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 will have a better understanding of how common climbing injuries present clinically and when it is best to see 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.

It is important to see a climbing physiotherapist ASAP if there is a suspected pulley tear since the finger may need urgent splinting. 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.

An experienced Physiotherapist will be able to differentiate between a SLAP injury and other forms of shoulder injuries.  Physiotherapy can provide a structured rehabilitation program to restore 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 require a rehabilitation program to restore 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.

You should see a physiotherapist if you experience an acute onset of knee pain associated with any of the following symptoms: swelling, loss of range of movement, instability/giving way, locking or catching during movement. Additionally, if you are experiencing recurrent pain with heel hooking or other climbing positions you should also seek professional advice! 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. Any elbow pain that occurs with an acute mechanism should be seen ASAP to check for a potential tendon tear.

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.  I rarely advocate for complete rest from climbing and instead opt for climbing modification to maintain strength and mental wellbeing. Climbers commonly wait too long to see a physiotherapist out of fear of being told to rest.