Sport Climbing: medical considerations for this new Olympic discipline
Author: C. Lutter, Y. El-Sheikh, I. Schöffl, V. Schöffl | Year: 2017
Summary/Results: This is a commentary by several leading climbing injury researchers on the medical considerations of climbing given its inclusion within the 2020 Olympics. The authors discuss some of the newer trends in climbing injuries, such as heel hooks and bone marrow edema (excess watery fluid collection in certain areas of the body) injuries, and make two recommendations. The recommendations are: (1) closer sports-specific medical supervision of elite athletes, and (2) monitoring of training and competition facilities for more careful route setting, attention to more ergonomic, less injury inducing hold use, and age-specific training programs.
Reference: Br J Sports Med. 2017 Jan;51(1):2-3.
http://bjsm.bmj.com/content/51/1/2 or PDF: http://dl.yums.ac.ir/bitstream/Hannan/188969/1/2017%20Sports%20Medicine%20%282%29.pdf
Rock climbing related bone marrow edema of the hand: a follow-up study
Author: C. Lutter, T. Hochholzer, T. Bayer, V. Schöffl | Year: 2017
Summary/Results: The researchers studied cases of hand and wrist injury in 31 climbers averaging between 5.10d and 5.14c. They found bone bruising and classified them according to the area of the wrist, primarily in the bones of the palm and the bones just above the wrist. The authors recommended avoidance of stress in all climbers, and the effects of the bone bruising lasted between 6 – 32 weeks. Most were classified with conservative treatment as having good outcomes, however 3 required surgery.
Reference: Clin J Sport Med. 2017 Jul 6.
Sagittal Band, Boutonniere, and pulley injuries in the athlete
Author: LC Grandizio, JC Klena | Year: 2017
Summary/Results: Researchers looked at recent literature on injuries important to climbers, namely the “pulley” (a stabilizing tendon that holds a finger-pulling tendon to the finger bone) injury tendons which wrap around each finger. They reviewed research on how to evaluate finger injuries, found new research on the pervasiveness of pulley injuries in the rock climbing community, the flexor tendon’s ability to pull away from the bone (called bowstringing), contradictory research on which pulleys are more important to “bowstringing”, and reviewed two different approaches to fixing torn pulley tendons.
Reference: Curr Rev Musculoskelet Med. 2017 Mar; 10(1): 17–22.
Ankle Fracture Associated with Rupture of the Achilles Tendon: Case Report and Review of the Literature
Author: M. Elmajee, A. Rafee, T. Williams | Year: 2017
Summary/Results: Researchers examined a case study of a rare combination of Achilles tendon rupture and ankle (Medial Malleolus) fracture. The rupture was initially missed and only identified during surgery, later confirmed with ultrasound and MRI. Reported patterns (a fall from height) make this combination of injury more likely to happen in climbing. Doctors recommend a thorough clinical assessment of musculoskeletal and neurovascular structure in such instances.
Reference: J Foot Ankle Surg. 2017 Nov – Dec;56(6):1320-1322.
Functional and sports-specific outcome after surgical repair of rotator-cuff tears in rock climbers
Author: M. Simon, D. Popp, C. Lutter, V. Schöffl | Year: 2017
Summary/Results: Researchers assessed 12 rock climbers with both chronic and acute rotator cuff (shoulder) injuries for their ability to come back to the sport of climbing after surgery. They found that arthroscopic (minimally invasive surgery) repair generally provides a good outcome [all climbers had started climbing by re-evaluation (defined as 27 +/- 12 months), but only 5 had reached pre-surgery climbing ability] toward returning to climbing, and that it’s slightly better in cases of acute injury than in cases of chronic injury.
Reference: Wilderness Environ Med. 2017 Dec;28(4):342-347
An uncommon location of black heels in a free climbing instructor
Author: A. Tammaro, F. Magri, E. Moliterni, FR Parisella, M. Mondello, S. Persechino | Year: 2017
Summary/Results: Researchers note a case of a climbing instructor who developed black spots on his feet. They confirmed that the case was benign, and that the atypical location of “black heels” was likely due to the configuration of climbing shoes which have a soft sole. However, they recommend consulting with a doctor to remove any doubt if others are afflicted with similar black spots. Beta-Angel note: this research will not help you heel hook, but it may cause you to check your heels regularly… no we’re not freaking out unnecessarily.
Reference: Int Wound J. 2018 Apr;15(2):313-315
Descriptive epidemiology, medical evaluation, and outcomes of rock climbing injuries
Author: JM McDonald, AM Henrie, M. Teramoto, E. Medina, SE Willick | Year: 2017
Summary/Results: Researchers conducted a survey of 553 males and 155 females on mountainproject.com to understand injury patterns by type of injury and to identify healthcare provider patterns for climbers, and also identify issues with returning to climbing. In addition to confirming injury rates from other studies, the authors found that 80.1% of all climbers who seek medical treatment for an injury get referred to a specialist, half of all climbers were not fully healed when returning to climbing, and a similar percentage developed chronic pain after injury, and the factors affecting return to climbing were: smoking, fractures, age, and surgery.
Reference: Wilderness Environ Med. 2017 Sep;28(3):185-196.
MRI sport-specific pulley injury
Author: MN Hoff, TD Greenberg | Year: 2017
Summary/Results: The researchers tested a novel climbing-specific crimp position using an MRI in a single individual in order to determine the MRI’s efficacy in measuring the bone to tendon distance (BTD), a traditional measure associated with diagnosing pulley (a stabilizing tendon that holds a finger-pulling tendon to the finger bone) injury injuries. The technique identified the BTD as 1.5 mm (which is less than 2 mm – the distance used to indicate a weakened pulley) across 3 images; one image of a relaxed crimp and two images of a stress crimped position. The authors note a wide range of benefits (e.g. outcome of surgery; rehab, etc.) to using a climbing-specific grip position using a relaxed and stressed method.
Reference: Skeletal Radiol. 2017 Oct 10
Pulley injuries in rock climbers: hand therapy clinical application
Author: L. Algar, M. Moschetto | Year: 2017
Summary/Results: The authors outline how to conservatively treat rock climbing pulley (a stabilizing tendon that holds a finger-pulling tendon to the finger bone) injuries. Specifically, they summarize the two mechanisms identified to date which reduce the distance between the tendon and the bone. This effect protects the pulley tendon. They are: (1) the H-taping method developed by Schöffl and his colleagues, and (2) the pulley protection orthosis (brace) developed by Schneeberger and Schweizer.
Reference: J Hand Ther. 2017 Oct 14
Flexor tendon pulley injuries in rock climbers
Author: EA King, JR Lien | Year: 2017
Summary/Results: Authors reviewed the state of pulley (a stabilizing tendon that holds a finger-pulling tendon to the finger bone) injury literature and provide recommendations regarding diagnosis, therapy, and surgical technique. They recommend the use of dynamic ultrasound for diagnosis; conservative therapy (time off, splinting, taping/bracing) for a single pulley injury and surgical reconstruction for multiple pulley injuries (while noting cases of successful conservative management of multiple pulley injuries), including the author’s preferred surgical method: a graft with three loops for the A2 (closer to the palm) and a graft with a single loop for the A4 (nearer the tip of the finger).
Reference: Hand Clin. 2017 Feb;33(1):141-148
Survey of hand and upper extremity injuries among rock climbers
Author: CE Nelson, GM Rayan, DI Judd, K. Ding, JA Stoner | Year: 2017
Summary/Results: Authors surveyed 397 climbers in order to identify and compare injuries between males and females. The authors found that females were both more likely to report shoulder injuries than males and also more likely to report surgery. In a literature review, the authors noted that other studies found an association between females and shoulder injuries, especially in some upper body sports (water polo, martial arts, tennis) and that this is due to instability and weakness around specific shoulder stability muscles such as the periscapular (trapezius, rhomboids, pectoralis minor, etc.) muscles and the rotator cuff. Beta-Angel note: the authors note that the shoulder injury reporting was separate from the surgery reporting, suggesting the two can’t be taken together.
Reference: Hand (N Y). 2017 Jul;12(4):389-394.
Pregnant Women in Sport Climbing – Is there a Higher Risk for Preterm Birth?
Author: J. Drastig, D. Hillebrandt, W. Rath, T. Küpper | Year: 2017
Summary/Results: Researchers assessed 32 female climbers using a self-report online questionnaire to determine whether pre-term birth is more likely in the climbing community than in the general population. Two women in the study reported a pre-term birth, and the study discusses the information provided by the questionnaire for these two subjects as well as the overall population. Based on this survey, the authors do not see climbing as being a risk factor for pre-term birth.
Reference: Z Geburtshilfe Neonatol. 2017 Feb;221(1):25-29.
Custom-made total talonavicular replacement in a professional rock climber
AUTHORS: S. Giannini, M. Cadossi, A. Mazzotti, L. Ramponi, C. Belvedere, A. Leardini | Year: 2016
SUMMARY/RESULTS: Researchers evaluated the utility of a custom-made ankle prosthesis that was inserted into a rock-climber who had developed arthritis from a fracture. The researchers noted that the prosthesis was an effective solution for a complex ankle injury in a patient who desires high functionality.
REFERENCE: J Foot Ankle Surg. 2016 Nov – Dec;55(6):1271-1275
Climbing has a positive impact on low back pain: a prospective randomized controlled trial
AUTHORS: M. Schinhan, B. Neubauer, K Pieber, M. Gruber, F. Kainberger, C. Castellucci, B. Olischar, A. Maruna, R. Windhager, M. Sabeti-Aschraf | Year: 2016
SUMMARY/RESULTS: The authors studied 30 patients with chronic lower back pain and divided them up into two groups: one group where the patients climbed, and one group where they did not. Improvements were found in climber vs. non-climber lower back pain, in the size of spinal disc protrusion and in the ability to stretch the lower back and hamstrings.
REFERENCE: Clin J Sport Med. 2016 May;26(3):199-205.
Caring for climbers
AUTHOR: C. Peterson, A. Ceraulo | Year: 2015
SUMMARY/RESULTS: The authors seek to provie familiarity with common climbing injuries and treatment for clinicians. The authors recommend general guidelines for physicians including: adequate preparation of tendon strengthening, opposing muscle groups, and flexibility. They recommend low weight and high repetition training, as well as body weight and training boards. They also suggest taping (they note H-taping method evaluated by Schoffl), ample recovery time, and give guidelines for rehabilitation, and emphasize the need for physicians to understand when surgical intervention is needed. Beta-Angel note: recommended reading due to the fact that the entire article is available to read online. That being said, a careful read is recommended, due to the fact that some of general recommendations may be outside the scope of what is directly referenced in the article (e.g. training board as finger ‘hardening’ tools).
REFERENCE: Curr Sports Med Rep. 2015 Sep-Oct;14(5):397-403
Indoor rock climbing (bouldering) as a new treatment for depression: study design of a waitlist-controlled randomized group pilot study and the first results
AUTHORS: K. Luttenberger, EM Stelzer, S. Forst, M. Schopper, J. Kornhuber, S. book | Year: 2015
SUMMARY/RESULTS: Researchers assessed the use of bouldering as an intervention for people with depression in two sets of two groups (2 intervention vs. 2 non-intervention) over the course of eight weeks using 27 females and 20 males. The researchers conclude that bouldering works as an intervention for depression. Beta-Angel note: the authors note that the waitlisted group had a somewhat higher initial depression score.
REFERENCE: BMC Psychiatry 2015 15:201
Footwear in rock climbing: current practice
AUTHORS: RD McHenry, GP Arnold, W Wang, RJ Abboud | Year: 2015
Summary/Results: Researchers investigated the use of tight footwear in 56 rock climbers with over a year experience. They found that 55 out of 56 rock climbers use excessively tight footwear and that foot pain during activity was common in 91% of climbers, and that 4 UK shoe sizes on average was found between normal shoes and climbing shoes.
REFERENCE: Foot (Edinb). 2015 Sep;25(3):152-8.
Climber’s hand injuries
AUTHORS: F. Moutet, F. Quaine | Year: 2015
SUMMARY/RESULTS: Researchers described the diagnosis of finger injuries using a review of literature. Additionally, they describe the mechanics of finger injuries by discussing the posture and stability of the body (in relation to the fingers) during climbing, finger behavior during gripping, and how the internal tendon structure engages during climbing. Beta-Angel note: oh! So much potential to be a good, short overview for the layman. But alas, we must keep searching.
REFERENCE: GIPSA-Lab, Grenoble University, France.
Evaluation of finger A3 pulley rupture in the crimp grip position: a magnetic resonance imaging cadaver study
AUTHORS: T. Bayer, W. Adler, A. Schweizer, I. Schoffl, M. Uder, R. Janka | Year: 2015
SUMMARY/RESULTS: Researchers attempted to identify good indicators for a pulley tendon rupture (full tear in the A3 – a tendon that holds your long flexor tendon [explained lower] to the bone). They found that a reduction of the distance between the volar plate (ligament holding two bones at the second knuckle from the tip of the finger) relative to the base of the middle phalange (the part of the finger between the tip and the part closest to the knuckle), and an increase in the distance of the flexor tendon (long tendon that controls movement in the fingers) with the volar plate body, were the most ideal indicators, while the distance between the flexor tendon and bone were not. Beta-Angel note: sorry for the wording – I think I could have done better. But the fact remains that this is just a bunch of nerds doing nerd things so they can diagnose the impact of you being dumb faster.
REFERENCE: Skeletal Radiol. 2015 Sep;44(9):1279-85.
Effects of a therapeutic climbing program on muscle activation and SF-36 scores of patients with lower back pain
AUTHORS: S. Kim, D. Seo | Year: 2015
SUMMARY/RESULTS: The researchers measured (using a questionnaire and an instrument which measures electricity in the muscles) thirty adults with chronic back pain by dividing them up into two groups: one which did middle-to-lower back stabilization exercises and the other which climbed. While both groups improved on their questionnaire, the stabilization group showed greater muscle electricity in the mid-to-lower back, while the climbing group showed greater increase in three stomach muscles on the front and side – which provide stability to the trunk.
REFERENCE: J Phys Ther Sci. 2015 Mar; 27(3): 743–746.
Complete spinal accessory nerve palsy from carrying climbing gear
AUTHORS: JM Coulter, WJ Warme | Year: 2015
SUMMARY/RESULTS: Researchers looked at a case study of a climber who hiked for 2.5 hours while carrying their load over one shoulder and across the body which resulted in compression of a nerve which controls shrugging of the shoulders and turning of the head. The researchers suggest proper load-carrying should distribute weight more evenly over a greater surface area. Beta-Angel note: not sure why this is in here….
REFERENCE: Wilderness Environ Med. 2015 Sep;26(3):384-6.
Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu
AUTHORS: BA Davis, LP Hiller, SG Imbesi, EY Chang | Year: 2015
SUMMARY/RESULTS: A case study about how force applied to the inside of the knee, on a part of the knee which stabilizes rotation, during a heel hook has the potential to cause injury. The authors recommended conservative management consisting of non-weight bearing for 1-2 weeks followed by physical therapy, with full function by 6 months. Beta-Angel note: The authors suggest that these are a majority of all heel-hooks, but while they (1) recognize that not all heel hooks involve downward force to the inside of the knee in external rotation, (2) they suggest that a majority do. We at the Beta-Angel Research Project note the discrepancy but can find no data on prevalence of the “side-heel” hook vs “downward-heel” hook.
REFERENCE::Skeletal Radiol. 2015 Aug;44(8):1175-9.
Effect of climbing therapy on gait function in children and adolescents with cerebral palsy — a randomized, controlled crossover trial
AUTHORS: H. Bohm, MK Rammelmayr, L. Doderlein | Year: 2015
SUMMARY/RESULTS: Researchers compared climbing and physical therapy interventions in order to test whether climbing can improve the manner of walking in children with cerebral palsy. The outcomes caused the researchers to be concerned about the potential for climbing therapy to deteriorate walking manner in children with cerebral palsy, and recommend changing climbing therapy protocols to strengthen the knee.
REFERENCE: European Journal of Physiotherapy, 7 (1), 2015
Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009 and 2012
AUTHORS: Schoffl, et al. | Year: 2015
SUMMARY/RESULTS: A4 Pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) Injuries, bone or “growth plate” fractures, and (probably) shoulder injuries are increasing. More A4 than A2 pulley injuries are being seen, a change since previous study which noted A2 over A4 – suggesting change in biomechanics of grip. More shoulder injuries are being seen as well – likely a cross between rising shoulder injuries and sample bias. Bone or “growth plate” fractures increased by 600%, likely due to increasing interest in adolescents.
REFERENCE: Wilderness & Environmental Medicine, 26 (1), 62-67 (2015)
Common neuromusculoskeletal injuries amongst rock climbers in the Western Cape
AUTHORS: Liezel Wegner, Jarryd E. Pagel, Ashley W. Smit, Aimee Straszacker, Sarah L. Swart and St John Taft | Year: 2015
SUMMARY/RESULTS: Research focused on indoor and outdoor climbers in the Western Cape. Most common injuries affected fingers, hands, and elbows. Risk of injuries correlated with gender, setting, grade, and type of climbing, but not frequency of climbing.
REFERENCE: Wegner, L., Pagel, J.E., Smit, A.W., Straszacker, A., Swart, S.L. & Taft, St.J., 2015, ‘Common neuromusculoskeletal injuries amongst rock climbers in the Western Cape’, South African Journal of Physiotherapy 71(1), Art. #227, 4 pages.
Preparticipation evaluation for climbing sports
AUTHORS: A.D. Campbell, C. Davis, R. Paterson, T.A. Cushing, P. Ng, C.S. Peterson, P.E. Sedgwick and S.E. McIntosh | Year: 2015
SUMMARY/RESULTS: Research focused on determining a more effective way to pre-screen people planning to participate in a climbing activity and determine their risk for injuries.
REFERENCE: Preparticipation Evaluation for Climbing Sports. Clinical Journal Of Sport Medicine, 25(5), 412-417.
Previous injury as a risk factor for reinjury in rock climbing: a secondary analysis of data from a retrospective cross-sectional cohort survey of active rock climbers
AUTHORS: Gareth Jones, David Llewellyn and Mark I. Johnson | Year: 2015
SUMMARY/RESULTS: Research found that the existence of a previous injury increased likelihood of experiencing reinjury, especially in the fingers.
REFERENCE: Previous injury as a risk factor for reinjury in rock climbing: a secondary analysis of data from a retrospective cross-sectional cohort survey of active rock climbers. BMJ Open Sport Exerc Med, 1(1), bmjsem-2015-000031.
Rock climbing injuries: acute and chronic repetitive trauma
AUTHORS: Connie Y. Chang, MD, Martin Torriani, MD, Ambrose J. Huang, MD | Year: 2015
SUMMARY/RESULTS: Review of climbing injuries, including acute and chronic injuries in the upper and lower extremities. Repetitive chronic injuries were more common, while acute injuries tended to be more severe.
REFERENCE: Rock Climbing Injuries: Acute and Chronic Repetitive Trauma. Current Problems in Diagnostic Radiology.
Risk factors for injury in sport climbing and bouldering: a systematic review of the literature
AUTHORS: Woollings, K.Y., McKay, C.D. and Emery, C.A. | Year: 2015
SUMMARY/RESULTS: A systematic literature review to explore common climbing injuries and determine how they could be prevented. Certain risk factors like climbing experience, age, skill level, “climbing intensity score”, and participation in lead climbing were established as potential risk factors.
REFERENCE: Risk factors for injury in sport climbing and bouldering:a systematic review of the literature. British Journal of Sports Medicine, 49 (17). pp. 1094-1099. ISSN 0306-3674
Rock climbing-related subclavian vein thrombosis
AUTHORS: Christoph Lutter, Erik Monasterio, Volker Schöffl | Year: 2015
SUMMARY/RESULTS: A case study of two climbers who developed Paget-Schroetter syndrome, a rare condition where blood clots form in the veins of the arm. Boulderers may be at increased risk of this condition due to the high amount of stress placed on the upper extremities.
REFERENCE: BMJ Case Reports 2015 Researchgate.net.
The roles of experience, participation rates and judgment in the injury rates of weekend warriors
AUTHORS: Jon Heshka, Jeff Jackson | Year: 2015
SUMMARY/RESULTS: This article refutes the idea that people are more likely to get injured on weekends due to lack of experience, and suggests that increased injury rates are seen because of overall increased participation.
REFERENCE: Canadian Journal Of Surgery, 58(1), E1-E2.
Stress examination of flexor tendon pulleyrupture in the crimp grip position: a 1.5-Tesla MRI cadaver study
AUTHORS: Bayer T, Fries S, Schweizer A, Schöffl I, Janka R, Bongartz G. | Year: 2015
SUMMARY/RESULTS: Researchers ran MRIs on cadaver fingers with artificially created pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) ruptures in neutral and crimp positions. The crimp position was found to cause an increased distance between the bone and tendon, placing more stress on the pulley.
REFERENCE: Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study. PubMed – NCBI.
The “weekend warrior”: fact or fiction for major trauma
AUTHORS: DJ Roberts, JF Ouellet, PB Mcbeth, AW Kirkpatrick, E Dixon, CG Ball | Year: 2014
SUMMARY/RESULTS: Researchers investigated whether individuals who participate in physical activities on weekends tend to become injured more often than those who participate in activities during the week from 1995 to 2009. Significantly more were injured on the weekend than the week, hiking or mountain/rock climbing was the second most common activity for injury, while ground-level or higher fall while hiking, mountain climbing or rock climbing was the most common method of injury.
REFERENCE: Can J Surg. 2014 Jun;57(3):E62-8.
Fracture of the lateral tubercle of the posterior talar process caused by a rock-climbing fall: a case report
AUTHORS: MA Blanchette, JM Grenier | Year: 2014
SUMMARY/RESULTS: Researchers presented a case study of a 29 year old male whose foot hit a wall during a fall and was diagnosed as an ankle fracture. The authors warn clinicians to be aware that a fracture of the ankle could be very similar in symptom to an ankle sprain and recommend 4 to 6 weeks of immobilization.
REFERENCE: J Can Chiropr Assoc. 2014 Sep;58(3):286-90.
Common musculoskeletal injuries in rock climbers
AUTHORS: A. Dabholkar, S. Tejani, S. Yardi | Year: 2014
SUMMARY/RESULTS: Researchers in India gathered information on rock climbing injuries from 40 climbers using a questionnaire. They found that ankle sprains were the most common injury, but that small climbing shoes and use of the crimp grip were risk factors in climbing.
REFERENCE: Indian Journal of Public Health Research & Development . Oct-Dec2014, Vol. 5 Issue 4, p184-189. 6p.
Talus fractures in climbers
AUTHORS: K. Bonetti, C. Bonizzoni, F. Di Giovanni, S. Nella, S. Cattaneo, M. Macchia, L. Briatico | Year: 2014
SUMMARY/RESULTS: The authors used a survey and subsequent statistical analysis of heel fractures in order to determine their cause, consequence, treatment, and likely outcome. 37.5% of fractures were on multi-pitch routes, 3.5% were at a “crag”, and 4% were indoor bouldering, while 21% were classified as “other.” While the authors note that heel fractures are most likely to occur as a result of a fall against ground, wall, or crash pad, the significant difference in the heel fractures and the small sample size did not allow the authors to come to conclusions about “best” treatment. Beta-Angel note: Considering the author’s own note that so few bouldering-related injuries were found due to the lack of boulderers participating in the study, the author’s probably did not find it helpful to differentiate “crag” between bouldering and sport-climbing.
REFERENCE: 2nd International Rock Climbing Research Congress, Sep 2014
Pulley ruptures in rock climbers: outcome of conservative treatment with pulley protection splint — first results
AUTHORS: M. Schneeberger, A. Schweizer | Year: 2014
SUMMARY/RESULTS: The authors used a survey to evaluate the effectiveness of a device to reduce flexor tendon “bowstringing” of 47 pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) ruptures. The authors primarily measured the distance between the tendon and the bone and provide useful statistics regarding the impact of the injury on the climbing of 44 subjects. From this information, the authors suggest that bowstringing (which forces the “finger flexor” tendons to attempt to pull away from the bone) can be reduced with conservative treatment using the device and that outcomes are solid. Beta-Angel note: previous work helps to explain why “bowstringing” exacerbates injury in pulley tendons – the tendons which hold other tendons (called long flexor tendons) to the bone and allow you to bend your fingers. See work by both Schoffl and Schweizer for more.
REFERENCE: 2nd International Rock Climbing Research Congress, Sep 2014
Or Full text: https://www.wemjournal.org/article/S1080-6032(15)00477-9/fulltext
Dupuytren’s disease in a rock climber with an unaffected identical twin
Acute injury risk and severity in indoor climbing — a prospective analysis of 515,337 indoor climbing wall visits in 5 years
AUTHOR: Schoffl, et al. | Year: 2013
Summary/Results: Tracked gym climbers over a 5 year period to identify rate of injuries during 1000 hours of climbing – a standard measurement in sports. 515,337 visits tracked, 63.6% male, ages 8 – 80, median of 34 years, average climb time 2 hours 47 minutes, thirty climbing injuries, 22 in males, acute injuries: 6 in bouldering, 16 in leading, 7 top roping, 1 third person 15 Were grade 2, 13 grade 3, 2 grade 4 based on Medical Commission standards. Overall injury rate was 0.02 per 1000 hours.
REFERENCE: Wilderness and Environmental Medicine, 24 (3), 187-194
Feet injuries in rock climbers
AUTHORS: V. Schoffl, T. Kupper | Year: 2013
SUMMARY/RESULTS: Researchers looked at lower body injury research. Findings suggest that approximately 50 percent of acute injuries involve the leg and feet and most frequently are strains, contusions, and fractures of the heel bone. However, the “tightness” of the modern climbing shoe is also concerning, and recommend a looser-fitting “training” shoe.
REFERENCE: World J Orthop. 2013 Oct 18; 4(4): 218–228.
Tendon injuries of the hand
AUTHORS: Schoffl, Heid, and Kupper | Year: 2012
SUMMARY/RESULTS: Analysis of multiple finger injuries and discussion of their treatments, including tendon injuries (surgical), bone fracture (conservative therapy), flexor tendon sheath or single pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone – conservative treatment recommended), multiple pulley injury (surgical), postoperative, early passive movement is important to trigger “intrinsic” tendon healing. Substances were evaluated, little evidence was found. Hyaluronic acid may be worthwhile. Beta-Angel note: hyaluronic acid is a compound that we have found conflicting evidence regarding. Caution is warranted.
REFERENCE: World Journal of Orthopedics 2012 June 18 3(6): 62-69
Injuries to the upper extremity in rock-climbers
AUTHORS: A. Schweizer, H.P. Bircher | Year: 2012
SUMMARY/RESULTS: The authors’ purpose is to provide an overview of common climbing injuries, as well as diagnosis and treatment options, for physicians and therapists. The authors emphasize overuse injuries in the upper body. Beta-Angel note: a good overview if you have access, but primarily intended for clinicians.
REFERENCE: Sports Technology, Volume 5, 2012, 3-4: climbing technology
The effects of therapeutic climbing in patients with chronic low back pain
AUTHORS: K. Engbert, M. Weber | Year: 2011
SUMMARY/RESULTS: Researchers studied 28 patients with chronic lower back pain to determine whether therapeutic climbing is comparable or superior to other forms of exercise in promoting physical and mental well-being. While climbing was comparable to a standard exercise regime in promoting physical and mental well-being, it was superior in promoting two components of physical and mental well-being: perceived general health and physical functioning.
REFERENCE: Spine Volume 36, Number 11, pp 1-8, 2011
Injury risk evaluation in sport climbing
AUTHORS: A. Neuhof, FF Hennig, V. Schoffl | Year: 2011
SUMMARY/RESULTS: The authors evaluated 1962 climbers with 699 injuries using a survey in order to determine how common injuries are in climbers and what factors are associated with injury. The authors found that years of climbing experience, difficulty level, and climbing time per week during the summer and winter months were associated with injury.
REFERENCE: Int J Sports Med. 2011 Oct;32(10):794-800
Comparisons of bone mineral density and bone quality in adult rock climbers, resistance-trained men, and untrained men
AUTHORS: VD Sherk, MG Bemben, DA Bemben | Year: 2010
SUMMARY/RESULTS: Researchers compared bone mineral density (such as calcium) in the body, forearm, lower back, and upper leg and bone quality (a series of measurements beyond bone density associated with bone strength) in the lower leg and forearm in 15 rock climbers, 16 resistance trained men, and 16 untrained males. The researchers found that resistance-trained men had higher bone density in the center part of their body than rock climbers but bone quality in the lower leg and forearm were similar between the resistance trained men and rock climbers.
REFERENCE: J Strength Cond Res. 2010 Sep;24(9):2468-74
Evaluation of injury and fatality risk in rock and ice climbing
AUTHORS: V Schoffl, A Morrison, U Schwarz, I Schoffl, T Kupper | Year: 2010
SUMMARY/RESULTS: The authors reviewed over 400 sport-specific injury studies to determine whether climbing (and its sub-disciplines) can be classified as a “high-risk sport.” The authors compared a standardized score for injury severity across the sports and determined (a) that while in some sub-disciplines of climbing (Alpinism and ice climbing) a fatality risk is evidenced, a determination of climbing being “high-risk” is subjective, and (b) that they recommend more work be done in researching how to evaluate injury risk and severity in climbing.
Reference: Sports Med. 2010 Aug 1;40(8):657-79
Isolated cruciate pulley injuries in rock climbers
AUTHORS: Schoffl and Schoffl | Year: 2010
SUMMARY/RESULTS: Analysis of 347 pulley injuries on 332 rock climbers and 15 non-climbers. Recommendation to treat cruciate (similar to annular, but found in an x-pattern and helpful for stability of the finger) pulley injuries with similar, conservative, treatment to annular pulleys (a tendon that holds the tendon you use to “flex” your fingers to the bone).
REFERENCE: The journal of hand surgery Vol. 35E No. 3 March 2010
The influence of concentric and eccentric loading on the finger pulley system
AUTHORS: Schoffl, et al. | Year: 2009
SUMMARY/RESULTS: Study looked at concentric vs. eccentric loading on 39 cadaver fingers using an isokinetic loading device. In concentric, A2 and A4 pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) ruptures including fracture of finger bone or tearing of flexor tendons, whereas A2 pulley rupture was most common in eccentric loading and other events were rare. Ruptures occurred at lower loads in eccentric (lengthening of muscle) loading, concluding that friction may be advantageous for holding force, but disadvantageous in potential for injury
REFERENCE: Journal of Biomechanics 42 (2009) 2124-2128
The influence of the crimp and slope grip position on the finger pulley system
AUTHORS: Schoffl, et al. | Year: 2009
SUMMARY/RESULTS: 9 fingers loaded into isokinetic device in slope grip position, 12 in crimp grip position. Rupture in A4 pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) mostly occurs in crimp, but not in slope, but alternative injuries more common in slope.
REFERENCE: Journal of Biomechanics 42 (2009) 2183-2187
The epidemiology of rock-climbing injuries
AUTHORS: G Jones, A Asghar, DJ Llewellyn | Year: 2008
SUMMARY/RESULTS: Researchers looked at the injury history in 163 male and 38 female climbers between the ages of 16 and 62 years. Over 50% of climbers had at least one injury in the year prior to the study. 10% of injuries were acute from a fall, 33% were chronic overuse injuries, and 28% were acute injuries by a strenuous climbing move. The authors found that climbing frequency and technical difficulty were associated with climbing injuries both inside and outside, particularly through a repetitive accumulation of trauma in the upper body.
REFERENCE: Br J Sports Med. 2008 Sep;42(9):773-8
Finger pain in rock climbers: reaching the right differential diagnosis and therapy
AUTHORS: Schoffl and Schoffl | Year: 2007
SUMMARY/RESULTS: Analysis of diagnostic and therapeutic procedures for the evaluation and treatment of finger pain. The ultrasound is most effective, with MRI for difficult cases. Shows tables of Acute, vs. Chronic vs. slow onset injuries. Identifies pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) rupture severity grades. Physiological adaptations due to high impact of rock climbing onto fingers need to be strictly separated from injury change. Article has information on growth plate fractures in youth climbers.
REFERENCE: J Sports Med phys fitness 2007; 47:70-8
Impact of taping after finger flexor tendon pulley ruptures in rock climbers
AUTHORS: Schoffl, et al. | Year: 2007
SUMMARY/RESULTS: Evaluate new “H” taping method in relation to flexor tendon bowstringing against pulleys (a tendon that holds the tendon you use to “flex” your fingers to the bone) by reducing tendon-bone distance using ultrasound AND evaluate strength of injured finger using a force platform on 12 subjects. New taping method decreased tendon-bone distance 16% vs. other taping methods. Strength was 13% better in crimp grip, but no effect observed in hanging grip. Prophylactic taping not indicated. Renew tape after every route. Beta-Angel note: See work by Schweizer and Schneeberger (2014) as well as Schoffl for more on bowstringing and why it’s injurious.
REFERENCE: Journal of Applied biomechanics 2007; 23:52-62. Copyright 2007 Human Kinetics, Inc.
Strength measurement and clinical outcome after pulley ruptures in climbers
AUTHORS: Schoffl, et al. | Year: 2006
SUMMARY/RESULTS: Evaluation of 21 rock climbers with grade 2-4 pulley injury were re-evaluated using a standard questionnaire and ultrasound 3-4 years after injury. Nonsurgical treatment of single pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) ruptures is recommended. Outcome was good to excellent, and no long-term strength deficit observed. Recommend surgical reconstruction for grade 4 injuries involving clinical bowstringing.
REFERENCE: American College of Sports Medicine, 2006.
Injuries to the finger flexor pulley
AUTHORS: Schoffl and Schoffl | Year: 2006
SUMMARY/RESULTS: Article provides anatomy, biomechanics, injury patterns, clinical findings, diagnostics, grading, therapy, conservative therapy, and surgical repair information on pulleys (a tendon that holds the tendon you use to “flex” your fingers to the bone).
REFERENCE: The Journal of Hand Surgery Vol. 31A No. 4 April 2006
Can rock climbing lead to Dupuytren’s disease?
AUTHORS: AJ Logan, G Mason, J Dias, N Makwana | Year: 2005
SUMMARY/RESULTS: Researchers used a survey of 1100 members of the climbers’ club of Great Britain to determine whether Dupuytren’s disease, which is the permanent bending of one or more fingers in a flexed position, is significant in climbers. Researchers found that there was a higher prevalence of the disease in rock climbers compared to the normal population, that climbers with the disease climbed with more intensity than other climbers, and that more severe examples of the disease was associated with a younger age of first presenting with symptoms.
REFERENCE: British Journal of Sports Medicine, Volume 39, Issue 9, 2005
Pulley injuries in rock climbing
AUTHOR:Schoffl, et al. | Year: 2003
SUMMARY/RESULTS: Creates a grading system for severity of pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) injuries which are used to set therapeutic pathways. Evaluates 604 injured rock climbers from 1998 to 2001. 39% are grade 1, 25% are grade 2, 30% grade 3, and 6% grade 4. Grade 1-3 injuries respond well to conservative treatment. Grade 4 require surgical repair with recommended “loop and a half” technique.
Effect of simulated rock climbing finger postures on force sharing among the fingers
AUTHORS: F. Quaine, L. Vigoroux, L. Martin | Year: 2003
SUMMARY/RESULTS: The authors studied the absolute pressure of fingers, as well as relative differences in pressure between the fingers, of six climbers using both what is traditionally called an “open hand” or slope grip, as well as a grip usually associated with “crimping.” The authors found that the middle finger provided the most absolute force, while the “relative involvement” of the ring finger was greatest during the grip associated with crimping – suggesting these are factors in the injury of these fingers. Beta-Angel note: we recommend reading this in combination with Konstantin Fuss/Niegl’s work on friction in individual fingers.
REFERENCE: Clinical biomechanics 18 (2003) 385-388
Biomechanical properties of the crimp grip position in rock climbers
AUTHOR: Schweizer, Ochsner | Year: 2001
SUMMARY/RESULTS: Researchers attempted to measure bowstringing and the forces on the crimp grip position using two devices, one of which was to measure the force and distance of bowstringing, while the other was meant to measure the force at the fingertip. Measurements were taken on 16 fingers of 4 living participants. Results support the theory that bowstringing causes more friction against the pulleys in the crimp grip position, but less so in the open hand grip position with the PIP joint extended. Researchers also found that over the course of a warm-up, bowstringing against the A2 pulley (a tendon that holds the tendon you use to “flex” your fingers to the bone) increased by 30%. Researchers recommend use of the open hand “slope” position while rehabbing from a pulley injury to reduce loads on the pulley. Beta-Angel note: See work by Schweizer and Schneeberger (2014) as well as Schoffl for more on bowstringing and why it’s injurious.
REFERENCE: J Biomech. 2001 Feb;34(2):217-23.
Getting a grip of rock climbing injuries
AUTHOR: D.M. Binney | Year: 2001
SUMMARY/RESULTS: The author goes over cause, diagnosis, and treatment in three case studies of common climbing-related injuries of the shoulder, elbow, and finger. The author’s primary concern is that so few climbers seek advice from a primary care practitioner, but that when they do, those doctors should be aware of common climbing-related injuries and the demands of the sport.
REFERENCE: Binney DM. Sport & Medicine Today, autumn, 2001.
Injuries and associated training and performance characteristics in recreational rock climbers
AUTHORS: R. Doran, M. Reay | Year: 1999
SUMMARY/RESULTS: The authors used a survey to evaluate type of injury, location, frequency, and severity in 111 British climbers. They found that perceived importance of climbing over non-climbing related sport activities, not “warming-down” after climbing, technical level of climbing, and duration of warm-up were all associated with injuries in climbers. Strikingly, a longer warm-up was associated with injury. Beta-Angel note: frustratingly, parts of this article are missing. We recommend this one for a read and discussion as the authors found some conclusions (e.g. warm-up) which the authors note contradict past findings on warm-up (Bollen, 1988).
REFERENCE: International Conference on Science and Technology in Climbing and Mountaineering, 1999 University of Leeds, UK.
Effect of habitual knuckle cracking on hand function
AUTHOR: Castelanos, Axelrod | Year: 1990
SUMMARY/RESULTS: 300 patients screened for knuckle cracking along with a number of other variables. No correlation identified with arthritis, however, correlation identifies with lower grip strength, likelihood of family members doing it, smoking, drinking alcohol, and biting nails.
REFERENCE: Annals of the Rheumatic Diseases 1990; 49: 308-309