Rock Climbing Injuries

Original Editor - Puja Gaikwad

Top Contributors - Puja Gaikwad, Kim Jackson and Rucha Gadgil  

Introduction

Rock climbing has become a professional competitive sport, many folks are being drawn to this sport with a parallel increase within the occurrence of sport-related injuries on both natural rock and artificial walls. Rock climbing is a physically and mentally challenging sport, one that often tests a climber's upper and lower body flexibility, strength, endurance, agility and balance along with mental control. It is a popular sport with the explosion in climbing gyms, bouldering venues and bolted sports routes.

Excessive loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that’s hampering experience level and quantity of participation. Injuries can range from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is important to diagnose, manage, and counsel the rock-climbing athlete.

Risk Factors 

1.     Age

2.     Higher skill (difficulty) level

3.     high CIS (Climbing Intensity Score)

4.     Poor climbing movement pattern: 

• An example of climbing inefficiently with bent elbows. This increases the stress on the biceps.
• Climbing with elbows in a chicken wing. This puts excessive stress on the shoulder joint and is a result of latissimus dorsi and shoulder internal rotators working too hard
• Too much wrist flexion and can compress the joint and nerve in the wrist as well as lead to elbow pain.

5.     Participating in lead climbing

6.     Using inadequate climbing equipment’s

7.     Improper Footwear- Shoes that are too tight and small

8.     Climbing in bad weather conditions

9.     Over-training lead to a number of overuse and traumatic injuries

Prevalence and incidence of injuries

Studies that have estimated the prevalence of injuries associated with rock climbing vary between 10% and 81% irrespective of cause, between 10% and 50% for impact injuries, between 28% and 81% for nonimpact acute trauma injuries and between 33% to 44% for chronic overuse injuries.(29)

Mechanism of Injury

Climbing above one’s skill level,. The body weight of the climber places a great deal of stress on not only the climber’s fingers, but also their wrists, elbows, and shoulders.

• Inherent within the characteristic of the sport, climbers frequently subject their bodies to repetitive traumatic forces, whether from throwing to succeed in holds (dynoing and deadpointing) or falling from climbs (especially with bouldering), which ends up in either overuse injuries or acute injuries.
• This apparent pattern of overuse injuries could be related to the architecture of climbing walls, climbing styles, training techniques, or relative weakness of specific anatomical structures.

Injuries in rock climbers

climbing-related injuries may be categorized as:

1. Impact injury caused by the climber falling onto a climbing surface and/or ground, or an object, such as a rock falling onto the climber.
2. Non-impact injury resulting from acute trauma to the body.
3. Chronic overuse injury from repetitive climbing.

A survey was conducted it shows, the majority of injuries (82%) were categorized by the respondents as overuse injuries. Upper extremity injuries were the vast majority and accounted for 63% of all injuries. Hand overuse injuries predominated (28% of all injuries), although elbow injuries were a close second (19%). Combined upper extremity overuse injuries were common. This apparent pattern of overuse injuries could be related to the architecture of climbing walls, climbing styles, training techniques, or relative weakness of specific anatomical structures. Consideration of the anatomical distribution of injuries associated with rock climbing may be useful in injury prevention and in rehabilitation of the injured climber. (25)

The most common injuries seen in rock climbers are:

Upper Extremity

Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. (28) Injuries of upper extremity are often among climbers (Folkl 2013). They vary from light abrasions, through more severe like Superior Labrum Anterior, flexor digitorum tendon pulley injuries, rotator cuff tears; to bony fractures like hamate fractures and phalangeal epiphyseal stress fractures. The most often injured part of upper extremity is flexor digitorum tendons pulleys (Bayer and Schweizer, 2009; Blanchette et al., 2015; Chang et al., 2016; Crowley, 2012; Desaldeleer and Le Nen, 2016; Lutter et al., 2016; Merritt and Huang, 2011).

Shoulder injuries in climbing

The shoulder typically accounts for 17% of all climbing-related injuries .Sport climbers and boulderers are particularly susceptible to the development of shoulder injuries due to prolonged and repetitive upper limb movements on vertical or overhanging terrain. A cross-sectional cohort study of 201 climbers found the shoulder injuries to be positively related to the frequency and difficulty of indoor and outdoor sport climbing and bouldering (17) An analysis of injury trends in sport climbing and bouldering over a 4-yr period found superior labral anterior posterior tears and impingement of subacromial structures to be the foremost common diagnosis. 

Subacromial Impingement

The unique physical demands associated with climbing, as well as a reported 33%-51% incidence of shoulder injuries in these athletes is suggestive of abnormalities in scapulohumeral biomechanics. (26) Clinically climbers with shoulder and arm symptoms are commonly observed with poor dynamic scapulothoracic and Glenohumeral control (Kibler et al. 2013). Scapula positioning on the thorax is important in order to create a stable base for shoulder movement and maintain the humeral head in the centre of the glenoid (Mottram 1997). If the shoulder blade is not moving properly, the shoulder joint will have to pick up the slack: this places climbers at an increased risk of impingement.

The shoulder blade is highlighted in red below. 

Put an image of abnormal shoulder blade (Optional)

Climbers also demonstrate relative weakness in the shoulder external rotators (teres minor and infraspinatus – see below). These muscles are part of the rotator cuff and sit on the back of the shoulder blade. These muscles help to stabilize the glenohumeral joint during upward reaching. If they are weak, it places climbers at a higher risk of impingement.

Anatomy of teres minor image (Optional)

Rotator Cuff Injuries

These injuries are common in rock climbers because of the amount of time they spend with their arms overhead pulling up their body weight. The rotator cuff provides stability for the shoulder. It is comprised of tendons in the shoulder that attach to the humerus, as well as the four major muscles that surround the shoulder joint. A weak rotator cuff and/or poor biomechanics can contribute to a tear or tendonitis. Common symptoms include pain, weakness when lifting or lowering the arm, limited range of motion, and hearing clicking or popping sounds.

Physiotherapy Management:

Conservative treatment can be effective in treating tendonitis and small tears. This includes rest, ice, anti-inflammatory medications, corticosteroid injections, and physiotherapy. Exercise program will focus on activating the appropriate muscles during climbing, then progressively strengthen them to improve performance and decrease the risk of injury in future.

Rotator cuff Strengthening : For a shoulder exercise to be effective it needs to be functional. There are two exercises which are found to be effective.  

1. Wall clock: It Strengthens rotator cuff muscles by simulating the action of reaching for climbing holds in varied positions  
2. Looped Band Reaches: It strengthens and stabilizes the shoulder in a range of motion that is common during climbing  
3. How to do: Wrap a single resistance band around wrist. Sit into a mini squat to mirror the position of the lower limb when climbing. Press outwards on the band and raise the arms overhead   
4. Robber *Scapular retraction  
5. Bent over I, T, Y  
6. Rows  
7. Hanging Scapular retractions  
8. Pull-ups:  

• Weight assisted with band
• Shoulder width
• Offset or wide: This position increases the likelihood of impingement, progress to this only when pain-free in the easier versions of the push-up

9. External rotation with a band, weights, etc.

10. Shoulder blade joint repositioning Rigid taping can be done in case of scapular dysfunction.

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