Rock climbing injury rates and associated risk factors in a general climbing population


Backe, S.; Ericson, L.; Janson, S.; Timpka, T.

Scandinavian Journal of Medicine and Science in Sports 19(6): 850-856

2010


The objective was to examine injury rates and associated risk factors in a representative sample of climbers. A random sample (n=606) of the Swedish Climbing Association members was sent a postal survey, with an effective response rate of 63%. Self-reported data regarding climbing history, safety practices and retrospective accounts of injury events (recall period 1.5 years) were obtained. Descriptive statistical methods were used to calculate injury incidences, and a two-step method including zero-inflated Poisson's regression analysis of re-injuries was used to determine the combination of risk factors that best explained individual injury rates. Overall, 4.2 injuries per 1000 climbing hours were reported, overuse injuries accounting for 93% of all injuries. Inflammatory tissue damages to fingers and wrists were the most common injury types. The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re-injury risk among male climbers and a lower risk among the older climbers. The high percentage of overuse injuries implies that climbing hours and loads should be gradually and systematically increased, and climbers regularly controlled for signs and symptoms of overuse. Further study of the association between body mass index and climbing injury is warranted.

Scand
J
Med
Sci
Sports
2009:
19:
850-856
doi:
10.11141600-0838.2008.00851.x
ei
2009
John
Wiley
&
Sons
NS
SCANDINAVIAN JOURNAL
OF
MEDICINE
&
SCIENCE
IN
SPORTS
Rock
climbing
injury
rates
and
associated
risk
factors
in
a
general
climbing
population
S.
Backe',
L.
Ericson',
S.
Janson',
T.
Timpka
2
Division
of
Public
Health
Sciences,
Karlstad
University,
Karlstad,
Sweden,
2
Department
of
Medical
and
Health
Sciences,
Linkoping
University,
Linkoping,
Sweden
Corresponding
author:
S.
Backe,
Division
of
Public
Health
Sciences,
Karlstad
University,
S-651
88
Karlstad,
Sweden.
Tel:
+46
739
856
245,
Fax:
+46
547
002
220,
E-mail:
Stefan.backe@kau.se
Accepted
for
publication
4
June
2008
The
objective
was
to
examine
injury
rates
and
associated
risk
factors
in
a
representative
sample
of
climbers.
A
random
sample
(it
=
606)
of
the
Swedish
Climbing
Associa-
tion
members
was
sent
a
postal
survey,
with
an
effective
response
rate
of
63%.
Self-reported
data
regarding
climb-
ing
history,
safety
practices
and
retrospective
accounts
of
injury
events
(recall
period
1.5
years)
were
obtained.
De-
scriptive
statistical
methods
were
used
to
calculate
injury
incidences,
and
a
two-step
method
including
zero-inflated
Poisson's
regression
analysis
of
re-injuries
was
used
to
determine
the
combination
of
risk
factors
that
best
ex-
plained
individual
injury
rates.
Overall,
4.2
injuries
per
1000
climbing
hours
were
reported,
overuse
injuries
accounting
for
93%
of
all
injuries.
Inflammatory
tissue
damages
to
fingers
and
wrists
were
the
most
common
injury
types.
The
multivariate
analysis
showed
that
overweight
and
practicing
bouldering
generally
implied
an
increased
primary
injury
risk,
while
there
was
a
higher
re-injury
risk
among
male
climbers
and
a
lower
risk
among
the
older
climbers.
The
high
percentage
of
overuse
injuries
implies
that
climbing
hours
and
loads
should
be
gradually
and
systematically
increased,
and
climbers
regularly
controlled
for
signs
and
symptoms
of
overuse.
Further
study
of
the
association
between
body
mass
index
and
climbing
injury
is
warranted.
The
popularity
of
climbing
has
increased
dramati-
cally
worldwide
in
recent
years,
both
as
a
recrea-
tional
physical
activity
and
as
a
competitive
sport
(International
Mountaineering
and
Climbing
Fed-
eration,
UIAA,
2007).
In
'Sweden,
the
number
of
participants
has
increased
by
90%
in
the
last
5
years
(Swedish
Climbing
Association,
2005).
Climbing
can
be
performed
outdoors
or
indoors,
and
a
member
of
a
climbing
club
can
partake
in
a
number
of
relatively
different
climbing
activities,
e.g.
the
competitive
forms,
such
as
bouldering
and
sports
climbing,
or
the
recreational
traditional
(trad)
climbing,
ice
climb-
ing
and
mountaineering
(alpine)
disciplines
(Long,
2003).
However,
most
existing
epidemiological
studies
reporting
climbing
injury
patterns
have
been
performed
in
specific
climbing
environments
and
populations.
This
research,
mainly
reporting
from
indoor
climbing,
has
reported
that
overuse
injuries
(tendonitis,
carpal
tunnel
syndrome
and
stress
factures),
particularly
to
the
fingers
and
wrists,
ac-
count
for
75-90%
of
climbing
injuries
(Bollen,
1988;
Limb,
1995;
Rooks,
1997;
Schoffl
&
Winkelmann
1999;
Patrick,
2001;
Martinoli
et
al.,
2005;
Jones
et
al.,
2007).
Climber's
finger,
an
A2
pulley
rupture
of
the
ring
finger,
has
been
described
as
being
particularly
prevalent
among
elite
competition
dim-
bers
(Bollen,
1990;
Bollen
&
Gunson,
1990;
Rohr-
bough
et
al.,
2000;
Schoffl
et
al.,
2003;
Schoffl
&
Kuepper,
2006).
There
are
few
studies
that
have
taken
into
account
actual
exposure
to
climbing,
thus
allowing
calculation
of
injury
incidences.
How-
ever,
Schoffl
and
Kuepper
(2006)
report
3.1
injuries
per
1000
climbing
hours
among
the
443
competitors
at
the
2005
World
Championships.
Traumatic
climb-
ing
injuries,
excluding
pulley
ruptures,
are
dominated
by
lower
extremity
lesions,
and
have
commonly
resulted
from
falls
while
leading
an
outdoors
climb
on
natural
rock
(McLennan
&
Ungersma,
1982;
Schussman
&
Lutz,
1982;
Bowie
et
al.,
1988;
Addiss
&
Baker,
1989;
Malcolm,
2001;
Monasterio,
2005).
Studies
of
associations
between
climbing
experience
and
injury
risk
have
shown
differing
results.
Bowie
et
al.
(1988)
and
Monasterio
(2005)
found,
in
con-
trast
to
some
high-altitude
mountaineering
epide-
miological
studies
(McLennan
&
Ungersma,
1982;
Schussman
&
Lutz,
1982),
that
climbers
with
a
relatively
long
climbing
experience
were
more
fre-
quently
injured.
Recent
studies
in
sports
and
tradi-
tional
climbing
have
reported
the
same
tendencies
(Paige
et
al.,
1998;
Gerdes
et
al.,
2006).
With
the
increasing
popularity
of
climbing,
it
is
unsatisfying
that
only
a
few
epidemiological
studies
850
Rock
climbing
injury
rates
and
associated
risk
factors
Statistical
analysis
To
ensure
accuracy,
all
data
were
entered
on
two
independent
occasions
using
SPSS
®
Data
Entry
for
Windows.
The
Orchard
Sports
Injury
Classification
System
(Orchard,
1995)
was
used
to
classify
the
injury
data
by
type
and
location.
SPSS
14.0
(SPSS
Inc.,
Chicago,
IL,
USA,
2005)
was
used
for
the
statistical
analyses.
Descriptive
statistical
methods
were
used
to
calculate
incidence
rates
and
confidence
intervals.
There-
after,
regression
analyses
were
performed
to
identify
risk
factors
associated
with
climbing
injury.
Several
regression
models
were
considered
for
the
multivariate
analyses,
e.g.
ordinary
count
models
(Poisson's
or
negative
binomial
regres-
sion)
and
zero-inflated
Poisson's
regression
(McCullagh
&
Nelder,
1983).
We
chose
to
use
a
two-step
method
where
zero-
inflated
Poisson's
regression
models
were
used
in
the
second
step
to
analyze
risk
for
re-injury
among
the
primarily
injured
climbers.
The
reason
was
that
the
count
data
in
the
study
were
highly
non-normal
and
that
excess
of
zeros
(representing
non-
injured
climbers)
are
not
well
estimated
by
traditional
multi-
variate
methods.
The
following
variables
were
included
in
the
analyses:
time
exposed
to
climbing
per
year
(continuous
variable),
body
mass
index
(BMI)
(continuous
variable),
sex
(female/male),
age
group
(<20/20-45/46+),
type
of
climbing
practiced
(trad/sport/bouldering),
and
years
of
climbing
ex-
perience
(0-4/5-9/10+).
Statistically
significant
variables
were
those
with
P-values
<0.05%
or
95%
confidence
intervals
that
excluded
unity.
The
data
were
analyzed
using
the
STATA
®
SE
program
version
10.2.
of
general
climbing
populations
are
available.
The
aim
of
this
study
is
to
examine
the
rates
and
associated
factors
for
sustaining
climbing
injuries
in
a
random
sample
of
climbers
who
were
members
of
a
club
associated
with
a
national
climbing
association.
The
study
also
seeks
to
identify
rock
climbers'
formal
climbing
and
first
aid
training
and
their
safety-related
practices.
Materials
and
methods
A
cross-sectional
retrospective
study
design
was
used
to
examine
self-reported
injury
rates
in
a
random
sample
of
Swedish
organized
climbers.
For
the
purpose
of
the
study,
climbing
was
sub-divided
into
bouldering,
rock
(trad)
climb-
ing,
sports
climbing
and
alpinism.
Injury
definition
Injuries
that
occurred
while
participating
in
a
climbing
activity
indoors
or
outdoors
and
that
resulted
in
an
injury
treatment
intervention
(medical
treatment,
hospitalization
and/or
dis-
continuation
and
rest
from
climbing)
were
included.
Trau-
matic
injuries
were
characterized
by
acute
onset,
while
overuse
injuries
were
defined
by
repeated
microtrauma
without
a
single
identifiable
event
(Fuller
et
al.,
2006).
A
climbing
incident
was
defined
as
a
distinct
event
that
occurred
while
participating
in
a
climbing
activity
indoors
or
outdoors
and
that
could
have
resulted
in
an
injury,
but
where
injury
was
avoided
at
the
last
moment
or
escaped
by
a
close
margin.
Data
collection
In
2005,
6067
individuals
were
members
of
a
Swedish
climbing
club.
Of
these,
53.4%
were
male
seniors,
21%
female
seniors,
13.1%
male
juniors,
and
12.5%
female
juniors
(Swedish
Climbing
Association,
2005).
During
May—June
2006,
a
postal
survey
asking
for
data
regarding
the
2005
climbing
season
was
distributed
to
a
random
sample
(n
=
606)
of
climbers,
com-
prising
10%
of
the
members
of
the
Swedish
Climbing
Asso-
ciation.
The
survey
was
resent
to
the
non-respondents.
All
participants
and,
where
applicable,
their
parents,
received
written
information
about
the
study
and
gave
written,
in-
formed
consent.
The
consent
could
be
withdrawn
at
any
time
during
the
study
without
specifying
the
reason.
All
collected
data
were
treated
confidentially.
The
survey
asked
for
infor-
mation
about
the
sportsperson
(sex,
age,
height
and
weight),
climbing
history,
amount
of
time
spent
on
climbing
per
year,
injury
prevention
practices
and
retrospective
accounts
of
injury
events
(type
of
injury,
which
month
the
injury
occurred,
body
part
involved,
treatment
received
and
type
of
climbing
activity
during
injury).
The
questionnaire
contained
predomi-
nantly
closed
items
("tick
the
box"
format).
The
face
validity
of
the
survey
questions
was
assessed
by
a
physiotherapist
and
a
panel
of
local
rock
climbers.
Two
questions
were
used
to
collect
information
regarding
the
individuals'
exposure
to
climbing:
how
many
climbing
sessions
(practice
and
competi-
tion)
the
climber
had
participated
in
each
month
and
in
total
during
the
past
12
months,
and
how
many
hours
active
climbing
(not
including
time
for
transportation
or
checking
the
equipment)
was
spent
per
session.
Results
A
total
of
37
questionnaires
were
returned
unan-
swered
due
to
an
incorrect
address,
and
nine
indivi-
duals
had
left
climbing.
355
(63.4%)
of
the
remaining
560
questionnaires
were
returned
answered.
A
tele-
phone
survey
(three
calling
attempts)
directed
to
50%
(102/205)
of
the
non-responders
was
answered
by
64
individuals.
These
climbers
reported
a
large
variety
of
reasons
for
not
having
returned
the
ques-
tionnaires,
the
most
frequent
being
lack
of
time.
The
dropout
analysis
did
not
reveal
any
notable
differ-
ences
in
terms
of
sex
or
age
(
<
20
and
20+)
between
participants
and
non-participants.
Men
comprised
70%
of
the
respondents
and
the
mean
age
was
30
years
(range
9-67)
(Table
1).
The
respondents
reported
climbing
on
average
75
days
per
year
(range
3.5-260).
More
females
(70%)
than
males
(46%)
were
novice
climbers,
and
a
higher
percentage
of
females
(34%)
than
males
(15%)
were
juniors
(age
<20
years).
In
all,
74.6%
of
the
participants
had
taken
part
in
a
climbing
course,
85%
of
which
were
held
by
an
authorized
instructor.
Very
few
(13%)
had
participated
in
a
first
aid
course
or
in
a
climbing
rescue
course.
The
total
recorded
exposure
to
climbing
was
49
986
h
(females
contributing
11
921
h
and
males
38
065
h).
In
total,
208
injuries
were
reported,
corre-
sponding
to
4.2
injuries
per
1000
climbing
hours
(Fig.
1).
One
hundred
and
six
climbers
(30%)
reported
at
least
one
injury,
the
proportion
injured
851
Backe
et
al.
Table
1.
Baseline
characteristics
of
the
study
participants
(n
=
355)
Baseline
characteristic
Percent
(n)
Female
(n
=
106)
Male
(n
=
249)
Total
(n
=
355)
Age
group
<20
34.0
(36)
15.0
(37)
21.0
(73)
20-45
59.0
(63)
77.0
(191)
72.0
(254)
46+
7.0
(7)
8.0
(19)
7.0
(26)
Total
100.0
(106)
100.0
(247)
100.0
(353)
Body
mass
index
(kg/m
2
)
<18.5
16.0
(17)
5.7
(14)
8.8
(31)
18.5-24.9
81.1
(86)
84.2
(208)
83.3
(294)
>
25.0
2.8
(3)
10.1
(25)
7.9
(28)
Total
100.0
(106)
100.0
(247)
100.0
(353)
Climbing
experience
Novice
(0-4
year)
70.0
(74)
46.0
(115)
53.2
(189)
Experienced
(5-9
year)
24.0
(26)
26.0
(64)
25.4
(90)
Veteran
(10+
years)
6.0
(6)
28.0
(70)
21.4
(76)
Total
100.0
(106)
100.0
(249)
100.0
(355)
Type
of
climbing
(first
choice)
Sport
climber
52.0
(55)
38.0
(95)
42.4
(150)
Rock/traditional
climber
25.0
(27)
34.0
(84)
31.4
(111)
Bouldering
21.0
(22)
24.0
(60)
23.1
(82)
Alpine/ice
climber
2.0
(2)
4.0
(9)
3.1
(11)
Total
100.0
(106)
100.0
(248)
100.0
(354)
355
climbers
(249
male
&
106
female)
14
traumatic
injuries
and
194
overuse
injuries
in
49
986
climbing-hours
106
injured
climbers
(29.9
%)
(86
male
&
20
female)
249
uninjured
climbers
(70.1
%)
(163
male
&
86
female)
53
climbers
(14.9
%)
(44
male
&
9
female)
with
a
single
injury
53
climbers
(14.9
%)
(44
male
&
11
female)
with
multiple
injuries*
15
climbers
(4.2
%)
(12
male
&
3
female)
with
>3
injuries
16
climbers
(4.5
%)
(12
male
&
4
female)
with
3
injuries
22
climbers
(6.2
%)
(18
male
&
4
female)
with
2
injuries
*
40
injury
events
with
>1
sustained
injury
were
reported
Fig.
1.
Overview
of
the
injury
patterns
in
a
random
sample
of
climbers
(n
=
355)
during
the
season
2005.
being
higher
for
male
climbers
(34.5%,
95%
CI:
28.6%,
40.4%)
than
for
females
(18.9%,
95%
CI:
11.4%,
26.3%).
The
primary
analysis
showed
an
increased
risk
for
sustaining
a
climbing
injury
for
climbers
with
a
higher
BMI
((3
0.046,
P
<0.015)
and
for
those
parti-
cipating
in
the
bouldering
discipline
((3
0.300,
P
<0.047).
In
the
zero-inflated
Poisson's
regression
analysis
of
risk
factors
for
re-injury,
significant
differences
in
injury
incidence
were
found
between
the
sexes
and
age
groups.
Being
male
was
associated
with
a
higher
re-injury
risk
((3
0.574,
P<0.019)
and
a
lower
injury
risk
was
observed
for
the
two
oldest
age
groups
(Table
2).
Tendencies
could
be
observed
toward
a
lower
re-injury
risk
among
the
more
experienced
climbers
and
a
higher
re-injury
risk
among
climbers
with
a
higher
BMI.
Overuse
injuries
accounted
for
93%
of
all
injuries,
and
28%
of
the
participants
reported
at
least
one
such
injury.
Fingers
and
wrists
were
the
most
common
anatomical
location
for
overuse
injuries
(Table
3).
The
quotient
between
upper
limb
injuries
and
lower
limb
injuries
was
the
highest
in
traditional
climbing,
with
a
ratio
of
9:1
(n
=
36:4)
in
contrast
to
5:1
(n
=
54:11)
for
sports
climbing.
However,
upper
limb
injuries,
especially
to
the
fingers
and
wrists,
were
also
the
most
common
overuse
injuries
among
climbers
who
often
practiced
sports
climbing
or
bouldering.
Traumatic
injuries
constituted
only
7%
of
all
injuries
and
only
4%
of
the
climbers
reported
having
sustained
traumatic
injuries
during
the
2005
season.
Of
the
traumatic
injuries,
50%
involved
the
lower
extremities
(foot,
toe
and
ankle),
while
upper
extre-
mities
accounted
for
36%.
The
most
common
type
was
ligament
injuries
(36%),
followed
by
contusions
and
lacerations
(29%),
while
fractures
constituted
21%.
In
terms
of
the
type
of
traumatic
injury
and
type
of
climbing,
joint
and
ligament
injuries
domi-
nated
in
bouldering
(80%),
while
contusions
and
laceration
dominated
in
rock
climbing
(75%).
Nearly
all
climbers
(85%)
who
had
sustained
a
traumatic
Table
2.
Risk
factors
for
re-injury
displayed
by
odds
ratios
from
Z-inflated
Poisson's
regression
analyses
Risk
factors
b
OR
95°/.
CI
Time
climbing
per
year
0.00063
1.0006
0.99-1.00
0.439
Body
mass
index
(kg/m
2
)
0.065
1.07
0.98-1.16
0.121
Sex
(male)
0.574
1.77
1.10-2.87
0.019
Age
group
(20-45)
-
0.804
0.45
0.26-0.76
0.003
Age
group
(46+)
-
1.684
0.18
0.08-0.45
0.000
Type
of
climbing
(sport)
-
0.089
0.91
0.56-1.48
0.719
Type
of
climbing
(bouldering)
0.363
1.44
0.91-2.28
0.122
Years
of
climbing
(5-9)
-
0.063
0.94
0.61-1.45
0.775
Years
of
climbing
(10+)
-
0.451
0.64
0.40-1.02
0.060
Goodness
of
fit
Log
likelihood
=
-
294.35
X
=
22.71
The
categories
female,
age
group
<20,
rock
(trad)
climbing,
0-4
years
of
climbing
were
used
as
reference.
852
Rock
climbing
injury
rates
and
associated
risk
factors
Table
3.
Anatomical
location
of
injuries
in
numbers
(percent)
displayed
by
injury
type
and
type
of
climbing
Injury
type
injury
location
Overuse
injury
All
overuse
injuriesTraunnatic
injury
All
traumatic
injuriesTotal
Rock
Sport
BoulderingAlpine
Rock
Sport
Bouldering
Upper
limbs
Shoulder
5
(12)
10
(14)
7
(12)
0
(0)
22
(13)
0
(0)
0
(0)
0
(0)
0
(0)
22
(12)
Upper
arm
12
(29)
15
(21)
18
(30)
1
(33)
46
(26)
1
(17)
1
(33)
0
(0)
2
(14)
48
(26)
Elbow/forearm
0
(0)
0
(0)
0
(0)
0
(0)
Hand/finger/wrist
19
(46)
29
(41)
24
(41)
1
(33)
73
(42)
2
(33)
1
(33)
0
(0)
3
(21)
76
(40)
All
upper
limb
injuries
36
(87)
54
(76)
49
(83)
2
(67) 141 (81)
3
(50)
2
(67)
0
(0)
5
(36)
146
(78)
Lower
limbs
Knee
1
(2)
5
(7)
2
(3)
1
(33)
9
(5)
0
(0)
0
(0)
0
(0)
0
(0)
9
(5)
Lower
leg
1
(2)
0
(0)
2
(3)
0
(0)
3
(2)
1
(17)
0
(0)
0
(0)
1
(7)
4
(2)
Foot/toe/ankle
2
(5)
6
(8)
3
(5)
0
(0)
11
(6)
1
(17)
1
(33)
4(80)
6
(43)
17
(9)
All
lower
limb
injuries
4
(9)
11
(15)
7
(12)
1
(33)
23
(13)
2
(33)
1
(33)
4
(80)
7
(50)
30
(16)
Head
/neck
Head/face/neck
1
(2)
4
(6)
1
(2)
0
(0)
6
(3)
1
(17)
0
(0)
0
(0)
1
(7)
7
(4)
All
head/neck
injuries
1
(2)
4
(6)
1
(2)
0
(0)
6
(3)
1
(17)
0
(0)
0
(0)
1
(7)
7
(4)
Trunk
Sternum/abdomen
0
(0)
2
(3)
2
(3)
0
(0)
4
(2)
0
(0)
0
(0)
0
(0)
0
(0)
4
(2)
Lower
back
0
(0)
0
(0)
0
(0)
0
(0)
0
(0)
0
(0)
0
(0)
1
(20)
1
(7)
1
(1)
All
trunk
injuries
0
(0)
2
(3)
2
(3)
0
(0)
4
(2)
0
(0)
0
(0)
1
(20)
1
(7)
5
(3)
Total
41
(100)71
(100)59
(100)
3
(100)174
(100)
6
(100)3
(100)5
(100)
14
(100)
188
(100)
Table
4.
Number
(percent)
of
traumatic
climbing
injury
events
and
incident
events
displayed
by
causes
(the
respondents
could
provide
several
causes)
Self-reported
causes
Injury
events
Incident
events
Total
n
%
n
%
n
%
External
causes
(weather
falling
rocks)
6
20.7
7
12.7
13
15.5
Human
mistakes
12
41.4
22
40.0
34
40.5
Fatigue
or
dread
3
10.3
7
12.7
10
11.9
Equipment
or
safety
bolt
failure
5
17.2
12
21.8
17
20.2
Other
(ignorance)
3
10.3
7
12.7
10
11.9
Total
29
99.9
55
99.9
84
100.0
injury
had
received
medical
attention,
while
15%
of
the
injured
climbers
required
hospitalization.
The
main
underlying
factors
reported
by
the
climbers
to
explain
the
traumatic
injuries
and
incident
events
were
human
factors
(mistakes
or
lapses
in
concentra-
tion)
(40%),
followed
by
equipment
failure
(20%)
(Table
4).
The
majority
of
these
injuries
and
incidents
had
occurred
on
rock
ledges
or
rock
faces
(64%).
Discussion
The
aim
of
this
study
was
to
examine
injury
rates
and
risk
factors
in
a
representative
sample
of
climbers
associated
to
a
national
climbing
association.
We
found
that
overuse
injuries
accounted
for
the
vast
majority
(93%)
of
the
total
injuries,
and
that
these
injuries
predominantly
involved
the
upper
limbs.
Furthermore,
being
male,
having
a
relatively
high
BMI
and
participating
in
bouldering
were
associated
with
an
increased
injury
risk.
The
mean
age
of
climbers
who
completed
our
survey
(30
years)
and
their
exposure
to
climbing
(on
average
75
sessions
per
year)
were
similar
to
the
data
reported
from
the
previous
studies
(Bowie
et
al.,
1988;
Paige
et
al.,
1998;
Gerdes
et
al.,
2006;
Jones
et
al.,
2007).
How-
ever,
comparisons
of
other
baseline
data
showed
differences.
Of
our
respondents,
30%
were
female
in
contrast
to
only
12-20%
in
other
reports
(Bowie
et
al.,
1988;
Paige
et
al.,
1998;
Gerdes
et
al.,
2006;
Jones
et
al.,
2007).
Furthermore,
most
respondents
(53%)
had
been
climbing
<
5
years,
while
other
survey
studies
report
a
higher
level
of
climbing
experience
among
the
participants.
A
possible
explanation
for
these
differences
is
that
the
previous
studies
may
not
have
captured
representative
samples
from
the
gen-
eral
climbing
population,
preferring
instead
to
recruit
participants
from
climbing
websites
(Paige
et
al.,
1998;
Gerdes
et
al.,
2006)
or
popular
climbing
venues
(Bowie
et
al.,
1988;
Jones
et
al.,
2007).
Climbing
has
physiologically
been
characterized
by
sustained
and
intermittent
(isometric)
forearm
muscle
contractions,
and
the
stereotype
for
an
elite
climber
has
been
an
athlete
small
in
stature,
with
low
percentage
body
fat
and
body
mass
(Sheel,
2004;
Giles
et
al.,
2006).
No
conclusive
scientific
evidence
is
available
regarding
associations
between
reduction
in
share
of
body
fat
or
possession
of
specific
physical
characteristics
and
improvement
in
climbing
perfor-
mance
(Mermier
et
al.,
2000;
Sheel,
2004;
Caine
et
al.,
2006;
Giles
et
al.,
2006).
In
light
of
these
findings,
our
observation
of
an
association
between
BMI
and
853
Backe
et
al.
climbing
injury
is
noteworthy.
One
possible
explana-
tion
is
related
to
the
source
of
participants
and
the
study
design.
Earlier
studies
that
have
analyzed
the
impact
of
BMI
have
been
based
on
homogenous
populations,
mainly
elite-level
competitive
climbers
being
small
in
stature
and
having
low
levels
of
body
fat.
In
our
study,
the
climber's
BMI
was
more
approaching
a
normal
distribution.
Also,
we
found
that
a
higher
BMI
was
related
to
an
increased
injury
risk
for
climbers
who
participated
in
bouldering.
This
can
be
explained
by
the
nature
of
competitive
disciplines,
as
they
are
designed
to
challenge
the
climbers'
ability
to
ascend
particularly
difficult
routes
that
often
have
small
footholds
and
handholds.
Furthermore,
even
though
bouldering
is
considered
to
be
the
"easiest"
climbing
discipline,
the
competi-
tive
environment
may
still
inspire
novices
to
attempt
routes
beyond
their
capability
and
repeat
strenuous
moves,
potentially
resulting
in
overuse
injuries.
Our
results
agree
with
the
recommendations
that
parents
and
coaches
should
be
made
aware
that
practice
schedules
designed
for
experienced
competi-
tive
athletes
in
a
variety
of
upper
extremity
weight-
bearing
sports
are
inappropriate
for
novices,
and
in
particular
adolescents
whose
bones
and
ligaments
are
not
fully
developed
(Dennis
et
al.,
2005;
Caine
et
al.,
2006;
Magra
et
al.,
2007;
Morrison
&
Schoffl,
2007).
Step-wise
increase
and
versatile
training
schemes
with
an
emphasis
on
skills
and
diversity
of
climbing
routes
(Morrison
&
Schoffl,
2007)
as
well
as
warming
up
and
taping
the
fingers
between
the
joints
have
previously
been
suggested
to
prevent
ruptures
(Bollen,
1990;
Bollen
&
Gunson,
1990;
Rooks,
1997),
although
no
clear
evidence
has
yet
been
established
regarding
the
preventative
value
of
taping
the
fingers.
However,
Schoffl
et
al.
(2003)
have
reported
that
injured
climbers
benefit
from
post-injury
therapeutic
finger
taping
for
at
least
12
months
during
climbing
activity
(Schoffl
et
al.,
2003),
and
Schweizer
(2000)
has
shown
that
taping
over
the
distal
end
of
the
proximal
phalanx
decreased
bowstringing
by
22%.
Despite
inconclusive
evidence
regarding
the
efficiency
of
preventative
taping,
the
experiences
from
other
sports
burdened
with
overuse
injuries
(Dennis
et
al.,
2005)
lead
us
to
propose
that
climbing
injury
pre-
vention
should
be
based
on
the
climbing
load
being
systematically
combined
with
rest,
starting
at
a
novice
level.
The
number
of
practice
days
per
week
in
harmony
with
the
bodily
adaptation
of
the
clim-
ber,
and
the
load
and
repetitions
during
each
prac-
tice,
should
be
adapted
to
the
climber's
age
and
climbing
experience.
In
addition,
climbers,
especially
novices,
should
be
taught
to
recognize
early
signs
and
symptoms
of
overuse
injuries,
i.e.
early
morning
stiffness
and
fine
motor
deficits.
Before
such
general
recommendations
can
be
issued
by
climbing
associa-
tions,
further
studies
are
warranted
of
specific
asso-
ciations
between
injury
rates
and
weekly
climbing
load.
Moreover,
based
on
the
notion
that
incidents
and
traumatic
injuries
largely
occur
due
to
human
mistakes,
educational
intervention
should
include
theoretical
and
practical
training
on
safety
practices
including
first
aid
and
climbing
rescue
techniques.
Organized
regular
incident
registration
"on
the
spot",
for
instance
through
a
website,
collecting
data
on
when,
where,
how
these
incidents
and
injuries
occur
would
provide
an
opportunity
for
analysis
and
rapid
debriefing
about
what
went
wrong
and
what
can
be
learnt
to
prevent
similar
events
from
occurring
again.
Several
important
limitations
must
be
considered
when
interpreting
the
results
of
our
study.
Firstly,
the
cross-sectional
study
design
does
not
allow
one
to
determine
specific
cause—effect
relationships
between
risk
factors
and
climbing
injury,
or
to
distinguish
between
re-injuries
and
new
injuries.
However,
the
aim
of
this
study
was
to
explore
the
rates
and
associated
factors
for
sustaining
climbing
injuries,
not
to
precisely
determine
the
mechanisms
involved
in
the
cause—effect
relationship.
Secondly,
because
it
is
probable
that
non-injured
climbers
were
over-
represented
among
the
non-participants,
it
is
likely
that
the
injury
incidences
and
proportions
reported
in
the
study
over-estimate
the
actual
injury
risk.
Thirdly,
traumatic
injuries,
such
as
pulley
ruptures,
are
diffi-
cult
to
diagnose
without
ultrasound
and
magnetic
resonance
imaging
(MRI).
Unfortunately,
we
did
not
ask
the
respondents
whether
their
overuse
injury
had
been
verified
by
such
diagnostic
methods.
Thereby,
traumatic
pulley
ruptures
may
have
been
misclassified
as
overuse
injuries.
Fourthly,
the
array
of
injury
events
reported
for
the
12-month
study
period
cov-
ered
a
maximal
recall
period
of
1.5
years,
from
January
2005
through
June
2006.
In
retrospective
surveys,
both
underreporting
due
to
memory
decay
and
over-reporting
due
to
telescoping
may
bias
the
analyses
(Harel
et
al.,
1994;
Mock
et
al.,
1999;
Petridou
et
al.,
2004).
Other
studies
have
demon-
strated
acceptable
reliability
in
self-administered
reports
of
specific
sports
injury
details,
such
as
the
body
part
injured,
while
self-administered
reports
concerning
the
severity
of
the
injury
do
not
corre-
spond
to
medical
record
data
(Valuri
et
al.,
2005).
Therefore,
data
on
injury
severity
were
not
collected
in
our
study.
In
view
of
these
remarks
and
based
on
the
narrative
data
surrounding
the
circumstances
deliv-
ered
by
respondents,
we
believe
that
our
self-report
sports
injury
recall
data
are
sufficiently
reliable.
Perspectives
In
this
study
of
a
representative
sample
of
climbers,
the
overall
injury
incidence
was
found
to
be
4.2
854
injuries
per
1000
climbing
hours,
which
is
slightly
higher
than
recently
reported from
indoor
elite
climbing
(Schoffl
&
Kuepper,
2006).
However,
the
proportion
of
injured
climbers
in
the
sample
was
lower
(30%)
than
the
50%
proportion
reported
from
a
study
based
on
convenience
sampling
from
indoor
and
outdoor
climbing
venues
(Jones
et
al.,
2007).
These
discrepancies
can
be
attributed
to
differences
in
the
selection
of
study
populations
and
in
non-participation,
and
imply
that
prospective
epide-
miological
studies
of
broad
climbing
populations
are
warranted.
Overuse
injuries
accounted
for
93%
of
all
injuries,
and
male
climbers
with
a
relatively
high
BMI
who
participated
in
the
bouldering
climbing
discipline
had
an
increased
injury
risk.
These
results
imply
that
climbing
hours
and
loads
should
be
gradually
and
systematically
increased,
and
climbers
regularly
controlled
for
signs
and
symptoms
of
over-
Rock
climbing
injury
rates
and
associated
risk
factors
use.
Further
study
of
the
association
between
BMI
and
climbing
injury
is
warranted.
Also,
studies
with
emphasis
on
age,
climbing
level,
disciplines
and
individual
athlete-hours
exposures
are
needed
in
order
to
attain
wider
knowledge
concerning
injuries
among
climbers.
Key
words:
rock
climbing,
general
climbing
popula-
tion,
associated
risk
factors,
injury,
safety.
Acknowledgements
We
gratefully
acknowledge
the
cooperation
of
the
Swedish
Climbing
Association,
Mikael
Svensson
for
statistical
advice,
Finn
Nilsson
for
correcting
the
vocabulary
and
the
Swedish
Rescue
Services
Agency
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researcher.
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