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Rock Climbing Injuries Part 1: What is common and how do I prevent it?

Hello climbers or aspiring climbers! Welcome to a 4-part series focused on common climbing injuries, and what you can do to decrease your risk. You will also learn about the parts of your anatomy involved in climbing, so you can better understand what is actually going on when you hear a friend say something like “I injured my A4 pulley.” Finally, you will get some suggestions of things you can do now to decrease your risk of injuring yourself in the future (because what type of climber doesn’t love a little risk mitigation).

In order to know what we want to prevent, we first need to know what we’re at risk of injuring. Luckily there have been several epidemiological research studies published that measured injury rates in different climbing populations around the world – all of the studies found similar results. However, before we dive into the specific injury rates, let’s learn the differences between two types of injuries: traumatic injuries vs overuse injuries.

Traumatic injuries typically occur in a single, high-force event and often consist of any combination of fracturing a bone or tearing a ligament, tendon, or muscle. Due to their unpredictability and the large amount of energy involved in causing traumatic injuries, it can be tough to prevent this type of injury. For this reason, I will present which traumatic injuries are common in climbers, but we will not discuss preventive exercises. The best prevention here is to always use safe climbing practices!

Overuse injuries, on the other hand, are caused by repetitive overuse or improper movement that your body tissues lack the conditioning to tolerate, which then results in injury. This type of injury also commonly affects ligaments, tendons, and muscles, but the onset is usually more gradual and can be prevented by proper loading of the particular tissue type.

Research has shown that overwhelmingly climbers injure their legs via trauma (usually from a big fall), while they injure their arms via overuse. Because of this, we will focus on upper extremity injuries in the next three blog posts. See the table below for the percentage of all reported climbing injuries for which each of these common injuries accounted.

  • Finger pulley / tendon: 34%
  • Elbow tendon: 11%
  • Shoulder muscle / tendon: 10%
  • Ankle ligament: 7%
  • Bicep tendon: 4.5%
  • Wrist tendon: 4.5%
  • Finger fracture: 4.5%
  • Shoulder dislocation: 3%
  • Ankle fracture: 3%

Next, injury rates per hour climbed were higher in bouldering than in sport climbing or trad climbing. Injury rates also increased as skill level progressed from beginner to professional. Both of these can be explained by our recently gained understanding of overuse injuries being caused by loading our tissues beyond their capacity. Bouldering involves testing your limits using explosive force for just a few moves, which can easily push you past your tissue tolerance level. Likewise, as you progress in skill level and are climbing harder routes, each move will require a higher average force output, increasing the stress on your tissues.

There are two final injury rate trends that I want to briefly discuss before moving on. The first is that one study found a statistically significant higher injury rate per hour climbed indoors vs outdoors. I am entering the realm of speculation, but I believe this is likely caused by climbers being less careful and disciplined in an indoor environment they perceive as being more controlled and safer than outdoors. The second is an alarming increase from 2001 to 2015 of epiphyseal growth plate fractures in the phalanges (bones of the fingers) in youth climbers. I recommend any parents or coaches reading this to implement a limit similar to a “pitch count” in baseball for high impact activities like campus boarding, a widely used training tool that improves rock climbing performance and usually has the climber using only their hands to climb the board.

Check back next week to learn more about climbing injuries of the hands in “Part 2: The Climber’s Hand – A Tale of A2 Pulleys.” If you are experiencing any of the symptoms outlined, or any kind of pain while climbing, you could probably benefit from an assessment from one of our highly trained and licensed physical therapists at MTI. Contact us to schedule an appointment today.


Adam Arlitt is a Physical Therapy student who was working with Greg Louie, PT, DPT, FAAOMPT, at MTI Physical Therapy’s Magnolia clinic in 2020. He is scheduled to graduate from Texas State University’s School of Physical Therapy in 2021 with a Doctorate of Physical Therapy. In his free time, he is an avid rock climber, focusing mainly on bouldering.

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