Rock climbing injuries: Accurate diagnosis and effective treatment at an arm’s reach

In this informative guide to the prevention, diagnosis and treatment of injuries sustained in rock climbing, we hear specialist insight from highly esteemed consultant orthopaedic and sports medicine surgeon Mr Simon Moyes. The revered specialist discusses the most common types of injuries suffered by rock climbers and the key movements which can cause strain and damage to climbers’ bodies.

Taking part in intense rock climbing can result in strains to the muscles, as well as injuries to tendons and ligaments. Moreover, it has the potential to inflict damage on soft tissues and even give rise to bone conditions like arthritis.

Rock climbing has become increasingly popular in the United Kingdom, with an estimated 1 million people taking part in one variation or other of the sport. Musculoskeletal injuries can occur across all types of climbing activities, ranging from knee ligament damage caused by deep knee bends to finger injuries as climbers ascend a wall. Additionally, shoulder pain can be caused by excessive strain or rotation, while foot injuries may occur due to the use of tightly fitting climbing shoes.

Most climbers, regardless of their skill level, understand the importance of warming up effectively and performing proper stretches to minimise the risk of injury. However, not everyone devotes as much time and effort to this crucial step as they should.

Climbing injuries can range from minor discomforts to severe traumatic injuries, but any type of injury should be treated seriously. If you experience persistent aches, pain, and limited mobility even after taking a short break and using anti-inflammatory medication, it is crucial to seek a comprehensive evaluation from a sports medicine specialist.

What causes rock climbers to sustain injuries?

Climbing ailments typically arise from excessive training and repetitive motions or a sudden traumatic injury, such as a torn ligament or fracture, which results from a strong force or impact. Damage to muscles, tendons, ligaments, and soft tissues is prevalent across all varieties of rock climbing, from bouldering to route climbing or fingerboard training.

Bouldering poses a particularly high risk of musculoskeletal injuries due to its vigorous, repetitive, and often dynamic movements that exert additional pressure on joints and muscles, along with the potential hazards of falling onto hard ground or a mat. Fractures and sprains are common impact injuries in both bouldering and roped climbing.

Flexibility plays a crucial role in climbing, and it is easy to strain or stretch muscles and connective tissues excessively, especially when your body is under tension during stretching or making a sudden move.

Climbers frequently experience injuries in the neck, shoulders, and upper back, in addition to the typical finger and elbow injuries. Muscle imbalance is often a contributing factor, such as having overdeveloped muscles in the upper back or forearm, which can lead to excessive strain on tendons in those areas.

What are the most common types of injuries sustained in rock climbing?

Intensive rock climbing can result in muscle strain, tendon and ligament injuries. Additionally, it can cause damage to soft tissues and potentially lead to bone-related conditions like arthritis. That's why it's crucial to accurately diagnose and treat any pain, stiffness, or limited range of motion before it develops into a serious problem.

Tennis elbow

Regular training can lead to micro-tears in the tendon that connects your forearm muscle to the bony protrusion on the outer side of your elbow. This results in pain around the outer area of the joint and weakness in the forearm.

Golfers' elbow

Similar to tennis elbow, this condition involves inflammation of the tendons that connect to the bony prominence on the inner side of the elbow. A rigorous climbing schedule can strain these tendons before they have a chance to fully recover. Over time, the accumulation of micro-tears can progress into tendinosis.

Biceps or triceps tendonitis at the elbow

Intensive training can strain the tendons that attach your upper arm muscles to the elbow, causing pain in the elbow crease (biceps tendon) or at the outside/back of the joint (triceps tendon).

Shoulder subluxation (partial shoulder dislocation)

The shoulder joint is highly mobile, sometimes excessively so. Sudden movements or gradual stretching can strain the tendons and ligaments that support the shoulder, resulting in laxity and weakness in the surrounding muscles. This increases the risk of the humerus head (the rounded top of the upper arm bone) slipping out of its socket (glenoid). Subluxation can be extremely painful and lead to ongoing structural issues such as cartilage tears (SLAP tears), impingement, rotator cuff tears, and arthritis.

Rotator cuff tears

The shoulder joint is stabilised by a group of muscles and tendons known as the rotator cuff. Overuse can cause small tears in the tendons, with climbing's repetitive overhead or rotational movements often being the culprit. Rotator cuff tendons can also experience partial or complete ruptures from traumatic injuries, such as dynamic twisting or jumping to grab hold of something. Rotator cuff tears result in shoulder pain, weakness, and limited range of motion.

Finger pulley injuries

Climbing places significant strain on the tendons that run along the sides and inside your fingers. Damaged finger tendons lead to joint pain and can hinder your climbing ability. Many climbers simply tape their painful fingers and continue, which can eventually result in long-term tendonitis in the fingers.

Meniscal tear

While upper body injuries are common in climbing, your knees are also subjected to substantial force. Frequent jumping or falling during bouldering or tackling technical routes involving twists and high steps increases the risk of tearing your meniscus. The meniscus is a rubbery cartilage pad in the middle of your knee joint, which can be torn by sudden twisting movements or impacts. A torn meniscus causes significant pain, feelings of instability, rapid muscle atrophy, swelling, and stiffness.

Knee ligament tear

The strong, fibrous ligaments that connect your thigh bone (femur) to your shin bones (tibia and fibula) can tear as a result of deep knee bends, sudden twisting actions, or awkward falls. Symptoms of a tear in the knee ligament include instability, weakness, pain, and swelling.

Morton's neuroma

Patients often report that this painful condition feels like stepping on a ball bearing under the ball of your foot. While it's commonly associated with wearing high heels, it also frequently occurs with tight shoes. The nerve that runs beneath the ball of your foot becomes inflamed and thickened, eventually becoming compressed between other structure within your forefoot. Typically, Morton’s neuroma is treated by wearing wider shoes but this may not be a suitable modification for climbers. You should seek advice from a specialist on how to best treat the condition in your individual case.

What are the most common treatment options for rock climbing injuries?

The majority of chronic climbing injuries can be effectively treated using a combination of rest, anti-inflammatory medication, and physiotherapy.

For the rehabilitation of ongoing injuries, it is essential that you get an accurate diagnosis followed by a tailored exercise and massage program designed specifically for climbers. In the case of traumatic injuries like tendon or ligament tears and bone fractures, more extensive intervention may be necessary, and sometimes surgery becomes the only option.

If you have sustained a climbing injury or are experiencing any pain that is stopping you from reaching your full climbing potential, you can schedule a consultation with Mr Moyes by visiting his Top Doctors profile.