Top 5 Most Common Climbing Injuries

In this blog post I will dive into the most common rock-climbing injuries that I see in the clinic. This includes:

• Finger pulley injuries

• Shoulder SLAP injuries

• Rotator cuff-related shoulder pain

• Knee injuries

• Elbow tendon injuries

Other common presentations include wrist TFCC tears (triangular-fibrocartilage), hamstring tears and ankle sprains. After reading this blog, you may gain a clearer idea of how climbing injuries can present and when it may be helpful to consult a climbing physiotherapist.

Finger Pulley Injuries

Finger pulley injuries, particularly affecting the A2 and A4 pulleys, are prevalent among climbers. These injuries occur when the flexor tendons in the fingers experience excessive stress, often during dynamic crimpy moves or when pulling hard on small holds. Injuries can vary from a strain to a partial or complete tear.

Clinical Presentation:

·       Pain: Sharp pain that is usually at the location of the pulley injured.

·       Tenderness: Tenderness when pressing on the pulley.

·       Swelling: Visible swelling around the affected finger if a tear is present

·       A noticeable "pop" at the time of injury

·       Weakness: Difficulty gripping holds, particularly with crimping.

If you suspect a pulley tear, consider consulting a physiotherapist promptly. Early assessment can help determine if splinting or other management may be appropriate. Indications of a suspected pulley tear include an audible pop or an acute onset of finger pain (rather than a gradual onset) combined with swelling, loss of range of movement and pain with crimping. For more information on finger injuries check out my previous blog on Understanding and Preventing Common Finger Injuries.

Shoulder SLAP Injuries

A SLAP (Superior Labrum Anterior and Posterior) tear involves injury to the top part of the labrum in the shoulder joint. This is the cartilage that lines the shoulder joint. Climbers are prone to SLAP injuries due to the repetitive overhead movements, which can strain the labrum and biceps tendon.

Clinical Presentation:

·       Pain: Deep, aching pain in the shoulder, often worsened by overhead or lifting activities. This pain may refer to the side or back of the shoulder.

·       Weakness: General weakness in the shoulder, especially during lifting or throwing.

·       Clicking or Popping: Sensation of clicking, popping, or catching in the shoulder.

·       Decreased Range of Motion: Difficulty moving the shoulder, particularly in overhead positions.

·       Instability: Feeling of shoulder instability or slipping.

A physiotherapist can assess whether a shoulder issue may be a SLAP injury and provide guidance on exercises and strategies to support shoulder strength and stability.

Rotator Cuff Related Shoulder Pain

Rotator cuff injuries, including tears and tendinopathies are common in climbers due to the high demands placed on the shoulders during climbing. The rotator cuff is a group of muscles that function to stabilise the shoulder joint. The tendons of these muscles are usually the culprit of persistent rotator cuff related shoulder pain.

Clinical Presentation:

·       Pain: Pain in the shoulder, particularly when lifting the arm overhead.

·       Weakness: Weakness in the shoulder, especially during lifting or rotating the arm.

·       Limited Range of Motion: Difficulty moving the shoulder in various directions.

·       Night Pain: Pain that worsens at night or when lying on the affected shoulder.

·       Tenderness: Tenderness when pressing on the rotator cuff muscles.

You should see a physiotherapist if you have experienced an acute onset of shoulder pain with associated loss of function such as range of movement and strength. Rotator cuff injuries are often managed with a rehabilitation program designed to support shoulder function and strength. A physiotherapist experienced in climbing is also able to modify climbing technique and climbing load to assist recovery and future injury prevention.

Knee Injuries

Knee injuries in climbers often result from twisting motions, falls, repetitive landing and heel hooks. Common knee injuries include meniscus tears, ACL (anterior cruciate ligament) tears, MCL (medial collateral ligament) tears, ITB (ilio-tibial band injury) and popliteus injury.

Clinical Presentation:

·       Pain: Sharp or aching pain in the knee, often exacerbated by movement or weight-bearing.

·       Swelling: Swelling around the knee joint.

·       Instability: Feeling of the knee giving way or instability.

·       Stiffness: Limited range of motion and stiffness in the knee.

·       Locking or Clicking: Sensation of the knee locking or clicking during movement.

It may be appropriate to consult a physiotherapist if you experience acute knee pain with any of the following symptoms: swelling, loss of range of movement, instability/giving way, locking or catching during movement. Recurrent discomfort with specific climbing moves (e.g. heel hooking) may also warrant professional assessment. Our physiotherapists are able to determine the need for a knee braces or the requirement for onward referral to a specialist.

Elbow Tendon Injuries

Elbow tendon injuries, such as medial and lateral epicondylalgia (commonly known as golfer's and tennis elbow or ‘tendinitis’), are caused by repetitive stress on the tendons around the elbow joint. Climbers often experience these injuries due to overloading the tendons of the elbow from overtraining whilst under recovering from their climbing sessions.  Tendon pain usually warms up with exercise resulting in climbers underestimating the severity of their injuries and often seeking helping far too late!

Clinical Presentation:

·       Pain: Pain on the inner (medial) or outer (lateral) side of the elbow that usually warms up with activity.

·       Tenderness: Tenderness when pressing on the affected tendon.

·       Weakness: Weakness in the forearm and reduced grip strength.

·       Stiffness: Stiffness in the elbow, particularly in the morning or after activity.

·       Swelling: Mild swelling around the elbow joint.

You should see a physiotherapist if you elbow pain is persisting for long than 2 weeks. If these injuries are addressed early, they can often be settled down quickly before they become persistent and difficult to manage. Acute elbow pain may warrant timely assessment by a physiotherapist to check for possible tendon involvement.

Final Thoughts

Rock climbing can unfortunately lead to a range of injuries that can significantly impact on our ability to climb hard. As a physiotherapist and boulderer, my advice is to prioritize injury prevention through proper training, technique, and self-care. Should an injury occur, early intervention and a structured rehabilitation program are crucial for a swift and effective recovery.  Many climbers can often continue climbing with modifications under professional guidance, helping to maintain strength and wellbeing. Early assessment by a physiotherapist can help determine appropriate strategies for your situation.