Rock climbing is an increasingly popular sport in the United States and abroad. This sport is unique in that it places considerable stress on the upper extremities, especially the fingers and hands. As the sport’s popularity increases, common climbing injuries and treatments have been better identified. In addition to traumatic injuries that occur during falls, climbers are also susceptible to chronic overuse injuries. A recent survey of rock climbers found that 50% of responders had experienced injuries related to climbing in the previous year. As much as 73%-89% of climbing injuries occur in the upper body, including shoulder, elbow, wrist and finger injuries.

Shoulder injuries can include labral tears, biceps tendon ruptures, impingement syndrome and rotator cuff tendinitis or tears among others. These injuries can be from acute trauma or overtraining. Symptoms will likely present as pain with overhead reaching during climbing, and significant pain with pull up movements at varying arm angles. Severe injuries which require surgery necessitate very stable repair with additional fixation for return to sport.

Elbow pain is common at multiple locations. Lateral elbow pain, or ‘lateral epicondylitis’ is much more common than medial elbow pain. Pain at the crease of the elbow is the most common site of elbow pain and has been referred to as ‘Climber’s Elbow.’ This pain is most likely tendinitis of the brachialis muscle and is often associated with repetitive pull ups or hanging with weight on bent elbows. These injuries are typically well managed with conservative treatment.

Wrist and hand pain is the most common complaint in rock climbers. One of the most common injuries occurs at the fibrous sheath that covers the flexor tendons that run on the palm side of each finger. This sheath has areas of thickened tissue referred to as pulleys. These pulleys help keep the tendons close to the bone throughout the finger’s range of motion. Falling while holding a small finger hold, may result in pulley damage or rupture. This rupture may be accompanied by an audible popping sound. Overtraining may also lead to damage of these pulleys and their adjacent tendons. The most vulnerable fingers are the ring and middle fingers.

Pain at the palmer surface of the finger joint or pain at the middle of a finger segment may represent small tears of the sheath or tendon. If this tearing progresses, the finger may develop ‘bowstringing’ which occurs when the finger tendon pulls away from the bone, due to damage to the sheath which normally holds the tendon in place. Bowstringing may be evident upon physician examination, however true bowstringing may only occur with rupture at multiple pulley sites. Bowstringing is not viewed as a reliable, stand alone diagnostic sign. Ruptures of the flexor sheath require diagnosis by ultrasound or MRI. As much as 26% of competitive climbers develop flexor pulley injuries. Chronic, untreated finger injuries can result in contracture and decreased movement of the fingers. Treatments of pulley injuries include surgery, splinting, physical/occupational therapy and activity modification, depending on the severity of the injury. Pain at the sides of finger joints may represent damage to collateral finger ligaments, which may progress if unaddressed. If you begin to notice progressive finger pain while climbing, it is advisable to first:

• Take several days rest from climbing
• Upon return to climbing, concentrate on routes with larger hand holds
• Use athletic tape around finger joints to reduce stress on ligaments
• If pain persists visit your physician

With all the injuries discussed above it is important to be proactive and visit your primary care physician or a sports medicine physician in order to establish the proper plan of care. In many cases referral to a physical therapist, occupational therapist or athletic trainer for further treatment is recommended. Rock climbing is a high risk sport, which is made more dangerous if climbing while injured, so be sure to be proactive with treatment and address any issues you have sooner rather than later.

The author of this article is Tom Rosinski, PT, from Novacare – Northwestern.