finger pulleys
Example of crimping a hold versus using an open hand technique. Which takes stress off the finger pulleys
Example of crimping a hold versus using an open hand technique. Which takes stress off the finger pulleys

Recovery time: We can be aware that we are training too hard and not allowing enough recovery time. Its okay to climb two days in a row and take a day off, but make sure you take 2-3 days off every cycle of 4 days of climbing to allow full recovery. And following days you push yourself to the maximum make sure you follow with at least two full rest days. Putting yourself in that 48-72 hour recovery range.
Note: Injury prevention is one of those things that is easy to forget. Its not until we are injured are we motivated to actually treat ourselves. With this in mind it’s important to remain sensitive to our bodies and function. If you feel like things are different, feeling weaker for any reason or whatever, it may be an indicator that you need to rest or try to do some balancing activities.
Basic Treatment Program
Lets say you get an injury, what do you do? It all depends on the type and severity of injury. With all types of injuries, first and foremost is rest. The amount of rest is based on severity. Whether the nature of your injury is sudden or a gradual onset you will need to rest until you have no pain. During that time you can ice. I have found that ice massage works very well. Simply freeze some water in a paper cup (or use a popsicle/icypole, I do this in rural China) and massage the region that hurts with the ice in direct contact with your skin. Do not exceed a duration of 10 minutes every hour.
Start climbing again when you have no pain. One really good test to see if you are ready is to make a fist, squeeze it tight, and note if you have any pain of restricted movement. If not you are ready to start climbing easy stuff again. Easy stuff is 5.5….not 5.10.
Be progressive as you return to activity. you may also want to a grip strengthening device to progress your strength. Keep in mind that if your injury is grade 2 or worse it could take 6 weeks to 6 months until you are pulling as hard as you want again. Some people with grade 3 strains have resolved to surgery to repair any deformities. Talk to a doctor if your injury is significant.

Take it as an opportunity to enjoy other aspects of climbing that aren’t just pulling hard. Climb easier grades and focus on technique.

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