How to Fix Lumbrical Shift Syndrome from Rock Climbing (2025)
Hooper’s Beta Ep. 153
Introduction
If you’ve had an unfortunate encounter with a pocket or an unexpected load to your ring or pinky fingers that left you with pain in the palm of your hand or the base of your finger, then you’ve come to the right place. In this video we’ll teach you everything you need to know about recovering from lumbrical shift syndrome, including what it is, why it happens, what exercises to perform, and how long it’ll take until you’re back to 100%.
What is Lumbrical Shift Syndrome?
Lumbrical shift syndrome can happen when the ring or pinky finger (or both) are loaded in an extended position while an adjacent finger is flexed. For example, if we grab a pocket with our middle two, our index and pinky fingers will often flex to help us pull harder. When pulling hard, the difference in position between the ring finger and pinky finger puts stress on these little muscles in our hands called lumbricals.
There are four lumbricals in the hand, but the third and fourth lumbricals are the most prone to injury in climbing due to their unique bipennate structure. This means they’re basically shaped like feathers, with the lumbrical muscle splitting off in two directions to connect to two adjacent but separate FDP tendons. If the two tendons are significantly misaligned and the force is too high, the lumbrical muscle can be damaged. We call this injury “lumbrical shift syndrome.”
Because the first and second lumbricals do not have a bipennate structure, they cannot be injured in this way. Thus, lumbrical shift syndrome only affects the third or fourth lumbrical. Aside from the aforementioned middle-two pocket example, which would affect the fourth lumbrical, this injury can also happen if we load our middle finger in an extended position while our ring finger is flexed, which would affect the third lumbrical.
How Bad Is It?
Lumbrical shift syndrome can be annoying in that symptoms can linger for quite a while if we don’t do specific recovery activities to promote healing. Trying to just wait it out isn’t a reliable option; I’ve heard many climbers complain of continued discomfort several months after the injury occurred.
Shameless plug: if you want to save yourself the time of figuring out your recovery and get started on the program I’ve used to help tons of climbers get back to 100% from this exact injury, check out our highly affordable Recovery Blueprints, available on our website for a variety of common climbing injuries with more in active development.
Luckily you can usually still climb during your lumbrical recovery with some safe grip position and taping practices, though you’ll of course have to modulate the intensity to make sure you don’t exacerbate the issue.
A grade I injury will involve mild pain in the palm (or, infrequently, on one side of the base of the finger) that’s usually not too noticeable unless you’re loading your fingers in a pocket-like position or performing the lumbrical stress test. The lumbrical stress test means simply extending the middle, ring, or pinky finger while flexing the others to see if it recreates your injury-related symptoms. Grip strength on four finger holds with a grade I injury will be largely unaffected, and there will be no swelling or bruising. With a quality recovery protocol, most climbers can achieve a full recovery in about six to eight weeks.
A grade II injury will involve more noticeable, sometimes sharp pain with the lumbrical stress test and possibly some discomfort with daily activities. There may be some tenderness with palpation or an odd feeling of instability with some grip positions as the fingers aren’t working together as smoothly as they should. Like grade I, there will not be any swelling or bruising. Full recovery is possible in about eight to ten weeks.
A grade III injury is rare and occurs mainly in extreme pocket-grip scenarios – like during a dyno or unexpected foot slip. Hallmark symptoms are sharp pain deep in the palm between the metacarpal heads, visible swelling, and a positive lumbrical stress test. Just trying to make a fist can cause pain, and diagnosis should be confirmed with ultrasound or MRI. Recovery often starts with brief immobilisation, followed by structured rehab; but fortunately surgery is seldom needed. Because active treatment should be directed by a qualified professional, those details aren’t covered in this video.
Other Injuries to be Aware Of
Some injuries can present with similar symptoms but require very different recovery programs, which is why we created this *free* injury assessment questionnaire on our website. It takes you through a series of tests and questions and then gives you a summary of the likely type and severity of your injury. Note this is not a replacement for medical advice or diagnosis of any kind, it’s just a helpful tool to jumpstart your recovery knowledge.
Now, luckily for climbers, there aren’t many other injuries that cause palm pain, so if you fit the criteria we’ve laid out thus far you can be fairly confident you have lumbrical shift syndrome. However, there are a few other injuries to be aware of:
Interpalmar plate ligament injuries affect the small ligament between the metacarpal heads and are often caused by hyperextension of the joint. The difference is this injury causes pain between the knuckles, not in the palm.
Interosseous muscle injuries affect the small hand muscles that help with spreading out and squeezing together our fingers. They're close to the lumbricals, so the pain may feel similar, but it will be provoked by spreading out or squeezing your fingers together rather than the lumbrical stress test.
Pulley injuries affect the annular ligaments and can cause pain at the base of the finger. The main difference is a pulley injury should cause relatively consistent pain when loading the injured finger regardless of the position of the adjacent fingers.
Flexor digitorum profundus (FDP) injuries affect the finger flexor tendon and can cause pain along the tendon all the way into the forearm where it attaches to the muscle. The main thing to be aware of here is that FDP injuries often occur alongside lumbrical injuries. We actually account for this in our injury assessment questionnaire and even offer combined lumbrical + FDP injury recovery programs, in case that applies to you.
How Do I Recover?
Just a reminder before we get into the recovery section: this information will focus on grade I and II lumbrical shift syndrome, as true grade III injuries require professional intervention.
1. Reduce Aggravating Factors
You usually don’t need to stop climbing with lumbrical shift syndrome, but you should reduce the intensity or volume or style (or all three) of your sessions to the point where they don’t noticeably aggravate your injury. Keep the pain at or below a 2/10.
Additionally, use buddy taping or figure eight taping when climbing to reduce stress on the lumbricals (around 3-6 weeks for grade I injuries and 5-8 weeks for grade II). For a third lumbrical injury, buddy tape the middle and ring fingers together. For a fourth lumbrical injury, buddy tape the ring and pinky fingers together. If you’re unsure which lumbrical is injured or just want to be extra cautious, you can use figure eight taping to bind the middle, ring, and pinky fingers together.
Outside of climbing, you don’t need to use tape or modify your activities at all unless something specific is causing pain.
2. Manual Therapy
While there is limited scientific evidence to support manual therapy for injury recovery, I still recommend it if you have any tenderness when palpating the injured area. It requires minimal time, presents virtually zero risk, and has some proposed mechanisms behind it that could improve your recovery – namely improving tissue remodeling and reorganization. I typically recommend daily 3-5 minute intervals with as much intensity as you want as long as you keep the discomfort at or below the usual 2/10 threshold. On the other hand, if you can’t feel any tenderness at all with palpation, this type of therapy is entirely optional.
3. Range of Motion Exercise
This activity involves fully flexing and extending your fingers in three different positions to encourage blood flow and tissue movement. Position 1 is at the bottom of the hand (close to the wrist). This is the most important one with a lumbrical injury as it has the highest level of activation of the lumbricals. Position 2 is in the middle of the palm. Position 3 is at the top (where you may have palm calluses).
To start, touch your fingers to position 1. Try to move your fingers in an arc rather than immediately curling them into a fist. This arc-like motion will place your hand in an “L” shape which is the important position for the lumbricals. Then, fully extend your fingers and repeat for position 2 and 3. Perform about 4-6 reps per position multiple times a day throughout your recovery for grade I and II.
4. Intrinsic Hand Stretch
Keeping the lumbricals mobile with this stretch can improve your recovery and reduce discomfort. Grab a thick dowel or appropriate substitute (highlighter, sharpie, etc. – the smaller the item, the more challenging this stretch will be). Hold it in your palm with fingers curled, then extend your fingers as far back as you can while maintaining hold of the object. Then return to the starting position and repeat. Perform 2 sets of about 6-8 reps as a warm-up for tissue loading activities. This can also be performed throughout the day as tolerated. This shouldn’t be a painful activity (at or below 2/10, as always), but you will likely feel a stretch in multiple regions, which is normal.
Climbers with PIP joint capsulitis may notice their range of motion during this activity is more limited by the PIP joint than the lumbrical injury. If that sounds like you, you should still perform this stretch to the best of your abilities but shouldn’t try to push through excessive joint pain just to get full range of motion.
5. Off-The-Wall Tissue Loading
This is the big one and should be started as soon as possible for grade I and II injuries. Off-the-wall tissue loading is essential for efficient recovery because it allows us to simulate healing in a specific, controlled, progressable manner. For lumbrical shift syndrome, there are a couple key points to dial in to maximize your results.
Key Grip Considerations
First, you’ll need to perform these exercises with two different grip types. For third lumbrical injuries, do a half crimp as well as a two finger pocket (index + middle or ring + pinky – whichever one feels like it stimulates the injured tissue the most). For fourth lumbrical injuries, do a half crimp as well as a three finger drag.
Second, you’ll need to play with the position of your “free fingers” relative to the fingers on the hold to modulate pain. As we learned earlier, the more two fingers are pulled in different directions, the more strain the bipennate lumbricals will encounter. So when your free fingers are parallel with your loaded fingers, you’ll place very little load on the lumbricals. As you curl down your free fingers more, the load on the lumbricals will increase. The goal is to work your way back up to your “normal” finger position – the one you’d use naturally while climbing. You may need to start with your fingers fully parallel at the beginning of your recovery to ensure the pain doesn’t exceed 2/10, but make sure you progress this over time to where you can eventually use a more natural position.
Now, let’s get into the exercises!
Submax Holds
Our initial tissue loading activity will be low intensity, high volume, sub-maximal holds on a comfortable 20-35mm edge. You’ll simply pull or hang for 30 seconds, rest for 30 seconds, and repeat. You should be able to perform all reps without going over 2/10 pain. Also, the intensity should be low enough that you do not feel fatigued at the start of each rep.
Recalling the key grip considerations we just discussed, for third lumbrical injuries perform about half your reps in a half crimp and the other half in a two finger pocket (either front two or back two – whichever feels most effective). For fourth lumbrical injuries perform about half your reps in a half crimp and the other half in a three finger drag.
Initially, do about 8-10 reps in total. As familiarity and tolerance improves, increase to 12 reps. In the early stages of recovery, perform this twice a day. In later stages, you can reduce to once a day since you should be doing additional tissue loading activities at that point. You can discontinue completely once you start doing recruitment pulls or block pulls.
Mobile Board Rows
Next, we’ll want to vary our tissue loading tactics with a more dynamic variation. We’ll accomplish this by performing band-resisted rows on a comfortable edge. We can modulate the intensity with the thickness of the band, the amount we stretch it, and the speed at which we pull. A band is actually preferred over a cable system here because it starts with minimal resistance and gradually ramps up, making modulating intensity more convenient during early recovery.
To gauge how hard you should be trying, use similar guidelines: discomfort/pain at or below 2/10 and no fatigue at the start of each *set.* (Notice I said “set” there, not “rep”).
If you have a force gauge, you can dial these in even further by seeing how hard you’re actually pulling. This is by no means necessary, but it’s another easy way to track your progress over time which helps you make more informed decisions about your recovery.
I typically recommend six sets of 10-15 reps. Follow the same grip guidelines as before, with about half the sets in a half crimp and the other half in a two finger pocket or drag (depending on which lumbrical is injured).
Recruitment Pulls
Next we’ll be progressing our tissue loading with recruitment pulls, which add a beneficial neural-recruitment factor into the mix. This is especially important when recovering from tissue tears because we quite often develop an overactive protective response to loading our injured tissue. Recruitment pulls, coupled with our other training, will help bring that response back to normal levels while also helping to safely retrain our fingers.
To perform recruitment pulls, pick a 20-35 mm edge (whatever feels more comfortable for the grip you're using), and pull as hard as you comfortably can over the course of 5-8 seconds, starting at low intensity and gradually increasing to maximum tolerable within the first few seconds. Rest for a second or two, then repeat.
This style of finger training should feel quite a bit different from the other tissue loading exercises, as all the force should come from trying to curl your fingers rather than simply stopping them from opening up. As with the previous exercises, limit your intensity so any discomfort/pain does not exceed 2/10.
I typically recommend about four to six sets of three reps, splitting those sets between half crimp and two-finger pocket for third lumbrical injuries and between half crimp and three finger drag for fourth lumbrical injuries. Optionally, you can do some single finger reps as well if you feel it’s beneficial. Perform roughly three times per week.
Block Pulls
Finally, we’ll add block pulls, which are an easily measurable, progressible means of finger strengthening. Block pulls are “yielding isometric” (as opposed to the “overcoming isometric” recruitment pulls), which will help round out our finger recovery.
This is also a great time to add in a new grip type: the claw grip. I’ve found this grip to be a bit of “secret sauce” for lumbrical recovery. Because of the activation of the FDP combined with the separation of the fingers, the lumbricals are forced to activate without “shifting” them, unlike regular pocket training. It’s a completely different, safe way of loading the tissue that will really round out your recovery.
Block pulls require a mobile board and attachable weights or a cable machine as well as an additional knob-like hold for the claw grip. Simply lift the weight off the ground by straightening your legs rather than pulling with your back or arm. Hold for 1-2 seconds at the top before controlling the weight back down to the ground.
Since this is meant to be an end-stage recovery / strengthening exercise, you should be using as much weight as possible without causing more than 2/10 pain. Also, make sure you can maintain your chosen grip position for the entire duration of each rep (i.e. your fingers should not open up halfway through – if they do, reduce the weight).
I typically recommend about three to four working sets of three to five reps using the claw grip. You can also add in a few more sets of half crimp and/or drag or pocket grips if you’d like. I generally don’t recommend doing more than about ten working sets of block pulls per session unless you’re advanced enough to know how to program that effectively.
Block pulls can be performed up to three times per week, but you may need to reduce that frequency depending on how much and how hard you’re climbing at this point. We don’t want to end up “overusing” the tissue and causing disorganized healing in this end stage, so if you’re climbing three times a week you may want to reduce the block pulls to just twice a week (or vice versa).
The Most Convenient Way to Recover
Just a reminder: if you want to take the guesswork out of your recovery, save yourself a whole lot of time, and get a program that’s specifically designed for your grade of injury, you can get that today on our website at hoopersbeta.com/recoveryblueprint. These are the exact injury-specific programs I’ve used in my practice to help hundreds of climbers get back on the wall pain-free. They’ll take you from the earliest stages of healing all the way to regaining full strength and returning to peak performance. Whether you’re dealing with a lumbrical issue, a pulley injury, capsulitis, or some other climbing-related finger issue, our Recovery Blueprints are a proven way to fast-track your recovery and get you climbing hard again.
We also recently added in self-paced Recovery Blueprints for all of our current programs, which allows you to progress in your recovery journey at your self-selected speed.
Can I Do Anything to Avoid a Lumbrical Injury?
There are a few strategies to help reduce risk.
1. Expose Yourself to Pockets Gradually
Don’t avoid pockets entirely. Climbers often aren’t exposed to pockets until intermediate and advanced grades, and as such their lumbricals aren’t prepared when they finally have to try them. You can avoid this by introducing pockets into your training, exposing your lumbricals to controlled, progressable stimulus off the wall (or on the wall if your gym set facilitates it).
2. Be Mindful of Your Grip
The position of your fingers on pockets makes a huge difference in how much strain your lumbricals encounter. You can drastically reduce the stress on your lumbricals by keeping your knuckles (MCP joints) aligned, though this will come at the cost of some grip strength.
3. Be Cautious When Fatigued
When you’re tired, your focus and accuracy goes down, making mistakes more common. A foot blowing or finger slipping off a hold unexpectedly can shockload your lumbricals, so be more cautious around pockets if you’re feeling fatigued.
Remember to take advantage of that FREE finger injury self-assessment and our follow-along or self-paced Recovery Blueprints.
Until next time: train, climb, send, repeat!
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