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Rock Climbing Injuries: Finger Pulley Injuries

The nature of rock climbing assumes some level of risk and one can imagine there will be some injury involved. Thankfully acute injuries due to falls account for a very small percentage of rock climbing injuries in comparison to chronic overuse injuries. While these overuse injuries are less traumatic and less life threatening, they prove to hinder performance greatly and are potentially even more challenging injuries to overcome.

Rock climbers are prone to many overuse injuries, predominantly in their shoulders, elbows, forearms, hands and fingers. Hand and finger injuries are the most common rock climbing injuries, specifically finger pulley injuries. Approximately 26% of competitive climbers could be dealing with this injury at any given time.

What are Finger Pulleys?

Muscles originating in the forearm and elbow are responsible for flexing the fingers and gripping. Tendons branch off from these muscles in the forearm and run into five fibrous tunnels that act as pulleys on the palmar surface of each finger. This finger pulley system allows the flexor tendons in the finger to remain close to the phalanges (finger bones) throughout the range of motion. The second pulley, named A2, is the most important pulley and also the most often injured. The A2 pulley of the middle and ring finger is of most concern for climbers. These pulleys can be strained or torn.

How Do I Know if I've Injured a Pulley?

There may be an audible “pop” upon injury of the finger pulley, but this may not occur in every case. Local pain, swelling, and decreased movement or range of motion of that area will likely be present. These symptoms require a visit to your health care professional (Chiropractor or Sports Medicine Physician) to diagnose your injury, initiate treatment, and potentially refer you for diagnostic imaging.​

How Should it Be Treated?

A visit to your health care professional will allow for a diagnosis and appropriate treatment plan. The severity of the finger pulley injury (strain, partial tear, complete tear) will guide treatment. An example of a progressive recovery plan is shown below, starting with the most severe case. As you progress move to the next stage of care. Keep in mind that some people will move faster or slower through this plan than others

Complete Rupture (Grade III)

Immediately stop climbing. Apply ice for 15 min at a time. For the first 4-6 weeks do not climb but keep the finger moving by opening and closing the hand. Between week 2 and week 6, add light massage, warm hand baths, and pain free putty use. Throughout this stage, seek regular treatment of the supporting hand and forearm muscles and fascia. After week 6, go to grade II protocol.

Partial Rupture (Grade II)

No climbing in the first 2 weeks. Warm the hands with a water bath or electric blanket, squeeze putty if not painful. Repeat a few times per day. Begin to tape the finger in weeks 3-6 and climb the biggest handholds you can find. Climb easy! Squeeze firmer putty. Seak soft tissue treatment of supporting hand and forearm muscles and fascia. Go to grade I.

Sprain (Grade I)

Tape the injured finger and climb at a level well below your normal climbing abilities. Stretch forearm and seek soft tissue treatment. Use firm putty. Recovery will usually take 3-8 weeks. Reinjury is likely if attempting to push beyond capabilities and may result in a chronic injury.​

Treatment Modalities and Manual Therapy

Manual therapy and similar techniques should be used in conjunction with self-care for all three grades of pulley injury to optimize soft tissue mechanics in the fingers and hand as well as promote improved neurological function.

Active Release Technique

A soft tissue technique in which the practitioners hands are used to separate soft tissue structures that have adhered together preventing ideal motion. Breaking down new and long standing scar tissue helps relative motion between tissue.

Medical Acupuncture

Resolves neurological tension in muscles of the hand, forearm, and shoulder by treating peripheral nerves.

Fascial Abrasion Tool

Loosens superficial fascial restrictions.


Local taping of the pulley will dissipate forces through the area. Regional taping will optimize mechanics in the upper back, shoulder, elbow and wrist.

How Can You Prevent Climbing Injuries

1. Don’t climb in pain! 2. Warm up 3. Vary the intensity and duration in which you are climbing 4. Do not attempt climbs far beyond your capabilities 5. Mix up the types of holds you are using 6. Seek regular Performance Care involving manual therapy

Happy Climbing

Dr. Trevor Vander Doelen

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