What Does Research Say About Climbing Risk?
Ryuichiro Tomizawa is a coach / physiotherapist for the Japanese National Team — and he’s interested in climbing risk. Recently, he asked me about western (US, European) research into climbing’s risk factors. I checked the Beta Angel Research Inventory (BARI) to see if I could help.
I then reached out to Renato Vilella of Brazil, Klaus Isele of Austria, and Gudmund Grønhaug of Norway for their thoughts. Klaus, physiotherapist for the Austrian National Team, asked my opinion about the relative importance of risk factors in climbing so I made an informal top 5. Since comparing across research papers is challenging, I decided to write a small synthesis involving one systematic review, one research paper on trends, and several systemic “impressions” of multiple pieces of research. Remember, this is all my simplified interpretation, and thus is subject to error.
CLICK HERE for an over-simplified list of risk factor research and physiotherapist / researcher commentary. CLICK HERE for practical advice. Limited time? Skim for the bold!
A single study isn’t necessarily conclusive, which is why we rely on systemic reviews. In 2015, KY Woollings, CD McKay, and CA Emery conducted a review of climbing risk literature by assessing 19 studies for “quality.” The authors found conflicting results and low-quality scores. Risk factors were: age, increasing years of climbing experience, skill level, and participating in lead climbing. “Climbing stress” is also a risk factor – this combines higher average grades of climbing and volume of climbing.
Tracking Risk Across Time
Comparing across time is also helpful, even when the samples aren’t the same. V. Schöffl, D. Popp, T. Küpper, and I. Schöffl conducted a survey of 836 patients from 2009 to 2012 and compared it to their data on climbing injuries from 1998 to 2001. The authors found more A4 pulley Injuries than A2s, more bone or “growth plate” fractures, and possibly more shoulder injuries. Possible causes: changes to the “biomechanics of grip techniques,” trends in routesetting, sample bias, and increasing interest from kids.
Repeat, Repeat, Repeat
A systemic risk appears to be repetitive stress and its relationship with acute stress. Repetitive stress often results in damage to soft tissue (e.g. muscles, tendons, ligaments, fascia, etc.). Climbing has multiple factors which could push “repetitive stress and enhancement:” projecting, physical training exercises, falling, the fact that it doesn’t “feel” like training. Sub-factors could include: grip style, preference for certain types of moves (e.g. heel hooks), and eccentric loading through shock-loading (slips; dynamics)
Two notes: (1) it’s very challenging to measure whether a sudden onset injury is in some way related to repetitive stress but it’s generally well accepted. (2) It’s important to note that each body is going to handle levels and rates of stress differently.
Current Trends (as of yesterday)
Stylistic and/or competition-related trends in indoor-climbing may impact trends in injuries; including types of holds / moves and intensity. Inverse from repetitive stress may be “accelerated stress,” as evidenced by what one team of researchers calls the “newbie syndrome”: newer climbers may be pushing themselves too far, too fast. A second example of an accelerated stressor was presented by a master’s thesis concerned with ‘interruptions in the continuity of training.’
The information climbers receive should be treated as a possible systemic risk. A Librarian writes: “most subjects reported that they received injury care information from a general health website, a general doctor, a climbing-related website, and a friend.” Speaking of information sources, we shouldn’t discount specialists who have access to “leading indicators” of unqualified trends: lower-back injuries (a contributing physios) or knee injuries (case study research).
Measurement and methodological approaches remain challenging. After my review, I want to make two notes: first, risk factor-related research is challenged by quality issues. Relatedly, the relationship and distinction between chronic and acute injury will remain fuzzy as repetitive stress injuries are often asymptomatic until they “present” as acute injuries.
Second, there are no representative samples yet in climbing. Data often comes from medical-seeking populations, either from gyms or practices. Or we have unrepresentative surveys of climbers which give us a “sense” of the problem. At this point, the real cost of climbing presents as a mosaic of puzzle pieces we’re forced to fit together.
It’s difficult for climbers to determine who is injured in climbing, and who is just experiencing some mild pain. Additionally, several climbing populations (male, experienced/elite, finger-specific) are reluctant to seek healthcare. We need to determine whether climbers (and sub-populations) are undervaluing (or overvaluing) their injury, and whether we can increase both the population of informed medical practitioners AND/OR climbers’ belief in health in medical practitioners’ ability to help.
A review by Gudmund Grønhaug waiting to be published looked at size of the population being sampled and the number of studies reporting a relationship of climbing with a risk factor and found 3 risk factors, 2 factors which weren’t a risk, and 9 factors which were inconclusive. Check back for updates.