A Guide to Indoor Rock Climbing Injuries

Extensor Mechanism Disruption with Multiligamentous Knee Injury from Bouldering

Extensor mechanism injuries and multiligamentous knee injuries are rare and typically are caused by high-energy injury mechanisms. We present a case of an active-duty military service member who sustained a patellar tendon rupture with concomitant multiligamentous knee injury due to a fall while bouldering. This case report is the first to highlight this significant injury due to bouldering, in addition to the surgical steps taken to get the patient fit for full military duty. These injuries often go undiagnosed and are incredibly important to recognize given the importance of prompt evaluation and ultimate surgical care in these scenarios.

Scaling the Heights: Rates of Pelvic Floor Dysfunction in Female Rock-Climbing Enthusiasts

INTRODUCTION

Rock climbing has recently gained popularity, particularly among females. There are no current studies evaluating pelvic floor dysfunction among female climbers. This cross-sectional study seeks to investigate the prevalence of incontinence and pelvic floor disorders among female rock climbers in the United States.

METHODS

This study utilized an online survey distributed via social media platforms to assess the prevalence of pelvic floor disorders. Participants were queried about demographic information, climbing habits, pregnancy history, and pelvic floor symptoms. Data analysis involved descriptive statistics and inferential analysis where applicable.

RESULTS

A total of 343 participants completed the study, with a median age of 34 years, lean body mass, and the majority identifying as White or Caucasian. The most common pelvic floor disorder was overactive bladder (n = 314, 91.5%), and the least common was pelvic organ prolapse (n = 6, 1.7%). Rope climbers were significantly more bothered by pelvic organ prolapse and anal incontinence symptoms than boulderers (4, p < .01 and 1.44, p < .01, respectively). Parous climbers reported significantly higher bothersome symptoms of OAB and SUI (1.43, p = .01 and 2.71, p < .01, respectively) than their nulliparous counterparts.

CONCLUSIONS

Although rock climbing represents a relatively low-impact sport and our sample was largely comprised of young, healthy, nulliparous women, female rock climbers demonstrated higher rates of pelvic floor disorders than a normative population, with rope climbers at higher risk than boulderers. Clinicians should be aware of the need for more frequent pelvic floor disorder screening in active women.

Upper Crossed Syndrome and Scapulae Upper-Trapping: A Mesotherapy Protocol in Cervicoscapulobrachial Pain-The 8:1 Block

Upper Crossed Syndrome (UCS), described by Vladimir Janda, is characterized by postural changes involving the cervical spine and trunk, leading to biomechanical limitations and cervicoscapulobrachial pain. This study proposes a mesotherapy protocol, termed the 8:1 block, to address cervicoscapulobrachialgia by targeting the scapulae and associated musculature. The scapula, central to shoulder girdle kinematics, often exhibits dyskinesis and muscular imbalances, notably the pattern referred to as scapular upper trapping (SUT). SUT involves scapular elevation, medial rotation, and shoulder protraction, contributing to cervicobrachial pain. The protocol includes a comprehensive assessment of muscle tone changes and biomechanical considerations, highlighting the importance of the scapula in upper limb movement and posture. Key anatomical changes involve tightened upper trapezius, levator scapulae, and pectoralis minor muscles, with weakened middle trapezius and serratus anterior. The mesotherapy approach targets these imbalances through specific injection points to alleviate muscle tension and correct postural deviations. Case studies from our clinic demonstrate the protocol's effectiveness in reducing pain and restoring scapular biomechanics. Patients reported significant improvements in pain relief and functional outcomes, underscoring the clinical utility of the 8:1 block in treating cervicoscapulobrachialgia. This protocol offers a feasible, cost-effective intervention that enhances the efficacy of traditional therapeutic exercises by addressing underlying muscular and biomechanical dysfunctions. In conclusion, the 8:1 block mesotherapy protocol provides a novel approach to managing cervicoscapulobrachial pain by focusing on scapular biomechanics and muscle tension. Further studies are needed to validate these findings and refine the protocol for broader clinical application.

More Than Just Another Elbow Tendinopathy: A Case Series of Misdiagnosed Ulnar Nerve Compression and Review of Common Upper Extremity Misdiagnoses in Climbing

ABSTRACT

Climbing is an increasingly popular sport. Yet, we have encountered numerous misdiagnosed climbing injuries, highlighting a gap in climbing-related literature and a need for heightened awareness within the sports medicine community. We present a case series that highlights the clinical manifestation of ulnar nerve entrapment and compression in three patients with initially misdiagnosed and mismanaged elbow tendinopathy. After a correct diagnosis of ulnar nerve pathology was made, each patient underwent a prescribed rehabilitation protocol that focused on nerve motility exercises (tensioning and flossing), resulting in a significant reduction in pain and a successful return to their pre-injury climbing performance. We thus aim to raise awareness of this often-mistreated presentation. Furthermore, we highlight other common upper extremity climbing misdiagnoses and provide relevant clinical recommendations to accurately identify and manage such injuries in climbers.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study

OBJECTIVES

To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.

METHODS

A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

RESULTS

A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).

CONCLUSION

The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Neuromechanics of finger hangs with arm lock-offs: analyzing joint moments and muscle activations to improve practice guidelines for climbing

Introduction

Climbing imposes substantial demands on the upper limbs and understanding the mechanical loads experienced by the joints during climbing movements is crucial for injury prevention and optimizing training protocols. This study aimed to quantify and compare upper limb joint loads and muscle activations during isometric finger hanging exercises with different arm lock-off positions.

Methods

Seventeen recreational climbers performed six finger dead hangs with arm lock-offs at 90° and 135° of elbow flexion, as well as arms fully extended. Upper limb joint moments were calculated using personalized models in OpenSim, based on three-dimensional motion capture data and forces measured on an instrumented hang board. Muscle activations of upper limb muscles were recorded with surface electromyography electrodes.

Results

Results revealed that the shoulder exhibited higher flexion moments during arm lock-offs at 90° compared to full extension (p = 0.006). The adduction moment was higher at 135° and 90° compared to full extension (p < 0.001), as well as the rotation moments (p < 0.001). The elbows exhibited increasing flexion moments with the increase in the arm lock-off angle (p < 0.001). Muscle activations varied across conditions for biceps brachii (p < 0.001), trapezius (p < 0.001), and latissimus dorsi, except for the finger flexors (p = 0.15).

Discussion

Our findings indicate that isometric finger dead hangs with arms fully extended are effective for training forearm force capacities while minimizing stress on the elbow and shoulder joints. These findings have important implications for injury prevention and optimizing training strategies in climbing.