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 increasewithin the occurrence of sport-related injuries on both natural rock and artificial walls. It emphasizes on physical and mental challenges, one that often tests climber's upper and lower body flexibility, strength, endurance, agility and balance along withmental 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 createan elevated and diverse injury potential that’s hampering experience level and quantity of participation. Injuries can range fromacute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but theremaining musculoskeletal conditions aren’t exempt from these kind of injuries. Understanding the techniques of rock climbingand 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 ofcause, 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 weight of the climber places an extensive amount of stress not only on the climber’sfingers, but also their wrists, elbows, and shoulders.

•       Inherent within the characteristic of the sport, climbers frequently subject their bodies to recurrent traumatic  forces,whether from throwing to succeed in holds (dynoing and deadpointing) or falling from climbs (especially withbouldering), which leads to either overuse injuries or acute injuries.

•       This apparent pattern of overuse injuries may be associated with the architecture of climbing walls, climbing styles,training techniques, or relative weakness of specific group of muscles.

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. Upperextremity injuries were the vast majority and accounted for 63% of all injuries. Hand overuse injuries predominated (28% of allinjuries), although elbow injuries were a close second (19%). Combined upper extremity overuse injuries were common. Thisapparent pattern of overuse injuries could be related to the architecture of climbing walls, climbing styles, training techniques, orrelative weakness of specific anatomical structures. Consideration of the anatomical distribution of injuries associated with rockclimbing 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 steepoverhanging positions, is associated with a unique distribution and form of upper limb injuries. (28) Injuries of upper extremityare 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 stressfractures. 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 particularlysusceptible to the development of shoulder injuries due to prolonged and repetitive upper limb movements on vertical oroverhanging terrain. A cross-sectional cohort study of 201 climbers found the shoulder injuries to be positively related to thefrequency and difficulty of indoor and outdoor sport climbing and bouldering (17) An analysis of injury trends in sport climbingand bouldering over a 4-yr period found superior labral anterior posterior tears and impingement of subacromial structures to bethe foremost common diagnosis. 

Subacromial Impingement

The unique physical demands associated with climbing, as well as a reported 33%-51% incidence of shoulder injuries in theseathletes is suggestive of abnormalities in scapulohumeral biomechanics. (26) Clinically climbers with shoulder and armsymptoms are commonly observed with poor dynamic scapulothoracic and Glenohumeral control (Kibler et al. 2013). Scapulapositioning on the thorax is important in order to create a stable base for shoulder movement and maintain the humeral head inthe centre of the glenoid (Mottram 1997). If the scapula is’nt moving properly, the shoulder joint will have to pick up the slack,this puts climbers at an increased risk of impingement.

The shoulder blade is highlighted in red below. 

Put an image of abnormal shoulder blade (Optional)

Often most of the rock climbers shows relative weakness of shoulder external rotators (teres minor and infraspinatus – seebelow). These muscles are a part of rotator cuff located on the dorsum of scapula. It helps to stabilize the glenohumeral jointduring upward reaching. This muscular imbalance creats a high risk of shoulder 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 theirbody weight. The rotator cuff provides stability for the shoulder. It’s comprises of tendons that attaches to the humerus, as well asthe four major muscles that surround the shoulder complex. A weak rotator cuff and/or altered biomechanics can contribute to atear or tendonitis. Common symptoms include pain, weakness on lifting heavy objects or lowering the arm, restricted range ofmotion, and hearing clicking or popping sounds.

Physiotherapy Management:

Conservative treatment can be effective in treating tendonitis and partial tears. This includes relative rest, ice, anti-inflammatorymedications, corticosteroid injections, and physiotherapy. Exercise program will focus on activating the appropriate musclesduring climbing, then progressively strengthen them to improve performance and minimise the risk of injury in future.

Rotator cuff Strengthening : For a shoulder exercise to be effective it must be functional. There are two exercises which are foundto 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 required to have 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. Windmill *Scapular retraction  
6. Bent over I, T, Y  
7. Rows  
8. Hanging Scapular retractions  
9. 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.

If symptoms don’t go away or there is a complete rotator cuff tear surgery may be necessary to repair the tendon. Research hasshown favourable outcomes  after arthroscopic repair in climbers that will allow most athletes to return to or near their preinjurylevel of climbing. Thus, surgery is a valid treatment for climbers with acute traumatic tears and those with chronic tears who failto respond to conservative treatment.(20)

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