By Jonathan Washatka, PT, DPT, CSCS
A couple of studies have looked at injuries in rock climbers (check these out: this one and this one), but if you’ve climbed long enough, you are probably familiar with many of the aches and pains that come with climbing on a regular basis. Some injuries are traumatic in nature (for example, falling while bouldering or a hard fall on lead) and though the risks can often be mitigated, they essentially can’t be eliminated. Other injuries are typical overuse injuries and can happen when you climb or train in a manner that overloads the tendons, joints, and muscles without allowing adequate rest and recovery periods for those tissues. I’ve chosen a few of those common overuse injuries. Let’s talk about what is actually happening to your body and why. While this blog will discuss how climbing injuries may happen, it will not discuss interventions for how to heal and rehabilitate once the injury has occurred. If you think you are suffering from a climbing injury, seek out a PT or specialist.
1. A Common Climbing Shoulder Injury
Rotator cuff tendinopathy/Shoulder Impingement
Shoulder impingement was traditionally used to describe shoulder pain and insinuated something in the shoulder (typically the rotator cuff tendons) was being impinged upon by a bone or ligament. However, as the rotator cuff can be injured and impaired without physical obstruction, the term “rotator cuff tendinopathy” is typically being used instead to describe general rotator cuff pathology.
What is the rotator cuff, why is it important, and how is it relevant to rock climbing?
The rotator cuff is comprised of 4 muscles (SITS – supraspinatus, infraspinatus, teres minor, and subscapularis) that essentially act as a suction cup to keep the bone of the shoulder joint in its proper place. They are important because they provide stability for the shoulder, which is a crazy mobile joint. If they aren’t strong, shoulder problems could follow. Conversely, they themselves can be a source of pain. I won’t get into it too much, but there are a lot of factors that can lead to rotator cuff issues (check out this great review).
A few factors that are relevant in rock climbing that can potentially lead to rotator cuff pathology are weak rotator cuff muscles themselves, weak scapular muscles, and poor posture/tight chest and shoulder musculature. Weak rotator cuff muscles can alter the positioning of the structures within the shoulder, leading to a not-so-great environment in the shoulder joint. The same goes for weak scapular muscles. If you’re tight in your pec minor and lats and have a posture of forward shoulders, this can be a cause for concern. I often see climbers sitting on the floor, resting from bouldering, with their shoulders hunched forward and their neck sticking out. This is a no-no. Trust me – it’s not cool to have the stereotypical climber’s posture – it can lead to injury.
2. A Common Climbing Elbow Injury
Lateral Epicondylalgia (Tennis Elbow)
Lateral epicondylalgia, commonly referred to as “tennis elbow,” is when a climber feels pain from the forearm tendons that originates on the outside on the elbow (there can also be sensitization of the nerves and other psychosocial issues going on, but we’ll keep it simple here). These tendons join together to form the common extensor tendon at the elbow. The individual muscles themselves have slightly different functions, but they essentially all can help to extend, or cock up, the wrist. We naturally, without realizing it, cock up our wrist when we need to grip something hard. Go ahead – try making a fist and squeezing really hard with your wrist flexed/curled. Now extend, or cock up, your wrist, and try making a fist. We produce much more force with our wrist extended due to length-tension ratio principles of tendons. So, when we use our finger flexors, as one does with climbing, we also use our wrist extensors, which start up at our elbow.
Let’s break this down.
As climbers, we use our finger flexors a lot. This means we also use our wrist extensors a lot. Often times, we do this without allowing proper rest. It is clear how climbers could irritate and overuse the elbow tendons.
3. A Common Climbing Knee Injury
A meniscus is a structure found in the knee joint, seated between the femur and tibia. The plural of meniscus is menisci; we have 2 menisci per knee. They help increase the surface area between the femur and tibia. If there is a larger surface area, there is not a single point which has a lot of stress. Therefore, the menisci can help spread out the load over a larger area, reducing stress.
Unfortunately, the menisci can tear. How does this happen? I can think of one scenario in rock climbing specifically that might cause this – the drop knee. Drop knees, repeated over and over again, may create rotational/shearing torque at the knee. This could be reduced by also rotating the foot so the foot and knee stay aligned, but sometimes you just gotta drop the knee and keep the toe hooked into a foothold. Every time I watch clips of Adam Ondra climb, I get slightly nauseous watching him perform drop knees. I can’t say with certainty that this type of move can cause a meniscus tear, but certain clinical tests that check for the presence of a meniscus tear place the knee in similar positions that it might be placed in during a drop knee.
4. A Common Climbing Finger Injury
Finger Pulley Injuries
No discussion on rock climbing injuries would be complete without the inclusion of the infamous finger pulleys. We have numerous pulleys, or what are basically circular bands, that run up our fingers. Imagine wearing 8 wedding bands from the base of every finger to the tip of every finger, and you can picture the finger pulleys (except they don’t wrap around the backs of the fingers – just the front). Now, the finger flexor tendons run along the base of the finger and are held tight to the finger by the pulleys. The pulleys prevent something called bowstringing, which is when the finger flexor tendons aren’t held tight to the finger anymore. This negatively affects the mechanics of the fingers.
The issue is that rock climbers exert crazy amounts of force through the finger tendons, which can load the pulleys. With enough force (often when closed-hand crimping), the pulleys can become injured, or even rupture. This article (which cites this article) notes that high forces occur during the crimp position. One specific taping method (H-taping) was studied to see if it could reduce the amount of force/friction between the tendons and pulleys in an effort to address this pulley injury issue. Check it out here.
- Rock climbers may be susceptible to rotator cuff injury from constant overhead shoulder use but can potentially alter certain related factors such as strength, flexibility, and posture
- Lateral epicondylalgia or tennis elbow can be from overuse of the wrist extensor tendons, which are required for strong finger flexor contraction
- Meniscus tears could occur from knee torsion/twisting/shearing, so be cognizant of your knee position (and careful on drop knees!)
- Finger pulleys can be injured due to high forces from the finger flexors which in turn places high forces on the pulleys (don’t close-hand crimp!)
About the Author
Jonathan Washatka, PT, DPT, CSCS, is a physical therapist who works in Sterling, Virginia for Select Physical Therapy. He has a Doctor of Physical Therapy degree, is a Certified Strength and Conditioning Specialist, and is currently working through a residency program to become a specialist in orthopedics in the field of physical therapy. He comes to the Sportrock in Sterling every couple of months to answer your injury questions. You can find him climbing at Sportrock in Sterling, hiking/walking/biking with his wife, or visiting a local brewery. Questions about rehabilitation, injuries, physical therapy, or anything climbing, orthopedic, or sports-related can be e-mailed to [email protected]. Check out his company website at https://www.selectphysicaltherapy.com/community/northern-virginia/center/?id=50605.
1. Oatis CA. Structure and Function of the Bones and Noncontractile Elements of the Knee. In: Oatis CA, ed. Kinesiology: The Mechanics & Pathomechanics of Human Movement. 2nd ed, Philadelphia, PA: Lippincott Williams & Wilkins; 2009.