Climbing injuries: fingers, shoulders, and the chain between them

A climber walks into the clinic with a sore A2 pulley on the ring finger. We talk about the route it happened on, the crimp, the pop. Then I ask them to reach overhead, and the shoulder blade on that side barely moves. They didn't come in for the shoulder. They didn't even know it was a problem. But it's almost always part of the story.

The chain, in plain language

Think of the arm as a chain that runs from the shoulder blade down to the fingertip. The scapula has to glide and rotate against the ribcage. That positions the head of the humerus correctly in the socket. The forearm muscles sit on top of that foundation, the wrist transmits load, and at the very end of the line, the finger pulleys hold the flexor tendons against the bone so they can do their job.

Take away control anywhere along that chain and the rest of it compensates. A scapula that doesn't rotate properly forces the front of the shoulder to take strain it wasn't designed for. Tight forearms pull on a wrist that can't extend cleanly. And at the end of the line, the pulleys absorb forces that should have been distributed across the whole arm. The injury shows up at the weakest link — which is often the finger — but the cause is usually higher up.

The A2 pulley

The A2 is a band of tissue on the front of the proximal finger bone. Its job is simple — hold the flexor tendon close to the bone when you crimp, so the tendon pulls the finger closed instead of bowstringing away. When you load a hard half-crimp or a full crimp, the forces through that little band are enormous.

A strain is a stretch of the fibres — sore, sometimes a little swollen, tender when you press on it. A partial rupture is a tear of some fibres but not all — usually a pop, more swelling, more pain on loading. A full rupture is all the fibres giving way at once, and you'll often see the tendon bowstring visibly when the finger closes. That last one is a surgical conversation, and it needs imaging. The first two — strains and most partials — respond to good rehab, load management, and addressing the rest of the chain.

The shoulder side

After a Kootenay winter of indoor climbing and desk sitting, I see the same picture again and again. The lower trapezius and serratus anterior have gone quiet. These are the muscles that should be drawing the shoulder blade down and around the ribcage as you reach overhead. When they're not firing, the scapula stays flat against the back, and the head of the humerus drifts forward in the socket. The front of the shoulder — the long head of biceps, the supraspinatus tendon, the anterior capsule — takes the strain that the back muscles should have been sharing.

It doesn't always hurt at first. A lot of climbers move into the outdoor season with this pattern already baked in and don't notice until something flares.

The indoor-to-outdoor transition

Indoors, holds are predictable. You know what you're grabbing, you know where your feet go, the wall angle is consistent. Outside, the rock is irregular. You're reaching to a sloper you can't quite see, hanging off one arm while you adjust, locking off in positions you didn't train for. The body is asking for fine scapular control and forearm endurance it hasn't built. That's when the pulley pops or the shoulder grumbles.

The other drivers

Training spikes are the classic one — going from two sessions a week to five because spring arrived and a project is calling. Inadequate wrist and forearm prep — the small muscles around the wrist need their own warm-up, not just a few easy boulders. Scapular dysfunction, as above. And sleep and food during a heavy training block — tissue repair is metabolic work, and shorting it shows up downstream.

What I actually do

I assess the whole chain. Articulation through the upper thoracic spine and the upper ribs, because a stiff thoracic spine forces the shoulder blade to compensate. Soft-tissue work through the forearm flexors. Gentle counterstrain on the pulley itself when it's acutely irritated — finding the position where it stops shouting and letting it reset. Muscle energy techniques to wake up the lower trapezius and serratus, and motor re-education so they actually fire during a reach overhead, not just on a clinic table.

And honest coaching on loading. What to keep climbing on — usually more than people expect. What to back off — usually crimping and full-crimping until the pulley settles. A graded return that respects tissue healing timelines rather than how motivated you feel.

What actually holds it

A pulley strain with the rest of the chain in good shape usually settles inside three or four visits, with a return to easy climbing in two to four weeks and harder loading building from there. A pulley strain with a frozen thoracic spine, sleepy scapular muscles, and a forearm full of knots takes longer — because we're not just rehabbing the pulley, we're rebuilding the chain that overloaded it.

A full rupture is different. That needs an X-ray or ultrasound and a surgical opinion. I'll be straight about that on the first visit if I think that's what we're looking at.

The climbers who do well are the ones who treat the off-season scapular work as part of the sport, not an extra. The finger holds because the shoulder works. The shoulder works because the thoracic spine moves. It's all one chain.

In health, Eli Mead, D.O.M.P.