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.