Climbing Strong: Understanding & Preventing Common Finger Injuries

As a climber and a physiotherapist with a special interest in climbing injuries, I understand firsthand the importance of staying injury free. There is nothing worse than an injury limiting our ability to train and climb hard. This blog outlines common finger injuries among climbers and explains physiotherapy strategies to help manage and reduce the risk of these injuries.

Finger Pulley Injuries

The most common (and feared) injuries amongst climbers are finger pulley injuries. Finger pulleys are dense fibrous bands that wrap around the tendons in the fingers to keep them against the bone.  They function like the eyelets on a fishing rod keeping tension in the fishing line. Climbers most commonly injure the A2 and A4 pulleys during dynamic crimping movements. Injury occurs when the outwards pressure on the pulley exceeds the load bearing capacity of the structure.

These injuries present as pain over the pulley which is aggravated with crimping load. Injuries can range from a sprain to a complete rupture. Tears are usually associated with an audible ‘pop’, swelling, loss of range of movement and tendon ‘bowstringing’ on imaging.

Physiotherapy may include graded strengthening exercises, soft tissue techniques, and activity modification to support recovery and functional use of the fingers. Prolonged periods of rest are often unhelpful in most cases of pulley injuries!

Flexor Tenosynovitis

Flexor tenosynovitis involves inflammation of the tendon sheath in the fingers due to friction between the tendon sheath and the pulleys. It is characterized by pain and swelling along the affected tendon and is commonly misdiagnosed as finger pulley injuries. A thorough physiotherapy assessment combined with ultrasound imaging is the commonly used approach to diagnose these injuries.

Physiotherapy involves manual therapy techniques to address soft tissue restrictions, exercises for tendon gliding, finger mobility and tendon loading where appropriate. A technical climbing assessment can also help identify potential contributing factors.

Finger Joint Synovitis

Finger joint synovitis involves inflammation of the synovial lining within the finger joints, resulting in pain, swelling, and stiffness. Climbers may develop this condition due to repetitive microtrauma and joint stress coupled with inadequate recovery. Climbers may develop synovitis following a collateral ligament injury. It most commonly presents in the middle finger.

Physiotherapy treatment for finger joint synovitis may include joint mobilization techniques to improve range of motion and reduce swelling, as well as strengthening exercises to stabilize the affected joints. Additionally, climbers can benefit from education on self-care strategies and load modification, to manage symptoms and prevent recurrence. Furthermore, building strength in an open hand grip position and utilising this more than crimping can aid recovery.

Digital Collateral Ligament Injuries

Digital collateral ligament injuries occur when the ligaments supporting the finger joints are stretched or torn, often resulting from torsional forces during gripping or impact during bouldering falls. These injuries can lead to pain, instability, and joint stiffness.

Physiotherapy interventions for digital collateral ligament injuries may include a combination of manual therapy, progressive strengthening exercises, and proprioceptive training to support joint stability and function. Additionally, climbers can benefit from education on injury-specific taping techniques and climbing modifications to support the injured finger joint during rehabilitation. It is important to splint high grade collateral ligament injuries early.

Lumbrical Tears

The lumbricals are muscles in the hand that attach to the fingers. They assist with pinching and gripping movements. Lumbricals are frequently injured from shearing forces that occur with monos, pockets and three finger dragging. Climbers often present with hand and finger pain, sometimes even with forearm pain depending on the extent of the injury.

Physiotherapy may involve soft tissue mobilisation, dry needling, and gradual reintroduction to climbing with activity modification and taping guidance. It is imperative that climbers perform strengthening and mobility exercises for the lumbricals, whilst gradually introducing the load and the shearing forces that initially caused the injury.

Volar Plate Injuries

Volar plate injuries involve damage to the ligamentous structure located at the base of the finger joints, typically resulting from hyperextension or traumatic impact. Climbers may be at risk of volar plate injuries during falls or when catching holds with extended fingers.

Physiotherapy interventions for volar plate injuries may include may include splinting, progressive strengthening, and range of motion exercises to support recovery.

Growth Plate Injuries

Growth plate injuries are the most common cause of finger pain in young climbers who are still undergoing skeletal development. The growth plates are areas of cartilage at the ends of long bones where bone growth occurs.

The growth plates are much weaker than the other structure in the fingers and therefore tend to be the first structure to get injured from the repetitive stress placed on the fingers during climbing. These injuries often present as pain and swelling in the middle joint of the middle finger.

Early identification is key in managing growth plate injuries. Any young climber with finger stiffness, loss of range of movement and pain should be assessed as soon as possible. Treatment may involve rest, activity modification, and targeted rehabilitation exercises, and education. Educating young climbers and their parents about injury prevention strategies, such as proper warm-up techniques and gradual progression in climbing intensity, is essential for reducing the risk of growth plate injuries.

See the most common finger injuries in the table above

Climbing Physio FAQ’s

Do I need to stop climbing if I have injured my hand or fingers?

Whether you need to stop climbing depends on the severity of your injury. In some cases, taking a break from climbing may be necessary to allow your injury to heal. A physiotherapist (Climbing Physio) can provide exercises and techniques to help maintain strength and flexibility during recovering. Seeing a physiotherapist familiar with climbing can help guide activity modification and support a safe return to climbing, while avoiding unnecessary rest. Prolonged rest may sometimes be less beneficial for climbers.

How can rock climbers prevent finger injuries?

It is essential to prioritize gradual progression in training intensity, maintain proper hand positioning and grip technique, and incorporate rest days into training schedules when feeling fatigued and overtrained. Additionally, climbers should focus on developing balanced hand and finger strength through targeted exercises and practice proper falling techniques to minimize the risk of acute injuries. Maintaining balance, strength and range of movement in the wrist, elbow and shoulders is also important in preventing these injuries.  By being mindful of these preventative measures and seeking timely physiotherapy intervention when needed, climbers can enjoy their bouldering pursuits safely and sustainably.

What is the most common finger injury in climbing?

The most common finger injury among rock climbers is a pulley injury. Pulleys are thick bands of tissue that help hold the flexor tendons close to the bones in your fingers. Pulley injuries often occur during dynamic movements or when using poor technique, such as crimping excessively on small holds. Please refer to the heading above on ‘Finger Pulley Injuries’ for more information.

Do physiotherapists treat hand and finger injuries?

Yes, physiotherapists are trained in the assessment, diagnosis, and treatment of musculoskeletal injuries of the hands and fingers. Seeing a physiotherapist who climbs and has a special interest in treating hand and finger injuries may provide more tailored care. A Climbing Physio can combine manual therapy techniques with progressive sport-specific strengthening to help restore function, support pain management, reduce future injury risk, and assist a safe return to climbing.

Hand and finger injuries are an unfortunate but sometimes an unavoidable aspect of rock climbing. However, with the right guidance and support from a qualified physiotherapist experienced in climbing and finger injuries you can navigate these injuries effectively. Climbers often finish a physiotherapy plan with injury prevention strategies and exercises to help address their weaknesses. Don't hesitate to reach out to us if you are dealing with a rock-climbing injury so our dedicated Climbing Physio can help you.