Tendon Pulley Injuries
I have had a number of tendon pulley injuries in the last few years. I suspect that I am just rather prone to this type of injury but I have a number of other climbing friends who have suffered from similar injuries over the years and, judging by the amount of strapped fingers I see out at the crag and down the wall, I suspect that most climbers, operating from the middle grades upward, experience these injuries at some point in their climbing careers. I thought that other climbers might be interested in my experiences and my current strategy for coping with these injuries and promoting their recovery.
I would think that most climbers are aware that fingers are bent mainly by muscles located in the forearm. Each finger is attached to the muscle that bends it by a tendon, which is a long, tough fibre that runs from the muscle, through the wrist, up inside the palm of the hand, and along the finger. Where this tendon runs along the finger it goes through a tunnel of fibre. At several places this tunnel is quite thick; these are the tendon pulleys. They stop the tendon ‘bowstringing’ away from the bones of the finger when it is bent. Climbing puts large stresses on the tendon pulleys. Research suggests that they can become injured through accumulated micro-trauma (an overuse injury) or can partially or completely tear as the result of a single incident of unusually high stress.
For all my injuries I can pinpoint the route, and in most cases the move, on which it occurred, although the symptoms only became noticeable after finishing the route or boulder problem (no sudden popping or cracking sounds). I would describe it as a dull ache at the relevant finger joint – it is not a sharp pain at all. The distinguishing symptom for me is that if I press on the joint or a point slightly towards the finger-end from the joint, the ache becomes very obvious – it feels much like some sort of bruise.
The problem with these injuries is how best to achieve long-term recovery. An ordinary physio will almost certainly suggest that the finger should be rested until it no longer hurts at all when you press on the joint, and then you should start very low levels of activity, gradually building up to normal climbing but immediately backing right off at the slightest sign of pain. Well, bugger that! My experience suggests that this would involve many months before getting back on hard routes. Not only is that just out of the question on grounds of terminal frustration, but I have found that actually my tendon pulley injuries only fully recover when I do climb hard on them. I don’t fully understand why, and it might not work for other people, but the first tendon pulley injuries I had dragged on for months whilst I tried not to over-stress them, and then finally cleared up when I gave up on ever recovering fully and just climbed normally again. Two more recent injuries both responded well to my new strategy and both fully recovered in less than six weeks despite sport climbing in Thailand and pushing both my on-sight and redpoint grades.
This is my current theory on the best treatment but I have to stress very strongly that I have only my own experience to draw from. It might not work for other people, and it might not work on injuries that are more severe than mine.
- I stop climbing as soon as possible after the injury.
- I apply ice if I have any and strap the joint immediately. I use tape strips about 1 cm wide, wrapped around the finger several times. I strap right into the point where the joint bends and go as tight as I can without the finger discolouring.
- I stop climbing for about a week or so and keep the joint strapped during the day. The pain largely disappears in this time.
- I start climbing again (always with the joint strapped) after a week or so, taking it easy for the first few days out, - it's a good chance to do some more exploratory trad. climbing - and then just carry on climbing as before but maybe with a few more rest days than normal. I still boulder and climb at the wall but would back off on any plans to intensify my training.
- The injury starts hurting again as soon as I start climbing on it but I can never feel it when I’m actually climbing, only when I press on the joint afterwards.
- I would stop if I could feel the injury whilst actually climbing but this has only happened to me once.
- I would also stop if the injury seemed to be getting worse with each climbing session but I have found it to remain fairly stable, the “pain when pressed” reducing if I go for a few days without climbing. After a time the “pain when pressed” after a climbing session starts getting less and fades more and more quickly. This is when I feel really good because I know the injury is recovering.
- I think it is a good idea to massage the injury site to break up any scar tissue. I have a small, hard lump on two of my old injury sites that I think I might have avoided. Consensus seems to be that massage should be along the length of the finger.
- I keep strapping the joint for climbing until well after all pain is a distant memory then start to reduce the strapping – keeping it only for hard days – and eventually stop altogether so the tendon pulley doesn’t become dependent on the strapping. It takes me at least three months after the pain has gone before I stop strapping completely. There has been some published research suggesting that strapping is ineffective in supporting the pulley but I thought the argument presented was flawed - I'm certainly going to keep using tape.
- I have only re-injured a tendon pulley once. Ironically on a mixed route on The Ben – no strapping, cold hands, I guess. Apart from that I have not injured the same tendon pulley twice, so maybe they end up stronger than before.
Of course prevention would be better than cure so here are my thoughts on how I might avoid too many more of these injuries.
I reckon that all my injuries have been the result of pulling really hard when my fingers were in a weak position. I have always been much stronger on closed crimps than when using open crimp or extended grip positions, but you can’t use a closed crimp in pockets. I think it is really significant that three of my injuries have occurred using pockets, two of these whilst making powerful reaches from underclings. Two more were from open crimp side-pulls, and the other also occurred using an open crimp position. I think that these less-used (by me) positions make use of muscles that are quite strong, but place stress on connecting tissue that is not sufficiently well-developed. Over this winter I intend to try to make greater use of open crimp and extended grip positions at the wall, without pulling too fiercely on them. The purpose of this is to train my tendon pulleys to cope with all finger positions. I will try to spend more time on pockets as well (although ironically walls don’t have many because of their tendency to cause injuries), again without pulling down too hard.
At the crag I will also be even more rigorous about warming up, but several of my injuries occurred well into climbing sessions in warm weather so I’m not sure that this offers much protection. It is definitely good to back off unexpectedly fingery warm up routes though.
I found a few websites with some interesting material on finger injuries:
I think Dave MacLeod's book is probably as good if not better than anything else but this older blog post is a good place to start if you haven't got his book about injuries yet.
This is a nice overview on the UKbouldering Wiki.
Pulley_Injuries_:_The_Science
Physiotherapist and climber, Tom Bond's website has another perspective
Here on UKC is an article by Robin O'Leary and Nina Leonfellner on Injury Management and Prevention: Fingers which has a series of rehabilitation exercises
If you want to start looking at academic research then it's behind a paywall but... Jebson P. & Steyers C (1997) Hand Injuries in Rock Climbing: Reaching the Right Treatment. Physician and Sportsmedicine 25(5) pp.54-63 with a variety of linked articles in a variety of other academic journals
This video shows the H taping method that is one of two methods of taping that have been found more effective than just taping round your finger.
Update
Since writing this article I had several years without a tendon pulley injury. Possibly this reflects the work that I put in to strengthen my fingers in open crimp and extended grip positions. I have just picked up another tendon pulley injury from an awkward match on a small sloping edge on a difficult boulder problem. This has responded well to the above treatment, possibly assisted by a couple of weeks during which family commitments kept me away from the crag at the weekend and work commitments kept me off the wall on my usual training evenings. I also now use a fingerboard for some training, which has the advantage of allowing the dodgy finger to be kept out of the way when attempting silly hangs. I fully intended to make use of the cold water treatment expounded by Dave Macleod but just didn't get my arse in gear.
However, more important than the healing of the injury, is the lesson in prevention that comes with it. I'm much happier with different grip positions but I am still generally crap on smallish slopers - the sort where it's hard to decide what grip to use, usually ending up with an awkward crimp effort - and I don't encounter them much on the south coast limestone nor at my local walls so again, a specific weaknesses possibly increases the potential for injury. Perhaps it is time to do some route setting at the wall - particularly since the entrance fee has just gone up again. Another possibility being the addition of this type of hold to my fingerboard, although any kind of crimp on the fingerboard feels dubious to me.