Characterizing the Consequences of Chronic Climbing-Related Injury in Sport Climbers and Boulderers

Effects of medical training therapy on injury rehabilitation and sports-specific performance in elite rock climbers: A randomized controlled trial

BACKGROUND

Medical training therapy (MTT) is an advanced, individualized rehabilitation approach that integrates multiple methods to improve physical function. It is widely applied to rehabilitate sports injuries. This randomized study evaluated MTT's effects on physical injury rehabilitation, mental function, and athletic performance in elite rock climbers.

METHODS

Thirty elite climbers (mean age 19.5 ± 2.9 years) from the Chinese National Climbing Team were randomly assigned to either an intervention group (MTT, n = 15) or a control group (CON, n = 15) for 16 weeks (May 6 to August 25, 2024). Both groups had access to the same rehabilitation facilities and physiotherapy. The CON group followed routine training, while the MTT group received additional exercises. The primary outcome was the incidence of climbing-related injuries across 19 body regions. Secondary outcomes included specialized abilities, Functional Movement Screen (FMS) scores, Self-Rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The total number of injuries (375, 4.74) and the duration of discomfort (weeks) in the MTT group were lower than those in the CON group (492, 7.26). The MTT group demonstrated significant improvements in outcomes at six sites including the shoulder, forearm, hand, wrist, upper back, and hip (10 % and 21.25 %, 6.67 % and 19.17 %, 27.08 % and 56.67 %, 10.42 % and 3.75 %, 17.08 % and 27.08 %, and 2.08 % and 4.58 % for the MTT and CON groups, respectively, p < 0.05). In tests of sports-specific performance and psychological functioning in rock climbing, time and between-group interaction effects were observed (p < 0.01) for the Finger Strip Endurance Test, Hanging L-Lift Leg Test, FMS, and SAS. After the intervention, the MTT group exhibited a relative increase in injuries to the neck, upper back, and knees (6.25 % and 1.25 %, 6.67 % and 13.33 %, and 13.75 % and 7.08 % for the MTT and CON groups, respectively, p < 0.05).

CONCLUSION

MTT is an ideal method for the rehabilitation of injuries in elite rock climbers and for facilitating their early return to sport. It addresses the majority of athletes' physical injuries and reduces the concentration of injuries in high-risk areas. Additionally, it specifically improves athletes' performance in specialized tests to alleviate the symptom of anxiety.

Top of the podium, at what cost? injuries in female international elite climbers

Objectives

Competitive sport climbing has made its way to the Olympic stage. This prestige has brought about route setting and training alterations which presumably affect injury epidemiology. Most of the climbing injury literature contains male climbers and lacks high performing athletes. Studies with both female and male climbers, rarely included separate analyses for performance level or sex. Therefore, injury concerns for elite female competitive climbers are impossible to discern. A former study examined the prevalence of amenorrhea in elite international female climbers (n = 114) and reported that 53.5% had at least one injury in the past 12 months, but injury details were excluded. This study's aim was to report these injury details and their associations with BMI, menstrual status and eating disorders of the cohort.

Methods

Online survey was emailed to competitive female climbers recruited through the IFSC database between June and August 2021. Data was analyzed using Mann-Whitney U, χ² and logistic regression.

Results

229 registered IFSC climbers opened the questionnaire and 114 (49.7%) provided valid responses. Respondents (mean ± SD; age = 22.9 ± 5 year) represented 30 different countries and more than half (53.5%, n = 61) reported an injury in the prior 12 months with the majority in shoulders (37.7%, n = 23) and fingers (34.4%, n = 21). Injury prevalence in climbers with amenorrhea was 55.6% (n = 10). BMI was not a significant predictor of injury risk (OR = 1.082, 95% CI: 0.89, 1.3; p = 0.440) while accounting for current ED over the past 12 months. However, the odds ratio for having an injury was doubled for those with an ED (OR = 2.129, 95% CI: 0.905, 5.010; p = 0.08).

Conclusion

With over half reporting recent injuries (<12 months) mostly to shoulders and fingers, development of new strategies for injury prevention in competitive female climbers are warranted. In addition, climbers with disordered eating behaviors and/or menstrual disturbances might be more prone to injury. More research in this population is required. Suitable screening to prevent these health issues and proper monitoring of these athletes are paramount to long-term athlete success.

Pectoralis Major Tendon Rupture While Bouldering

Pectoralis major tendon ruptures are rare injuries. We present a case of a pectoralis major tendon rupture incurred while bouldering that required surgical repair. The diagnosis of pectoralis major tendon rupture relies predominantly on clinical examination. Among athletes, outcomes after surgical repair are superior to those after nonoperative therapy in most cases of complete tendon rupture. Although infrequent, pectoralis major tendon ruptures can occur while climbing, and early recognition and expedited surgical treatment are paramount to maximize functional recovery.

A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.

Upper Extremity Injuries in Rock Climbers: Diagnosis and Management

Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.

Characteristics of bouldering injuries based on 430 patients presented to an urban emergency department

INTRODUCTION

Bouldering is a climbing sport that has been attracting a greater number of recreational and professional athletes over recent decades, which has led to an increase in sport-related injuries. The aim of this study was to determine the characteristics and the types of acute injuries caused by bouldering. Further athlete-specific factors and covariates for the trauma types were investigated.

MATERIALS AND METHODS

In this retrospective analysis, all patients presented to the level 1 trauma center at the hospital of the Technical University of Munich after an acute trauma related to bouldering were identified via the hospital documentation system. The period of observation was ten years, from 2010 until 2020. Epidemiological and injury-specific information as well as the initial treatment were registered. In a second step, the affected patients were invited to participate in an online survey in order to collect information about their skills, experience, and details about the trauma.

RESULTS

A total of 430 patients with 447 acute injuries were identified. There were 244 injuries among female and 203 injuries among male patients. The most common anatomical region affected was ankle (36.7%), knee (16.8%), elbow (12.3%), spine (7.2%) and shoulder (6.3%). The majority of 273 (61.1%) injuries were located at the lower extremities. The most frequent types of injury were sprains (53.0%), fractures (22.8%) or joint dislocations (11.9%). Surgical treatment was necessary for 89 (19.9%) patients. A return to bouldering was more likely in male patients 50 (75.8%) than in females 47 (59.5%) (p = 0.038). Subjectively, inexperienced boulderers were also less likely to return to the sport than advanced boulderers with greater experience (p = 0.001) CONCLUSION: The incidence of bouldering injuries is rising. Typical bouldering injuries could be identified and quantified at least for those patients who were presented to a hospital emergency department. Injuries in this setting do differ from the injury types known from rock climbing injuries as they are located on the lower extremity more often. Injuries of the fingers and hand, which are common climbing injuries, have been barely encountered in the emergency center.

Retrospective Analysis of Functional Pain among Professional Climbers

Climbing became one of the official Olympic sports in 2020. The nociplastic pain mechanism is indicated as important in professional sports. Functional pain, which has not been examined in climbers until now, can be an example of nociplastic pain. This study aimed to determine functional pain locations in climbers according to gender and dominant climbing style. Climbers (n = 183) and healthy subjects (n = 160) completed an online survey focused on functional pain occurrence in the head, spine, and upper limbs. The logistic regression showed that climbing predisposes one to functional pain at: Gleno-humeral joint (odds ratio (OR): 3.06; area under the curve (AUC): 0.635), elbow (OR: 2.86; AUC: 0.625), fingers (OR: 7.74; AUC: 0.733), all (p < 0.05). Among the climbers, the female gender predisposed one to pain at: GHJ (OR: 3.34; AUC: 0.638), thoracic spine (OR: 1.95; AUC: 0.580), and lumbosacral spine (OR: 1.96; AUC: 0.578), all (p < 0.05). Climbing predisposes one to functional pain development in the upper limb. While the male climbers mainly suffered from finger functional pain, the female climbers reported functional pain in the GHJ and the thoracic and lumbosacral spine. Further studies on functional pain occurrence are recommended.

Evaluation of a four-week Adjunct Compensatory Training for the treatment of climbing-specific overstrain syndromes of the shoulder

BACKGROUND

 Although climbing is an increasingly popular sport, there is a lack of scientific evaluation of suitable training methods for climbers, especially with a view to prevention and rehabilitation. A specific rehabilitation program, Adjunct Compensatory Training (ACT), has recently been presented, but it has not been evaluated scientifically to date.

OBJECTIVE

 To investigate the effects of Adjunct Compensatory Training on climbing-specific overstrain syndromes of the shoulder.

METHODS

 Twenty active boulderers and climbers with an average age of 28.9 (± 7.4) years performed a guided shoulder program of six specific exercises from the ACT program over a period of four weeks. They were examined before and after the intervention. Pre- and post-interventional measurements included the Constant-Murley Score, the QuickDASH Score and the measurement of shoulder ROM (range of motion).

RESULTS

 The Constant-Murley Score increased from 82 (± 10.0) to 104.1 (± 8.2) at follow-up (p < 0.001). The VAS value for bouldering and climbing decreased from 5.25 (± 1.4) before to 2.4 (± 1.6) after the intervention (p < 0.001). Shoulder flexion increased from 167.5 (± 14.9) to 173.1 (± 7.7) after the intervention (p < 0.05), abduction from 172.5 (± 14.9) to 179.6 (± 5.9) (n. s.), external rotation from neutral zero position from 77.6 (± 16.8) to 86.3 ± (8.3) (p < 0.05). Feasibility and acceptance of the intervention were good. Ninety-five percent of the participants continued to exercise, and 100 percent recommended the program to others.

CONCLUSION

 The ACT led to an improvement in pain, activities of daily living, range of motion and strength in boulderers and climbers with overstrain symptoms of the shoulder. It is also classified as a realistically feasible workout. The extent to which this effect will continue, and whether or not the program can prevent injuries, remains to be seen. It can only be presumed that regular exercises prevent shoulder injuries in the climbing population.

Impact of 30 years' high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers

BACKGROUND

Rock climbers are particularly susceptible to shoulder injuries due to repetitive upper-limb movements on vertical or overhanging terrain. However, the long-term effects of prolonged climbing on the shoulder joints are still unknown.

PURPOSE

The purpose of this study was to analyze the prevalence of pain and degenerative changes in the shoulder joints after high-level rock climbing over at least 25 years. We hypothesized that specific climber-associated patterns of degeneration would be found.

METHODS

Thirty-one adult male high-level rock climbers were compared to an age- and sex-matched control group of 31 nonclimbers. All participants underwent a detailed interview, standardized clinical examination, and bilateral (climbers) or unilateral (nonclimbers, dominant side) magnetic resonance imaging (MRI) scans. Clinical and MRI findings of the groups were compared.

RESULTS

The lifetime prevalence of shoulder pain in the rock climbers was 77%. The rock climbers had significantly more abnormalities in the labrum (82% vs. 52%; P = .002), long biceps tendon (53% vs. 23%; P = .006), and cartilage (28% vs. 3%; P = .005). These increased changes positively correlated with climbing intensity. There were no differences between the 2 groups with respect to rotator cuff tendon pathology (68% vs. 58%; P = .331) and acromioclavicular joint degeneration (88% vs. 90%; P = .713). Despite the increased degenerative changes in the rock climbers, their Constant score (CS) was still better than that of the nonclimbers (CS 94, interquartile range [IQR] 92-97, vs. CS 93, IQR 91-95; P = .019).

CONCLUSIONS

Prolonged high-level rock climbing leads to a high prevalence of shoulder pain and increased degenerative changes to the labrum, long biceps tendon, and cartilage. However, it is not related to any restriction in shoulder function.

Development of a comparative chimpanzee musculoskeletal glenohumeral model: implications for human function

Modern human shoulder function is affected by the evolutionary adaptations that have occurred to ensure survival and prosperity of the species. Robust examination of behavioral shoulder performance and injury risk can be holistically improved through an interdisciplinary approach that integrates anthropology and biomechanics. Coordination of these fields can allow different perspectives to contribute to a more complete interpretation of biomechanics of the modern human shoulder. The purpose of this study was to develop a novel biomechanical and comparative chimpanzee glenohumeral model, designed to parallel an existing human glenohumeral model, and compare predicted musculoskeletal outputs between the two models. The chimpanzee glenohumeral model consists of three modules - an external torque module, a musculoskeletal geometric module and an internal muscle force prediction module. Together, these modules use postural kinematics, subject-specific anthropometrics, a novel shoulder rhythm, glenohumeral stability ratios, hand forces, musculoskeletal geometry and an optimization routine to estimate joint reaction forces and moments, subacromial space dimensions, and muscle and tissue forces. Using static postural data of a horizontal bimanual suspension task, predicted muscle forces and subacromial space were compared between chimpanzees and humans. Compared with chimpanzees, the human model predicted a 2 mm narrower subacromial space, deltoid muscle forces that were often double those of chimpanzees and a strong reliance on infraspinatus and teres minor (60-100% maximal force) over other rotator cuff muscles. These results agree with previous work on inter-species differences that inform basic human rotator cuff function and pathology.

Post-activation Potentiation Response of Climbers Performing the Upper Body Power Exercise

The purpose of this study was to determine a performance-enhancing effect of post-activation potentiation (PAP) stimulus on climbing-specific upper body power exercises, measured by the IRCRA Power Slap test on a campus board. Two groups of climbers performed the test under one of two conditions: without initial pre-loading (control group) or after 5RM (repetition maximum) pull-ups (PAP group). The test was performed at four time points: at baseline (PRE) and after 4 (POST4), 6 (POST6), and 8 (POST8) minutes of a PAP stimulus (PAP group) or after the same rest period lengths (control group). The results showed that post-baseline slap distances were significantly greater in the experimental group while no change was seen in the control group [repeated measures ANOVA: F _{( 3},_{42 )} = 6.26, p = 0.001]. Post hoc analysis revealed no significant difference between any of the post-baseline trials in both groups. The mean improvement in the first POST4 test in the experimental (PAP) group was +6.5 cm (6.8%). The results of the present study suggest that PAP might be beneficial for acute improvement of upper body power performance in climbers. Therefore we conclude that such stimuli might be advisable for climbers as a part of the warm-up before bouldering competitions and training as well. They might also offer a stronger stimulus for climbers working on power development.

No pain no gain: a survey of use of healthcare and reasons not to seek healthcare by Norwegian climbers with chronic injuries

Objectives

To assess the use of healthcare, and reasons not to seek healthcare, by climbers with a chronic injury.

Method

Retrospective survey.

Setting

Web-based questionnaire.

Participants

667 active climbers (385 with chronic injuries).

Outcome measure

Use of healthcare (including reasons not to seek healthcare if the patient was not attended by health professionals), performance level in sport climbing, onset of a climbing-related injury, site of injury, preferred style of climbing and gender differences.

Result

Of the 667 respondents, 385 had experienced a chronic injury in the past 6 months. Climbers with a chronic injury are reluctant to seek healthcare, and male climbers are less likely to seek healthcare than female climbers. The two most frequent reasons not to seek healthcare were: (1) an assumption that the injury was not serious enough (70%) and (2) a belief that a health professional could not help (60%). Only one in five of the climbers with a finger injury sought healthcare. The more experienced climbers were less likely to seek healthcare than recreational climbers.

Conclusion

Use of healthcare among climbers with a chronic injury is limited and injured climbers self-assess the injury before seeking medical aid. Experience is a strong predictor for not seeking healthcare after an injury. These findings open up the possibility that some of those who do not seek healthcare after self-assessing the injury are underestimating the seriousness of the injury due to lack of confidence in the health professionals’ abilities to help treating chronic climbing related injuries.

Long-Term Radiographic Adaptations to Stress of High-Level and Recreational Rock Climbing in Former Adolescent Athletes: An 11-Year Prospective Longitudinal Study

BACKGROUND

In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport.

PURPOSE

While radiographic changes in long-term climbers are known, there are little data available on adolescent climbers. The question arises as to whether climbing at high levels at a young age leads to radiographic changes and possibly an early onset of osteoarthritis of the finger joints.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 19 members of the German Junior National Team (GJNT group) and 18 recreational climbers (RC group) were examined clinically and radiographically in 1999. In 2011, these climbers were re-examined (mean follow-up, 11.3 ± 1.2 years). Radiographs were evaluated using a standard protocol, searching for physiological adaptations such as cortical thickness of the middle phalanx and an increased adopted Barnett-Nordin index, as well as for early-onset osteoarthritic changes of the hand. In contrast to the Kellgren-Lawrence scale, subchondral sclerosis was added to the group of physiological, adaptive stress reactions and was not defined as osteoarthritis. Osteoarthritis was defined by a Kellgren-Lawrence grade ≥2.

RESULTS

Overall, 15 of 19 (follow-up rate, 78.9%) climbers in the GJNT group and 13 of 18 in the RC group (follow-up rate, 72.2%), with a mean age of 26.8 years, were examined at the 11-year follow-up. Five climbers (33%) in the GJNT group presented with a decreased range of motion for the finger joints, in contrast to only 1 climber (8%) in the RC group. Radiographic stress reactions of the hand were found in 80% of the GJNT group and 46% of the RC group, including cortical hypertrophy (GJNT: 73%; RC: 23%), subchondral sclerosis (GJNT: 80%; RC: 31%), a broadened proximal interphalangeal joint base (GJNT: 67%; RC: 38%), and a broadened distal interphalangeal joint base (GJNT: 53%; RC: 31%). Training intensity in 1999 and body weight in 1999 were significant for the development of radiographic stress reactions in 2011 (P < .05 for both). Signs of early-stage osteoarthritis were seen in 6 climbers: 4 (27%) in the GJNT group and 2 (15%) in the RC group. Significant statistical influences for the development of early-onset osteoarthritis were found for overall total training years (P = .024), use of campus board training in 1999 (P = .033), and climbing level (P = .030).

CONCLUSION

One-quarter of climbers who performed at a high level in their youth showed a "mild" form of osteoarthritis (Kellgren-Lawrence grade 2). In analyzing the training regimens of our climbers for longer than 10 years, we conclude that intensive finger training (eg, campus board training) can lead to early-onset osteoarthritis of the hand. We also demonstrate that a high Union Internationale des Associations d'Alpinisme (UIAA) climbing level correlates with the risk for early-onset osteoarthritis of the hand and therefore must be seen as a risk factor for developing early-onset osteoarthritis of the finger joints.

Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock Climbing Injuries

OBJECTIVE

To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries.

METHODS

Design: retrospective cross-sectional study.

SETTING

web-based survey.

PARTICIPANTS

rock climbers who sustained a climbing-related injury during the prior 24 months. Criteria for inclusion: aged ≥18 years; participation in rock climbing at least 4 times per year in the United States.

INTERVENTIONS

none.

MAIN OUTCOME MEASURES

percentage of injured climbers seeking medical care, providers seen, subspecialty referral, development of chronic problems, factors affecting return to climbing, injuries by climbing type, body region, and injury type.

RESULTS

Data were collected over a 60-day period using the Research Electronic Data Capture (REDCap) survey system. Seven hundred and eight surveys were collected from 553 male and 155 female climbers. Thirteen hundred ninety seven injuries were reported, and 975 injuries were suitable for analysis. The most common provider initially seen was a primary care provider. Subspecialty referral was commonly obtained. Injury patterns differed by climbing type. The percentage of respondents that returned to climbing before their injury was fully healed was 51.1%, and 44.9% of respondents developed chronic problems related to their climbing injury. Twenty-eight percent of respondents were unable to return to their previous level of climbing performance. Several factors were associated with delayed recovery from climbing injury.

CONCLUSIONS

A significant number of climbers sought healthcare after injury. A majority of climbers who sought treatment were referred to subspecialist providers. About one-half of climbers were symptomatic when they returned to climbing and developed chronic problems after injury. Factors associated with slower return to climbing included increasing age, smoking, fractures, and surgery.

Preparticipation Evaluation for Climbing Sports

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.

Preparticipation Evaluation for Climbing Sports

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.

Rock Climbing Injuries: Acute and Chronic Repetitive Trauma

Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis.