Rock Climbing, Part 2: Prevention and Treatment
Rock climbing requires a great deal of whole-body fitness. The physical demands on the body in climbing can be divided up into body regions. The primary strains from climbing are in the hands, elbows, and shoulders. Then the landing injuries that can occur when bouldering (climbing on rocks less than 20 feet off the ground) affect the foot, ankle, knee, and low back.
Physical therapists that treat patients with climbing injuries find that hand injuries are the most common. They tend to be overuse injuries of the flexor tendons of the hand. Imagine holding your body on a rock wall with your fingers for 2-3 minutes at a time. When a climber moves up the wall, the different handholds creates a bit of a break for specific muscles. You can see why climbers tend to be on the thinner side of the population.
The second most common injuries are in the elbow region. Tendinitis and nerve entrapment issues are commonplace. You can see how these two regions are similar. All the movements and gripping of the hand and wrist are controlled by the muscles in the forearm that attach to the elbow.
Shoulder injuries round out the third area of the upper body with common injuries. I have found the primary reason for shoulder injuries in most athletes is mechanical (i.e., weakness in the middle and lower traps and external rotators). This is common with baseball players, primarily pitchers and catchers, as well as swimmers.
Jason Hooper, PT, DPT, has developed a rock-climbing specific program at the outpatient clinic at UC San Diego La Jolla campus stated, “The external rotators are paramount in rock climbing. When they’re weakened, that creates huge biomechanical deficits for climbing.”
The fourth area of the body that climbers seek medical help for are injures to the foot and ankle. These are typically falling while bouldering, even with a mat in place for protection.
Research on Climbing Injuries
A literature review of the incidence and risk factors for finger injuries in rock climbing published in the American College of Sports Medicine in 2016 cited, "many chronic overuse injuries in climbing populations go undiagnosed," in part "due to the perception by climbers that some health care professionals are not familiar with climbing-related injuries." Other studies have had the same conclusions. However, four years later and the onset of PTs becoming rock climbers, treating themselves and their friends, and lastly, creating prevention and treatment protocols for injuries to this patient population has exploded. And finally, utilizing our skills in identifying an accurate musculoskeletal diagnosis, providing effective treatments, and then creating protocols for prevention of common climbing injuries, climbers are receiving excellent care.
Preventing Rock Climbing Injuries
Jennifer Truong, PT, DPT, who has been climbing for 13 years and now works in private practice in Bend, Oregon, states, "It's important for climbers to spend at least 20 – 30 minutes being deliberate with their warm-up. They should start with bigger holds to give the fingers and hand muscles a chance to increase blood flow." She also recommends 'downclimbing' some of the easier climbs. This slow lowering is an excellent warm-up because it requires a great deal of motor control, which is easier on the muscle and joints.
Camping in cold weather and then climbing first thing in the morning without a proper warm-up or going to the gym after sitting at a desk for 8 hours and jumping on the wall without adequate warm-up are classic mistakes that cause injuries. Lastly, experts in healthcare that treat climbers have stated that cross-training is an excellent way to stay fit year-round. Weightlifting, Pilates, and yoga, to name a few, are excellent examples of exercises that will compliment a rock climbers' whole-body strength.
Treating Rock Climbers
Much of the treatment of rock-climbing injuries is managing an acute injury from overuse. Once the target tissue (i.e., shoulder pain) has calmed down, the PT will address the shoulder complex muscular imbalance. Once the climber has improved strength and control of the shoulder, they typically return to climbing without pain and improved strength when doing a familiar route on a wall. Different regions in the US require a unique set of skills to climb a route. For example, in Tennessee where there is a lot of sandstone rock and overhung roof formations, a particular move called a heel-hook, and toe-hook maneuvers require the use of your foot to reach above your head and wedge it into the rocks and then pull your body upwards using the hamstrings and gluteal muscles. Therefore, hamstring injuries are common in this part of the US. Once these injuries are healed a thorough strengthening and flexibility program for hamstring and gluteal muscles is implemented.
Treating a rock climber injury can expand the whole gamut from head to toe. I have found that climbers are some of the most motivated of my active caseload. I get it to spend a full day outdoors experiencing the elements while having spectacular views of your surroundings while working hard with a partner to accomplish a task of ascending a pitch - that would motivate me.
The next time you drive up the Donner Pass Road and see all those rock climbers working their way up the wall with the precision, strength, and aide from their partner belaying them, you may want to stop and watch. It is quite impressive. I watch, then get back on my bike and do my version of climbing. Allez!