Rock climbing is an increasingly popular sport world wide despite the obvious inherent risks.1-3 Previous studies have established that elite competitive indoor climbers are particularly susceptible to overuse injuries of the fingers, due to the intense forces involved.4-7 However, relatively little is known about injuries occurring at outdoor venues or injuries incurred by recreational climbers.

Logan et al conducted a postal survey of hand and wrist injuries in 545 climbing club members.8 Climbing club membership was selective and predominantly male. They discovered that hand and wrist injuries were relatively common (28%), and that climbing intensity over a climber’s career predicted these injuries. Wright et al conducted a survey of overuse injury in 295 spectators and competitors at the World Climbing Championships.5 In this study, 44% of climbers reported an overuse injury at some time; the most common site of injury was the fingers (32%). The probability of sustaining an overuse injury was higher in men, those who had climbed for >10 years, those climbing harder routes, and those who ”boulder„ or ”lead„ more than they ”top rope„. Gerdes et al conducted an internet survey of 1887 climbers; 82.1% reported a climbing injury.3 Fingers, ankles, elbows and shoulders were the most commonly described injury sites. Climbers who participated in traditional leading and soloing reported more injuries.

Of 19 climbers presenting to an urban accident and emergency (A&E) department over a year, 14 were injured at outdoor venues.9 Of the 19 climbers, 18 had been injured as the result of falls, and 12 had sustained fractures (4 of which were missed on initial attendance).

Bowie et al questioned 220 injured rock climbers or their partners presenting to Yosemite Medical Clinic over a period of 3.5 years.10 Of the climbers presenting to the clinic, 13 died (a case-fatality ratio of 6%). Of the injured climbers, the majority had been injured as the result of a fall (66%). Skin or subcutaneous areas and ankles were the most common injury sites, and fractures, abrasions, contusions, lacerations, and sprains or strains were the most common injury types.

Misdiagnosis and delays in treatment occur due to unfamiliarity with climbing injuries.9 11 12 However, more accurate information regarding the nature and aetiology of climbing injuries has the potential to guide more effective interventions and improve diagnostic assessment and treatment.13 The aim of the present study was therefore to examine the nature, prevalence and predictors of climbing injuries in a diverse group of active rock climbers.

METHODS

Institutional ethics approval was obtained for the study, and the participants gave written informed consent.

Participants

Of the 205 active British rock climbers approached, 201 (98%) completed a self-administered anonymous questionnaire. Climbers were recruited from five outdoor climbing venues (a range of roadside and mountainous crags) (n = 100), and six indoor climbing facilities (n = 101) in the UK. Climbers were selected by convenience sampling from those arriving at the climbing venues. The 163 male climbers and 38 female climbers did not differ significantly in age or in years of climbing experience (male climbers: mean age 35.2 (SD 11.8) years and 13.9 (11.8) years of climbing experience; female climbers: mean age 35.1 (10.7) years and 11.6 (9.2) years of climbing experience).

Outcome measures

Climbers were asked to indicate the anatomical site of any climbing injuries that had occurred in the past 12 months (fig 1). Climbers were classified as injured if they reported a climbing injury that required medical attention or withdrawal from participation for ⩾ 1 day.14 Injuries were categorised into those that had occurred as a result of a fall, overuse injuries, and those resulting from a strenuous climbing move. Climbers were also asked to indicate, if applicable, whom they had sought treatment or advice from for a climbing injury in the previous 12 months.

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Figure 1 Section of the questionnaire dealing with climbing injuries.

Explanatory variables

Demographic information and details of each climber’s climbing background were also recorded (fig 2). The variable ”years of participation in rock climbing„ was incorporated as an overall measure of rock climbing experience. More detailed information regarding the frequency of participation in key forms of rock climbing (ie soloing, traditionally protected leading, indoor and outdoor sport leading, and bouldering) in the past 12 months was also obtained.15 Soloing is where a climber ascends without a rope, and is completely unprotected in the event of a fall. Traditionally protected leading is where climbers place pieces of climbing protection as they progress up a rock face outdoors. In this case, the outcome of a fall is determined by the nature of the climb itself and the skill of the climber in placing protection. Sport or bolt-protected leading (both outdoors and indoors) is similar to traditionally protected leading, but expansion bolts are prearranged as protection and the consequences of a fall are typically less serious. Bouldering is where a climber tackles particularly difficult problems on very short climbing routes close to the ground.16 The difficulty (climbing grade) at which the climbers could consistently perform each type of climbing technique over the past 12 months was also recorded, giving domain-specific measures of technical difficulty accomplished. For further explanation of climbing terminology, readers are referred to Fyffe and Peter’s Handbook of climbing.15

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Figure 2 Section of the questionnaire dealing with climbing background.

Statistical analysis

Data analysis was carried out using Stata SE V.9.2. Square root transformations were performed to reduce mild positive skew observed in five variables (years climbing, soloing frequency, soloing grade, traditional lead frequency and outdoor sport lead frequency). Descriptive statistics were calculated, and logistic regression analyses were performed to examine the associations between confounded potential risk factors5 and climbing injuries while controlling for the influence of key demographic variables. Statistical significance was preset at p<0.05.

RESULTS

In total, 101 climbers (50%) had sustained at least 1 injury in the past 12 months, causing a total of 275 distinct anatomical injuries. Of these, 21 climbers (10%) had sustained acute climbing injuries as a result of a fall, 67 (33%) had sustained chronic overuse injuries, and 57 (28%) had sustained acute injuries caused by strenuous climbing moves.

The distribution of climbing injuries resulting from falls, overuse and strenuous moves is shown in figures 3 and 4. Other injuries, mainly abrasions to various anatomical sites (six climbers), were the most common fall-related incidents. Subcutaneous injuries to the ankle, hand/wrist and the lower back were also relatively common. Four climbers reported sustaining a fracture to the upper or lower extremities, and no climber had sustained a concussion. Subcutaneous trauma to the finger and shoulder were the most common injuries resulting from both overuse and strenuous moves. Elbow, forearm, wrist and other injuries were also reported.

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Figure 3 Frequency and location of fall-related climbing injuries.

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Figure 4 Frequency and location of overuse and strenuous climbing injuries.

Table 1 shows the results of the analysis of possible risk factors for injury, controlled for key demographics. Of the risk factors explored, only outdoor sport lead grade predicted fall-related injuries. The frequency and difficulty of all forms of climbing behaviour were associated with overuse injuries, with the exception of soloing grade and traditional lead frequency. Bouldering grade was the sole predictor of injuries relating to strenuous moves.

In total, 76 climbers (38%) had sought treatment or advice for a climbing injury in the past 12 months. The principal sources of treatment or advice sought by climbers were physiotherapists (18%), other climbers (14%) and doctors (11%). Other less common sources of treatment or advice were osteopaths (2%), chiropractors (1%), and others (7%).

DISCUSSION

Climbing injuries are common, and around half of all climbers in our study had sustained an injury within the past year. Physiotherapists, other climbers and doctors were the key sources of treatment or advice. Dedicated climbers operating at the highest levels are most at risk of overuse injury, particularly to the finger and shoulder. Fall-related injuries are comparatively uncommon, although often serious, and all climbers may incur them. Previous research has tended to focus upon the description of climbing injuries in specific groups5 8 or those presenting at medical facilities.9 10 The present study therefore extends the existing literature by examining the associations between a wide range of potential risk factors and injuries in a diverse sample of active rock climbers.

With a response rate of 98%, the present study compares favourably with that obtained in some previous studies. For example, Logan et al conducted a postal survey and obtained a response rate of 51%, which they acknowledge as a limitation.8 The response rate that we obtained is consistent with the study of Wright et al, in which climbers were also directly approached.5

Some methodological limitations should be considered when assessing these findings. Although the present study provides valuable new information about the association between climbing behaviours and climbing injuries, the mechanisms underlying these relationships remain unclear due to the cross-sectional design.17 Our sample excluded those climbers who are no longer active, perhaps as a result of a climbing injury, which may have biased our study towards those with lower levels of injury. Further research is therefore necessary to examine these associations longitudinally.

Participants were drawn from both indoor and outdoor climbing venues in order to capture variations in climbing behaviours and injury patterns. However, no comprehensive listing or registration for the population at risk exists, and the extent to which our findings are generalisable remains largely unknown. That said, we incorporated a more diverse range of climbers than in previous studies, and the proportion of women incorporated (19%) is consistent with existing evidence.1 Differences in the proportion of female climbers incorporated may help to explain why sex differences in overuse injuries have been observed previously (males are more susceptible),5 although we observed no significant difference.

Several previous studies have relied upon the self-diagnosis of discrete climbing injuries (eg A2 pulley rupture).8 However, climbing injuries are particularly difficult to evaluate and diagnose clinically.12 We therefore adopted an alternative approach, requiring climbers to indicate the anatomical site of any climbing injuries in an attempt to reduce self-reporting biases.5 However, the reliance on subjective measures remained a limitation of the present study. This may have introduced a number of different types of bias, for example climbers may forget key information or exaggerate levels of performance. The retrospective timeframes adopted in previous research vary considerably, for example the study of Wright et al used an open-ended timeframe.5 In an attempt to minimise recall inaccuracies, we asked participants to report injuries and climbing behaviours over the past 12 months. The adoption of different timeframes may explain why Wright et al observed that the number of years of climbing predicted overuse injuries,5 although we observed no such relationship with overuse injuries occurring over the past 12 months.

A wide range of complex factors can influence whether a climber falls, and whether a fall results in injury. For example, injuries are more likely if safety equipment at indoor climbing walls is in poor condition.9 The association between outdoor sport grade and fall-related injuries may reflect the “red-pointing” of sport routes, where climbers routinely take many falls while practising routes at the limit of their abilities.15 Climbers with severe injuries such as fractures are more likely to present to A&E departments.10 However we did not find that the riskier forms of climbing (traditional leading and soloing) predicted fall-related injuries. We theorise that this may reflect the comparatively infrequent nature of fall-related injuries—for example, only four climbers reported sustaining a fracture (2%).

The frequency and difficulty of a wide range of climbing behaviours were associated with overuse injuries in the present study. This is consistent with previous findings suggesting that climbing more frequently and at a higher standard results in cumulative trauma to the upper extremities.18 19 Bouldering difficulty was the sole predictor of injuries resulting from strenuous climbing moves. This may reflect the intense difficulty of modern bouldering, where climbers perform more intense athletic moves than are possible on longer routes.16

As participation in rock climbing increases, it is likely that a greater number of climbers will incur overuse injuries, particularly to the upper extremities. Future research adopting a longitudinal framework would shed further light on the mechanisms involved in climbing injuries. Further research is also necessary to understand the effects that high level climbing may have on the physical development of younger climbers. Practitioners dealing with climbing injuries should familiarise themselves with the range of climbing specific injuries that can occur. Educating climbers through the specialist climbing literature about the nature of climbing injuries and preventative strategies may represent the most realistic opportunity for effective intervention.