Rock climbing is a popular sport worldwide, as a recreational activity and as a competitive sport. Several disciplines of the sport exist, including traditional climbing, sport climbing and bouldering. Sport climbing and bouldering, the newest disciplines, can be performed on artificial surfaces as well as on natural rock. Sport climbing routes are typically up to 30 m high. The climber is attached to a rope clipped onto permanent bolts using ‘quickdraws’, spaced intermittently from the bottom up (lead climbing), or the rope is anchored at the top of the climb (top roping), to allow climbers to incur frequent falls safely. Bouldering uses crash mats instead of ropes to protect climbers from falls. ‘Boulder problems’ are usually short and low to the ground.free rock climbing

As sport climbing and bouldering employ specific movements and techniques, these two climbing disciplines lead to specific injuries. Previous research, involving primarily adult populations, suggests that upper extremity overuse injuries and acute flexor tendon pulley strains of the fingers are the most common injuries sustained by rock climbers in varying disciplines, though ankle injuries are also common due to falls. There have been no reviews examining specific risk factors for injury in sport climbing and bouldering. By identifying potentially modifiable risk factors for these injuries, it may be possible to develop and evaluate injury prevention strategies.

Intrinsic risk factors Extrinsic risk factors
Sex Lead climbing and top roping
Age Lead climbing and top roping
Years of experience Climbing volume
Difficulty (skill) level Climbing intensity score (CIS)
Body mass index (BMI) Influence of drugs/alcohol
Body weight Other risk factors
Grip strength  

Sex

Twelve studies examined sex as a potential risk factor for injury in sport climbing, bouldering, or both. Results were conflicting; six studies found no difference in injury risk between sexes, while four found that males were at greater risk than females. Nelson et al17 found that females were at higher risk of sprain and strain injuries, while males were at higher risk of lacerations and fractures.

Age

Age was investigated as a possible risk factor in nine studies. Five reported that injury risk was not associated with age. Backe et al found that the risk of reinjury increased for the adolescent age group, as opposed to older climbers. Carmeli et al reported finding significantly more hand and finger injuries and a higher incidence of tendonitis in the long flexor tendons of the second and third fingers for those 19–34 years of age versus those aged 9–18 years.

Years of experience

Total years of climbing experience were examined as a risk factor in seven studies. Three found the number of years of climbing participation to have no significant impact on the risk of injury while four found this factor to be a significant predictor of injury. Rohrbough et al found that history of medial epicondylitis increased with increasing experience, though these authors found no impact by experience on any other injuries.

Difficulty (skill) level

In general, participants who climbed at higher grades reported more injuries.free climbing training room

Body mass index (BMI)

Higher BMI was significantly associated with a higher risk of injury, and of reinjury.

Extrinsic risk factors:

  • Lead climbing and top roping

Lead (sport) climbing was investigated in five studies. Most of these articles compared it to top roping, though two also compared it to bouldering, and a third included bouldering, traditional climbing and free soloing (free soloing is a type of climbing where no ropes, harnesses or any other protective gear are used, and therefore falls would likely be fatal). Four of these studies suggested that lead climbing was a risk factor for injury. Shahram et al were the only authors who found that lead climbing was not associated with injury, though this conclusion was based on prevalence proportions, as incidence and risk were no captured in their study.

  • Climbing volume

The amount of time spent climbing (per week or per year) was examined in three studies. Backe et al who scored highest on methodological quality at 15/32, found that the total climbing time each year did not have a significant effect on injury for their 355 participants, though the authors did control for exposure hours in thei injury IR.

  • Climbing intensity score (CIS)

A climbing intensity score (CIS) was used in two studies to examine degree of exposure to ‘climbing stress’ as a risk factor. CISs, introduced by Logan et al, and used again by Pieber et al, indicate the climbing intensity and volume by multiplying the average grade of climbing by the mean number of climbing days per year. Both studies found participants who scored higher in climbing intensity to be at a higher injury risk.

  • Indoor versus outdoor climbing

Two studies investigated outdoor climbing compared to indoor climbing as a predictor for injury.

  • Influence of drugs/alcohol

Only two articles studied the influence of drugs or alcohol on climbing injury, and these yielded different results. Gerdes et al (Downs and Black score: 9/32) found that substance use significantly increased the potential for injury in their 1887 participants, while Hasler et al (Downs and Black score: 13/32) found no significant increase in risk in their 113 participants.

Prevention measures

The self-reported use of a warm-up and different lengths of warm-up were investigated in three studies, and no significant difference in injury was found between groups. Stretching prior to climbing was reported to be significantly associated with overuse injury by Tomczak et al. Conversely, Josephsen et al, who scored higher on methodological quality (12/32), found no significant difference in injury risk between those climbers who stretched versus those who did not. Imposing strict regulations regarding equipment use and instructor presence was not found to significantly decrease the risk of injury in sport climbing or bouldering, nor was the presence or number of safety mats used, nor the number of spotters. Josephsen et al also investigated the taping of fingers and wrists, taking glucosamine and other supplements, heating hands prior to climbing, taking time off to prevent injuries, the use of corticosteroid injections, and weight training as potential preventive measures. Of these strategies, only taping wrists and weight training were found to be significantly associated with a decreased rate of injury.

CONCLUSIONS AND PERSPECTIVES

Intrinsic and extrinsic risk factors for injury specific to sport climbing and bouldering have not previously been the subject of reviews. Twelve electronic databases and several other sources were searched systematically, to examine risk factors and prevention strategies for injury in these disciplines, and to assess the methodological quality of existing studies. The injury incidence proportions and rates are inconsistent throughout the literature, emphasising the need for standardised injury reporting in climbing research. However, several potential risk factors for injury in sport climbing and bouldering were highlighted, including age, increasing years of climbing experience, higher skill (difficulty) level, a high CIS and lead climbing. Several potential risk factors are worth further investigation, namely those that are modifiable, such as BMI, taping, weight training and the use of stretching. Results regarding injury prevention measures remain inconclusive. Future avenues for research in climbing should include previous injury, as it has been shown to be a significant predictor for subsequent injury in other sports, as well as examining the use of correct climbing technique and the growing issue of ‘climber’s back’. As climbing continues to gain popularity, understanding the healthcare burden presented by this sport is essential. Developing injury prevention measures will reduce the strain on healthcare resources, and disseminating knowledge about the main types, mechanisms and risk factors for injury will be important to reduce these injuries through awareness, for climbers as well as for healthcare providers. It will be important for future research to involve youth, such that young climbers, their parents and coaches, will be able to learn safe development and training for climbing.