Acute Injury Risk and Severity in Indoor Climbing—A Prospective Analysis of 515,337 Indoor Climbing Wall Visits in 5 Years

Prospective analysis of injury demographics, distribution, severity and risk factors in adolescent climbers

Objective

This study aims to prospectively analyse current demographics, distribution and severity of climbing injuries in adolescents. We hypothesised that the injury distribution of adolescent climbers would differ from adults, as presented in the literature and that primary periphyseal stress injuries of the finger (PPSI) will be very common and correlate with training hours and climbing level.

Methods

We performed a prospective single-centre injury surveillance of all adolescent (<18 years of age) climbers who presented between 2017 and 2020. A standard questionnaire, including questions for medical history, injury and training data and an examination protocol, was conducted in all patients. Injuries were graded, and risk factors, anthropometric specifics and stages of development were analysed. Injury epidemiology of adolescents was then compared with adults as presented in the literature.

Results

137 independent climbing-related injuries were found in 95 patients. Injury onset was acute in 67 (48.9%) and chronic in 70 (51.8%). Forty-one injuries (29.9%) occurred during bouldering, 18 (13.1%) during lead climbing, 2 (1.5%) in speed climbing and 1 (0.7%) while training on the campus board. Average International Climbing and Mountaineering Federation injury score was 1.5±0.5 (range 0-3). Females had more training hours (p=0.004), more campus board use (p=0.004) and more acute injuries than males (p<0.001). 82% of the injuries affected the upper extremity and the most frequent injury was PPSI (45.3% of all injuries). Finger injuries were significantly more common in males than in females (p<0.05). The injury distribution in adolescent climbers differed significantly from adults (p<0.001).

Conclusions

Injured adolescent climbers had mostly chronic injuries affecting the upper extremity, with almost half of the injuries being PPSIs of the fingers. Further preventive measures targeting this type of injury need to be identified. Reducing the use of the finger crimp grip, monitoring the load, ensuring adequate recovery and targeted education appear to be crucial.

Biomechanical Evaluation of a Novel V-Shaped A2 Pulley Reconstruction Technique Using a Free Palmaris Longus Tendon Graft Tenodesis

Background: The aim of this biomechanical investigation was to evaluate a V-shaped three-point graft tenodesis technique using a free palmaris longus (PL) tendon for reconstructing traumatic A2 pulley lesions and to compare its biomechanical performance with two previously described reconstruction techniques. Methods: After A2 pulley lesion simulation in 27 fingers (index, middle and ring finger) from nine human anatomical hand specimens, reconstructions were performed using the innovative V-shaped graft tenodesis technique, a double-loop encircling technique and a suture anchor graft fixation technique. Load at failure and the failure mechanisms were evaluated. Results: The V-shaped graft tenodesis technique was superior biomechanically (p = 0.004) considering load at failure (mean: 299 N). The only observed failure mechanism in this group was the extrusion of the central tenodesis screw. In contrast, reconstructions in the other two groups failed due to suture cut-out. Conclusions: Patients may benefit from the new technique's high load tolerance during early mobilization. Furthermore, a reduction in complications may be anticipated due to an absence of sutures and the sparing of extensor structures.

The psychology of rock climbing: A systematic review

BACKGROUND

Psychology plays an important role in rock climbing performance and safety. Many studies have examined the psychology of rock climbing, a sport that has grown in popularity and status over the past few decades.

OBJECTIVE

This systematic review aimed to summarize published research on the psychology of rock climbing, find commonalities and disagreements within the current research and illuminate future research areas.

METHODS

A systematic literature search was conducted in three electronic databases (Scopus, PsycINFO and SPORTDiscus) in July 2023. Key search terms such as 'sport climbing' and 'psychology' were included and combined using the operators "AND", "OR". The search syntax initially identified 504 records. After screening abstracts and full texts, 83 studies examining the psychology of rock climbing remained.

RESULTS

Studies were sorted by whether they measured climbing-specific or psychological variables. Climbers are conscientious, intrinsically motivated and task-oriented. Flow is brought on by novel, challenging climbing situations and increases enjoyment and performance. Climbing ability correlates with self-confidence, decision-making ability, tactile and spatial perception and anxiety facilitation. Better and more experienced climbers better manage risk with less psychophysiological effects. Weaknesses of the current body of literature and avenues for future research were highlighted.

CONCLUSION

Findings from this review suggest rock climbers are a unique group of athletes who balance risk with performance in different environments. Flow, confidence, anxiety facilitation and perception all play key roles in climbing performance. The optimal levels and development of these and more psychological variables have yet to be clarified by existing literature.

A Retrospective Observational Study of Rock-Climbing Injuries in Singapore

Background Rock climbing is becoming increasingly popular in Singapore resulting in an increasing number of rock-climbing-associated injuries requiring surgery. The main objective of this study is to evaluate the demographics, mechanism, and extent of injuries in patients admitted following rock-climbing-related injuries over a seven-year period. Method All patients admitted to the Department of Orthopedic Surgery between January 2017 and December 2023 with injuries related to rock-climbing accidents were recruited. Data collection was performed retrospectively on the patient profile, day and time of injury, type of rock climbing, mechanism, pattern, and the extent of injury. Results Across 22 patients, 68.4% of injuries occurred in the afternoon, distributed equally across the week. Demographically, majority were young adults (27.3 + 7.8 years), female (77.3%) with a mean BMI of 23.67 + 3.27 kg/m2. A total of 90.9% of them fell from height commonly resulting in fractures (95.5%), of which 54.5% sustained two or more fractures and 9.5% sustained open fractures. Comparatively, falling from a higher height resulted in multiple injuries, though not statistically significant. The two patients who sustained open fractures fell from a height of 2 m and 10 m. Lower limb injuries (72.7%) were more common than upper limb (18.2%) and spine (22.7%) injuries. A total of 90.9% of them required surgery, of which 36.8% required a second surgery. A relatively equal number of injuries were sustained from bouldering (45.5%) and sport climbing (54.5%). Females were shown to be more likely injured from bouldering than sport climbing (p = 0.040). A total of 100% of bouldering injuries occurred due to falls from height, while 16.7% of injuries during sport climbing were due to laceration or hand-hold injury. Patients who fell from sport climbing fell from a higher height of 3.35 + 2.6 m compared to bouldering at 2.5 + 0.9 m. Moreover, 33.3% of patients injured from sport climbing sustained multiple regions of injuries, two of which were open fractures, while all injured from bouldering only sustained injuries in a single region, only sustained closed fractures, and none affected the upper extremity. A total of 100% of bouldering injures and 80% of sport-climbing injuries required surgery where around 37% of patients in both groups required repeat surgery. Patients with sport-climbing injuries had a longer length of hospital stay (13.8 + 18.3 days) and duration of hospitalization leave (dHL) (81.3 + 45.5 days) compared to bouldering injuries. Conclusion Rock-climbing-associated injuries are predominantly caused by falls, commonly resulting in fractures requiring admission and surgical intervention, especially in the lower extremities. With increasing popularity and accessibility of the sport in Singapore, there is an expected increase in the number of orthopedic injuries. Injuries vary widely from lacerations to fractures of the extremities and spine to open fractures requiring emergency surgery. Proper safety precautions, equipment, training, and strict regulations for belay certification should be put in place to mitigate the risk of such injuries.

Mid- to long-term functional outcome and return to sport after elbow dislocation in bouldering: a clinical retrospective cohort study

INTRODUCTION

Traumatic elbow dislocations are among the most common injuries in sport climbing. They occur most frequently in bouldering (a climbing discipline with strong upward trend often performed indoors) due to the typical low-height backward fall into crashpads. There is still no data about the functional outcome and return to sport of this typical bouldering injury.

MATERIALS AND METHODS

All Patients with elbow dislocations due to a bouldering associated fall between 2011 and 2020 were identified retrospectively in our level I trauma centre. Trauma mechanisms, injury types and therapies were obtained. Follow-up was performed with an online questionnaire including sports-related effects, return to sport and the Elbow Self-Assessment Score (ESAS).

RESULTS

30 patients with elbow dislocations after bouldering accidents were identified. In 22 (73.3%) patients the injury was a simple dislocation. The questionnaire was completed by 20 patients. The leading mechanism was a low-height fall into crashpads. Surgical procedures were performed in every second patient. 18 patients (90%) reported return to bouldering after 4.7 ± 2.1 months. 12 patients (66.7%) regained their pre-injury level. Mid-/Long-term follow-up (mean 105 ± 37.5 months) showed excellent results in ESAS score (97.2 ± 3.9 points). Persistent limited range of motion or instability was reported by only 3 patients (15%).

CONCLUSION

Most athletes are able to return to bouldering but only two thirds regain their pre-injury performance level in this demanding upper-extremity sport. The unique low-height trauma mechanism may create a false sense of security. Specific awareness and safety features should be placed for climbing athletes to reduce elbow injuries.

Less Talk More Chalk: A Retrospective Review of Rock Climbing-Related Trauma

Introduction Climbing is a strength and strategy-driven sport that has greatly increased in popularity over the last decade, partially due to its debut in the Tokyo 2020 Summer Olympics. With an increasing number of new climbers and the emergence of recreational indoor climbing facilities, fall injury risk remains a legitimate concern within the climbing community. This study evaluates the pattern of injury in trauma patients presenting to the Desert Regional Medical Center, a level 1 trauma center in Palm Springs, CA, following falls from height while rock climbing. Methods Our study retrospectively investigated a de-identified dataset on trauma patients at the Desert Regional Medical Center, a level 1 trauma center located in Palm Springs, CA, from 2016 to 2021. This analysis focused on 75 patients who presented following falls from height while rock climbing. We reviewed several parameters, including patient demographics, Injury Severity Score (ISS), hospital length of stay (LOS), injury type, and patient outcomes. Descriptive statistics including median values, standard deviations (SD), and P-values were assessed via Microsoft Excel. Several paired, one-tailed t-tests and a Pearson's correlation test were also conducted to further evaluate the association between variables within the dataset. Results In this retrospective analysis of patients presenting to the emergency department post-fall from heights while rock climbing, the patient profile was predominantly younger or middle-aged climbers under 60 years old (65, 86.7%). The mean patient age was 37 years old. The majority of patients were non-Hispanic (69, 92%), noting a male predominance (57, 76%). Most patients (60, 80%) required partial trauma code status. Hospitalization was required for most individuals (67, 89.3%), with several requiring intensive care unit (ICU) admission (29, 38.7%). The average hospital LOS was 6.7 amongst all admissions. Patients requiring LOS greater than 10 days had a higher average ISS (12.9) when compared to climbers with shorter lengths of admission (ISS of 10.4). There was no significant difference in ISS between younger patients (ISS of 9.3) and those 60 and older (ISS of 10.6). The most common critical injury was lower extremity fracture (36, 48%), noting no significant increase in injury incidence over the last five years. Conclusion Rock climbers who experience falls from cliffs are most at risk for a lower extremity fracture. Demographically, a majority of injured climbers in this study were young males, who may exhibit risk-taking behavior. To better prevent critical injuries within the climbing sector, we encourage an increase in safety measures (crash mats, harnessing) and the implementation of a new climber education program.

Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial

BACKGROUND

In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort.

METHODS

Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test.

RESULTS

Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking.

CONCLUSIONS

Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).

Analyzing Injury Patterns in Climbing: A Comprehensive Study of Risk Factors

Climbing, a sport with increasing popularity, poses diverse risks and injury patterns across its various disciplines. This study evaluates the incidence and nature of climbing-related injuries, focusing on how different disciplines and climbers' personal characteristics affect these injuries. Data on injury incidence, severity, and consequences, as well as climbers' personal attributes, were collected through a questionnaire and analyzed using generalized linear models and generalized linear mixed models, Cochran-Armitage tests, and multivariate analysis. Our findings indicate a direct correlation between time spent on bouldering and lead climbing and increased injury frequency, while injury incidence decreases with time in traditional climbing. Interestingly, personal characteristics showed no significant impact on injury incidence or severity. However, distinct patterns emerged in individual disciplines regarding the recent injuries in which age and weight of climbers play a role. While the phase of occurrence and duration of consequences show no significant variation across disciplines, the intensity of the required treatment and causes of injury differ. This research provides insights into climbing injuries' complex nature, highlighting the need for tailored preventive strategies across climbing disciplines. It underscores the necessity for further investigation into the factors contributing to climbing injuries, advocating for more targeted injury prevention and safety measures in this evolving sport.

Self-Reported Injuries in Indoor Gym-Based Rock Climbers: A Retrospective Study of Predictors of Prolonged Injury and Seeking Medical Care

INTRODUCTION

Indoor climbing injuries are often related to overuse, and climbers choose between self-management and seeing a medical practitioner. This study evaluated predictors of prolonged injury and seeking medical care for indoor climbing injuries.

METHODS

A convenience sample of adult climbers from 5 gyms in New York City was interviewed about injuries over the past 3 y, because of which they stopped climbing for at least a week or saw a medical practitioner.

RESULTS

In total, 122 of 284 (43%) participants had at least 1 injury, for a total of 158 injuries. Fifty (32%) were prolonged, lasting at least 12 wk. Predictors of prolonged injury included older age (odds ratio [OR], 2.28, per 10-y increase; 95% CI, 1.31-3.96), hours per week spent climbing (OR, 1.14, per 1-h increase; 95% CI, 1.06-1.24), climbing difficulty (OR, 2.19, per difficulty group increase; 95% CI, 1.31-3.66), and years of climbing experience (OR, 3.99, per 5-y increase; 95% CI, 1.61-9.84). Only 38% of injuries were seen by a medical practitioner. Predictors of seeking care included prolonged injury (OR, 3.04; 95% CI, 1.39-6.64) and rope climbing preference (OR, 1.98; 95% CI, 1.02-3.82). The most common theme for seeking care was serious pain or interference with climbing or daily activities.

CONCLUSIONS

Despite prolonged injuries being common, especially in older, more experienced, and higher-level climbers, only a third of climbers with injuries seek medical care. Outside of injuries causing minimal pain or limitation, those who self-managed reported receiving advice from other climbers or online research as a prominent reason for that choice.

Epidemiology of sport climbing injuries caused by a climbing fall among climbers of the French Federation of Mountain and Climbing

BACKGROUND

Fall-related injuries (FRIs) are the most severe sport climbing injuries. The main objective of this study was to measure FRI prevalence and risk factors in a representative sample of climbers of the French Federation of Mountain and Climbing. The second objective was to explore FRI mechanisms.

METHODS

The study included 3919 climbers aged 16+. They were invited to fill out an online questionnaire where they reported sociodemographics, sport-related characteristics and whether they had sustained an FRI in the past 12 months (12-FRI), and over their entire career (ALL-FRI). The mechanisms of 12-FRI were asked for. Multivariable logistic regression analyses were performed to evaluate the association between sport-related characteristics and FRI.

RESULTS

Nine per cent of the participants reported a 12-FRI and 29% an ALL-FRI. No statistically significant effect of sex, context of climbing, or onsight level was observed on 12-FRI. Climbers with 0-3 years of experience (YE) were 1.7 (95% CI: 1.2-2.6) and 3.6 (95% CI: 2.2-6.3) times more likely to have sustained a 12-FRI compared with those with 5-8 YE and 14-23 YE, respectively. An interaction effect was found between YE and onsight level. Among climbers with 0-8 YE, those with a higher onsight level had a higher risk of 12-FRI. Natural falls, unexpected falls and static belaying were the most commonly reported 12-FRI mechanisms.

CONCLUSIONS

These results highlight that future FRI prevention programs should target priority-inexperienced climbers who have progressed rapidly. Climbers should be taught as a priority to stay focused while belaying even in the least difficult passage, and to belay dynamically.

Head Injuries in Rock Climbing: A Scoping Review

Rock climbing was recognized as a sport at the 2020 Tokyo Olympics. Despite its increasing participation, there is no knowledge synthesis of head injuries (HIs), defined as any injury to the head, associated with climbing, making it challenging for clinicians to provide evidence-based care. Our aim was to synthesize HI literature within rock climbing and identify knowledge gaps. Six databases (Medline, Embase, Sports Medicine & Education Index, SPORTDiscus, CINAHL, and Cochrane) were searched. Two reviewers screened 345 studies and 31 studies were selected for data abstraction. We found the quality of individual studies mainly "fair" to "good." Both HI and traumatic brain injury (TBI) had inconsistent definitions and categorization. The HIs represented between 0 to 36% of reported climbing injuries. Between 11 to 100% of HIs were TBIs, defined as an HI with permanent or temporary neurological sequelae. The most common causes of HIs were outdoor falls and falling objects. Climbing-specific factors associated with the causes were infrequently examined in the literature. Data sources of safety practices were incomplete. Overall, there was a lack of literature examining HIs, mechanisms of injury, and safety practices associated with climbing. To improve the tracking of HIs in climbing, we suggest the use of consistent reporting standards and the creation of a climbing injury surveillance system.

Effect of Indoor Climbing on Occupational Self-Efficacy and Employability: Results of a 10-Month Randomised Controlled Study of Persons with Intellectual Disability

(1) Background: Indoor climbing has different effects at various levels, including physical, psychological, and social ones. It is of high interest to assess whether social skills developed through climbing can be transferred to another environment, such as the working environment. This study investigates the effects of indoor climbing on employability and occupational self-efficacy of people with intellectual disability, who possess lower levels of social competences in general. (2) Methods: A randomised controlled study (RCT) experimental study design with three groups was formed-one intervention (IG) and two control groups (CGI&II). For 10 months, the IG went climbing (two times per week), whereas the first CG followed a sports programme and the second CG served as controls. (3) Results: IG participants showed significant improvement in mental and somatic health over time. Regarding occupational self-efficacy, females had a significantly lower mean. Nevertheless, only the IG's female participants mean increased significantly over time. (4) Conclusions: Indoor climbing can be effective for improving occupational health and can be beneficial for specific groups; however, additional research is needed to further specify the influence of indoor climbing on a wider variety of aspects of the life of people with intellectual disability.

The Origin, Application and Mechanism of Therapeutic Climbing: A Narrative Review

As an innovative exercise therapy, therapeutic climbing (TC) has attracted more attention than ever before in recent years. In this review of the related studies on TC, the authors explore its origin and development; summarize its therapeutic effect in treating depression, low back pain and other diseases; and further analyze its underlying mechanism. According to the literature, TC was primarily applied in the field of orthopedics and then was gradually used in neurology, psychiatry and psychology. It provides a new means for the treatment of depression, lower back pain, multiple sclerosis and other diseases. There are two potential mechanisms: physiological and psychological. In the future, exercise effects, adverse effects and exercise prescriptions of TC should be explored with large samples and high-quality randomized controlled trials.

Risk profiles in two different alpine rock climbing styles

INTRODUCTION

The aim of this study is to evaluate the injury risk profile of the two different styles of rock climbing, alpine climbing with minor route protection (AC) and alpine sport climbing on well-protected routes (SC), in order to develop preventive strategies for risk management.  PATIENTS AND METHODS : 18 SC and 12 AC rock climbing accidents were evaluated retrospectively with a focus on climbers` demographics (age, experience, training intensity, performance level), accident demographics (unforeseen events preceding the injury, ascending or descending, fall height), injury patterns (injury severity, pathologies, pathomechanism) and environmental conditions (rock characteristics, route frequency, route grade, weather).  RESULTS : Injuries were mainly sustained by male lead climbers during ascent (80%). The lower extremity was injured in 46%, the upper extremity in 40%, the pelvis in 6% and the head, chest and spine in 3%. Climbers were significantly older (43 vs. 31 years; p=0.03) and more experienced (21.5 vs. 5.7 climbing years) in AC. Falling height was significantly greater in AC (14.8 vs. 4.7m). Unforeseen events preceding the injury differed significantly between both groups. Slipping off and letting go preceded the fall in 78% in SC, while rock dislodging occurred only in AC. There was a tendency that climbers in SC climbed near or above their performance level, while climbers in AC climbed below their level. SC climbers tended to show more ankle fractures while AC climbers tended to present more cases with multiple injuries.

DISCUSSION

AC and SC climbers differ in their risk profiles. Poorer route protection in AC resulted in more severe injuries. Yet in SC routes, good protection alone was not enough to avoid severe injuries. For prevention, climbers should be aware of the specific risks in AC and SC routes and should adjust their behaviour accordingly. Athletic skills were overestimated in SC, while alpine demands were underestimated in AC. A higher focus on visual and haptic grip control may help to prevent loss of hold. A careful lining of the rope into solid rock can reduce rockfalls for the seconder. Continuous attention is mandatory in rope handling and belaying. Applying more mobile pros is recommended in AC because they may shorten fall heights.

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.

Injuries in outdoor climbing: a retrospective single-centre cohort study at a level 1 emergency department in Switzerland

Objectives

Outdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland.

Methods

A retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012-December 2018.

Results

78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1-38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF.

Conclusions

Accidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.

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.

Shoulder Pathology on Magnetic Resonance Imaging in Asymptomatic Elite-Level Rock Climbers

Background:

The prevalence of findings on shoulder magnetic resonance imaging (MRI) is high in asymptomatic athletes of overhead sports.

Purpose/Hypothesis:

The purpose of this study was to determine the prevalence of atypical findings on MRI in shoulders of asymptomatic, elite-level climbers and to evaluate the association of these findings with clinical examination results. It was hypothesized that glenoid labrum, long head of the biceps tendon, and articular cartilage pathology would be present in >50% of asymptomatic athletes.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 50 elite climbers (age range, 20-60 years) without any symptoms of shoulder pain underwent bilateral shoulder examinations in addition to dedicated bilateral shoulder 3-T^† MRI. Physical examinations were performed by orthopaedic sports medicine surgeons, while MRI scans were interpreted by 2 blinded board-certified radiologists to determine the prevalence of abnormalities of the articular cartilage, glenoid labrum, biceps tendon, rotator cuff, and acromioclavicular joint.

Results:

MRI evidence of tendinosis of the rotator cuff, subacromial bursitis, and long head of the biceps tendonitis was exceptionally common, at 80%, 79%, and 73%, respectively. Labral pathology was present in 69% of shoulders, with discrete labral tears identified in 56%. Articular cartilage changes were also common, with humeral pathology present in 57% of shoulders and glenoid pathology in 19% of shoulders. Climbers with labral tears identified in this study had significantly increased forward elevation compared with those without labral tears in both active (P = .026) and passive (P = .022) motion.

Conclusion:

The overall prevalence of intra-articular shoulder pathology detected by MRI in asymptomatic climbers was 80%, with 57% demonstrating varying degrees of glenohumeral articular cartilage damage. This high rate of arthritis differs significantly from prior published reports of other overhead sports athletes.

Analysis of Feature Dimension Reduction Techniques Applied on the Prediction of Impact Force in Sports Climbing Based on IMU Data

Sports climbing has grown as a competitive sport over the last decades. This has leading to an increasing interest in guaranteeing the safety of the climber. In particular, operational errors, caused by the belayer, are one of the major issues leading to severe injuries. The objective of this study is to analyze and predict the severity of a pendulum fall based on the movement information from the belayer alone. Therefore, the impact force served as a reference. It was extracted using an Inertial Measurement Unit (IMU) on the climber. Additionally, another IMU was attached to the belayer, from which several hand-crafted features were explored. As this led to a high dimensional feature space, dimension reduction techniques were required to improve the performance. We were able to predict the impact force with a median error of about 4.96%. Pre-defined windows as well as the applied feature dimension reduction techniques allowed for a meaningful interpretation of the results. The belayer was able to reduce the impact force, which is acting onto the climber, by over 30%. So, a monitoring system in a training center could improve the skills of a belayer and hence alleviate the severity of the injuries.

Longer Tendon-Bone Distances of the A2 and A4 Annular Pulleys in Experienced High-Level Sport Climbers: Injury or Adaptation?

INTRODUCTION

Experienced high-level climbers are subject to a number of bone and soft tissue changes over the years and are also among the most exposed to pulley injuries. One of the main consequences of pulley rupture is the separation of the flexor tendons from the subjacent phalanges, also known as bowstringing. The purpose of this study was to determine whether this population has asymptomatic bowstringing of the A2 and/or A4 pulleys as determined by tendon-bone distance (TBD) values when compared to nonclimbers.

METHODS

High-resolution ultrasound TBD measurements in active forced flexion were made for the A2 and A4 pulley of the ring finger bilaterally. Participants were 21 asymptomatic sport climbers who had 21 consecutive years of climbing at a level above 9.66 in the International Mountaineering and Climbing Federation difficulty metric scale. Control subjects were 21 age-matched nonclimbers.

RESULTS

A significantly longer TBD-25% (0.3 mm) and 35% (0.4 mm) for the A2 and A4 pulleys, respectively-was found in the experienced climbers group (experienced climbers group: A2 1.6±0.5 mm and A4 1.6±0.4 mm; nonclimbers group: A2 1.2±0.1 mm and A4 1.2±0.2 mm).

CONCLUSIONS

Our results suggest that bowstringing of A2 and A4 pulleys occurs in asymptomatic experienced high-level climbers, which could be interpreted as either an adaptive mechanism to workloads endured over years of climbing or a consequence of underdiagnosed pulley ruptures.

Non-trophic Functional Ecology of Vertebrate Teeth: A Review

Teeth are critical to the functional ecology of vertebrate trophic abilities, but are also used for a diversity of other non-trophic tasks. Teeth can play a substantial role in how animals move, manipulate their environment, positively interact with conspecifics, antagonistically interact with other organisms, and sense the environment. We review these non-trophic functions in an attempt to place the utility of human and all other vertebrate dentitions in a more diverse framework that emphasizes an expanded view of the functional importance and ecological diversity of teeth. In light of the extensive understanding of the developmental genetics, trophic functions, and evolutionary history of teeth, comparative studies of vertebrate dentitions will continue to provide unique insights into multi-functionality, many-to-one mapping, and the evolution of novel abilities.

The epidemiology of indoor and outdoor rock climbing injuries presenting to United States emergency departments

BACKGROUND

The popularity of both indoor and outdoor rock climbing has dramatically increased over the last decade. The purpose of this study is to evaluate trends in United States climbing injury rates as well as assess specific injury characteristics, especially in the context of indoor and outdoor climbing.

METHODS

The National Electronic Injury Surveillance System database was queried (2010-2019) to compare national weighted injury estimates and compare various injury characteristics from climbers presenting to US emergency departments.

RESULTS

The annual national estimates of rock climbing-related injuries presenting to US emergency rooms increased significantly (p=0.030) from 2010 (N=2,381; CI 1,085-3,676) to 2019 (N= 4,596; CI 492-8,699). 58.7% of the injuries in this study that could be classified by location occurred climbing outdoors. Ankle injuries were 2.25 times more likely (CI 1.03-3.08) to occur indoors than outdoors. Outdoor climbers were 2.25 times more likely to sustain an injury via falling and 13.8 times more likely to be injured by being struck by an object than indoor climbers (CI 1.05-2.42, CI 10.67-17.78).

CONCLUSIONS

Indoor and outdoor rock climbing are associated with different injury characteristics and risks. Therefore proper safety precautions, equipment, and training specific to terrain should be observed by all climbers in order to help decrease the rising trend of rock climbing-related injuries in the United States.

Epidemiology of Ice Climbing Injuries Among Recreational Ice Climbers at the 2019 Ouray Ice Climbing Festival

INTRODUCTION

As a close relative to the sports of mountaineering and rock climbing, water ice climbing has been traditionally considered "high risk." There is little data to support or refute this assertion. Prior estimates of the injury rate range from 4.8 to 248 injuries per 1000 participation hours. In this study, we characterized the types of injuries and determined an injury incidence among water ice climbing participants at the 2019 Ouray Ice Festival climbing manmade ice walls.

METHODS

A survey was distributed during the 2019 Ouray Ice Festival in Ouray, Colorado. Respondents were asked to include festival-related injuries and estimate their participation time at the 4-d festival. Individuals who reported an injury were asked to provide additional details with regard to injury type, location, and timing. The injury incidence rate was calculated as the total number of injuries reported divided by the total number of participation hours and is reported as injuries per 1000 participation hours.

RESULTS

A total of 75 surveys were analyzed. A total of 16 injuries, all which were minor, and 912 participation hours were reported, resulting in an injury incidence of 17.6 injuries per 1000 participation hours.

CONCLUSIONS

This study reports an injury incidence based on an unselected sample of water ice climbers at an ice climbing festival. Water ice climbing at festivals appears to result in injuries of minor severity with no major accidents or fatalities. This study could be repeated to confirm its validity with a larger sample size.

Indoor Bouldering-A Prospective Injury Evaluation

INTRODUCTION

Bouldering has become a sport of growing interest, but little prospective evidence exists about injury proportions and patterns. The purpose of this study was to prospectively evaluate the cause of injuries sustained during indoor bouldering, proportion of affected body location, and injury severity.

METHODS

Proportions and patterns of injury among German-speaking indoor boulderers were evaluated prospectively in an explorative cohort study. Participants completed a baseline questionnaire assessing anthropometric data and sport-specific potential preventive and risk factors, followed by monthly injury questionnaires including injury location and injury severity over a period of 12 mo.

RESULTS

Out of 507 boulderers, 222 (44%) sustained 305 injuries. Of those, 78% (n=238) were classified as Union Internationale de Associations d'Alpinisme (UIAA) 1, 19% (n=57) as UIAA 2, and 3% (n=10) as UIAA 3. Injuries of the upper extremities accounted for 63% (n=191) of all injuries. Injuries of the lower extremities accounted for 23% (n=71) but were more often classified as UIAA≥2 (P=0.0071; odds ratio [OR] 2.23; 95% CI 1.23-4.04) and were more often caused by falling (P=0.0005; OR 2.92; 95% CI 1.57-5.42) and jumping off the wall (P<0.0001; OR 4.39; 95% CI 2.25-8.56) than injuries of other body locations. There was no statistically significant protective effect of the evaluated potential preventive measures. Participants who used heavily downturned climbing shoes had a higher risk of sustaining a UIAA ≥2 injury (P=0.0034; OR 2.58; 95% CI 1.34-4.95).

CONCLUSIONS

Injuries in indoor bouldering are common. Lower extremity injuries are associated with higher injury severity. Preventive measures need to be established to reduce bouldering injuries, especially during falls and landings.

Expert Views on Therapeutic Climbing-A Multi-Perspective, Qualitative Study

Therapeutic climbing (TC) is regularly used as an add-on treatment option for a variety of disorders. However, evidence on the assessment of professionals deciding on the treatment options or assessing the appropriateness of treatment options is lacking. Therefore, the aim of the present study was to assess the potential of TC as an exercise intervention from different expert perspectives. The study was designed as a qualitative, problem-centered interview experiment to assess the perspectives of pedagogues, physicians, and psychologists on exercise therapy in general and the potential of TC. The sample consisted of 30 experts (10 pedagogues, 10 physicians, and 10 psychologists) with different levels of experience in TC (ᴓage: 41.7 years, ♀ = 43%). Overall, the potential of TC as an add-on treatment option for various disorders was rated by the respondents as positive and useful. The interviewed experts believed that TC can have a decisive effect on the social, psychological, and physiological domain as a sensibly used add-on therapy. However, considering the reported potential adverse effects and the costs connected with TC, it should not be considered as a panacea. Although research in this area is still much in its infancy, the positive perspective of the professional representatives surveyed could facilitate access to TC for patients and may foster more research in this field.

Olympic competition climbing: the beginning of a new era-a narrative review

Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.

Affective responses to climbing exercises in children and adolescents during in-patient treatment for mental health disorders a pilot study on acute effects of different exercise interventions

The aim of the present study was to compare acute effects of a climbing intervention (CI) on affective responses with a different exercise intervention (swimming, SI) and an occupational therapy intervention (OTI) in children and adolescents during in-patient treatment for mental health disorders. The following study was designed as a cross-over study. Participants completed three single 60 min interventions of CI, SI and OTI. Affective responses were assessed pre and post intervention and at 20 and 40 min during intervention. The sample consisted of 33 children and adolescents in mental-health inpatient care (ᴓage: 13.3 ± 2.2 years, ♀=39.4%). A significant time effect was seen in all interventions in increasing positive and reducing negative affect, p<.028, eta²>0.144. Repeated measures ANOVAs revealed a significant time by intervention effect for affective valence (p=.011, eta²=0.09), but not for perceived activation, favouring CI over SI and OCT between pre-test and the first 20 or 40 min, respectively. All interventions showed similar effects on affective responses pre to post interventions. CI seems to increase affective valence more strongly during intervention compared to SI and OTI. The present results may have implications for therapy adherence and acute emotion regulation in children and adolescent in-patients with mental health disorders.

Comprehensive Review of Rock Climbing Injuries

Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary 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. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.

Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes

BACKGROUND

There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes.

PURPOSE

To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores.

RESULTS

Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5).

CONCLUSION

Increased attention should be placed on the climber's knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.

Climbing Accidents-Prospective Data Analysis from the International Alpine Trauma Registry and Systematic Review of the Literature

Climbing has become an increasingly popular sport, and the number of accidents is increasing in parallel. We aim at describing the characteristics of climbing accidents leading to severe (multisystem) trauma using data from the International Alpine Trauma Registry (IATR) and at reporting the results of a systematic review of the literature on the epidemiology, injury pattern, severity and prevention of climbing accidents. We found that climbing accidents are a rare event, since approximately 10% of all mountain accidents are climbing related. Climbing accidents mainly affect young men and mostly lead to minor injuries. Fall is the most common mechanism of injury. Extremities are the most frequently injured body part. However, in multisystem climbing-related trauma, the predominant portion of injuries are to head/neck, chest and abdomen. The fatality rate of climbing accidents reported in the literature varies widely. Data on climbing accidents in general are very heterogeneous as they include different subspecialties of this sport and report accidents from different regions. A number of risk factors are accounted for in the literature. Appropriate training, preparation and adherence to safety standards are key in reducing the incidence and severity of climbing accidents.

How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina

OBJECTIVE

To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018).

METHODS

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff.

RESULTS

In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes.

CONCLUSION

The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.

Evaluation of Rock Climbing Related Injuries in Older Athletes

INTRODUCTION

With the growing enthusiasm from people of all ages about rock climbing and bouldering, adaptions and medical conditions of the older athlete have become increasingly important. We aimed to analyze injury demographics, distribution, and severity for the older rock-climbing athlete.

METHODS

During a 3-y period, we performed a single-center injury surveillance in athletes ≥35 y of age presenting with rock climbing-related injuries or complaints. A standard questionnaire and examination protocol were conducted.

RESULTS

A total of 198 patients (age 44.2±7.1 [35-77] y) (mean±SD, with range) with 275 independent injuries were recorded. Ninety percent of all injuries affected the upper extremity, 6% the lower extremity, and 4% other body regions. The Union Internationale des Associations d'Alpinisme injury scores were 2.0±0.3 (1-4), and no fatalities occurred. Acute injuries were observed in 32% and overuse injuries in 68% of all injuries. Among the overuse injuries, 47% were classified as degenerative overuse conditions. Athlete age did not significantly correlate with the development of overuse injuries and UIAA injury score, but subgroup analysis showed a weak correlation of the climber age with the development of degenerative conditions (P<0.05). The leading diagnosis of degenerative conditions was subacromial impingement syndrome of the shoulder.

CONCLUSIONS

Compared to younger athletes, older rock climbers demonstrate a higher proportion of overuse injuries, especially degenerative conditions. Profound knowledge of climbing injuries patterns and conditions in older rock climbers is crucial to prevent injuries among all age groups and to decrease the number of degenerative injuries.

Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review

Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.

Rock Climbing Injuries Treated in US Emergency Departments, 2008-2016

INTRODUCTION

Previous research identified a trend for increasing numbers of injuries sustained while rock climbing. This study investigates whether that trend continued and describes characteristics of climbing injuries.

METHODS

The National Electronic Injury Surveillance System registry was searched for rock climbing injuries in US emergency departments in 2008 through 2016 among patients aged ≥7 y. Variables included each patient's age, diagnosis, injured body part, mechanism of injury, and disposition. Injuries were graded using International Mountaineering and Climbing Federation injury grades. National estimates were generated using sample weighting.

RESULTS

An estimated 34,785 rock climbing injuries were seen in emergency departments nationally, a mean of 3816 per year (SD 854). The median age of injured climbers was 24 y (range 7-77), with those aged 20 to 39 y accounting for 60% and males for 66%, respectively. Fractures (27%) and sprains and strains (26%) were the most common types of injuries. The most frequently injured body parts were lower extremities (47%), followed by upper extremities (25%). The most commonly fractured body part (27%) was the ankle. The knee and lower leg accounted for 42% of all lacerations and were 5.8 times as likely as lacerations to other body parts. Falls were the most common mechanism, accounting for 60% of all injuries.

CONCLUSIONS

This study reports continued increase in annual numbers of climbing injuries. Whether this is based on a higher injury rate or on a higher number of climbers overall cannot be stated with certainty because no denominator is presented to estimate the injury rate among climbers.

Risks Seem Low While Climbing High: Shift in Risk Perception and Error Rates in the Course of Indoor Climbing Activities

Little is known about people’s risk perception while participating in potentially harmful activities. In a field study conducted in a climbing gym, we investigated how the climbing activity influences climbers’ risk perception and error rates. Based on research on embodiment, we argue that the perception of risks may differ between being in an active state during climbing and being in an inactive state before or after climbing. In addition to subjective risk perception, error rates were observed as an objective measure of behavior that increase the risk for accidents. Experience was included as a potential moderator because indoor climbing is also accessible to inexperienced people. Drawing on the affect heuristic, we hypothesized that experienced climbers are guided by their intuitions, which makes them less susceptible for influences of their physical state when judging climbing risks. Less experienced climbers need to rely more on deliberative thinking and their judgments may be more distorted by the effects of being in an active state. Climbers were asked to judge climbing risks at five points in time (twice before, twice during and once after climbing in a gym). In addition, the amount and type of climbing errors was observed at two points in time during the activity. We recruited 57 participants (32% female) in a large climbing gym in Germany, who were between 18 and 57 years of age. Results show that participants’ perception of climbing risks generally decreased during the activity phase as opposed to the pre-activity phase, while error rates increased. Higher experience was associated with lower risk perception, but also more errors. Further, experience may weaken the influence of physical activity on risk perception. In higher risk sports people have to make important decisions while being active. Our results suggest that especially climbers need to be aware that being physically active can distort their risk perception.

Effects of Sport Climbing on Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system (CNS) with different types of disease courses (relapsing-remitting, secondary-progressive, primary progressive) that leads to physical as well as mental disability. The symptoms comprise paresis or/and paralysis, ataxia, bladder dysfunction, visual problems as well as effects on cognition. There is limited data regarding the possible effects of sport climbing respectively therapeutic climbing on patients with MS. Sport climbing offers many potentially beneficial effects for patients with MS since there are effects on coordination, muscular strength, and cognition to name the most relevant ones. Also, disease models in rodents point toward such positive outcomes of climbing. Therefore, we assessed the currently available research literature on general effects of physical exercise, impact of climbing on body and mind and therapeutic climbing for prevention or therapy for the treatment of MS. The sparse published controlled trials that investigated this sport activity on different groups of patients with neurological or geriatric diseases grossly differ in study design and outcome parameters. Nevertheless, it appears that climbing offers the opportunity to improve some of the symptoms of patients with MS and can contribute to an enhanced quality of life.

To be active through indoor-climbing: an exploratory feasibility study in a group of children with cerebral palsy and typically developing children

BACKGROUND

Cerebral Palsy (CP) is the most common cause of motor disabilities in children and young adults and it is also often associated with cognitive and physiological challenges. Climbing requires a multifaceted repertoire of movements, participants at all levels of expertise may be challenged functionally and cognitively, making climbing of great potential interest in (re)habilitation settings. However, until now only few research projects have investigated the feasibility of climbing as a potential activity for heightening physical activity in children with CP and the possible beneficial effects of climbing activities in populations with functional and/or cognitive challenges. The aim of this study was therefore to test the feasibility of an intensive 3 weeks indoor-climbing training program in children with CP and typically developing (TD) peers. In addition we evaluated possible functional and cognitive benefits of 3 weeks of intensive climbing training in 11 children with cerebral palsy (CP) aged 11-13 years and six of their TD peers.

METHOD

The study was designed as a feasibility and interventional study. We evaluated the amount of time spent being physically active during the 9 indoor-climbing training sessions, and climbing abilities were measured. The participants were tested in a series of physiological, psychological and cognitive tests: two times prior to and one time following the training in order to explore possible effects of the intervention.

RESULTS

The children accomplished the training goal of a total of nine sessions within the 3-week training period. The time of physical activity during a 2:30 h climbing session, was comparably high in the group of children with CP and the TD children. The children with CP were physically active on average for almost 16 h in total during the 3 weeks. Both groups of participants improved their climbing abilities, the children with CP managed to climb a larger proportion of the tested climbing route at the end of training and the TD group climbed faster. For the children with CP this was accompanied by significant improvements in the Sit-to-stand test (p < 0.01), increased rate of force development in the least affected hand during an explosive pinch test and increased muscular-muscular coherence during a pinch precision test (p < 0.05). We found no improvements in maximal hand or finger strength and no changes in cognitive abilities or psychological well-being in any of the groups.

CONCLUSIONS

These findings show that it is possible to use climbing as means to make children with CP physically active. The improved motor abilities obtained through the training is likely reflected by increased synchronization between cortex and muscles, which results in a more efficient motor unit recruitment that may be transferred to daily functional abilities.

TRIAL REGISTRATION

ISRCTN18006574; day of registration: 09/05/2017; the trial is registered retrospectively.

Lung function and dust in climbing halls: two pilot studies

In climbing halls, high levels of dust are found because magnesia powder is used to dry hands. Concerns have been raised about possible health effects after reports from asthmatics experiencing worsening of symptoms while or after climbing. We investigated acute and sub-acute effects of climbing in dusty halls on lung function in two pilot studies. The first study examined 109 climbers before and after a climbing activity that lasted at least 1 h. In the second study, 25 climbers from different age classes participated in a 2-day climbing competition. Of these, 24 agreed to take part in our investigation, but only 22 provided valid lung function tests on both days. The climbers underwent lung function tests before the first round of the competition (in the morning), after the second round approximately 3 h later and in the morning of the second day before the competition started again. In the first study, we found acute effects, a decline in lung function immediately after the exposure, likely due to protective reflexes of the bronchial muscles and stronger declines in persons with higher exhaled nitric oxide (NO) pre-climbing. In the second study, we also expected sub-acute effects on the next day due to inflammation. On the first day of the competition (second study), dust levels at a central monitor increased over time in a linear manner. Most of the dust was in the size range between 2.5 and 10 μm and dust levels of particulate matter (PM10) reached 0.5 mg/m3. There was a decline in lung function over 24 h in persons with higher exhaled NO levels pre-exposure. All spirometric parameters were affected though the effects were not statistically significant in all cases. Younger age classes started earlier in the morning. Because of the increasing trend in dust levels we expected stronger effects with higher numbers but for the acute effects the reverse was true, possibly because younger climbers use magnesia more or with less experience thus causing higher individual exposure. No differences by age or by time of the first climb were observed for the 24-h lung function change.

Hand Injury in Rock Climbing: Literature Review

With the amazing increasing in number of participants, rock climbing has become a popular sport in the last decade. A growing number of participants, with different skill level, inevitably leads to an increased number of injuries related to this practice. The kind of lesions that can be observed in rock-climbers is very specific and often involves the hand. For this reason is very important for any hand surgeon that is exposed to sport injuries to know which and the most common injuries related to this sport and which are the basic principles for the treatment of those. The aim of this article is to review the literature that has been published in the last ten year in this topic. On the NCBI database 22 articles where found that where related to rock climbing lesion affecting the hand or the whole body. Differences where found according to kind of rock climbing activity that was analyzed, alpine climb leads to more serious injuries, often affecting the lower limb, while in sport and recreational rock climbing the upper limb and the hand are definitely the most affected parts. Flexor pulley lesions, followed by fractures and strains are the most common lesions affecting the hand that are related to this practice.

Previous injury as a risk factor for reinjury in rock climbing: a secondary analysis of data from a retrospective cross-sectional cohort survey of active rock climbers

Background

The aim of this article is to report the findings of a secondary analysis of a previous injury study to consider previous injury as a risk factor for reinjury in rock climbing.

Methods

We completed a secondary analysis of 201 questionnaires that were gathered as part of a retrospective cross-sectional cohort survey that investigated the epidemiology of injuries in a representative sample of British rock climbers. Participants had actively engaged in rock climbing over the previous 12-month period and were recruited from six indoor climbing centres and five outdoor climbing venues (men n=163, mean±SD, age=35.2±11.8 years, participating in rock climbing=13.88+11.77 years; women n=38, mean±SD, age=35.1±10.7 years, participating in rock climbing=11.62+9.19 years).

Results

Of the 101 participants who sustained a previous injury, 36 were found to have sustained at least one reinjury. The total number of reinjuries was 82, with the average probability of sustaining at least one reinjury being 35.6% (95% CI 34.71% to 36.8%; p<0.001, McNemar's χ² test) with the relative risk of reinjury being 1.55 (95% CI 1.34 to 1.80). The fingers were the most common site of reinjury (12 participants, 26%; χ²=43.12, df=5, p<0.001).

Conclusions

Previous injury was found to be a significant risk factor for reinjury, particularly at the site of the fingers. Technical difficulty in bouldering and sport climbing behaviours were significantly associated with repetitive overuse reinjury. As participatory figures increase, so does the likelihood that a high proportion of climbers may sustain a reinjury of the upper extremity.

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.