Rock climbing is a sport that has been gaining popularity over the last few years. The diverse range of movement, mobility, and strength the sport requires makes it appealing to everyone from the weekend warrior to the most serious and dedicated athlete. This fast-growing allure has helped catapult climbing into the 2020 Olympic Games in Tokyo. The three disciplines that will be included in the upcoming Olympics are sport, bouldering, and speed. Each discipline has its own unique demands varying in power, agility, strength, and endurance naturally inducing risk for both traumatic and overuse injury. In this article I will highlight the most common injuries seen in rock climbing and demonstrate climbing-specific exercises based on research and biomechanics to prevent these injuries.
The finger is the most common site of injury in rock climbing accounting for up to 52% of all injuries sustained.1 It is important to understand both the normal anatomy of the finger pulley system, and the kinetics (forces and torques that cause motion) of different grips to make a differential diagnosis. The type of finger injury sustained is largely dependent on the type of grip being utilized by the climber. The grip a climber decides to use is determined by the size and shape of the handhold, body orientation, and overall strength. The common grips are: closed crimp (A), open crimp (B), open hand (C), undercling (D), pinch (E), pocket (F).
The crimp position naturally creates an uneven distribution of force amongst the fingers, with the largest force being placed on the middle and ring fingers. The ring finger is responsible for controlling the rotational movement along its own longitudinal axis, increasing the likelihood of sustaining an injury compared to the other digits. The size of the handhold available to crimp will also affect the contribution of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles.
Crimp grips generate large flexion moments that cause loading of the FDS and FDP tendons. A smaller crimp that only allows for placement of half of the distal phalanx will increase activation of the FDP compared to the FDS. High force repetitive loading can create microtrauma to the flexor tendon, tendon sheath, or collateral ligaments resulting in pain, inflammation, and swelling.
Annular Ligament Injury
The annular pulleys of the fingers have been reported to be the most commonly injured structures in both sport climbing and bouldering. These fibrous bands of tissue (A1-A5) are important for maintaining close contact between the finger flexor tendon and its underlying bone. The A2 and A4 pulleys have a direct attachment to the bone, making them the most important for maintaining the integrity of the flexor tendon system. Studies have reported the A2 pulley is capable of withstanding up to 400N of force, that’s the equivalent of holding a 90lb dumbbell completely still against gravity. Biomechanical analyses have shown that a crimp position generates up to 450N (102lb dumbbell!) of at the A2 pulley, and 269N at the A4 pulley.
Factors that may contribute to annular ligament injuries include:
- Overuse and overload
- Decreased shoulder and wrist stability
- Decreased finger flexor tendon mobility
- Lack of finger specific warm-up
The shoulder is the second most common region of injury following the finger. Shoulder injuries make up about 17% of all rock climbing injuries, and chronic pain has been reported in 33% of elite climbers.3 The most common shoulder pathologies include: superior labral extending anterior to posterior (SLAP) tears, subacromial impingement syndrome, anterior dislocations with bankart lesion, biceps tendon tears or ruptures, and supraspinatus tendinopathy, respectively.
Factors that may contribute to these various shoulder injuries include:
- Overuse and overload
- Decreased neuromuscular control and weakness
- Glenohumeral and scapulothoracic muscle imbalances
- Posterior rotator cuff tightness
- Joint capsule laxity
- Postural dysfunction
Modifying these risk factors is a must for any serious or recreational climber that wants to #climbpainfree. Due to the varying risk factors that contribute to each individual shoulder injury, it is important to identify which of the risk factors is most affecting YOUR movement. There is no “one size fits all” assessment, however, improving the strength and dynamic control of the entire shoulder complex will help keep your shoulder in a safer and more optimal position when on the wall.
Increasing strength, motor control, and mobility off the wall is important, but it is crucial that a climber takes these improvements to the wall. Some climbers may do all the prehab in the world, but none of that matters if they don’t utilize it when climbing. Following the above exercise with similar body tension and active shoulder engagement on the wall is essential for effective injury prevention. Many climbers climb with disengaged scapulas, or take a break and “dead hang” in a position that compromises their rotator cuff, biceps tendon, and labrum. Although it feels good to take a break and shake out with shrugged shoulders, it is doing more damage than good by increasing the stress on these structures, which can lead to injury.
Lower Extremity Injuries
Lower extremity injuries account for more than 40% of acute rock climbing injuries, and ankle injuries comprise about 20%. Bouldering is a discipline of rock climbing that does not include any ropes or safety harnesses, using only crash pads to decrease the ground reaction force taken on by the body. Considering this lack of safety equipment, lower extremity injuries such as lateral ankle sprains, anterior and posterior cruciate ligament sprains/ruptures, collateral ligament tears, and patellar dislocations are very common in bouldering. Sport and speed climbing also have risks for lower extremity injuries such as fractures resulting from a wall collision. Learn more about what to do after an acute ankle sprain and how to [p]rehab your ankle sprain by clicking here.
The climbing shoes typically worn tend to be sized down to increase proprioceptive feedback and maximize efficacy. The size and shape of the shoe creates flexion at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, while extending the metatarsophalangeal (MTP) joints.
This shoe fit places the foot into a supinated and inverted position. If the foot is already biased in this orientation, it can make lateral ankle sprains a more likely occurrence.
Incorporating mobility exercises for the talocrual and subtalar joints is important to ensure that a climber has the available range necessary to safely negotiate a fall. Also, addressing balance impairments has been shown to decrease the recurrence of ankle sprains. Plyometric exercises such as the drop jump can be useful to train a climber’s dynamic balance system and prepare her for a fall. Addressing strength, mobility, and single leg stability should all be performed in a comprehensive prevention program.
- Strength to actively absorb the shock
- Mobility to avoid abnormal joint positions causing connective tissue damage
- Single leg stability
- Falls occurring unilaterally
- Improve on the wall balance to decrease chance of falling
- Jones G, Johnson MI. A critical review of the incidence and risk factors for finger injuries in rock climbing. Curr Sports Med Rep. 2016;15(6):400-9
- Schoffl V, Popp D, Kupper T, Schoffl I. Injury trends in rock climbers: Evaluation of a case series of 911 injuries between 2009 and 2012. Wilderness Environ Med. 2015;26(1):62-7
- Chang CY, Torriani M, Huang AJ. Rock climbing injuries: acute and chronic repetitive trauma. Curr Probl in Diagn Radiol. 2016;45(3)205-14
- Schweizer A, Hudek R. Kinetics of crimp and slope grip in rock climbing. J Appl Biomech. 2011;27:116-121
About The Author
Chris Zipser is a 3rd year DPT student at the University of Southern California with a passion for rock climbing and the outdoors. You can find more of his content by checking out his Instagram page @climbpainfree where he is helping climbers bridge the gap between performance and longevity. You can also email him with any questions from this article firstname.lastname@example.org