Climbing

Injuries and
Prevention
Mathew Haager, PT, DPT

Who Are We?

Altitude Physical Therapy and Sports Medicine
o 5 locations
o Doctors of Physical Therapy
o Experts in:
Movement disorders
Sports injuries
Post-op rehabilitation
Preventative care

Common Climbing
Injuries
What will be talking about today?
o Finger
Pulley strains/tears
o Elbow
Medial/lateral elbow pain
o Shoulder
Rotator cuff pathology

62% of all climbing related injuries occur in the

hand, wrist, and elbow and are specific to the
type of holds and movements encountered in the
climbers preferred climbing style.1

Pulley Strain/Rupture Prevalence

Ruptures of A2 and A4 pulleys observed in 40% of
competition climbers.2,3
40% of all climbing related injuries are to the
fingers with half of these being injuries to the
flexor tendon pulleys4

Pulley Strain/Rupture Anatomy

Pulley Strain/Rupture
Climbing
Crimp grip vs. slope grip
Advised to use slope grip
instead of crimp grip to
decrease risk of injury.
o FDP primary finger flexor in crimp grip
o FDP and FDS equally tensioned during
slope grip

Ruptures of the pulley

system are typically
associated with use of the
crimp grip.5

Pulley Strain/Rupture Presentation

Signs and Symptoms6:
o
o
o
o

Audible pop at time of injury

Swelling at one or more pulley systems
Pain
Bruising

Grades of Injury4
o
o
o
o

Grade I: No dehiscence of the tendon from the bone (< 2 mm)

Grade II: Compete rupture of A4 or partial rupture of A2 or A3
Grade III: Complete rupture of A2 or A3
Grade IV: Complex multiple pulley ruptures or single rupture of A2 or
A3 with associated lumbrical musculature or collateral ligament injury.

Pulley Strain/Rupture:
Prevention Tip
Utilization of H-taping
method around injured
pulley will provide some
protection but will not
be supportive enough
to prevent complete
rupture of pulley.6
Strength development
at taped joint shown to
increase strength by
13% while in the crimp
grip position.7

Medial/Lateral
Epicondylalgia - Prevalence
Approximately three-fourths of all climbers (74%
Shea et al, 89% Rooks et al) can be expected to
develop some type of upper extremity overuse
injury.
Tendonitis/tendinopathy appeared to be more
common in beginner climbers.8
Overall, lateral epicondylalgia is more common
than medial (10-20% of reported cases).10

Medial/Lateral Epi
Anatomy/Presentation
Lateral:11,12
o Extensor carpi radialis brevis and
common extensor tendon
o Pain with combined wrist and
finger flexion
o Pain with resisted wrist extension
and supination
o Pain with varus stress test

Medial:10
o Pronator teres, flexor carpi
radialis, flexor carpi ulnaris, flexor
digitorum longus, palmaris longus
o Pain with combined wrist and
finger extension
o Pain with resisted wrist flexion
and pronation
o Pain with valgus stress test

Medial/Lateral
Epicondylalgia - Climbing
Lateral:
o Pain on the inside of the elbow
with crimps, jugs, sloping

Medial:
o Pain with wrist curls,
manteling13

Medial/Lateral Epi
Prevention Tip
Eccentric contraction:
o Targets tendon of muscle instead
of muscle belly

Lateral Epicondylalgia:
o Palm down, passively raise wrist
into extension
o Slowly lower into wrist flexion

Medial Epicondylalgia:
o Palm up, passively raise wrist
into flexion
o Slowly lower into wrist extension

Want to develop
endurance:
o High reps, low weight

INSERT PICTURE OF
MEDIAL/LATERAL EPI
ECCENTRICS

Rotator Cuff Tendinopathy Prevalence

Shoulder pain is a common problem with up to
the population experiencing at least once episode
per year.14
o Pathology of the rotator cuff is thought to be the most common cause

Shoulder issues have peak prevalence in mid to

older age groups.15
Rotator cuff pathology includes a spectrum of
pathologies (tears, inflammation, tendonitis,
degeneration) involving contractile and other
local structures around the shoulder joint giving
rise to similar signs and symptoms.16

Rotator Cuff Tendinopathy

Anatomy/Presentation
Rotator cuff composed of
four muscles:
o
o
o
o

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

Signs/Symptoms:
o Symptom duration > 3 months
o Minimal resting pain
o Largely preserved shoulder range of
motion
o Pain exacerbated by resistance
testing (abduction, internal rotation,
external rotation)
o Pain with overhead movement
o Painful arc during shoulder elevation
o Positive impingement test

Picture of RTC mm
Picture of humerus, GH
joint, scapula, AC joint
Picture of FMS
impingement clearing
test

Rotator Cuff
Tendinopathy - Climbing
Importance of
symmetry between
muscles of rotator cuff.
o Contracture vs. inhibition

Posture
o Forward head, rounded
shoulder

Rotator Cuff Tendinopathy

Prevention Tip
Self test strength of
rotator cuff muscles:
o Supraspinatus:
Stand at wall, abduct into
wall
o Infraspinatus and teres minor:
Stand at wall, externally
rotate into wall
o Supscapularis:
Stand at wall, internally
rotate into wall
o All of these motions should feel
strong, pain free and completed
without apprehension

If any of these tests are

less than optimal:
o Isometric holds

Sources
Holtzhausen LM, Noakes TD. Elbow, forearm, wrist, and hand injuries among sport rock
climbers. Clinical Journal of Sport Medicine. 1996; 6:196-203.
Doyle JR. Anatomy of the flexor tendon sheath and pulley system: a current review. Journal of
Hand Surgery. 1989; 14:349-351.
Bollen SR, Gunson CK. Hand injuries in competition climbers. British Journal of Sports
Medicine. 1990; 24:16-18.
Schffl VR, Hochholzer T, Winkelmann HP, Strecker W. Pulley injuries in rock climbers.
Wilderness and Environmental Medicine. 2003; 14:38 43.
Vigouroux L, Quaine F, Labarre-Vila A, Moutet F. Estimation of finger muscle tendon tensions
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Schffl I, Einwag F, Schffl VR. Impact of Taping after finger flexor tendon pulley ruptures in
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Rooks MD, Johnston R, Ensor CD, McIntosh B, James S. Injury patterns in recreational rock
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Shea KG, Shea OF, Meals RB. Manual demands and consequences of rock climbing. J Hand
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Wise S, Owens DS, Binkley HM. Rehabilitating athletes with medial epicondylalgia. National
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Sources
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