Finger pulley injuries Finger pulley tears are now more common than any other in rock climbing, yet few climbers know much about how to treat or even avoid pulley tears. After trawling the scientific and climbing literature on the issue (not to mention treating my own injuries!), I realised there was plenty of knowledge out there… Definitions and Diagnoses
There are two tendons which flex your fingers and are tensioned while you pull on holds. The tendons are held in place by the flexor pulley system; a series of ligamentous bands stretching over the tendons, along the length of the fingers. The pulleys withstand astonishing forces, especially during crimping. If these forces are high enough or if there is a sudden additional loading, they can and do tear. The severity of the tears can range from partial tears of isolated pulleys to complete rupture of several pulleys! Often there is an audible popping noise if a pulley ruptures, (remember you might not hear this if you are concentrating on the job in hand!). Later there may be visible bowstringing, where the tendons can be seen to bulge in the finger when you flex it against resistance. This might not be obvious if the finger is too swollen and painful to examine. If you suspect a rupture, you MUST try to see a specialist to have a scan (ultrasound, MRI or CT) and receive expert advice. Complete rupture may require splinting and/or surgery to repair and ignoring the problem can lead to further tears, permanent loss of ability to bend the finger and arthritis. Partial tears of isolated pulleys are much more common and heal remarkably well compared to certain other ligament injuries. You might feel a sudden twinge of pain in the affected finger (and possibly a small pop). However, it is possible not to notice the injury at all during the climb or session. There might be localised pain and tenderness over the area the next morning or the next time you climb. The most commonly injured pulley is A2, which is near the base of your finger. A1 or A5 tears almost never occur. If you have a pulley injury, and the acute inflammation is not too bad, it should still be possible to pull on holds with a fully open-handed grip without pain. If the pain becomes much worse during or after crimping, this indicates a pulley injury. Another common finger injury is flexor unit strain. These are tendon strains which often occur in the ring finger when using two or three finger, open handed holds. Unpleasant twinges of pain are felt along the length of the tendon through the finger and palm. For this injury, follow the treatments below and avoid gripping positions which irritate it. Preventing pulley tears If you have a history of repeated finger injuries, or even if you just want to protect against ever getting one, you must look at your climbing and lifestyle. Tears are most often caused when you are pulling hard on a crimp and your feet slip off, placing a sudden additional load on the pulleys. To avoid injuries in general, you must try to be in control of your movement as much as possible. This is a difficult and multifaceted skill to learn! An important thing to understand is that it is possible to stretch your abilities to the absolute limit, pull with 110% and climb explosively, yet still be ‘in control’. The goal is to be more aware of what your body is doing and how it moves. In this way you can predict what it will do before it happens. If you can improve this skill you will not only prevent injury but climb better too! Try to feel how your feet are positioned on each foothold, feel the traction. If you can do this then you will be ready if they slip.
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The first problem is deciding what your injury is! Most of us can’t afford to pay for specialist sports injury consultations or therapy and it’s safe to say that your GP alone is unlikely to provide an accurate diagnosis or strategies for repair of this extremely sport specific injury. 