Rock climbing is a sport of increasing popularity due to the combination of widening access to indoor walls and artificial surfaces in more urban areas and increasing awareness of the sport via the media.
When most people consider injuries occurred when climbing they will immediately think of the serious traumatic injuries associated with falling that we hear about in the media. Surprisingly these are relatively infrequent with only 7% of injuries caused by trauma. 50% of these traumatic injuries are to the lower limb and include ligament injuries (36%), contusions and lacerations (29%), and fractures (21%) (Backe et al, 2009).
Much more common are the overuse injuries, accounting for 97% of climbing injuries with the vast majority affecting the hand and fingers which, if not managed correctly, can cause prolonged periods of absence from the sport. Other common sites of injury include the elbow and shoulders due to the fact that it is a biomechanically and anatomically unique sport, requiring the use of the upper limbs to aid propulsion and support the body weight (Crowley, 2012). Often this load is across a very small surface area which increases the risk of repetitive microtrauma to tendons and other soft tissues leading to long term injury.
Prevention of these types of injuries can be aided by sport specific strength and conditioning and minimising the risk factors associated with injury, along with educating novice climbers to the early signs of injury such as loss of fine motor control and early morning pain and loss of mobility.
Style of climbing is an important factor when considering injury management with bouldering showing an increased risk of injury rate, possibly due to the competitive nature of this discipline which may cause climbers to push beyond their normal capabilities and leave inadequate recovery periods to allow muscle and tendon adaptation (Donath et al, 2103). Other risk factors include having an increased BMI, male gender, climbing for more than 10 years and increased route difficulty.
Overuse of the crimp position also significantly increases the risk of “climber’s finger” which is a rupture of the A2 pulley in the finger. The pulleys in the finger are bands of connective tissue that anchor the flexor tendons down and prevent bowstringing. The ring finger is the most vulnerable digit as the neighbouring 5th digit provides less support than the other digits which can overload the 4th causing it to fail. Crimping is used to gain a more favourable grip on smaller holds but it applies very high forces to the flexor tendon pulleys, 3-4 times greater than at the fingertip and up to 380N in the recreational climber (Crowley, 2012). The A2 pulley is calculated to withstand loads of 400N so it is clear that repetitive high loads can lead to injury. Climbers who sustain this injury describe a sudden onset of pain during a difficult move and will sometimes even hear a “pop”, swelling will quickly occur. Early assessment of these injuries is required to establish the severity and provide correct management.
Climbing requires a combination of muscular strength, power and endurance, therefore, a well rounded climber must train all three of these pathways. Specific types of climbing and the severity of the route may determine the ratio of these components with traditional climbing allowing relatively longer periods of recovery to allow for gear placement. Specific strength training should include isometric holds through a combination of climbing specific exercises such as the use of a hang bar and also by modification of more general exercises such as pull ups incorporating isometric holds at various ranges. Specific eccentric strengthening (muscles lengthening) and slow concentric (muscles shortening) exercises are important along with more dynamic movements to replicate the use of the upper and lower limbs to generate propulsion of the body combined with generalised aerobic conditioning such as running or cycling. Balance and stability training should also be included to allow the climber to adapt to the demands of moving over small holds and also maintain body position along with exercises that facilitate a good body position on overhanging rock.
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