Finger or flexor pulley injuries are one of the most common climbing injuries both in the gym and outdoors. You might have heard terms like ‘A2 pulley’ or ‘pulley injury’ thrown around but not many people fully understand what the injury is.
In this article, we’re going to cover everything you need to know about finger pulley injuries, including:
What Are Finger Pulleys?
A flexor or finger pulley is the name given for the annular (ring-shaped) connective tissue that keeps your finger tendons close to the bone. Depending on where they are in the finger depends on what they are called.
As seen below, we have five pulleys in each finger called A1, A2, A3, A4, A5. The tendons passing through them attach the muscles in your forearm to the bones in your finger.
In climbing, because each finger has three bones and three joints, each pulley is put under a different amount of stress depending on how you’re gripping the wall.
What Is an A2 Injury?
You’ve likely only heard of A2 (maybe A3) injuries because they are the most commonly injured. When the first finger joint is flexed past 90 degrees (seen below), there is 3–4 times more stress on the A2 pulley than at the fingertip. When the A2 pulley cannot bear the stress, you may hear and feel a pop as the tissue is sprained or torn.
How to Diagnose a Pulley Injury
They can be difficult to diagnose alone and we therefore strongly advise you to seek a medical professional’s assessment to help you grade the severity of your pulley injury. This can be done via an ultrasonography scan.
Severity is graded on a scale of 1-4 (1 being the least severe to 4 being the most severe):
Grade 1 – pulley sprain
Grade 2 – complete rupture of A4 or partial rupture of A2 or A3
Grade 3 – complete rupture of A2 or A3
Grade 4 – multiple ruptures as in A2/A3, A2/A3/A4, OR single rupture A2/A3 WITH trauma to the lumbrical muscles or other ligaments
As a rough guide, a grade 1 sprain describes a stretch or partial tear to the pulley, whereas a grade 2-4 rupture describes a complete tear of the pulley.
In both instances, your finger will have the following symptoms:
- swelling and inflammation
- be painful to grip or crimp a hold
- tenderness along the pulley when pressed.4
How to Rehab a Pulley Injury
The good news is that not all injuries need surgery.
Invasive repair is now seen as a last resort and even then, usually only considered if you’ve ruptured multiple pulleys at the same time. However, this will largely depend on the severity of your injury.
How to Tape a Pulley Injury: H-Taping
Healing Time (When Can I Climb Again)?
The honest answer: everybody heals differently, so this can vary – a Physiotherapist can help you with this decision though.
Once you have the go-ahead, generally speaking, climbers being treated conservatively (no surgery involved) can expect to follow a progressive rehabilitation programme outlined below. As you can see, supportive tapping will play an important role in your recovery.
Image property of Will Anglin5
How to Prevent Pulley Injuries
- The key is to respect how you’re feeling. Warm-up, begin with easy routes, don’t push through the pain, and stop for rest after 2-3 attempts.
- Technique is important. Climbing with smooth, precise whole body moments can put less strain on your fingers. For example, you can try open hand crimps. They may feel awkward or like you might slip but practice makes perfect.
- Book an appointment with a physiotherapist or sports therapist who can analyse your climbing and create a training programme to offload your finger pulleys as you climb.
If It Happened Today, What Should You Do?
- First, you will need a diagnosis. For this either call 111, attend a minor injuries unit, or go to your local A&E.
- Second, you will need to get control of that swelling. Ice and compression are good ways to do this.
- Once you are happy the bone is ok, and other pathologies have been ruled out by a professional, gentle movements of the finger can help to get back its range of motion.
- Do not load it until advised to. Speak with a physiotherapist for help around this.
- Research suggests grade 1-3 pulley injuries can often be managed without surgery but you will need an assessment to help decide this.
- Grade diagnosis can help determine your progression of rehab and off the wall duration.
- Ruptured pulleys do not grow back but with time, the resilience of the others can leave you with the same finger strength as you had before (Tommy Caldwell can do it with part of his finger missing!).
- It may take up to a year to climb at full capacity but you can still climb in that time when you get the go-ahead from a professional.5
- Grade 4 injuries will likely need surgery but do have good recovery success rates.
DISCLAIMER: All content within this column is provided for general information only and should not substitute for the medical advice of your own doctor or any other health care professional. S57 Health & Wellbeing Clinic is not responsible or liable for any diagnosis made by a user based on the content of this site.