Pulley Sprain

Rock Rehab Protocol

The Pulley Sprain “Rock Rehab Protocol” is a step-by-step rehabilitation and injury prevention plan designed specifically for rock climbers who have pain in the front of their finger. The goal of the four-phase process is to take you from the pain, inflammation and tissue overload stage to gain full mobility, strength and eventually pain-free climbing movement.

  • How to get out of pain
  • How to unload tissue with tape
  • How to strengthen the area
  • How to avoid injury again

Signs and Symptoms

  • Can occur over any digit, but most commonly occurs over the ring finger along the A2 pulley
  • Tender to the touch along the injured pulley
  • Swelling, redness and inflammation
  • Stiffness bending the fingers
  • Painful to actively crimp and grip


The forearm muscles transition into long, narrow tendons as they extend into the wrist and fingers. These tendons thread through fibrous sheaths and pulleys, which keep them gliding flush to the finger bones, similar to the way a climbing rope runs through quickdraws. In each finger, there are five annular pulleys, which sling around the front of the bones like the eyelets of a fishing rod, and three cruciform pulleys, which form crosses over the bones, to secure the tendons. When the forearm muscles contract, they pull these tendons and flex the fingers. If the finger flexor tendons create too strong of an outward force – something that can happen if you pull hard on a mono pocket, for example – they can stretch, tear or completely rupture a pulley.

Step 1: Determine Your Injury

Disclaimer: The information on this page is not intended to diagnose or treat any medical condition. Always consult your physician or physical therapist before performing any assessment or beginning a rehabilitation protocol. 

Pulley sprains are classified into four grades (see table below) according to severity, based on research by Dr. Volker Schöffl and Dr. Isabelle Schöffl. The A2 pulley is the most commonly injured in climbers because it’s subject to greater outward forces than the others.

Diagnostic ultrasound, an imaging technique that uses high-frequency sound waves to visualize structures within the body, is the most effective tool to diagnosis and grade a pulley sprain. It allows medical practitioners to view the flexor tendons in the finger, and measure the distance between the tendons and the bone. If you don’t have access to diagnostic ultrasound, there’s no need to panic. Other criteria exist. A paper by Dr. Carrie Cooper et al., published in the Journal of Hand Therapy, presented a classification schema to assist in determining the severity of a pulley sprain without diagnostic imaging. This method uses clinical findings such as range of motion, muscle contraction, and palpation to classify whether the degree of injury is mild, moderate, or severe (see the table below).

  • Pain: Measured with a numeric scale of 0-10.
  • Active Range of Motion: Straight fingers to fully-flexed hook/claw
  • Resisted Tests: Use the thumb of your opposite hand to pull against your fingers in sloper (open hand), half crimp and full crimp positions. Tests for weakness and/or pain.
  • Palpation: Use the thumb of your opposite hand to palpate the pulley region. The degree of skin blanching (when the skin turns paler after you press on it) is associated with the amount of pressure you apply.

Step 2: Determine Your Rehab Category

If you injure a pulley, use the guidelines below based on the degree of injury.

  • Grade I or Mild: Rock rehab pyramid (mobility, strength and movement)
  • Grade II or Moderate: Medical practitioner consult, rock rehab pyramid (tape, mobility, strength and movement)
  • Grade III or Severe: Medical practitioner consult, rock rehab pyramid (splint, tape, mobility, strength and movement)
  • Grade IV: Immediate surgical consult

Note, clinical findings (loss of mobility, decreased strength, and pain) do not always correlate perfectly with the results of a diagnostic ultrasound. For example, a grade I injury may present severe, or a grade II pulley sprain may present mild. If you have imaging of your finger, use the grade of injury (I, II, III or IV) as the primary criteria to fit into a rehabilitation category, otherwise use the clinical criteria (mild, moderate, severe). If there is a large discrepancy between the two, consult with your medical practitioner to determine your rehabilitation category.

Step 3: Start The Protocol

Once you have determined your rehabilitation category, you can begin the rock rehab protocol. The protocols contain a detailed timeline and step-by-step instructions. They utilize a four-phase system to unload the injured tissue, gain full mobility, improve strength and eventually return to pain-free climbing movement. The protocols can either be viewed within the program or downloaded as a PDF.

Get The Pulley Sprain Protocol $15

Sample Videos

These are videos from the actual Rock Rehab Protocol where professional climbers teach you efficient climbing movement and proper exercise performance.

Mobility Level 2

The aboce exercise glides the tendons in the fingers underneath the pulleys to improve range of motion and tissue healing.

Strength Level 1

The above exercises improve the strength of the finger extensors to unload pressure on finger pulleys.

  • Decrease pulley load with therapeutic taping techniques.
  • Improve mobility of the fingers with tendon glides.
  • Regain pain-free finger range of motion.
  • Strengthen the muscles that stabilize the fingers.
  • Mirror rock climbing grips with specific strengthening exercises.
  • Teach a specific pulley adaptation hang protocol.
  • Emphasize optimal climbing movement patterns.

Recommended Rehab Tools 

The Rock Rehab Protocols were built specifically for rock climbers. It is for this reason that any tool that is used in the protocol can either be bought as a rehabilitation tool or created from retired climbing equipment or household items. If you use retired climbing equipment or household items, it will be referenced in the videos as a “dirtbag substitution.” Below you will see a list of rehabilitation tools recommended for the Pulley Sprain Protocol.

If you would like to purchase any of the rehab tools, you can find them in the links below:

About the Climbing Doctor

  • Doctor of physical therapy
  • University of Southern California professor
  • Residency trained in orthopedics
  • Fellowship trained in movement science
  • 9 years of concentrated academic study
  • Over a decade of clinical experience treating climbers
  • Board certified orthopedic clinical specialist
  • Certified strength and conditioning specialist
  • Numerous articles on preventing injuries
  • Lectures internationally on injury prevention
  • Author of best selling book Climb Injury-Free

Get All Six Protocols for Just $75

Avoid injuries by following protocols for pulley sprain, shoulder impingement, rotator cuff strain, lateral epicondylosis, medial epicondylosis and neck strain/sprain.

Get All 6 for Just $75

Get The Companion Book

The “Climb Injury-Free” book will teach you how to diagnosis, treat and prevent the 10 most common climbing injuries in step-by-step chapters. Learn exclusive injury advice with over 30 profiles from top professional climbers including Adam Ondra, Sasha DiGiulian Sean McColl, Jonathan Siegrist and many more. Now you can utilize the system used by thousands of climbers worldwide and see the results for yourself.

  • Prevent climbing injuries before they happen
  • Learn how to rehabilitate the 10 most common climbing injuries
  • Discover the 30 incorrect movement patterns that cause injury
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