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story

What Are Finger Pulleys?The muscles on the front side of our forearm

flex our wrists and fingers. These muscles are

connected to tendons, which pass through

tunnels, or sheaths, to their connection with

the finger bones. In the climbing world,

these sheaths are known as pulleys and their

function is to prevent tendon bowstringing.To visualize tendon bowstringing, picture an

archer`s bow. In this analogy, the string of

the bow symbolizes the flexor tendon while

the finger bones are represented by the bow.

Bows do not have pulleys and therefore the

string pulls straight from end to end. With

a ruptured pulley, when the finger is flexed,

the tendon (string) is no longer held close to

the bones (bow); this results in bowstringing

which looks just like the string of a bow.

Five flexor tendon pulleys attract the most

attention from climbers. The pulleys are

numbered Ato Afrom the joint between

the palm of the hand and the finger (A), to

the joint nearest the finger tip (A). If you

look at your chalky palm, you will notice

that your fingers are divided into three seg-

ments. The first segment is where the Apulley is located. The Apulley is considered

the most important pulley, allowing for the

proper functioning of the flexor tendons. It

is also the most commonly injured among

climbers. In particular, the Apulley of the

ring finger is at the highest risk of injury.

While climbing, the middle and ring finger

pulleys are placed under stresses that near

their rupture thresholds, unlike the pulleys

of the other fingers. Since our hand rotates

inwards in a crimping position, more force

is placed on our middle and ring finger.

While our middle finger is supported by

strong and long fingers on either side of it,

our poor ring finger is left with the weaker

and often much shorter pinkie finger as its

only support on the outside, leaving it moresusceptible to injury.

Pulleys can be strained or partially or fully

ruptured. In the case of a strain, small tears

similar to those you acquire in a muscle strain

exist in the pulley itself. A partial rupture

leaves the pulley intact, but with significant

tears, while in a complete rupture, the pulley

either detaches from its attachment site or

completely tears elsewhere.

How Do I Know If I Have aFinger Pulley Injury?If you heard a loud pop while pulling down

on a crimp or a pocket and experiencedimmediate pain, you might want to book

a doctors appointment. Swelling will be

noticeable in the injured area, the range of

motion of the finger will be limited and

you will sense pain with finger movement

and with touch at the affected location. If

your pulley has been fully ruptured, tendon

bowstringing could be visible. There are

other finger injuries with similar symptoms,

so have your injury diagnosed.

Story by Carla Cupido

I matched hands on the chalk-caked sloper, the last solid hold on the problem. I

reached for an intermediate rail and with a rehearsed motion, my toe found a hooks that

would allow for full body extension into the crux. I compressed, convinced myself I could

stick it, and lunged towards an improbable two-finger pocket. My fingers wrestled the lip.

My feet cut and were stretching for the polished chip when I dropped like a bag of dirt. All

I could feel was intense pain radiating from my ring finger. So began my five month hiatus

from climbing. The medical diagnosis was right hand, fourth finger, grade II strain of theApulley.

The hand is the most common injury site for climbers and, not surprisingly, finger pulley

injuries lead the charts in frequency. We demand a lot from our hands, placing tremendous

stress on one of the smallest parts of our body. But if you do injure your hand, how do you

get back on the rock as fast as possible?

Finger

PulleyInjuriesWhat To Do

About Them

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How Is A Pulley InjuryDiagnosed?A strained pulley can be diagnosed by a

medical practitioner such as a chiropractor or

medical doctor through history and physical

examination. A partial or total rupture, how-

ever, is best identified by diagnostic imaging.

Injuries to the Aand Apulleys can be seen

on diagnostic ultrasound, while A and A

pulley injuries need to be diagnosed using

magnetic resonance imaging (mri). Being

assessed by a clinician soon after the onset of

injury will improve your chances of recover-

ing quickly as your doctor will be able to

determine which course of management is

best for you.

What Can I Do?Apply ice to the injured area immediately.

Proceed calmly, while suppressing your frus-

tration, to a health care practitioner whocan properly diagnose your injury. Modest

amounts of research currently exist on

conservative care options for finger pulley

injuries. Ultrasound has had varying reports

regarding its effectiveness for most injuries,

while laser therapy is still relatively new to

the scene but shows positive results to date

for tissue healing time. ifc (interferential

current) may be beneficial for decreasing

both swelling and pain.

A2 pulley injury: partial tear (top)versus complete tear (bottom)

Active Release Technique (a.r.t.) and Graston Technique are effective treatment metho

designed to break down the scar tissue associated with overuse injuries as well as acute inj

ries. Scar tissue can cause pain, decrease range of motion, and diminish muscle power whcreating abnormal muscle firing patterns. These treatment options are best applied duri

post-inflammatory stages. Although the location of the initial injury is the pulley, adjace

tissues such as tendons and intr insic hand muscles can often become bogged down with sc

tissue. This can hinder the function of the involved tissues. Kinesiotaping can also be utiliz

to manage muscles which have become affected by the injury.

Correct diagnosis must precede rehabilitation to ensure that the appropriate program

established, as the rehab for a tendon injury will differ from that for a pulley. Both activ

rehabilitation and passive rehab (treatment) cannot be stressed enough in injury recovery.

Once you are again blissfully covered in chalk, finger taping is strongly recommend

upon your comeback. Studies are now showing the H-taping technique to be the mo

effective in minimizing bowstringing on crimps in previously ruptured pulleys.

How Do I Apply The H-Tape Technique?

Take cm of .cm wide tape and cut longitudinally from both ends leaving a bridge cm in the middle. Apply the first two straps to the part of your finger immediately befo

your second knuckle, then flex the joint slightly for the remaining two straps to be tigh

wrapped around the section of finger immediately after the knuckle.

Can I Prevent Pulley Injuries?Mitigating the risks for pulley injuries is important if you want to stay on the rock, off t

couch, and be able to feed yourself when you are . If you are always pulling off of t

same holds, you are at an increased risk of overuse tendon injuries such as tendon and shea

inflammation (tendovaginitis or tendovaginosis), chronic finger swelling and of course, fing

pulley injuries. Modifying your training and climbing regime is essential to staying injur

free. Here are a few simple rules to follow:

1. If it doesnt feel good, dont do it.

2. Warm up properly.

3. Avoid projects too far beyond your strength until your body is ready.

4. Regularly change the angle you are climbing on.

5. Mix up the types of holds on which you are pulling.

6. Vary the intensity and duration at which you are climbing.

7. Do not integrate the use of intensive finger-specific training tools

(hang board, campus board, etc.) into every training session.

Remember, pulley injuries are not tendon injuries. Strong flexor muscles and tendons a

important in avoiding overuse injuries to the muscles and tendons, but the rules listed abo

are the best way to avoid season-ending pulley injuries.

Dr. Carla Cupido is a chiropractor in Vancouver, B.

Visit Eric Horsts trainingforclimbing.comfor more about injuries and trainin

Bones: Proximal Phalanx, Middle Phalanx, Distal Phalanx

Joints: PIP, DIP

Collateral Ligament

FDP Tendon

FDS Tendon

A1 C0

C1C2

A3

A2

A4

C3A5

Annular Pulleys: A1, A2, A3, A4, ACruciform Pulleys:C0, C1, C2, C

feature

Finger Anatomy

IllustrationsCourtesyofTrainingforClimbing

Annular PulleyInjuries