An introduction to the prevention of climbing related injuries
It doesn’t take a specialist to see how or why injuries occur in climbing. When else would you place such high demands through your fingers like crimping or stacking and twisting your fingers into various width cracks or pockets, and committing to dynamic moves above often bad (or just soft) landings. When else would you put your shoulders and rotator cuff tendons under such tension as when you’re performing gastons and big burly compression moves on overhanging faces. And less often considered in climbing… the forces required from your hamstring and cruciate ligaments like a heel hook, high rock-over or drop knee. As climbers too, we’re notoriously guilty for thinking that just one more attempt on that project or crux move won’t make the pain any worse… And one more go? Infact, it’s not just climbers, Phillip Latter wrote in Runner’s World Magazine this month about ‘Pain and The Brain’ and highlighted how many runners, particularly those with type A personality traits (motivated, proactive and organised) often ignore the message their body is trying to relay to the brain and persist with training until their body imposes it on them. This can result in making a 6 week rehabilitation period out of what would have been a few days rest. He then goes on to write about the importance of ‘prehab’: recognising a potential precursor to full blown injury and addressing it before the damage is done. No matter the sport, injuries are never welcomed!
This blog is an introduction to the prevention of climbing related injuries and the research principles that underpin injury prevention. We will address the prevention of particular symptoms and syndromes in subsequent blogs.
So what are the three stages of injury prevention? And how do they relate to climbers?
The first, and arguably the most important is known as ‘primary prevention’. In general medicine this would include not smoking, eating a healthy, balanced diet and leading an active, non-sedentary lifestyle to help prevent a whole bunch of non-communicable diseases. Essentially, any intervention or abstaining of unhealthy habits to reduce the risk of injury or disease falls under primary prevention. In relation to climbing related injuries, primary prevention is determined by the common causes and presenting symptoms that we see in research and in clinics. For example, we commonly see ruptured finger pulleys (backed by clinical studies as the most common acute climbing injury(1). Often it’s revealed in the assessment that perhaps the climber had not really warmed up, was crimping really hard, foot popped off and their finger made one hell of a noise (maybe you’ve been here? Or the odds suggest you know someone who has). Then we dig a bit deeper in our assessment and find that the climber had been progressing super fast, upped their training volume and intensity, using full crimps on nearly every hold because it feels strong and their posture and muscle tightness may have been limiting range of movement and altering muscle balance, increasing the stress through their fingers (2,3). So if they could rewind time, their primary prevention might have been to work on their footwork, allow steady progression with a focus always on using the correct technique, perhaps train open handed crimps in a controlled manner, stretch tightened muscles, strengthen weak or imbalanced muscles and warm up effectively before each session.
It’s easy to identify these when it’s too late. So what can you do to help prevent injuries? (A broad overview).
- Undertake an effective, progressive, climbing specific warm up! Before EVERY session. And re-warm up after taking a break. (2, 4, 6).
- Work on technique always and even seek help from a qualified coach to ensure that you have the fundamentals locked down! ‘Practice makes Permanent’. (4).
- Listen to your body and ensure adequate recovery. According to Yann Le Meur, sports scientist, ‘90% of recovery is about rest, sleep, nutrition and hydration. Do the basics consistently well’ (@YLMSportScience).
- Moderate your repeats on strenuous moves and try to keep your training varied (4). Avoid increasing more than one variable in your training, i.e. volume OR intensity.
- Dedicate time to a stretching regime particularly upper trapezius, forearms, latissimus dorsi (lats), pectoralis major (pecs) and hamstrings (2). Static stretches should be performed after climbing or on your rest days, not before your session (2).
- Strengthen the antagonist muscles, particularly mid/lower traps, triceps, wrist and finger extensors, hamstrings and glutes- future blog on this to come soon! (2,4).
- Use a foam roller or keep your body in tune with regular sports massage to target over-trained, tight, or sore muscles.
The second stage is the immediate and appropriate treatment to any sustained injuries. Again, in general medicine this may be a course of antibiotics to nip a nasty infection in the bud. An example of this in relation to climbing injuries would be the use of ice, compression and elevation following a sprained ankle from an unfortunate landing on the pad or soft matting, followed by a well designed rehabilitation programme to include ‘optimal loading’ and strengthening (7). The idea is to prevent unnecessary secondary damage and limit delay of the bodies optimal healing response to injury. As a physiotherapist, it would also be considered second stage injury prevention to facilitate the return to climbing without the risk of causing further damage to the healing/ recovered tissues, including taping and strapping methods, avoiding overloading the vulnerable tissues and ensuring post training recovery. It is essential in this stage that the advice and recommendations you are following are well informed by your doctor or physiotherapist. It’s a natural reaction for other climbers to want to offer all the advice they can give and share with you their own tips when they discover you have an acute injury. And you’ll likely receive different advice from each person you speak to. Here are our recommendations for stage 2 injury prevention:
- Seek immediate professional medical advice from your doctor or physiotherapist following sporting injury
- For acute injuries: Protect, ice, compress, elevate and then progress with optimal loading for the tissues as advised by your therapist (7). A general protocol for ice is to apply for only ten minutes each hour following injury for the first 48 hours to help reduce swelling (8).
- Have your therapist help you design a rehabilitation programme that enhances recovery of the injured tissues and facilitates a safe return to climbing (2,4)
- Effective taping techniques, particularly finger taping to increase support to the tissues and restrict unwanted excessive range of movement (2). Don’t be tempted to tape it yourself the day of your injury and continue to climb… Seek advice from a medical professional.
The third and final stage of injury prevention in sport is aimed at preventing the reoccurrence of injury. After a climbing or sporting injury this may include strengthening muscles to support vulnerable structures, proprioception exercises to reduce the risk of recurrent strain or sprain and physiotherapy techniques to improve the quality of scar tissue and ensure normal movement patterns and joint range of motion following injury.
- Progression of your rehabilitation programme, which overlaps your return to climbing
- Strengthen the recovered tissues and supporting structures and stretch tightened muscles
- Work with your therapist to ensure return of normal movement patterns, muscle control and joint stability (2, 4, 5)
- Mobilisations, muscle energy techniques or soft tissue release to regain normal range of movement and functional mobility in the muscles and joints.
So there you have a very short and broad overview of injury prevention in climbing. We will be posting more injury specific preventative and rehabilitation protocols in the near future so watch this space. In the meantime, if you have any questions just drop us a message or if you wish to book in to see one of our physiotherapists at Climbing Physio, head over to our online booking page. Our aim is to keep you climbing!
- Schöffl VR, Hoffmann G and Küpper T (2013). Acute injury risk and severity in indoor climbing-a prospective analysis of 515,337 indoor climbing wall visits in 5 years. Wilderness Environ Med 24(3): 187-94.
- Schöffl VR and Hochholzer T (2006). One Move Too Many… How to understand the injuries and overuse syndromes of rock climbing. Sharp End Publishing. USA.
- Saunders, J (2005). Shoulder impingement. Rock: 35.
- MacLeod, D (2015). Make or Break. Don’t let climbing injuries dictate your success. Rare Breed Productions.
- Brukner, P and Khan, K (2012). Brukner & Khan’s Clinical Sports Medicine. 4th Edition. McGraw-Hill Education. Australia.
- McGowan CJ, Pyne DB, Thompson KG and Rattray B (2015). Warm-Up Strategies for Sport and Exercise: Mechanisms and Applications. Sports Med, Sep 23: p1-24
- Bleakley CM, Glasgow P, MacAuley DC (2012). PRICE needs updating, should we call the POLICE? Br J Sports Med; 46: 220-221.
- MacAuley DC (2001). Ice therapy: how good is the evidence? International Journal of Sports Medicine; 22(5): 379-84.