In the early days of climbing, classic heavy mountaineering boots were worn for climbing in alpine regions as well as in rock faces. It was only in the early 1980s when the first real, or modern, climbing shoe with a friction sole was introduced. One common characteristic which all climbing shoes share is the tight, squeezed fit required to obtain optimal contact with the rock. This excessively tight footwear leads to foot problems, such as callosity, toenail infections, or, in a longer term perspective, a hallux valgus deformity [14]. The introduction of predrilled anchoring bolts was an important factor for the explosive development of the climbing grades scaled. Lead climber falls, relaying on the rope and anchoring bolts, are common for sport climbers now. The climbing harnesses used have improved. While a combination of chest and sit harness has been used in traditional mountaineering, a pure sit harness design is now used in sport climbing. This allows maximum free movement while climbing and aims to reduce injury when falling [9, 15]. Bolts, ropes, harnesses, and other equipment used should carry the UIAA Safety Commission approval.

Ice climbing equipment also developed a long way from the tools used in classical mountaineering. Modern crampons with the prominent frontal spikes have initially become popular when Anderl Heckmaier and Wiggerl Vörg used them for the first ascent of the Eiger North Face. Nowadays, a single frontal spike or a heel spur is considered a state-of-the-art. Ice axes were already in use at the time of the first ascent of the Mont Blanc by Pascard and Balmat on 8 August 1786 and have evolved remarkably since. Recent technological advances have helped to transform these long-shafted tools into a short-shafted curved and surprisingly light crossbar that resembles a mythical medieval weapon. It is a topic of wide and hot discussion in the ice climbing community whether ice axes should be used with or without a leash. Leashes attach the ax to the climber’s wrist, reduce stress onto the forearms, but increase the risk of injuring oneself from the ax during a fall where typically the ax bounces back into the climber’s face. In parallel with the technological advancements in crampons and ice axes, Erich Friedli from Switzerland developed the first real ice screw [10]. This ice screw has played a pivotal role in increasing the safety of the sport. If placed correctly, in good ice and proper angle, it may guarantee a comparable pullout strength to bolts. All climbing disciplines use climbing ropes for protection. These ropes are dynamic ropes, in contrast to static ropes as used in sailing and caving. Dynamic ropes have a stretch of roughly 5 m per 50 m when stressed, which reduces the force onto the falling climber’s body.

The recent increase in levels of technical difficulty in rock climbing has intensified the impacts of the sport onto the musculoskeletal system. The age of the top athletes, especially in competition climbing, has steadily decreased. In 1986, the average competitive member of the German National Climbing Team spent about 10 h per week training and was 26 years old. By 1996, the competitive climber was spending 21 h a week training and his/her age had dropped to 22 years [2]. Today it is not uncommon for 50 % of World Cup finalists to be under 18 years old. In this age, the finger phalanges’ growth plates have not fully closed yet in some of these young strong climbers, which frequently leads to unusual epiphyseal fatigue injuries [16]. While the majority of climbing activity and training is performed on rock or artificial climbing walls, certain climbing-specific training forms must also be considered. One of the most specific isolated and designated training forms is “to campus” (Fig. 2.4).

The legendary “campus board,” built by Wolfgang Güllich and Kurt Albert at the Nuremberg “campus” gym, has become a household term among climbers. By training on the campus board, both in a positive and negative slope, Wolfgang developed his finger and forearm strength for the first ascent of “Action Directe” (the world’s first UIAA 11/5.14d, in Frankenjura, Germany). The campus board is a slightly overhanging board with different-size rungs in a constant pattern screwed onto it. Basic exercises contain climbing up and down hand over hand without feet, increasing the distance between the rungs used. A special training technique is “double dynos.” Based on the training principle of “plyometric training,” the climber jumps up and down from small-sized rungs. This applies very high forces onto the fingers and, respectively, onto the ligaments, bones, and cartilage. While “campusing” is a good training exercise in the elite ranks, it should have no place in training of beginners, intermediates, and especially preadolescent climbers! According to the author’s experience, two-thirds of junior climbers who trained regularly on the campus board sustained an injury! These injuries, commonly epiphyseal fatigue fractures, lead, if neglected, to a permanent damage of the affected finger. As a result, the main focus in the education of trainers, climbing instructors, parents, and young climbers should be focused on proper training methods and avoiding, as much as possible, techniques which may lead to these well-described injuries.

While climbing relies on the synchronized and optimal function of the whole body, activity and performance are primarily limited by finger and forearm strength. The various gripping techniques (mostly crimp and hanging grip) (Figs. 2.5 and 2.6), which are used by the climber, led to the transmission of extremely high forces in the anatomical structures of the fingers. As a logical consequence, finger and hand injuries, predominantly overuse syndromes, are the most common complaints in rock climbers [7, 8, 17, 18]. A study evaluating 604 injured rock climbers found that 247 (41 % of injuries) sustained finger injuries (Table 2.2) [19, 20]. Some injuries, such as flexor tendon pulley ruptures or the lumbrical shift syndrome, are very unique and specific for the sport of climbing and are rarely seen in other patient populations [7]. As a result of this, it can be difficult to establish a diagnosis in uncommon and yet characteristic injuries for the general physician unfamiliar with climbing injury patterns (Table 2.3).