How to Diagnose and Rehab a Finger Pulley Injury

A pulley injury is the most common injury in rock climbers, accounting for over 40% percent of all climbing injuries. You know the feeling exactly when it happens. Maybe you are tired and are crimping down on a crux move. You try one last go on your project and then…you hear the dreaded pop. But lucky for you, there’s a straightforward way to diagnose, classify, and start a rehabilitation program with research-based timelines. In the article below, I’ll be taking you step-by-step through the process.

What is a finger pulley and why is it important for climbing?

Watch the video below to learn more about the anatomy, biomechanics, and research related to pulley injuries. This will give you a strong foundation of understanding so that you can determine the correct path to rehabilitate the injury.

Diagnosis

One of the most important steps after a pulley injury is to have it properly diagnosed. There are two ways to go about this. If you have access to a practitioner who uses diagnostic ultrasound, they can grade the injury based on the degree of tendon bowstring – which is the distance of the pulley tendon from the bone.

Lutter and colleagues have revised the criteria to grade pulley injuries based on diagnostic ultrasound. As you can see in the table below, pulley injuries are graded, based on ultrasound evidence, as Grade I, II, III, IVa, or IVb.

If you do not have access to diagnostic ultrasound, not to worry. Cooper and colleagues have developed a clinical criterion that you, or a medical provider can use, to grade the severity of a pulley injury. This includes how much pain you have during the day, pain while climbing, range of motion, strength, and pressure sensitivity.

This criterion allows you to clinically grade the injury as mild, moderate, or severe. You can see the criteria in the table below:

Once you have identified the timeline, you can then follow a progressive framework to return back to full health. To do this, you can follow the rock rehab pyramid from the book “Climb Injury-Free.”

This pyramid takes you through the four phases of rehabilitating a pulley injury: unloading the tissues, increasing mobility, improving strength, and returning back to climbing movement. Watch the video below, to learn how to utilize the rock rehab pyramid to rehabilitate your pulley injury.

Happy sending!

Hopefully this article will help you understand how to diagnose and classify a pulley injury. Once diagnosed you can use the timelines to know when to load the finger and when to return to climbing based on the most current available research. You can then use the Rock Rehab Pyramid as a framework to rehabilitate your finger injury. It is always recommended that you see a medical provider to help guide you through the process.

References

• Schöffl, V., Popp, D., Küpper, T. and Schöffl, I. (2015). Injury Trends in Rock Climbers: Evaluation of a Case Series of 911 Injuries Between 2009 and 2012. Wilderness & Environmental Medicine, 26(1), pp.62-67.
• Lutter, C., Tischer, T., & Schöffl, V. R. (2021). Olympic competition climbing: the beginning of a new era—a narrative review. British Journal of Sports Medicine, 55(15), 857-864.
• Cooper, C., & LaStayo, P. (2019). A potential classification schema and management approach for individuals with A2 flexor pulley strain. Journal of hand therapy: official journal of the American Society of Hand Therapists.
• Schneeberger, M., & Schweizer, A. (2016). Pulley ruptures in rock climbers: outcome of conservative treatment with the pulley-protection splint—a series of 47 cases. Wilderness & environmental medicine, 27(2), 211-218.
• Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34:217-223.
• Roloff, I., Schöffl, V. R., Vigouroux, L., & Quaine, F. (2006). Biomechanical model for the determination of the forces acting on the finger pulley system. Journal of biomechanics, 39(5), 915-923.
• Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217–23
• Doyle JR. Palmar and digital flexor tendon pulleys. Clin Orthop Relat Res. 2001;383:84–96.
• Chow JC, Sensinger J, McNeal D, Chow B, Amirouche F, Gonzalez M. Importance of proximal A2 and A4 pulleys to maintaining kinematics in the hand: a biomechanical study. Hand (NY). 2014;9(1):105–11.
• Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech. 2001;34(2):217–23.
• Vigouroux, L., Quaine, F., Labarre-Vila, A., & Moutet, F. (2006). Estimation of finger muscle tendon tensions and pulley forces during specific sport-climbing grip techniques. Journal of biomechanics, 39(14), 2583-2592.
• Vigouroux, L., Quaine, F., Paclet, F., Colloud, F., & Moutet, F. (2008). Middle and ring fingers are more exposed to pulley rupture than index and little during sport-climbing: a biomechanical explanation. Clinical biomechanics, 23(5), 562-570.

Take the Next Step

If you’re interested in following a research-based rehabilitation protocol for your pulley injury, there’s one available on the trainingbeta site. More information below:

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