Thoughts on a pulley injury, or how to get an answers about weird climbing-specific injuries
My journey through a minor finger injury, navigating the healthcare system that doesn’t know much about climbing as a sport, and finding awesome resources via the internets.
If you’re here because you have a finger injury and want to know what I did without reading all of my words, here you go:
Steps if you have what you think is a pulley injury
Find a specialized occupational therapist, who can give you an accurate diagnosis and help you on your rehab plan: https://www.htcc.org/
Read up on anatomy and injuries: https://theclimbingdoctor.com/pulley-injuries-explained-part-1/
Use my OT who I loved: https://hocinc.us/ They helped me reduce inflammation, assess mobility, and made me a customized pulley splint.
Explore alternate activity while you can’t climb: https://theclimbingdoctor.com/more-for-less-what-every-climber-wants/
Read up on rehab once you’re ready to load your finger again: https://www.blackdiamondequipment.com/en_US/experience-story?cid=esther-smith-nagging-finger-injuries
Why I got injured: a lookback at why it’s important to check in with your body
I’ve been on a tear this year to climb better, stronger, faster — basically to train my way to a v10. I’ve been climbing at v8 level for awhile, and feel like I have it in me to do more. I just needed to eke out that extra training to get it done. I’ve trained with Lattice over the last half year or so, off and on, which means working on some of my weaknesses (ability to sustain power over long problems, overall core and body tension). This means that I’ve been pushing myself to do more and train more. More hours at the gym, while trying not to budge on the hours I’ve been at work or the weekend trips I take to go climbing. All this means.. Less sleep and a more fatigued body. For me, this all culminated on an injury during a trip to my local nemesis, great stone face in Berkeley. Anyone who’s climbed that knows it’s an intense, fingery problem with dynamic movements, small holds, and bad feet.
The week before, I pushed myself to the limit, doing moonboard sessions, high volume days, and hangboarding. I’m pretty sure overloading my training days, along with poor consumption of water, and lack of sleep all came together for a perfect storm. I remember thinking “my fingers are pretty tired” when I decided to give the problem one last go, and that’s when I heard my fingers give that crazy “pop” sound.
The road to confusion
The strange thing after I got injured was that it wasn’t painful at all. I had no visible pain during movement, just tenderness, swelling, and low-level pain when pressing on the bottom part of the finger (which led me to believe it was an a2 injury of some kind)
First, some anatomy
I won’t pretend to be a finger expert, but I learned a lot by reading on the internet and talking to healthcare friends. What I thought my injury was, based on the localized swelling and area where it was tender, was that I had injured my a2 pulley in my middle finger. Here’s a snazzy diagram I took from Matt DeStefano’s much better article about anatomy:

The search for an accurate diagnosis
I stayed off of it (lots of cardio that week) and decided to book an appointment with a hand specialist (hand surgeon) that I thought would be able to do some specialized imaging, either an MRI or ultrasound that would be able to tell me definitively what I had. My experience at the surgeon was confusing. He offered me an x-ray (which I didn’t want, thinking I was sure it wasn’t a fracture, but is common practice among doctors, to rule out any bone injuries), and then seemed to have less knowledge than I did about my possible injury and what I was supposed to do. He also seemed confident that I had a full rupture, which I was pretty bummed about.
Getting an accurate diagnosis, again
I felt dissatisfied emotionally by the doctor’s evaluation and the whole experience. I didn’t have a clear plan for rehab, I felt that I read conflicting things online about what helped and what didn’t (ice/don’t ice, rest, consider surgery, etc), and I wasn’t sure the perspective they supplied was more helpful than what I had read. So, I kept searching and happened upon a Beth Rodden article from 2012 where she talks about how she had OTs, or Occupational Therapists, that specialized in hands, help her through her many finger injuries.
What the OT did for me, and what they can do for you
First, I learned what the difference between an OT and a PT is. OT tends to be upper extremities and focused on getting you doing your everyday activities, whereas PT is more sports specific, and lower-body focused. At the OT’s office, it’s an interesting mix of sports specific clients (baseball, climbing) as well as elderly people who are working on their mobility for everyday activities. The first appointment I had quickly gave me diagnosis (partial pulley sprain, not serious and not a full rupture), as well as a plan (no gripping for 1 week, no climbing for 5+, main goal is to reduce the inflammatory response aka swelling in my finger). They also made a custom pulley splint for me. For me, with a PPO insurance, I was able to get visits covered with a prescription from my primary care doctor.

What my normal OT appointment would be like
- 10min heat pack (reduce inflammation)
- Massage/stretching and graston scraping
- Ultrasound (reduce inflammation and scar tissue?)
- 10min ice w/ electrical stimulation (this is to reduce pain)
- Use putty to roll out the affected finger and break down scar tissue
- Ice massaging my pulley area for 3 min

My homework
- Ice 3x a day (this was really hard to stay faithful to)
- Putty roll once a day
- Massage and graston scraping (I got this tool which my OT used on me)
- Coban tape the finger every night to reduce inflammation
- Wear the pulley ring for about 5 weeks

Where I am now
After 6 weeks of not climbing, and going to OT every week, the inflammation in my finger has reduced dramatically. To be clear, you can do all most of these management techniques at home, but I felt that going into their office kept me accountable, the massage and graston was easier when someone else was doing it for you, and their gear was nicer (huge ice packs and heat packs). Plus, I’m lucky enough to have it covered by insurance.
I was able to start composite grip exercises in about 6 weeks (forearm curls, static hanging 30sec on, 2min off, TRX bands) and then move to hangboarding rehab (similar to what Esther Smith outlines in her article for Black Diamond) as well as start easy climbing (v0-v2+). While I ramp back up, I’m also using Blood flow restriction therapy (outlined by tyler nelson) to supplement my lessened climbing.
The weird thing that the articles don’t talk about is how emotional it can feel when you become injured. Climbing has really crept up slowly and become a huge part of my life, my self-worth, and my identity. When some small thing threatens to take that away, it feels like you’re unmoored and have to re-establish who you are to yourself. Navigating the traditional healthcare system was also super frustrating at times, where I felt that there should be clear and easy answers to my questions, backed by science. Surrounding yourself with other activities, supportive people (who are willing to listen to you complain), and finding ways to occupy your time productively should also be part of a good rehab plan. I’ve also found that holistic healthcare and OTs are really helpful in gaining mobility back and reducing inflammation, but you as a climber still need to have an opinion and make informed decisions about your own rehab plan, since it’s unlikely (unless you have a coach or are lucky to work with a healthcare professional who is also a climber) that they’ll be able to do that for you.
Good luck all you injured climbers! And in the meantime revel in your newfound free time.
