By Nigel Chua, Hand Therapist (Occupational Therapist), Phoenix Rehab Physio & Hand, Singapore.
Climbers are the most stubborn patients I see.
Not difficult. Stubborn in a very specific way. A runner with a sore knee stops running. A climber with a sore finger tapes it, drops a grade, and keeps climbing for another four months.
I understand why. Climbing is not really a workout. It is a social life, a problem to solve, a project you have been on for six weeks, and a group of people expecting you on Tuesday. Stopping costs more than the pain does.
So here is what I am going to do. Not tell you to rest. Tell you exactly what is happening in your body, what makes each of these injuries permanent, and where the line actually sits between an injury you can train around and one you cannot.
Three of the five are hand and wrist injuries, which is my own field. The other two sit with our physios at Phoenix Rehab, and I have flagged which is which.
The A2 Pulley Injury (Your Finger)
The one everybody has heard of and almost nobody understands correctly.
What it actually is. Your finger has no muscles. Tendons run from your forearm through the finger and pull it closed. Those tendons are held tight against the bone by a series of thin fibrous rings called pulleys. The biggest and most important one, called A2, sits over the first section of your finger.
When you crimp, especially a full crimp with the finger bent hard and the fingertip pressed down, the tendon tries to lift away from the bone. The pulley is the only thing stopping it. All of that force lands on a structure a few millimetres wide.
How you will know. Most people hear or feel a pop. Sharp pain at the front of the finger, near the base, on the palm side. Swelling comes in over the next day. Bending the finger against resistance hurts. In the worst cases, when several pulleys go at once, you can actually see the tendon lifting off the bone under the skin when you make a fist. That is called bowstringing and it is a surgical problem.
Where climbers go wrong. Two places.
First, they call it a tendon injury. It usually is not. The tendon is fine. The retaining ring failed. That distinction matters because tendons and pulleys heal on different timelines and respond to completely different loading.
Second, and this is the expensive one, pain settling down is not the same as the pulley healing. The pulley remodels and regains strength over months, not weeks. Around week four or five most people feel fine and go straight back to crimping. That is precisely when the structure is at its most vulnerable and precisely when the partial tear becomes a complete one.
What treatment actually looks like. Most pulley injuries do not need surgery. The graded strains and even many complete single pulley ruptures do well with the right programme. Protection early, often with a thermoplastic ring worn over the injured section. Then a staged return where open hand and half crimp positions come back long before full crimp does. Hard crimping is usually the last thing to return, sometimes at the three month mark and beyond.
Multiple pulley ruptures with visible bowstringing are a surgical conversation, and I will send you for one.
About taping. Tape does not prevent pulley injuries in any meaningful way. What it does do is give useful support during a controlled return to climbing. So use it as part of a plan, not as permission to keep loading something that is torn.
The Swollen, Stiff Finger Joint
This is the injury nobody posts about, and the one I most want climbers to take seriously.
What it actually is. The middle joint of the finger gets loaded, twisted and compressed thousands of times per session on small holds and pockets. The joint lining becomes irritated and thickened. The small ligaments on the sides of the joint get strained. Over time the joint itself starts laying down extra bone at the edges.
How you will know. The finger is puffy around the middle knuckle. It is stiff in the morning and takes a while to close fully. It aches after sessions rather than during. There is often no single moment where it went wrong, which is exactly why it gets ignored.
Where climbers go wrong. They accept it. Fat fingers get treated as a badge of the sport, the visible proof you actually climb. And for a while it is harmless.
Here is the part that is worth knowing. Long term climbers develop measurable joint changes in their fingers, and the ones who get there fastest are the ones who spent years climbing through chronically swollen, stiff joints without ever changing anything. Cartilage does not grow back. The thickening you can see on your finger is not decoration. It is the joint responding to more load than it can handle.
What treatment actually looks like. This is unglamorous and it works. Settling the swelling. Restoring full straightening of the joint, because a joint that never fully straightens stiffens faster. Finding which grip positions and which board angles are driving it, then adjusting the volume rather than stopping the sport. Sometimes a small night orthosis to hold the joint out straight while you sleep.
The goal is not to make you climb less. It is to make sure you are still climbing at fifty.
Climber’s Elbow
What it actually is. Two different problems that get the same nickname.
The common one is pain on the inside of the elbow, at the bony bump. The muscles that close your fingers all originate there through one shared tendon. Every hard crimp pulls on that spot. Load it faster than it can adapt and the tendon becomes irritated and disorganised.
The other one sits slightly higher, in the front of the elbow, in the brachialis muscle. This is the lock off injury, the one that shows up after a phase of steep board climbing and big static moves. It feels deep and it responds to a different programme.
How you will know. Inside elbow pain that is quiet at rest and loud on the first few pulls of a session. Painful to grip. Sore when you carry the shopping. It often creeps in over weeks after a training block or after starting a hangboard.
Where climbers go wrong. They stretch it and they rest it completely. Neither works well. Tendons that have been under too much load do not want zero load. They want the right load, applied in the right way, for long enough to remodel. Complete rest gives short term relief and a weaker tendon, which is why the pain comes straight back on the first session after a two week break.
What treatment actually looks like. Our physios at Phoenix Rehab load these deliberately. Controlled, progressive, boring, effective. It takes weeks to months and it is measured by capacity rather than by how it feels on any given day. Most climbers keep climbing throughout, at a modified volume, which is usually what makes them willing to actually do it.
The Shoulder
What it actually is. The shoulder trades stability for range, which is what lets you reach a hold above and behind you. The price is that it depends heavily on muscular control rather than bone shape.
Climbers load it in the two positions it likes least. Overhead and pulling, repeatedly, thousands of times. Then suddenly, catching a dynamic move or a foot cutting loose, with the arm extended.
That produces rotator cuff pain, irritation of the tissue under the bony arch, and sometimes damage to the labral rim inside the joint, particularly after a sudden loading event with a clear before and after.
How you will know. Pain reaching overhead or across the body. A deep ache at the front or outside of the shoulder. Trouble sleeping on that side. In the sudden onset version, a specific move you can name and a shoulder that has not felt the same since.
Where climbers go wrong. Pulling more to fix it. Climbing is already an enormous pulling volume with very little pushing. The muscles that hold the shoulder blade in the right position get out muscled by the ones dragging it forward. Adding more pull ups to a shoulder problem is pouring petrol on it.
What treatment actually looks like. Our physios work out whether this is a control problem, a capacity problem, or actual structural damage, because those three need completely different plans. Most climbing shoulders are the first two and respond well. The sudden onset ones with a clear pop and a lasting change need proper assessment before anyone starts a strengthening programme.
Ulnar Sided Wrist Pain (The Little Finger Side)
Back in my own field, and the one most likely to be misdiagnosed.
What it actually is. On the little finger side of your wrist sits a small cartilage and ligament complex that lets the wrist rotate while still carrying load. Climbers hammer it. Mantling. Underclings. Any press out where the palm is down and the weight goes through a bent wrist. Slopers with the wrist rotated. Heel hooks where you are twisting your whole body around a loaded arm.
There is also a tendon that runs along that same side of the wrist and can become irritated or unstable, and the two problems feel almost identical from the outside.
How you will know. Pain on the pinky side of the wrist. Worse turning a door handle, pressing up out of a chair, or opening a jar. Sometimes a click or a clunk. Often no single incident, and often described as a sprain that never quite went away.
Where climbers go wrong. They wait. This is the injury I most often see six or nine months late, and the reason is always the same. It was called a sprain, they rested it, it improved slightly, they went back, and it settled into a low grade problem they stopped expecting to fix.
Some of these settle beautifully with the right load management and a period of protection. Some involve a tear that needs a surgical opinion. You cannot tell which one you have from a website, and the difference between the two matters more the longer you leave it.
What treatment actually looks like. Proper assessment first, because ulnar sided wrist pain has a long list of possible causes and treating the wrong one wastes months. Then protection, staged loading, and a return to climbing that reintroduces mantling and rotation under load last rather than first.
The One Everybody Forgets: The Heel Hook Knee
Not in the top five, but it deserves a mention because it is the injury that ends seasons.
A hard heel hook puts your knee in deep flexion with the hip turned out and the whole body weight pulling through it. That is a brutal position for the cartilage discs inside the knee and for the hamstring where it attaches at the back.
If you felt something in your knee on a heel hook and it has been swelling or catching since, do not train around it. Get it looked at.
Traffic Light: Should You Be Climbing On This
The amber column is where the money is. Almost every long, miserable, career limiting climbing injury I treat spent months sitting in that middle column being ignored.
The Honest Summary
Climbers do not get injured because they are reckless.
They get injured because the sport lets you keep going. There is always an easier grade, a different wall, a way to grip that does not hurt as much. So the injury never forces the decision, and the decision never gets made.
The finger is the part I care about most, because fingers do not have spare capacity. You have ten of them and you use every one for the rest of your life. A shoulder can be rehabilitated for years. A joint that has already lost its cartilage cannot be given it back.
Get assessed early and the plan is usually small. Load management, a few weeks of protection, a staged return, and you keep climbing through most of it. Get assessed late and the conversation changes completely.
Getting It Looked At
Hand therapy is a small field in Singapore. There are many physiotherapy clinics. There are very few therapists who spend every working day on hands and wrists, and who can tell the difference between a strained pulley and a torn one, or between a wrist sprain and a cartilage tear, in the first appointment.
That is what decides your plan.
WhatsApp us at 83366009
Tell us what you felt, which finger or joint, and how long ago. We will tell you honestly whether this is something to manage while you keep climbing, or something that needs a proper look before you touch a wall again.
One to one sessions at Orchard, Tampines, Serangoon and Tanjong Pagar.
You did not get into climbing to be careful. You got into it to move well, pull hard, and still be doing this in twenty years. That last part is the one worth protecting.
Frequently Asked Questions
I heard a pop in my finger while climbing. Is it serious? An audible pop with pain at the front of the finger near the base is the classic presentation of a pulley injury. Most are treatable without surgery, but the plan depends entirely on how much of the pulley failed. Get it assessed rather than guessing.
How long before I can climb again after a pulley injury? Easy climbing on open hand grips often returns within a few weeks. Full crimping is usually the last thing to come back and can take around three months. The timeline is set by the tissue, not by how the finger feels, which is why so many climbers reinjure at the six week mark.
Why are my fingers swollen after bouldering? Repeated compression and twisting irritates the lining of the finger joints. Occasional puffiness after a hard session is common. Swelling that never fully settles, or a joint that has become permanently thicker, means the load has been exceeding what the joint can handle for a long time.
Does taping prevent climbing finger injuries? Not meaningfully. Tape gives some support during a controlled return to climbing after an injury, but it does not protect a healthy pulley from a bad crimp. Treat it as a rehab tool, not as protective equipment.
Can I keep climbing with an injured finger? Sometimes, at reduced volume and on modified grip positions. It depends on the structure involved and the grade of injury. Climbing through a partial pulley tear on full crimp is the single most reliable way to turn a six week problem into a six month one.
What is climber’s elbow and how do I fix it? Pain on the inside of the elbow from the shared tendon of the finger flexors, or in the front of the elbow from the brachialis muscle after heavy locking off. Complete rest tends to fail. Progressive loading, guided properly, is what rebuilds tendon capacity.
Why does the pinky side of my wrist hurt when I mantle? That side of the wrist carries a small cartilage and ligament complex that takes heavy load when the wrist is bent back and rotated. Pain there is commonly labelled a sprain and commonly is not one. It is worth a proper assessment, because some of these involve a tear.
Should I stop climbing completely while I recover? Usually not. Total rest deconditions the tissue and rarely holds up when you return. The better approach for most climbing injuries is a modified plan that keeps you on the wall while removing the specific position or grip that is driving the problem.
When should I see a hand therapist instead of waiting it out? If you heard a pop, if there is swelling that keeps returning, if a finger will not fully straighten or bend, if pain has lasted more than two weeks despite dropping grades, or if you have lost grip strength. Any of those is worth an appointment.
Do climbing injuries cause arthritis later? Long term climbers do show more joint changes in the fingers than non climbers. The risk is highest in people who trained hard for years through chronically swollen and stiff joints. Managing the load early is what protects the joint later.
