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Heal and Rehab Your Pulley Injury

In order to empower you to understand how to properly care for a pulley injury, Dr. Warme put together some insights about the healing process as well as a scientifically-based and conservative rehab protocol!​

Facts About Pulley Healing

1. Resolution of finger pain is not a reliable indicator of pulley healing.

  • The absence of pain is NOT an indicator of healing!

  • Inflammation in the tissues causes pain, and this will dissipate around 2 weeks after the injury, but the pulley is NOT healed at 2 weeks!!

  • Unlike a common ankle sprain that is ready for running when it stops hurting, a pulley won’t be painful even when it isn’t ready for climbing.

2. Pulley injuries are common in climbers and take time to heal.

  • There are no scientific studies to quote regarding the exact strength of a torn pulley during each phase of healing, but we can make inferences from what we know about healing of other ligamentous structures about when it is safe to return to climbing. (See below for biomechanical facts about pulleys, and footnotes for references.)

  • Torn pulleys heal first with scar tissue in 6 weeks. With more time collagen bundles form. Over 3-6 months the tissue remodels and becomes stronger.

  • Pulleys are very weak for the first 6-8 weeks after injury and are prone to stretching out and reinjury. Limiting stress on the pulley and cross-training are paramount. Bouldering and normal climbing are “off the menu”.

  • Pulleys can take more stress at 9-16 weeks gradually handling progressive loading and strengthening. Pulleys are not ready for crimping or projecting until after 4 months of progressive training, see RocknSPOrt protocol.

3. Pulley injuries need an external splint to heal properly.

  • A torn pulley MUST have proper support while it heals to not stretch out and to keep the tendon close to the bone. This will facilitate as close to anatomic healing as possible.

  • Tape alone will NOT provide adequate support! This is scientifically established!

    • Circumferential Taping (around finger) is ineffective. [1, 2]​

    • H-taping is ineffective. [3]

  • An external splint is effective in supporting pulleys.

    • Semi-Lunar Pulley Orthosis (SPOrt) [4]​

    • Pulley Protection Splint (PPS) [5]

Biomechanical Facts

  1. Pulleys are ligament-like tissues primarily made of type 1 collagen.

  2. Ligaments take 8 weeks to heal and more than 16 weeks to regain near normal strength, [6].

  3. Intact pulleys are very strong, [7].

    • A2 ~ 400 N or 90 lbf (41 kgf)

    • A4 ~ 200 N or 45 lbf (20 kgf)

  4. Loads on the pulleys can meet or exceed their breaking strength while climbing especially in the crimp configuration, [8].

  5. Pulleys that heal in a stretched-out configuration allow for increased forces to be applied to the other finger pulleys putting them at greater risk for rupture when returning to climbing. 

Ultrasounding a climber's ring finger.

Summary

  • Pulley injuries are common, they can heal and get strong but it takes time.

  • Be patient! You will get back to climbing!

  • This anatomically focused RocknSPOrt Protocol is more conservative than many you will find on the internet, but it is based on science not anecdote. It may be 5-6 months before you are back to your pre-injury crushing prowess, so pace yourself and plan accordingly.

  • Have a positive attitude and focus on what you can do to actively facilitate healing (e.g. nutrition, sleep) and not what you are missing out on.

Footnotes

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  1. Warme WJ., Brooks D. The Effect of Circumferential Taping on Flexor Pulley Failure in Rock Climbers. American Journal of Sports Medicine, 28(5): 674-678, Sep-Oct 2000.

  2. Schweitzer A. Biomechanical Effectiveness of Taping the A2 Pulley in Rock Climbers. Journal of Hand Surgery (British and European Volume, 2000) 25B: 1: 102±107

  3. Salas C et al. A Biomechanical Analysis of the H-Taping Method Used by Rock Climbers as Prophylactic or Stabilizing Fixation of Partial A2 Pulley Tears. J Hand Surg Am.2023;48(12):1272.e1-e8

  4. Warme WJ. The Novel Semilunar Pulley Orthosis (SPOrt) Decreases Flexor Tendon-Phalanx Distance in Climbers with Chronic A2 Pulley Ruptures. University of Washington Discoveries 2018;24-26.

  5. Schneeberger M, Schweizer A. Pulley Ruptures in Rock Climbers: Outcome of ConservativeTreatment With the Pulley-Protection Splint—A Series of 47 Cases. Wilderness & Environmental Medicine. 2016;27(2):211-218. doi:10.1016/j.wem.2015.12.017https://journals.sagepub.com/doi/10.1016/j.wem.2015.12.017

  6. Woo S, An K, Arnoczky SP, Wayne JS, Fithian DC, Myers BS. Anatomy, Biology, and Biomechanics of Tendon, Ligament and Meniscus. In: Simon SR (ed) Orthopaedic Basioc Science. Am Acad Orthop Surg, Park Ridge; 1994:69,70.

  7. Lin et al. Mechanical Properties of Human Pulleys. Journal of Hand Surgery (BritishVolume, 1990) 15B: 429-434. 

  8. Schweizer A. Biomechanical Properties of the Crimp Grip Position in Rock Climbers. Journal of Biomechanics 34 (2001) 217-223. 

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