Getting a Grip: Assessing and Treating Rock Climbing Injuries

Rock climbing is one of the fastest-growing sports in the United States. With exposure through Academy Award–winning climbing documentaries and the recent recognition of climbing as an Olympic athletic event, the popularity of indoor climbing gyms has surged. As more people take up rock climbing, there is a corresponding increase in the number of climbing-related injuries, creating an escalating demand for medical providers who possess specialized knowledge of the sport.

The unique challenges rock climbers face bring equally unique challenges for clinicians. Rock climbing activates specific parts of the body, so it is essential to have a comprehensive understanding of the sport and the injuries that can arise in order to provide treatment and rehabilitation services.

To learn how to treat rock climbers, it is important to gain an understanding of the terminology climbers use to describe their movements and techniques. This includes distinguishing rock climbing features and the hand and foot positions that utilize those features. Identifying rock climbing movements is critical too, as being able to analyze faulty movements allows you to see patterns that may be contributing to a climber’s symptoms.

Rock Features

Climbers utilize irregularities and openings in the surface of the rock as they ascend. These are called features. Features occur in many shapes and sizes. They can exist naturally on outdoor rock surfaces, or they can be created artificially indoors on climbing walls. Two common rock features climbers use are holds and cracks.

Holds

It might surprise you to learn that, in rock climbing, “holds” are not movements of the hand. Rather, they are shapes and cuts in the surface of the rock.

In an outdoor setting, rock holds are simply irregularities in the rock. In an indoor setting, such as a climbing gym, rock holds are variously sized wooden or plastic shapes that are screwed onto the wall. Whether they are found inside or outdoors, the types of holds are the same:

• Jugs: Large holds that climbers can grasp using their entire hand
• Pockets: Holes in the rock where climbers can insert one, two, or three fingers
• Slopers: Large convex bulges in the rock that climbers can grip with an open hand and flexed wrist
• Edges: Small in-cut surfaces where climbers will typically use a specialized grip known as a crimp

Holds can be grasped in numerous ways, with climbers choosing their grip style based on factors such as the size, orientation, and type of the rock hold. Each hold offers unique characteristics and requires specific techniques to ensure a secure grasp while climbing. Some of the more common grips used on rock holds are open-hand grips and crimp grips. These grip types are often used on small edges where only a few fingers can grasp the surface.

• Open-hand grip: Minimal bend of the first, second, and third joints in the fingers
• Half crimp: Bend of the first and second joint and no hyperextension of the third joint
• Full crimp: Bend of the first and second joint and hyperextension of the third joint
• Closed crimp: Bend of the first and second joint and hyperextension of the third joint with the pad of the thumb pressed on top of the tip of the pointer finger

The video below describes common climbing grips:

Cracks

Cracks are breaks in the rock. Climbers insert their fingers, hands, or fists into the crack in a technique called a “jam.” Once the climber’s hand is inserted into the crack, the hand and fingers are rotated, expanding and torquing them in a specific orientation that locks them into a secure position. Several types of jams are used, which depend on the size of the crack, including finger jams, hand jams, and fist jams.

• Finger jam: Used for thin cracks where only the fingers can fit inside, torqued in the crack to create a secure position
• Hand jam: Used for medium-width cracks where the entire hand can fit inside with the thumb opposed and the metacarpophalangeal joint flexed so that the hand fills the space in the crack
• Fist jam: Used for wide cracks where the entire fist can fit inside, fingers flexed, fist twisted, and the wrist deviated to fill up the space within the crack
• Off width jams: Used for extra wide cracks that are too large for a hand or fist jam where two hands are placed within the crack to fill the space

The video below describes jams used in rock climbing:

Injury Assessment and Treatment

Utilizing Rock Climbing Holds in Assessment

Once you understand the various rock features that climbers use and the hand positions used as grips on those features, you can gain a deeper understanding into the causative factors of a climber’s injury. A starting place is to analyze the climber gripping a specialized training tool known as a fingerboard.

There are two main types of fingerboards. One type is an unmounted, portable board, which climbers can grip or allow to hang at their sides with or without attached weights. The other type of fingerboard is mounted on a wall or structure, allowing climbers to hang as they would while climbing.

The portable fingerboard is a small unit with a series of shallow edges and/or pockets used for gripping. Weights are attached to the fingerboard and small increments are added or removed to increase or decrease the challenge. Climbers start from a standing position with one arm gripping the fingerboard resting at their side. Observe any suboptimal movements with gripping. Two common suboptimal movements are finger torsion or asymmetrical finger abduction.

Analyzing how a climber grips a portable fingerboard with the arm down at the side is a useful starting point for assessments of the fingers, hand, and wrist. Typical portable fingerboards have identified holds and edge depths. For example, in the video below, 10 mm, 20 mm, 2-finger pocket, pinch, and a 1-finger pocket are used. An assessment can turn into an exercise that can be prescribed to the climber to utilize the proper movement technique.

Watch the video below to learn how to use a portable fingerboard to progressively load the fingers to aid in the rehabilitation of a finger injury.

The other type of fingerboard is larger and overhead. With the climber hanging from the board, you can also assess the climber’s shoulder girdle and core when hanging and gripping, progressing assessments closer into function.

The challenge of hanging from a fingerboard can be increased or decreased by selecting a smaller or larger hold. Additionally, adding weight to the climber’s body via a weight belt or removing weight by partially supporting the climber’s body with a pulley system aids analysis during the assessment. Typical suboptimal compensations can be excessive humeral internal rotation, excessive scapular elevation, and excessive lumbar extension.

Common techniques for an overhead fingerboard include:

• Two-arm hanging—bodyweight: With only body weight, the climber hangs from a fingerboard on a desired edge with their fingertips. No weight is added or removed.
• Two-arm hanging—weight added: Weight is added to the body with a weight belt to make the hang more difficult.
• Two-arm hanging—weight removed: Weight is removed from the body through use of a supportive pulley system to make the hang not as challenging.

The assessment dictates the treatment. If climbers demonstrate movement compensation that may be contributing to their pain, they can be prescribed fingerboard exercises with movement corrections to restore the optimal hanging position.

The following video describes various ways to adjust the challenge of a two-arm hang:

To learn more techniques to treat hand, wrist, and finger injuries, complete MedBridge’s CHT Exam Prep Program.

Utilizing Rock Climbing Movements in Assessment

Identifying common technique errors or the lack of utilizing movement helps aid in understanding potential contributing factors to a climber’s injury. After analyzing a climber both with a portable fingerboard and when hanging from an overhead fingerboard, assessments can be enhanced by watching a climber on the wall.

In addition to being familiar with rock features and able to analyze grip positions, clinicians should also recognize the various movements and body positions that climbers use while gripping holds to ascend a rock. A lock-off, flag, and high step are three essential techniques in rock climbing.

• Lock-off: A lock-off is a technique where climbers grip a hold with one hand while maintaining a static position with their other arm. This technique is often used to reach a higher hold or to rest between difficult moves.
• Flag: A flag is a technique where climbers place one foot on a hold and extend the other leg behind them to counterbalance their weight. This technique is used to maintain balance on steep or overhanging terrain.
• High step: A high step is a technique where climbers raise one foot as high as possible and place it on a hold, allowing them to reach a higher hold with their other hand.

All three techniques are important for a successful ascent because they help climbers conserve energy and maintain balance while climbing. The incorrect choice of technique or the improper use of a correct technique can result in unnecessary fatigue and can stress injured tissues.

Watching how a climber moves on the rock wall and being able to make a hypothesis of what impairments may be contorting movement patterns can help identity the causative factors of pain or injury.

Conclusion

Rock climbing is a complex sport that relies on high levels of flexibility, strength, and technique. Its increasing popularity has made an understanding of the sport an important skill for any physical therapist. As the number of climbers continues to grow, it becomes more important to have a baseline knowledge about the sport and about managing climbing injuries. This includes an understanding of rock climbing features and movement techniques and the ability to analyze a climber’s use of features and climbing movements and hanging to determine potential sources of injury and pain.

Check out my website The Climbing Doctor to learn additional examples of various climbing-specific movement performance assessments.