Pain guide · Wrist and hand pain
The pulleys are bands that hold the finger tendons against the bone. Crimping on small holds, or a sudden load when a foot slips, can strain or tear them, usually the A2 or A4 pulley of the middle or ring finger. It is the commonest finger injury in climbers, often with a pop and pain at the base of the finger.
Most pulley injuries, even a complete tear of a single pulley, heal well without surgery, with a short spell of protection, tape or a ring, and a gradual return to climbing over about 6 weeks to 3 months. Several torn pulleys need a hand specialist's opinion about surgery. This guide covers the grades, what tape and rings do and a staged plan with 3D demos, and it says where the evidence for the rehab is thin.
Exercise is for pain that has been checked or is clearly mild and settling.
The tendons that bend your fingers run through a series of tough bands, the pulleys, that hold them close to the bone. The A2 pulley (over the first finger bone) and the A4 pulley (over the middle bone) take most of the load. A pulley can be strained, partly torn or completely torn (ruptured). When it tears, the tendon lifts away from the bone as you grip, which is called bowstringing.
Mostly climbers. Among 604 injured climbers seen at a German specialist centre, 20% had a pulley injury: 48 strains and 74 ruptures, almost all of a single pulley. Among 911 injuries at the same centre about a decade later, fingers made up 52%, pulley injuries were the commonest finger injury, and A4 injuries had overtaken A2. In 426 recreational indoor climbers followed for a year, the finger was the commonest place for an arm or hand injury (36%).
The middle and ring fingers take about 60% of the load at the fingertips and are injured most. Outside climbing it is rare.
The crimp grip (fingers bent sharply at the middle joint, with the end joint pulled back) multiplies the force on the pulleys, and a sudden load, such as a foot slipping off a hold, can push a pulley past its breaking point.
Crimping, climbing harder, bouldering, campus board training (which went with about 2.5 times the odds of an injury) and a previous injury (about 3 times) go with more injuries. Warm-ups, stretching and taping weren't linked with fewer.
Sudden pain at the base of the finger on the palm side, sometimes with a pop, then swelling, tenderness over the pulley and pain when you crimp or grip; some tears follow a few weeks of aching.
An X-ray only rules out a broken bone. A dynamic ultrasound scan, which watches how far the tendon lifts from the bone as you grip, is the usual first scan (in the study a 2022 review cites, it picked up 98% of tears with no false alarms), with MRI (magnetic resonance imaging) if the scan is unclear.
Doctors grade pulley injuries from 1 to 4 (the Schöffl grades), and the grade guides treatment:
Trigger finger is different: a thickened pulley at the base of the finger in the palm (the A1 pulley) that catches, usually without an injury, and it has its own guide. A broken finger, a drooping fingertip (mallet finger) or a sprained joint need the NHS finger pain advice. In a teenager, a gradual ache on the back of a middle finger joint suggests a growth plate stress fracture, and tingling in the ring and little fingers points to a nerve problem instead, covered in the ulnar nerve guide.
Most climbers do well. In Schöffl's series, about 90% of those treated without surgery were climbing again by 3 months, and 8 of 81 re-examined still had pain at 3 months, mostly from an irritated tendon. Climbers with old single ruptures had excellent function and no loss of strength. With a pulley-protection ring, 38 of 43 climbers with complete tears got back to their previous level, on average 8.8 months after the injury.
In Schöffl's 2003 study of 122 pulley injuries, grades 1 to 3 did well with treatment without surgery, while grade 4 needed an operation. In the follow-up of the same series, 115 climbers were treated without surgery, and the 7 grade 4 injuries were reconstructed, with mostly good results. Later reviews agree: no surgery for grades 1 and 2, surgery mainly for grade 4, and grade 3 a grey area where both have done well. These are cohorts and case series, not trials.
This is Schöffl's protocol as two reviews summarise it. It is expert guidance that hasn't been tested in trials, and your clinician sets your own timeline.
An H-shaped tape across the middle finger joint reduced the gap between tendon and bone by 16% on ultrasound in 8 climbers with ruptures, where a ring of tape at the base of the finger didn't, and in 12 climbers with old injuries it added 13% to crimp strength. A 2022 review of 9 studies (206 climbers) found low to moderate certainty that taping reduces bowstringing by 15% to 22%, very low certainty for pain and getting back to climbing, no harms, and no protection against a pulley tearing in cadaver fingers.
In a 2023 review of 34 studies of adult climbers, taping wasn't linked with fewer overuse injuries, and nor were warm-ups or stretching. Tape is for protecting a healing pulley, not for prevention.
Source 6
In 47 complete ruptures in 45 climbers treated with a thermoplastic pulley-protection splint, the gap between tendon and bone shrank (from 4.4 to 2.3 mm at the A2 pulley), every finger improved, movement and strength matched the other hand, and 38 of 43 regained their climbing level. In 4 climbers with grade 1 to 3 A2 injuries who kept climbing 3 times a week in a custom ring for 12 weeks, all improved steadily. These are small case series.
After reconstruction for multiple ruptures, 30 of 38 high-level climbers got back to their previous level, more often when the bowstringing was fully corrected. But in a series of 11 people with triple tears (A2 to A4), the 7 treated early with rings and extension splints for 2 months were climbing at their previous level by 6 months, while 2 of 3 diagnosed late needed an operation. The decision is a hand specialist's.
There are no trials of pulley rehabilitation. Reviews recommend protection with tape or splints, and a 2023 clinical commentary argues for progressive loading built on strength and conditioning principles. Hangboard trials in uninjured climbers show finger strength responds to load added in small steps, such as 1.25 kg a week, over 10 weeks of two sessions a week. An open hand loads the pulleys far less than a crimp, so the plan here goes from an open hand on big holds to crimps and small edges last.
Fingers keep growing until about 17. The British Mountaineering Council's guide says a slow build-up of pain on the back of a middle finger joint, swelling, tenderness or less movement after training in a young climber means stop climbing, see a GP and insist on an urgent hand-surgeon referral; X-rays can miss it, an MRI may be needed, and left untreated it can damage the joint for good. At one specialist centre, 14 of 20 injured climbers under 15 had growth plate fractures.
No trial has set a pain limit for pulley rehab, so this rule is ours, set lower than the 5 out of 10 used elsewhere on this site because a healing ligament is being loaded.
While the finger is protected, exercises should be pain-free at the pulley. When you start loading it, keep any pain at the pulley to 2 or 3 out of 10, gone within an hour and no worse the next day, and pressing on the pulley should feel less tender week by week. A new pop, sharp pain, swelling or pain in a crimp means stop and go back a stage.
The British Mountaineering Council's fingerboard expert puts the test this way: if the injury has healed enough to cope with fingerboarding without getting worse, it's OK. Teenagers should never train through finger pain.
Start at the first stage. Each move opens a full guide with a 3D demo.
Stop climbing and hard gripping. Your clinician sets the protection: in the usual protocol, no splint for grade 1, about 10 days immobilised for grade 2, and about 14 days for grade 3, then a pulley ring. When the protection allows, move the finger gently, keeping it pain-free at the pulley. Keep the rest of you training without gripping. The doses here are editorial unless marked.
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment4 to 6 of each position, 5 s holds, up to 4 times a day, pain-free · The dose is an NHS hand-therapy leaflet's; using it after a pulley injury is our suggestion
Harder: Ball squeeze
3D demoForearm plankIntermediate · No equipment3 holds of 20 to 30 s · Hands open and relaxed: no gripping
Easier: Stomach vacuum (drawing-in) · Harder: Plank walk-up
Move on when: The protection period is over, the finger bends and straightens fully without pain, and pressing on the pulley is only mildly tender.
Starts when the immobilisation ends: straight away for grade 1, after about 10 days for grade 2, and after about 14 days for grade 3, with the ring on. In the usual protocol this functional phase lasts about 2 to 4 weeks. Wear tape or the ring for these exercises; open hand only, no crimping. The doses are editorial.
3D demoBand finger extensionBeginner · A band2 sets of 15, with a 5 s hold at the top
Easier: Ball squeeze · Harder: Plate pinch
3D demoBall squeezeBeginner · Other / check instructions10 gentle squeezes of a soft ball, 5 s holds · Open hand, keeping pulley pain to 2 or 3 out of 10
Harder: Band finger extension
3D demoWrist curlsBeginner · A dumbbell2 sets of 12 to 15, light
Easier: Wrist-extensor eccentrics · Harder: Plate pinch
3D demoReverse wrist curlBeginner · A dumbbell + A bench or box2 sets of 12 to 15, light
Easier: Wrist-extensor eccentrics · Harder: Plate pinch
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 m · Thick handles, held in an open hand
Harder: Suitcase carry
Move on when: These are comfortable with tape or the ring on, and the pulley no longer hurts when pressed.
In the usual protocol, full climbing at about 6 to 8 weeks for grades 1 and 2 and about 3 months for grade 3, with tape or the ring for 3 to 6 months. Easy climbing comes first, once the functional phase has gone well: big holds, an open hand and static moves, then the half crimp before the full crimp, with small edges, dynamic moves and campus boards last. Your clinician decides the timing. Load the fingers in small steps, as the hangboard trials did. The 3D demo below shows a full bar hang; here it stands in for an open-hand hang on a large fingerboard edge with your feet taking some of your weight, which this site doesn't demonstrate yet.
3D demoBar hangIntermediate · Pull-up bar + A step7 s on, 3 s off, 6 times; 2 sets, 3 minutes apart, 2 sessions a week · A stand-in for a feet-assisted, open-hand edge hang: feet on the floor or a box to take weight off, an open-hand grip, and a slight bend in the arms. Take a little more weight into your hands each week. The hang and rest timings are the British Mountaineering Council's basic fingerboard routine, which also suggests a foot on a chair to make it easier; twice a week, and using it after an injury, are our suggestions
Easier: Exercise ball pyramid drape · Harder: One-arm dead hang
3D demoBand finger extensionBeginner · A band2 sets of 15 to 20 · The climbers' antagonist workout dose
Easier: Ball squeeze · Harder: Plate pinch
3D demoWrist curlsBeginner · A dumbbell3 sets of 10, a little heavier · Editorial dose
Easier: Wrist-extensor eccentrics · Harder: Plate pinch
3D demoScapular pull-upIntermediate · Pull-up bar2 sets of 6, open hand · The climbing warm-up dose; keep your feet ready to take your weight
Easier: Assisted pull-up (machine) · Harder: Pull-up
Move on when: Easy climbing on big holds is pain-free that day and the next. Then bring back harder holds one change at a time, with the climbing guide's warm-up and its hangboard advice.
H-tape: cut a strip of rigid tape about 10 cm long and 1.5 cm wide lengthways from both ends, leaving the middle centimetre whole, so it makes an H. Wrap the two ends of one side round the first finger bone, just short of the middle joint, bend that joint, then wrap the other two ends round the middle bone, just past it. Wear it for loading and, later, for climbing.
A pulley ring is a rigid thermoplastic ring made by a hand therapist, used mainly for complete A2 or A3 tears.
While the finger heals, keep your legs, trunk and shoulders training, and keep up the parts of the climbers' antagonist workout that don't load the finger. This is our suggestion.
Start on big holds with an open hand and static moves. Bring back the half crimp before the full crimp, and leave small edges, dynamic moves and campus boards until last. Keep the tape or ring on for 3 to 6 months. A previous injury tripled the odds of a new arm or hand injury in indoor climbers, so build up over weeks, not days.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Climbing on through a pop | The NHS says a snap or pop at the time of the injury needs advice from NHS 111. | Stop, get it assessed, then follow the protection for your grade. |
| Crimping, small edges, dynamic moves and campus boards early on | The crimp loads the pulleys most, and campus boards and a previous injury raise the risk. | Open-hand climbing on big holds and static moves; crimps and small edges last. |
| Relying on tape to prevent a first injury | Taping wasn't linked with fewer injuries in a review of climbing studies. | Graded training and sensible load, as the climbing guide says. |
| Going straight back to full training when it stops hurting | A previous injury triples the odds of another, and grades 1 to 3 usually need 6 weeks to 3 months. | Follow the stages, with tape or the ring for 3 to 6 months. |
| A teenager training through finger pain | It can be a growth plate stress fracture. | Stop, see a GP, and ask for an urgent hand surgeon referral. |
| Hard squeezing with a stress ball | Squeezing hard loads the healing pulley (our caution). | A soft ball, an open hand, within the pain rule. |
A 15-minute climbing warm-up: easy movement, shoulder and hip mobility, wrist and finger glides, scapular pulls, then hangs of 5, 10 and 20 seconds.
15 minBeginner9 movesPull-up bar, A bandA 30-minute antagonist workout for climbers: push-ups and presses, band rotations, Y-T-W raises and face pulls, wrist and finger extensions, and a side plank.
30 minBeginner13 movesA band, A dumbbellA 20-minute grip session: warm up the wrists and fingers, train the hand and forearm muscles, then carry and hang to load your grip the way everyday life does.
20 minBeginner10 movesOther / check instructions, A bandWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellSudden pain at the base of a finger on the palm side, often with a pop, then swelling, tenderness and pain when you crimp or grip. Contact NHS 111 if you heard a snap or pop, the pain is severe or you can't move the finger.
A clinician examines the finger and usually arranges a dynamic ultrasound scan, which shows the torn pulley and how far the tendon lifts from the bone as you grip. MRI is used if that's unclear, and an X-ray only rules out a broken bone.
Grade 1 is a strain; grade 2 a complete A4 or partial A2 or A3 tear; grade 3 a complete A2 or A3 tear; and grade 4 several tears, or one with other damage. The grade guides the treatment.
In the usual protocol, full climbing returns at about 6 to 8 weeks for grades 1 and 2 and about 3 months for grade 3, with tape or a ring for 3 to 6 months. About 90% were climbing again by 3 months in one large series.
Usually not. Single tears, even complete ones, do well without surgery; surgery is mainly for several torn pulleys, and most climbers get back to their level after it.
Cut a strip of rigid tape (about 10 cm by 1.5 cm) lengthways from both ends, leaving the middle centimetre whole, so it makes an H. Wrap the two ends of one side round the first finger bone, just short of the middle joint, bend that joint, then wrap the other two round the middle bone, just past it. It reduced the tendon lifting from the bone by 16% in one study, but whether it speeds recovery is unknown.
A rigid thermoplastic ring is used for complete A2 or A3 tears; in 47 ruptures it helped the tendon settle back towards the bone, and most climbers regained their level. Tape is used for milder grades.
Easy climbing on big holds starts once your clinician's protection period is over and the finger is pain-free with tape or a ring. Open hand comes first and crimps later, with small edges and dynamic moves last, building up over weeks.
Later, once the finger takes load without getting worse, as the British Mountaineering Council's expert says. Start with an open hand on a big edge and your feet taking some weight, and increase slowly.
A previous injury roughly triples the odds of another, so return gradually. Limit hard crimping and campus boards, which raise the risk. Warm-ups and taping haven't been shown to prevent injuries, though a warm-up still helps you start ready to climb.
In under-18s, a gradual ache on the back of a middle finger joint is more likely a growth plate stress fracture. Stop climbing and see a GP, who should refer urgently to a hand surgeon.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
