Rock Climbing Injuries Part 2: The Climber’s Hand – A Tale of A2 Pulleys
Injuries to the hand typically involve ligaments and can affect the finger flexor tendons as well. Ligaments and tendons are similar in multiple ways: both are made up of connective tissue fibers called collagen, and neither receive a direct blood supply, which means they have a poor ability to heal compared to other tissue types. Ligaments attach bone to bone, provide stability and are not built to allow much stretch. If they are lengthened for a prolonged period, they have a hard time shortening back to their normal length and provide less stability for your joints. Tendons attach muscle to bone and can stretch while functioning as a “spring,” storing energy to increase the power of our muscles.
Let’s take a look at the hand. In this image, we see an illustration of the pulley system of the fingers. Each pulley is a circular (annular) ligament that serves to keep your finger flexor tendons close to the bones allowing hinge points so you can curl your fingers. Climbers primarily injure either an A2 pulley or an A4 pulley. When climbers sustain a pulley injury, they are either fully tearing one of these ligaments, or partially tearing them which results in a looser ligament allowing the flexor tendon to pull away from the bone. You can probably see why having healthy pulleys is important for climbing – no amount of muscle will keep you on the wall if your finger flexors cannot efficiently flex your fingers!
Injury Prevention
As discussed above, the finger pulleys are ligaments, and ligaments have poor blood supply and are not meant to stretch. Throughout our bodies, our ligaments receive nutrients from our blood that allow them to stay healthy. Repeated motion causes compression and decompression in the area that helps blood diffuse from areas surrounding the ligament, into the ligament itself. This is best accomplished with light loads and high repetitions. Since we want to avoid stretching the pulley ligaments while doing this, I recommend the following exercise to help improve the blood supply, while protecting the integrity of the pulleys.
Finger Rolls: Begin by holding a barbell with your fingers and wrist fully flexed around it, then slowly unroll your wrist, then your fingers joint by joint until you are holding the barbell at your fingertips, then reverse the motion. To keep your pulleys healthy and decrease your risk of a pulley injury, you should aim to do 2-3 sets of 30 repetitions at about 30% of your 1 repetition max when performing this exercise.
Here is a link to a video of this exercise: https://www.youtube.com/watch?v=MWxz3yTVVdM&ab_channel=GregLouie
BONUS: To decrease your risk of a finger flexor tendon injury, do this same exercise but perform 5-8 repetitions at about 70-85% of your 1 repetition max.
Injury prevention exercises will decrease the risk of injury, but it will not eliminate the risk entirely. Should you sustain an injury while climbing, I encourage you to schedule an appointment with an MTI physical therapist who will guide you through your individual rehab process.
The next part of this 4-part series will focus on the Climber’s elbow.
