Bouldering, a sport that combines physical strength and problem solving skills, has grown immensely in popularity over recent years, especially with its sports debut in the Tokyo Olympics of 2020 (2021 with the delay of COVID but we’re trying to move on from this). Bouldering is a form of rock climbing in which the athlete climbs several meters (13-15meters) above the ground over a soft, floor pad without the use of a harness or safety equipment. Like most sports, it’s easy to be susceptible to injuries especially with the rising ease in access of indoor climbing gyms and the risk of falls that comes with bouldering. Regardless, there are definitely ways we can work to decrease our risk of overuse injuries to keep climbing safely and strongly!

Common Bouldering Injuries: 

The most common injuries in bouldering involve the hand/fingers, shoulder, wrist, ankle, and feet. Most upper body injuries are typically due to overuse while lower body injuries come from mislanding from a fall or due to footwear issues. 

Hands: Common injuries include tenosynovitis, strains, and tendon pulley ruptures due to the shear nature of gripping required for the sport. 

The hand itself is a complex structure; the fingers are composed of three bones called “phalanges”, which are divided into a proximal, middle and distal phalanx (the thumb only has a proximal and distal). The phalanges are connected to the metacarpals of the hand. Most muscles of the hand originate from the forearm however the tendons course through the wrist, hand and fingers. The main flexors of the fingers, flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP), attach on the middle and distal phalanx respectively. The tendon pulley system consists of the annular and cruciate pulleys, however we will focus on the role of the annular pulleys. There are five annular pulleys that act as round ligament straps to adhere the flexor tendons to the bone itself or the volar plate (ligament that connects the phalanges together) to create an optimal line of pull. The A2 and A4 pulleys are the major pulley systems and the most prone to injury as they insert directly onto the bone. The flexor tendons and pulleys sustain high amounts of load when subjected to increased forces at the fingertips and flexion angles at the PIP joint commonly seen in climbing.

• Tendon pulley ruptures occur most commonly when using a “crimp grip” which puts excessive force on our finger flexors to maximize force against shallow ledges/holds. Crimp holds increase flexion (bending) at the PIP joint than the normal open grip which increases stress on the A2 pulleys. Generally, these injuries will cause a loud “pop” sensation and severe pain at the base of the finger that is worse with finger flexion (bending).

• Tenosynovitis is an inflammation of the tendon sheath of the hand due to chronic overuse which can occasionally cause swelling and pain that extends into the palm or forearm. 

Shoulder: Common injuries include SLAP tears, rotator cuff strains, or impingement of subacromial structures due to repetitive and prolonged overhead hangs. The shoulder joint consists of the glenohumeral joint, acromioclavicular joint, scapulothoracic joint, and the sternoclavicular joint. The glenohumeral joint is a ball and socket joint that connects the proximal humerus and the glenoid of the scapula. The labrum is a fibrocartilaginous ring within the glenoid cavity of the scapula that forms around the socket of the shoulder to increase shock absorption, depth, and stability within the joint. 

• SLAP (superior labrum anterior to posterior) tears involve tearing of the top of the shoulder labrum from the front to back of the shoulder joint.

• SLAP tears are divided into different grades depending on if there is involvement of the bicep tendon that inserts onto the labrum. 
• Grade II slap tears which involve a detachment of the bicep tendon with a tear of the labrum are the most common in the bouldering world due to stress placed on the labrum in the abducted and externally rotated shoulder position (“chicken wing position”) and inadequate rest breaks in between climbs leading to poor adaptation and fatigue of the tendons that attach to the labrum.

• Subacromial impingements, a broad term for entrapment of musculature, tendons, or bursa under the acromial space, may also occur due to frequent overhead positions which can cause small tears in the soft tissue leading to friction between the tendons and coracoacromial arch. Weakness in the rotator cuff muscles can also lead to poor static and dynamic stability of the shoulder.

Wrist: Wrist injuries are more commonly seen in high performance athletes. However, there have been incidence of stress fractures specifically at the hook of the hamate due to contact pressure. 

Knee/Pelvis: Less common but complaints of posterior (back) knee/hip pain have been found occasionally when using heelhook technique. The heel hook is performed by anchoring the heel on the rock and pulling backwards with the foot causing activation of our posterior chain muscles (glutes, hamstring, calves). Oftentimes this is done with the knee outwardly rotated which can cause an increased strain on the structures back and lateral to the knee such as the lateral collateral ligament, anterior cruciate ligament, hamstring tendons, etc.) 

Ankle/feet: Common lower body injuries include ankle sprains and fractures of the talus or calcaneus due to ground falls while foot/toe strains occur due to improper footwear.

• The pointed, concave shape of modern day climbing shoes causes the feet/toes to conform leading to scrunching of the toes and a hallux valgus (bunion) of the first toe leading to changes in the biomechanical position of the foot within the shoe.
• Studies have found an average two shoe size difference between normal and climbing shoes. 
• 80-90% of climbers reported willingness to accept pain and discomfort in their climbing shoes as long as it improves their performance. 

X-ray shows a) climber’s barefoot standing. b) same foot in climbing shoes. c) Side view of “crimping toes’ ‘ and hallux valgus of the big toe with the shoe on. 

Tips to decrease risk of injury 

As bouldering is a whole body sport that involves climbing in both vertical/horizontal planes and even the use of momentum to get to the next hold (dynos), it is important to train our body to adapt to the various stressors. As bouldering and rock climbing is primarily a pulling sport, it’s also important to train the opposite motions and antagonist muscles to prevent muscle imbalances as well as strengthen the small stabilization muscles that are often overlooked during our workout regimen. Additionally, spending time to work on mobility drills will help improve overall joint health to help with reaches and overhangs. A key component of mobility training is not just having the motion available to us, but being able to control the movement. Mobility training involves conditioning the body to move our joints into its end range of motion which will help to improve the mind-body connection (motor control) at extreme positions. This requires a combination of strength, flexibility, and control. Taking time to work on mobility teaches the joints how to adapt and bear load in vulnerable positions thereby decreasing our risk of injury when subject to these motions during sports such as climbing. Is your body ready for the stresses that are going to be put on it?

• Make sure you are performing a dynamic warm up prior to climbing.

 ○ As much as we want to go straight into it, it’s imperative to warm up those muscles for a solid 10-15 minutes before your climb to get your muscles pumped. 

○ A dynamic warm up should consist of activities that correlate to climbing and targets all the body parts will be integral to climbing your very best. (ex. Jumping jacks, lunges, arm/wrist/hip/ankle circles, squats,etc.) 

○ This will help to increase blood flow and oxygen to the muscles throughout your body and prepare the muscles neuromuscularly for activity. 

• Ensure you are falling safely and correctly! Your muscles should be slightly tensed however overall relaxed to help distribute the weight as you fall.

 ○ Don’t try to catch yourself with your hands. 

○ Check your surroundings for people or items prior to falling. 

○ While there are different ways to fall depending on how you’re positioned, generally tuck you arms in as you try to land on the both feet (rather than just the toes/heel) with the legs slightly bent, and then roll onto your back

to absorb force from the momentum. You can slap your arms out to the side again to help redistribute the weight of the fall. 

Exercises to decrease risk of injury 

Hip Controlled Articular Rotations (CARs) – These drills are great for improving mobility and control of the end-range motion we have. The goal of CARs is to move your joints slow and controlled through the outer limits of your range of motion to increase tissue adaptability and stimulate neuromuscular adaptation. The idea is to create larger circles with each rep which increases the tension of each movement. These contractions send messages to the brain that you have this new mobility available and how to control it.

Begin on the floor on all fours. You can place a yoga block behind your back as a tactile cue to avoid excessive low back compensation; if you are using pure hip mobility the yoga block should be able to be maintained without falling off. With each movement you will be moving slowly into the max range you can go as bring the knee in towards your chest, lift the hip out away from you, then begin to rotate the knee inwards as you slowly extend your leg back behind you and up into the ceiling, and finally bring the knee back together with the other leg. Return back to the starting position by extending the hip back behind you, rotating the knee and hip outwards until you bring the knee back up towards your chest until finally it is back parallel to the other knee. Try 5 reps on each side. Check out this video from our Perfect Stride team for a visual demonstration. https://www.youtube.com/watch?v=EWvPoRUEzRc 

Shoulder CARs – Similar to the joint, try to move the shoulder in a circular direction through its full range of motion. The arm is straight throughout the entire movement. Bring the arm forward and up as much as you can, rotate the arm in (thumbs down) as you bring the arm out to the side, then extend back behind you. Bring the arm back. Reverse the sequence back to the starting position; rotate you arm inwards, extend back, rotate your arm outwards (thumbs up) as you lift out and up back over your head, then finally down to the starting position. Try 5 reps on each side. Check out this video from our Perfect Stride team for a visual demonstration.  https://www.youtube.com/watch?v=ewRzru80p_w

Seated wrist flexor stretch – This helps to stretch the wrist flexors that are often overused from gripping. Complete 3 sets for 30 second holds 

Prone I/Y/T’s – Start by lying on your belly and with NO weight. These exercises will help on working the scapular stabilizers such as lower, middle, and upper traps.

•  I’s: Starting with your arms straight by your side, squeeze the shoulder blades together as you lift your arms up towards the ceiling. Be careful not to shrug your shoulders and focus mainly on feeling the muscle activation in between your shoulder blades. 

• T’s: Starting with your arms out by your side, squeeze the shoulder blades together as you lift your arms up towards the ceiling. Be careful not to shrug your shoulders and focus mainly on feeling the muscle activation in between your shoulder blades. 

• Y’s: Starting with your arms above your head in a 45 degree angle, squeeze the shoulder blades together as you lift your arms up towards the ceiling. Be careful not to shrug your shoulders and focus mainly on feeling the muscle activation in between your shoulder blades.

• Changing towards a more overhead angle increases the difficulty level so start with the I’s and progress to the y’s as tolerated! 
• Try 2-3 sets of 8 to start. 

Standing serratus wall slides – Stand with your forearms on the wall and place a band around both wrists. Push out into the band as you slowly slide the hands up and down against the wall. This works on strengthening your rotator cuff muscles and serratus anterior which will help with overhead stability. Try 2 sets of 10 to start.

Side plank with external rotation – Lie on your side and prop up onto your forearm with the moving arm bent at 90 degrees and resting along your stomach. This exercise can be done with a band or a weight however begin with a light weight. Anchor the band with your free hand as you rotate the top arm up towards the ceiling feeling the muscles working in the back of the shoulder. Regress the exercise by performing a half side plank with the knees bent. This will help to strengthen your obliques, shoulder stability and rotator cuff muscles. Try 2-3 sets of 8 to start. 

Dumbbell chest press – Lie on your back with your elbows out to the side in a 45 degree angle with a dumbbell in each hand. This is your starting position. Press forward and extend both arms over the chest. Slowly lower weights back down to the starting position. This helps to strengthen the antagonistic muscles (pecs). Try 3-4 sets of 8-10 to start. 

Bulgarian split squat – Start standing in front of a short bench or a chair. Place one foot back onto the step; you can place the foot on top of the bench or flex the ankle and balance with the balls of your feet. The ideal starting position should have your foot lower than your calf. The back foot serves mainly for balance and 90% of the load should be on the front foot as you slowly lower the leg, and drive back up. This will help to strengthen your quads, glutes, and core. Try 3 sets of 6-10 to start.

Single leg deadlift, curl, to overhead press – Start standing shoulder width apart holding a dumbbell in one hand that you will be able to bicep curl and lift overhead with. Standing on your left leg, brace your core, bring that right shoulder blade down and back to engage your scapular stabilizers as you begin hinging your hips and extending the right leg back. The right arm should hang straight down towards the floor simultaneously. Slowly bring in the extended leg and arm to return to starting position to perform a bicep curl and lift straight overhead. This can be progressed by extending the moving leg straight out to challenge your balance but should only be done after your form is perfected in a bent knee position. This is a complex exercise that will help strengthen hamstrings, glutes, core, biceps and shoulders as well as challenge your balance and coordination. Try 3 sets of 6-8 to start. 

Final Thoughts

Bouldering is a fun and exciting sport that provides a full body workout while also challenging your problem solving skills. Like most sports, we want to consider and be aware of any potential injuries that can arise. Try out these tips and tricks to help improve overall joint health and decrease your risk of injury to keep climbing for a long time!

Author: Jean Qi, PT, DPT

References 

1) Jones, Gareth PhD1; Schöffl, Volker PhD1,2,3,4; Johnson, Mark I. PhD1. Incidence, Diagnosis, and Management of Injury in Sport Climbing and Bouldering: A Critical Review. Current Sports Medicine Reports: November 2018 – Volume 17 – Issue 11 – p 396-401 doi: 10.1249/JSR.0000000000000534 

2) Kubiak, Erik & Klugman, Jeffrey & Bosco, Joseph. (2006). Hand injuries in rock climbers. Bulletin of the NYU hospital for joint diseases. 64. 172-7. 3) NHS Ayrshire & Arran. (n.d.). NHS Ayrshire & Arran. NHS Ayrshire & Arran – Subacromial Impingement Syndrome. Retrieved August 11, 2022, from https://www.nhsaaa.net/allied-health-professionals-ahps/musculoskeletal-service/ subacromial-impingement-syndrome/ 

4) Schöffl V, Küpper T. Feet injuries in rock climbers. World J Orthop. 2013 Oct 18;4(4):218-28. doi: 10.5312/wjo.v4.i4.218. PMID: 24147257; PMCID: PMC3801241. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801241/ 

5) Schöffl, Volker & Schöffl, Isabelle & Frank, L. & Küpper, Thomas & Simon, Michael & Lutter, Christoph. (2020). Tendon Injuries in the Hands in Rock Climbers:Epidemiology, Anatomy, Biomechanics and Treatment An Update. Muscle Ligaments and Tendons Journal. 10. 233. 10.32098/mltj.02.2020.08. 

6) Schöffl V, Lutter C, Popp D. The “Heel Hook”-A Climbing-Specific Technique to Injure the Leg. Wilderness Environ Med. 2016 Jun;27(2):294-301. doi: 10.1016/j.wem.2015.12.007. Epub 2016 Mar 21. PMID: 27009908. 

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