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    Jun 20266 min
    Eder Lomba, online climbing coach — Finger Pulley Injuries in Climbing: What They Are and What to Do

    Finger Pulley Injuries in Climbing: What They Are and What to Do

    A cracked or strained pulley is climbing's most common injury. Learn the grading system, early warning signs, and a coaching approach to smart recovery.

    The most common climbing injury by a large margin are pulley injuries in climbers. We have all heard the scary tale of a friend, one day climbing, presumably everything was okay and Tlack, a noise that crosses distance to horrify belayers, spotters... or we all know that climber who ignores the early signs, and gets away with it. Many athletes I have worked with have climbed on a pulley injury for weeks before they have even reported it to me as they weren't even sure there was something wrong with it, just some very mild discomfort. Okay here is a top tip, any mild discomfort should always be reported to your coach. And if you don't have a coach, hire me hahaha no, get a notebook and write it down, scale the discomfort on a scale 1-10 and keep track of it over the next few days or until it disappears. Over time you will have a curve you can use to learn about what is making these discomforts worse, or better. This is gold.

    This is what you need to know, from a coaching perspective not a clinical one. If you think you have a pulley injury, get it properly assessed by a professional. I know it might be a little disappointing to hear this. Trust me, I was once as well googling this myself, with the world crumbling around me looking for answers, a magic recipe… there isn't one. Luckily for me the pain went away in a couple of days. But this might not be your case so let's go ahead and explore your options together, you have this, and in the large scheme of things honestly a pulley injury is not the end of the world. Before anything else I'm sorry you are here, and I'm also sorry I won't be able to give you a full diagnosis. But what I can give you right now is what I have seen, and what the research tells us. Bear in mind this is simply my own interpretation of the current research available, research I looked at and mixed with my own reflections and experiences on the matter, please don't take my word as final.

    What is a pulley injury?

    Pulleys are small tunnels of fibre that hold your flexor tendons close to the bone. They act as guides that allow your fingers to generate force efficiently. There are five annular pulleys in each finger. In climbing the A2 pulley sits under the greatest mechanical load, making it the most commonly injured pulley in climbers, followed by A4. The ring finger is the most frequently affected, followed by the middle finger.

    Bla bla bla right? They are thin connective tissue that keep your tendon close to the bone along the length of your fingers, maintaining the mechanical efficiency of force transfer to the fingertips. Without them the tendon bows away from the bone and you lose a considerable amount of the force that would otherwise get to the fingertips. (Annoying grumpy tissue)

    How does it happen?

    Crimping. Specifically full crimping, where your middle finger joint is bent at roughly 90 degrees while your fingertip is hyperextended. That grip puts massive stress on the A2 pulley. Research has shown the load on the A2 pulley while full crimping is approximately 3 to 4 times the force you are applying at your fingertip. On a small hold, under fatigue, that number is not comfortable to digest.

    And here is something most people do not know, and the research makes it very clear. It is often not while you are boning down on a crimp that the pulley goes. It is when your grip starts to give way. When a foot slips, when fatigue comes to visit and the finger begins to open under load. The pulley is most vulnerable not at peak effort, but at the moment it starts to lose the fight.

    Fatigue and sudden spikes in training load relative to what the tissue is conditioned to handle are the clearest risk factors in probably all the research. Bouldering shows up more often as associated with higher injury rates than sport climbing or trad climbing. But by all means I am definitely not trying to imply that intensity is the issue here. It is the combination of intensity, volume, fatigue and how quickly you step up your training relative to what your tissue can actually handle. Any one of those alone is manageable. All of them together, without awareness, is where things tend to go west.

    The grading system

    Just some general education here. I do think this is relatively interesting and important to understand.

    Schöffl's grading system is the most widely used in climbing medicine:

    Grade 1: strain, no structural damage. (No massive deal if well managed)

    Grade 2: complete rupture of A4, or partial rupture of A2 or A3. (In my experience these tend to be annoying for a while, but you will be fine and come back stronger. Just make sure you manage them properly)

    Grade 3: complete rupture of A2 or A3. (Honestly not the end of the world just make sure you manage them properly)

    Grade 4: This one is the most serious. It involves either multiple pulley ruptures at the same time or damage to surrounding structures like the lumbrical muscles or collateral ligaments. At this grade you may actually see your tendon bow outward under the skin of your finger. If you do, stop climbing and get it assessed by a professional immediately. This grade often requires surgery and a longer, more thorough rehab process. I know this might feel like a weight dropping on you, and I am genuinely sorry if you are here reading this right now. But injuries at this level, as serious as they are, do not end climbing careers. People get back to climbing hard, and some get back to climbing very hard. There are excellent professionals who deal with these injuries every day and know exactly what they are doing. You are not alone in this and you will climb again.

    Grade 1 and 2 are the most common, grade 3 and 4 are serious. And you probably need professional assessment, as it can be hard to tell what is exactly going on.

    There is so much you can do for your climbing while you are recovering from a pulley injury, I have countless examples of athletes, friends that have overcome them within a few weeks or months and got to climb harder than ever shortly after, this is not a cliche comment. This is concrete, this is facts.

    Track your pain, manage your volume and intensities. Be sensible, be smart, you will be out of it in no time.

    What does it feel like?

    • Pain localised at the base of the finger for A2 and for A4 injuries the pain may sit further up toward the middle of the finger on the palm side
    • Pain when crimping or applying pressure to the area
    • Sometimes a pop at the moment of injury, sometimes nothing at all
    • Localised swelling around the finger, the location depends on which pulley is affected
    • Weakness when loading the finger
    • Pain and stiffness that lingers after climbing
    • Loss of range of movement

    These signs unfortunately also overlap with other injuries. The only certain way to get a proper diagnosis is through imaging, which will give you a clear picture of what is going on. Ultrasound is the most common diagnostic tool. If the ultrasound assessment is inconclusive you might get referred for an MRI. Ideally you want a physio who understands climbing and what it means to you, not just what is wrong with your finger. Someone who gets it. The difference in the quality of care and how supported you feel through the process can be significant and key to tackle rehab with motivation and hope.

    What I do if I think an athlete has a pulley injury

    This will depend very much on the specific case I am dealing with. Did we hear a Tlack? Is it just a very mild discomfort? Does your tendon bow? It just hurts quite a bit before climbing and it goes away?

    I would probably ask them to get it properly assessed, so I can get a good idea of what we are dealing with here.

    Each of the 4 grades of pulley injuries deserve a different rehab plan, and a different recovery time bracket. There are options, they will be fixed, it will be annoying, but you will be fine.

    Your options

    Grade 1, 2 and 3: The rehab approach I use follows broadly the same principles. The difference is the timeline, how much climbing you need to step back from, and how quickly you can progress loading your fingers again. And that depends on two things: the grade of the injury and which pulley is affected. An A2 injury at grade 2 will generally take longer than an A4 at grade 2. There is no universal timeline I can give you here because it genuinely varies that much from person to person.

    Stepping back from climbing loads does not necessarily mean stopping climbing completely, in specific cases climbers can still climb at a high level with an injured finger and still within the recovery bracket. What I mean is that this can actually become a great time to step up your general strength training, but please be mindful of the stress going through your fingers in everything you do. A heavy deadlift adds considerable load to your finger so you might want to use straps or hooks. Be realistic about your recovery capabilities, and learn to listen to your body.

    Progressive loading is key, in the gym and for your fingers, start conservative and build slowly. The fingerboard is a well established rehab tool here, and controlled loading protocols using it have been part of climbing injury rehab for years. Keep tracking your pain on your 1 to 10 scale every day, when you wake up and before going to bed. That data will tell you more than anything else about how you are progressing and what is actually helping or upsetting your finger.

    Grade 4: Leave this one to your doctor to assess carefully before doing anything else.

    What not to do

    • Don't ignore it
    • Don't tape it and assume that is treatment
    • Don't assume it is fine because you can still climb
    • Don't climb through pain without a plan

    What about warm up?

    You might have made it all the way to the bottom of this article looking for the perfect warm up protocol. The one specific routine that will fix everything and make sure this never happens again. I get asked this all the time.

    Here is the honest answer. Warm up has been widely recommended in coaching since forever. But the research on whether it actually prevents injury is genuinely mixed. The only systematic review specific to climbing, which analysed 34 studies, found very limited evidence for a clear relationship between warm up and injury prevention. Across other sports the picture is equally unclear, with some studies finding a benefit and others finding none.

    I always think of warm up as something you do to psychologically and physically feel activated and ready to go. Not something you do to be able to tolerate what you are going to do in the session. That tolerance is something you build over hundreds of sessions before this one. Not because of the perfect warm up routine. Keep it simple and effective.

    Manage your load. Track your pain. Progress smart. Listen to your body. That is the protocol. That is how you fight injury.

    Frequently Asked Questions About Finger Pulley Injuries

    How do I know if I have a pulley injury or something else?

    Honestly you probably can't know for certain without imaging. The symptoms overlap with other finger injuries. Localised pain on the palm side of the finger, pain when loading the finger, swelling around the joint, these are the classic signs but they are not exclusive to pulleys. Get it assessed. That is the only way to actually know what you are dealing with.

    Can I keep climbing with a pulley injury?

    In my experience, Yes, depending on the grade. Stepping back from climbing loads does not necessarily mean stopping completely. But climbing through pain without a plan is not smart, managed loading. And you probably want to know what you have before you decide what you can do with it.

    How long does a pulley injury take to heal?

    It genuinely varies that much from person to person that I can't give you a universal timeline. Grade 1 and 2 are usually weeks, but some people carry them for a couple months. Grade 3 is longer. Grade 4 is a different conversation entirely. Which pulley is affected matters too. An A2 at grade 2 will generally take longer than an A4 at the same grade. Track your pain daily and let that data guide you.

    Does taping actually help?

    Taping can provide some mechanical support and may help with pain management, but the research on whether it changes outcomes is genuinely unclear. Do not tape it and assume that is treatment. It is not a substitute for managing load, progressive rehab, and understanding what is going on.

    References