Climbing Injuries, Treatment, and Injury Prevention
Katrina D. Warme
Winston J. Warme
BRIEF HISTORY OF CLIMBING
Initially, climbing was about ascending the available summits. Mt. Everest, the tallest peak on the planet at 29,035 feet, finally succumbed to Sir Edmund Hillary and Tenzing Norgay in 1953. Subsequently, climbers turned their attention to the most difficult lines on mountains and often the most direct line (directissima) or the steepest, most sustained face. This desire to achieve increasingly technically difficult climbs led to focused and sport-specific training in preparation for climbing, rather than just maintaining good aerobic conditioning and overall fitness. Climbers took to the gyms and developed novel indoor training techniques. As time has progressed, these exercises and protocols have become more and more sophisticated. With the genesis of professional climbers (alpine guides, World Cup competitors, and sponsored climbers), athletes are able to climb and train for climbing full time. This has allowed for subspecialization in climbing, with subspecialists pushing the limits in each discipline.
EVOLUTION OF CLIMBING
In the past 25 years, the sport of climbing has increased in its popularity, and the numbers of participants has greatly expanded. The stigma of climbers being a reckless fringe element of extreme risk takers has changed, and climbing has become more acceptable as its participants include a broad spectrum of the population from kids to executives. Females can often climb as well as men and make up about a quarter of the participants.
With the advent of climbing gyms in populous cities, more people are introduced to climbing in a safe and supervised setting. The first climbing gym in the United States was established in Seattle in 1987. At the time of this writing, there are over 233 climbing gyms in the United States, not including those on college campuses, in camps, or in fitness clubs. Many recreational (casual) climbers have joined the sport, and serious climbers are spending more time training.
In 1989, the estimated number of active climbers in the United States was 100,000 (1). As of 2008, it estimated to be approaching 2 million.
The sport of climbing is categorized into different subspecialties or disciplines:
Bouldering: Shorter routes, usually 15-20 feet in height, are undertaken without any ropes, usually to train more difficult moves. Thick foam pads are commonly placed below the route to cushion falls, and participants will often spot the climber.
Traditional climbing: Longer routes, 50 to several hundred feet in length, where the climber must use the features of the rock itself, such as a crack, to place protection. Initially, these were metal pitons that were hammered into cracks, which have largely been replaced with removable stoppers and camming devices. These are designed to resist pull out and shorten the climber’s fall by catching the rope, which is secured by the belayer.
Sport climbing: Routes where protection such as bolts and anchors are already present in the rock face; makes protecting the climb easier. This approach allows the climber to push his physical limits more with more robust fixation available should a fall occur. Additionally, climbers can protect sheer walls without options for natural protection, opening up new and often challenging terrain to other climbers.
Alpine climbing: Climbing style where only the bare essentials are taken; usually describes longer endeavors (days to weeks) to reach the summits of mountains, and includes all the disciplines of climbing; rock climbing, ice climbing, and glacier travel are often carried out at high elevations and in severe weather conditions.
Ice climbing: A style of climbing that involves ascending ice formations, such as frozen waterfalls, icefalls, and rock faces that are covered in ice, using ice axes and crampons (spikes that are fastened to mountaineering boots). Ice screws (hollow metal tubes with threads) are placed into
the ice as the climber ascends. These are used to protect the climber as the rope can be clipped in, such that the belayer can catch a fall. This form of protection can be weak or strong depending on the quality of the ice.
Speed climbing: A style of climbing where the ultimate goal is speed; often aspiring to break exisiting records. This is done to some degree in subspecialties, by a small elite percentage of climbers. Extra risks are taken to save time, such that this can be a very dangerous practice.
Solo climbing: Also known as “soloing.” A style of climbing without someone else belaying. There are four subcategories, listed in ascending level of risk:
□ Top-roping: climbing the rock with a fixed rope and with a self-locking device as back up should a fall occur.
□ Lead climbing alone with a rope and a self-locking device to stop a fall.
□ Deep-water soloing/psicobloc: climbing over water without a rope, using the water as a landing substrate to cushion falls.
□ Free solo climbing: climbing without a rope or other forms of protection.
Aid climbing: A form of climbing where one inserts devices in the cracks in the rock to pull up on or to step up on rather that just using the rock itself to hold on to. Sometime aiders, or étriers (short stepladders made of webbing), are used to clip into the protection and then the climber can stand in them. This is a slow form of climbing that is very gear intensive. Often climbers will take haul bags full of gear and folding cot-like “portaledges” to sleep on during multiday ascents.
Focused training: As climbers have become more subspecialized, they have developed different training techniques that allow for plyometric and dynamic movements, which can yield impressive strength gains but can also generate high loads and place climbers at greater risk of injury.
□ John Gill: The father of modern bouldering, circa 1950s. He was a gymnast who eschewed concentrated gymnastic-type effort to overcome short climbs on boulders. He used gymnastic training techniques to increase strength, especially hand and core strength, for climbing (e.g., one-finger one-arm pull-ups and front levers) and introduced the use of chalk (to improve the climbers grip) and dynamic movements to climbing.
□ Wolfgang Gullich: A German climber circa 1980s who pushed the limits and trained specifically in the off-season to be able to do certain climbs; invented the “campus board.” This device is a series of holds placed horizontally a fixed distance one above the other on an overhanging piece of plywood. These rungs were of various widths, and this device was used to develop finger strength and the ability to develop “lock off,” or hold one’s body at the top of a pull up with one hand. This built both strength and endurance for physically taxing climbs.
□ John Bachar: Very instrumental in the 1980s when he was pushing the limits of roped climbing in Yosemite and also began pushing the limits of soloing. As part of his training, he developed an upside-down rope ladder that he often climbed with weights to develop upper body strength and endurance, known as the “Bachar ladder.”
□ Chris Sharma: Probably still the top rock climber today, amazingly staying at the forefront of rock climbing for over 10 years, and has pushed technical difficulties into the 5.15a/b range, along with other climbers. (See rating scale below.)
□ Climbing difficulty has a variety of rating schemes; the Yosemite Decimal System most commonly used in this country rates a climb as 5.0 where a rope should be used or a serious fall could occur. A 5.4 or 5.5 climb could be done by most athletes, but after that, practice, composure and sports-specific strength are needed. Serious experienced climbers climb in the 5.10-5.12 range with subdivisions of a, b, c, and d separating climbing difficulty above 5.10. A very select few climbers ever manage to climb above 5.13.
□ Reinhold Messner: A German visionary for traveling fast and light in the mountains; he renounced the conventional siege approach to the biggest mountain and made his mark in the 1970s and 1980s as the first to summit all of the 8,000-meter peaks. He was not afraid to climb these peaks solo and without supplemental oxygen and was renowned for his hardcore “deprivation training” to prepare him physically and psychologically for the rigors of climbing in the “death zone.” This term is used to describe the region above an altitude of 26,000 feet or 8,000 meters where the human body cannot adapt or acclimatize, such that the human body cannot survive here for more than a few days (10).
□ Ueli Steck: Took a scientific approach to training at a new level in the 21st century and brought speed climbing to the high mountains. Known for speed ascents of the Trilogy of North Faces of the Alps (Eiger, Grand Jorasses, and Matterhorn), each in under 3 hours, as well as similar exploits in the Himalayas.
Because of the extreme nature of the sport, injuries in climbing are common, and around half of all climbers surveyed in one study had sustained an injury within the last year (11). Throughout several studies conducted, overuse injuries were found to be the most prevalent of all climbing injuries.
Overuse injuries accounted for 93% of injuries reported, and 28% of climbers reported at least one such injury (2). Dedicated and experienced climbers are more susceptible to overuse injuries, whereas casual and new climbers more often experience fall-related injuries (11,15). Contributing risk factors associated with increase in injuries include climbing frequency and technical difficulty (2,11).
Rock climbing has a spectrum of sport-specific injuries, almost half involving the wrist and hand (12). Understanding these injuries, the types of training techniques, and the obsession of many climbers to train can help physicians deliver optimal care and advice in an appropriate way such that their patients will have the best chance of healing and preventing further injury.
“A series of repetitive high torque movements of the upper limbs are needed to ascend a wall or rock face. These movements subject the hand and wrist to large forces, potentially resulting in ligament and tendon sprains or rupture” (12). Contrary to popular belief, descending is not more risky than ascending; 69% of injuries occur during ascending (1).
Injuries in rock climbers are common. During their climbing career, 83%-89% of climbers reported a history of least one acute injury symptomatic for 10 days or more (7). “These acute injuries are mainly the result of a sudden tendon/ligament strain or a fall, with almost half occurring while training and two-thirds during the ascent. Overuse injuries are also common and occur in more than 40% of indoor rock climbers. Hand and wrist injuries account for almost half of all acute climbing injuries” (12).
Many of these injuries are covered in different chapters because falls are not unique to climbing, but can be sustained in a variety of sports. The injuries from falls are not necessarily readily classified as climbing related because they are similar to those experienced by skiers, parachutists, or hikers.
However, due to the advent of climbing gyms, international speed climbing competitions, World Cup climbing events, and other competitions with monetary rewards, as well as the individual climber’s drive to climb at the highest level physiologically possible, overtraining injuries have far surpassed fall-related injuries in terms of incidence (23). These competitions have accelerated participants’ interest in training, subsequently resulted in overtraining, and have increased the public’s awareness of and interest in climbing.
Contrary to conventional wisdom, some types of climbing are relatively safe. “Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed” (16).
Compared to overuse injuries, fall-related injuries are relatively infrequent, although do still occur (11).
However, with regard to cases seen in emergency rooms between 1990 and 2007, three-quarters of rock climbing-related injuries were a result of falls. These falls were twice as likely to involve injury to the torso (15). Severity of injury is found to be directly related to the length of the fall (24).
“It is not found that the riskier forms of climbing (traditional leading and soloing) predicted fall-related injuries. This may reflect the comparatively infrequent nature of fall-related injuries, for example only four [in a small series] climbers reported sustaining a fracture (2%)” (11).
“Falls while climbing represent one of the more common causes of serious injury, although acute and chronic musculoskeletal injuries of the hands and extremities are also frequent afflictions” (19).
In a survey of the British Climber’s Club in 2003, one-fifth of hand injuries were fractures. These included wrist (12%) and phalangeal/metacarpal bone fractures (7%), which are usually a result of falls or rock falls. “Phalangeal and thumb dislocations were common, accounting for 13% of the total number of hand injuries” (12).
“In the United States, head injuries are the leading cause of death in both mountaineering and rock climbing. Most of the rock climbers sustained their injuries as a result of falls while leading, with lower extremity injuries predominating” (24