Previous injury as a risk factor for reinjury in rock climbing: a secondary analysis of data from a retrospective cross-sectional cohort survey of active rock climbers


Jones, G.; Llewellyn, D.; Johnson, M.I.

BMJ Open Sport and Exercise Medicine 1(1): 1-5

2015


The aim of this article is to report the findings of a secondary analysis of a previous injury study to consider previous injury as a risk factor for reinjury in rock climbing. We completed a secondary analysis of 201 questionnaires that were gathered as part of a retrospective cross-sectional cohort survey that investigated the epidemiology of injuries in a representative sample of British rock climbers. Participants had actively engaged in rock climbing over the previous 12-month period and were recruited from six indoor climbing centres and five outdoor climbing venues (men n=163, mean±SD, age=35.2±11.8 years, participating in rock climbing=13.88+11.77 years; women n=38, mean±SD, age=35.1±10.7 years, participating in rock climbing=11.62+9.19 years). Of the 101 participants who sustained a previous injury, 36 were found to have sustained at least one reinjury. The total number of reinjuries was 82, with the average probability of sustaining at least one reinjury being 35.6% (95% CI 34.71% to 36.8%; p<0.001, McNemar's χ<sup>2</sup> test) with the relative risk of reinjury being 1.55 (95% CI 1.34 to 1.80). The fingers were the most common site of reinjury (12 participants, 26%; χ<sup>2</sup>=43.12, df=5, p<0.001). Previous injury was found to be a significant risk factor for reinjury, particularly at the site of the fingers. Technical difficulty in bouldering and sport climbing behaviours were significantly associated with repetitive overuse reinjury. As participatory figures increase, so does the likelihood that a high proportion of climbers may sustain a reinjury of the upper extremity.

Open
Access
Research
BMJ
Open
Sport
&
Exercise
Medicine
Previous
injury
as
a
risk
factor
for
reinjury
in
rock
climbing:
a
secondary
analysis
of
data
from
a
retrospective
cross-sectional
cohort
survey
of
active
rock
climbers
Gareth
Jones,
1
'
2
David
Llewellyn,
3
Mark
I
Johnson
1
'
2
To
cite:
Jones
G,
Llewellyn
D,
Johnson
MI.
Previous
injury
as
a
risk
factor
for
reinjury
in
rock
climbing:
a
secondary
analysis
of
data
from
a
retrospective
cross-sectional
cohort
survey
of
active
rock
climbers.
BMJ
Open
Sport
Exerc
Med
2015;0:e000031.
doi:10.1136/bmjsem-2015-
000031
Prepublication
history
for
this
paper
is
available
online.
To
view
these
files
please
visit
the
journal
online
(http://dx.do
Lo
rg/10.1136/
bmjsem-2015-000031).
Accepted
2
August
2015
41)
CrossMark
'Faculty
of
Health
and
Social
Sciences,
Leeds
Beckett
University,
Leeds,
UK
keeds
Pallium
Research
Group,
Leeds,
UK
3
University
of
Exeter
Medical
School,
Exeter,
UK
Correspondence
to
Dr
Gareth
Jones;
g.j.Jones@leedsbeckettac.uk
ABSTRACT
Background:
The
aim
of
this
article
is
to
report
the
findings
of
a
secondary
analysis
of
a
previous
injury
study
to
consider
previous
injury
as
a
risk
factor
for
reinjury
in
rock
climbing.
Methods:
We
completed
a
secondary
analysis
of
201
questionnaires
that
were
gathered
as
part
of
a
retrospective
cross-sectional
cohort
survey
that
investigated
the
epidemiology
of
injuries
in
a
representative
sample
of
British
rock
climbers.
Participants
had
actively
engaged
in
rock
climbing
over
the
previous
12-month
period
and
were
recruited
from
six
indoor
climbing
centres
and
five
outdoor
climbing
venues
(men
n=163,
mean±SD,
age=35.2±11.8
years,
participating
in
rock
climbing=13.88+11.77
years;
women
n=38,
mean±SD,
age=35.1±10.7
years,
participating
in
rock
climbing=11.62+9.19
years).
Results:
Of
the
101
participants
who
sustained
a
previous
injury,
36
were
found
to
have
sustained
at
least
one
reinjury.
The
total
number
of
reinjuries
was
82,
with
the
average
probability
of
sustaining
at
least
one
reinjury
being
35.6%
(95%
CI
34.71%
to
36.8%;
p<0.001,
McNemar's
x
2
test)
with
the
relative
risk
of
reinjury
being
1.55
(95%
CI
1.34
to
1.80).
The
fingers
were
the
most
common
site
of
reinjury
(12
participants,
26%;
x
2
=43.12,
df=5,
p<0.001).
Conclusions:
Previous
injury
was
found
to
be
a
significant
risk
factor
for
reinjury,
particularly
at
the
site
of
the
fingers.
Technical
difficulty
in
bouldering
and
sport
climbing
behaviours
were
significantly
associated
with
repetitive
overuse
reinjury.
As
participatory
figures
increase,
so
does
the
likelihood
that
a
high
proportion
of
climbers
may
sustain
a
reinjury
of
the
upper
extremity.
Rock
climbing
represents
one
of
the
fastest
growing
sporting
activities
in
Britain
reflected
by
an
increase
in
the
number
of
registered
indoor
climbing
walls
in
the
UK
from
40
in
1988
to
353
in
2014.
1
There
are
a
variety
of
different
types
of
climbing
beha-
viours
which
take
place
both
at
indoor
and
outdoor
climbing
venues.
For
example,
Summary
box
F
Rock
climbers
operating
at
the
highest
levels
who
have
sustained
a
previous
injury
are
at
sig-
nificant
risk
of
reinjury.
The
fingers
are
a
common
site
of
reinjury
due
to
repetitive
overuse.
Fall-related
reinjuries
are
comparatively
infrequent.
traditional
climbing
takes
place
outdoors
and
utilises
a
rope
which
is
attached
to
safety
equipment,
placed
during
the
ascent,
as
pro-
tection
in
the
event
of
a
fall.
Sport
climbing
takes
place
both
indoors
and
outdoors
and
utilises
a
rope
that
during
the
ascent
is
attached
to
permanent
safety
anchors,
as
pro-
tection
in
the
event
of
a
fall.
Soloing
is
where
the
climber
ascends
a
traditional
climb
unroped,
and
is
considered
a
riskier
form
of
climbing
behaviour
as
serious
injury
or
death
may
result
in
the
event
of
a
fall.
Bouldering
is
also
performed
unroped
and
takes
place
both
indoors
and
outdoors.
It
involves
approximately
6-8
movement
sequences
per-
formed
at
relatively
low
heights
with
a
safety
mat
placed
below
the
climber
to
reduce
the
risk
of
injury
as
a
result
of
a
fall.
Rock
climbing
is
widely
regarded
as
a
`high-risk'
sporting
activity
because
of
the
inherent
risk
of
serious
injury
or
fatality,
with
a
high
prevalence
of
acute
and
overuse
injur-
ies
to
the
fingers
and
hand
being
reported.
2
3
A
recently
published
study
found
compar-
able
rates,
types
and
mechanisms
of
injury
in
youth
rock
climbers
as
compared
with
adult
rock
climbers.
4
Interestingly
they
identified
injuries
sustained
during
other
sports
as
a
risk
factor
for
future
injury.
Previous
injury
within
the
same
sport
has
been
found
to
be
Jones
G,
et
al.
BMJ
Open
Sport
Exerc
Med
2015;0:e000031.
doi:10.1136/bmjsem
-
2015
-
000031
1
Open
Access
a
risk
factor
for
reinjury.
5
6
To
our
knowledge,
there
have
been
no
studies
that
have
investigated
the
epidemi-
ology
of
reinjury
for
different
types
of
climbing
behaviour.
Previously
we
published
the
findings
of
a
retrospective
cross-sectional
study
that
investigated
the
nature,
preva-
lence
and
predictors
of
climbing
injuries
in
a
diverse
group
of
active
rock
climbers.
We
found
that
101
of
201
(50%)
rock
climbers
sustained
at
least
one
injury
in
a
12-month
period.
The
cause
of
these
injuries
were
repetitive
overuse
(67
of
201
(33%)),
acute
trauma
from
undertaking
a
strenuous
climbing
move
(57
of
201
(28%))
and
falls
(21
of
201
(10%)).
We
concluded
that
climbing
frequency
and
technical
difficulty
were
asso-
ciated
with
climbing
injuries,
particularly
to
the
upper
limb,
occurring
at
both
indoor
and
outdoor
climbing
venues.
We
did
not
conduct
analysis
of
reinjury
in
the
original
study
as
the
specific
aim
was
to
investigate
the
relation-
ship
between
climbing
behaviour
and
injury
mechanism,
that
is,
fall,
strenuous
move,
repetitive
overuse.
The
study
by
Woollings
et
al
has
highlighted
the
need
to
con-
sider
previous
injury
as
a
risk
factor
for
reinjury
in
rock
climbing
and
the
need
to
account
for
the
complexities
of
individual
climbing
behaviour.
A
greater
understand-
ing
of
these
factors
may
contribute
to
reduce,
control
or
eliminate
reinjury
occurrence
and
the
development
of
appropriate
rehabilitation
strategies.
The
original
study
is
representative
of
British
rock
climbers
across
a
range
of
climbing
behaviours
and
stan-
dards
in
performance.
The
data
capture
tool
used
(Climbing
Inventory
Questionnaire)
gathered
data
on
injury
occurrence,
site
of
injury
and
mechanism
of
injury
enabling
calculation
and
analysis
of
previous
injury,
reinjury
and
multiple
reinjury
of
the
same
ana-
tomical
site
via
the
same
mechanism.
Thus,
study
data
are
ideal
for
secondary
analysis.
The
aim
of
this
article
is
to
report
the
findings
of
a
secondary
analysis
of
previous
injury
as
a
risk
factor
for
reinjury
in
rock
climbing.
METHODS
Study
design
We
completed
a
secondary
analysis
of
201
questionnaires
that
were
gathered
as
part
of
our
retrospective
cross-
sectional
cohort
survey
that
investigated
the
epidemi-
ology
of
injuries
in
a
representative
sample
of
British
rock
climbers.
The
original
study
gathered
data
on
demographics,
operational
measures
of
climbing
behav-
iour
and
injury.
Participants
Participants
had
actively
engaged
in
rock
climbing
over
the
previous
12-month
period
and
were
recruited
from
six
indoor
climbing
centres
and
five
outdoor
climbing
venues
in
Britain
(men
n=163,
mean±SD,
age=35.2
±11.8
years,
participating
in
rock
climbing=13.88
+11.77
years;
women
n=38,
mean±SD,
age=35.1
±10.7
years,
participating
in
rock
climbing=11.62
+9.19
years).
The
163
male
climbers
and
38
female
clim-
bers
did
not
differ
significantly
in
age
(t=0.05,
p=0.964)
or
in
the
number
of
years
of
climbing
experience
(t=1.09,
p=0.275).
Participants
completed
a
Climbing
Injury
Questionnaire
developed
by
the
authors
that
gath-
ered
information
about
the
prevalence
and
nature
of
climbing
injuries
that
had
occurred
in
the
past
12
months
including
site,
frequency
and
cause
of
the
injury
and
whether
medical
attention
or
withdrawal
from
participation
was
necessary.
Participants
also
completed
the
Background
Climbing
Questionnaire
developed
by
the
authors
to
gather
infor-
mation
about
the
type,
frequency
and
performance
level
of
climbing
behaviour
which
were
used
as
proxy
mea-
sures
of
exposure
and
ability.
Data
analysis
examined
associations
between
potential
risk
factors
and
climbing
injuries
while
controlling
for
the
influence
of
key
demo-
graphic
variables.
The
reader
is
referred
to
the
Methods
section
in
Jones
et
al
for
a
full
description.
Data
processing
procedure
Data
were
used in
its
original
format
without
the
collec-
tion
of
any
additional
raw
data.
Previous
injury
was
cate-
gorised
as
those
resulting
from
a
fall,
those
resulting
from
repetitive
overuse
and
those
resulting
from
a
strenuous
move.
Participants
were
dichotomised
as
rein-
jured
or
not
reinjured
through
reanalysis
of
individual
responses
to
questions
relating
to
the
cause
and
site
of
injury.
Those
individuals
who
reported
an
injury
at
the
same
anatomical
site
precipitated
by
the
same
cause
on
at
least
two
occasions
within
the
12-month
reporting
period
were
categorised
as
reinjured.
Multiple
reinjury
was
defined
as
those
individuals
who
reported
an
injury
at
the
same
anatomical
site
precipitated
by
the
same
cause
on
at
least
three
occasions
or
greater
within
the
12-month
reporting
period.
Epidemiological
incidence
proportion
(IP)
provides
an
average
measure
of
injury
risk
for
the
12-month
reporting
period.
Clinical
inci-
dence
provides
a
useful
measure
of
incidence
in
terms
of
clinical
resource
utilisation.
Reinjury
was
considered
as
the
dependant
variable
and
climbing
behaviour
in
terms
of
frequency
and
grade
as
the
independent
variables.
Variables
for
correlational
analysis
were
treated
as
continuous
data,
including
gender,
which
was
considered
a
'dummy
variable'.
Prior
to
analysis,
variables
were
examined
for
accuracy
of
data
entry,
missing
values,
and
fit
between
their
distributions
and
the
assumptions
of
parametric
analysis.
Three
vari-
ables
whose
departure
from
normality
was
severe
(number
of
reinjuries
as
a
result
of
(1)
a
fall,
(2)
repeti-
tive
overuse
and
(3)
strenuous
climbing
moves)
were
dichotomised
in
order
to
reduce
levels
of
skewness.
?
All
data
analysis
was
performed
using
SPSS
V.21.12.0.1.
statistical
software
(SPSS
Inc,
Chicago,
Illinois,
USA).
The
epidemiological
IP
and
clinical
incidence
were
cal-
culated
with
95%
CIs.
Correlational
analysis
was
per-
formed
using
one-tailed
Pearson's
r
test
to
analyse
the
2
Jones
G,
et
al.
BMJ
Open
Sport
Exerc
Med
2015;0:e000031.
doi:10.1136/bmjsem-2015-000031
I
p
Open
Access
strength
of
the
relationship
between
reinjury
and
climb-
ing
behaviour
as
a
positive
directional
hypotheses
had
been
proposed.
?
McNemar's
x
2
test
with
Yates
correction
was
utilised
to
calculate
the
association
probability
between
previous
injury
and
reinjury.
RESULTS
Of
the
201
participants
who
completed
the
original
survey,
101
sustained
at
least
one
injury
from
climbing
in
the
past 12
months.
Of
these
101
participants,
36
sus-
tained
at
least
one
reinjury.
The
total
number
of
reinju-
ries
in
these
36
participants
was
82,
with
a
clinical
incidence
of
1.78
reinjuries
per
climber.
The
epidemio-
logical
IP
for
reinjury
was
0.356
(95%
CI
0.347
to
0.368).
Thus,
the
average
probability
of
sustaining
at
least
one
reinjury
as
a
result
of
climbing
was
35.6%
(95%
CI
34.71%
to
36.8%).
Three
participants
sustained
at
least
one
reinjury
as
a
result
of
a
fall;
29
participants
sustained
at
least
one
rein-
jury
as
a
result
of
repetitive
overuse
and
14
participants
sustained
at
least
one
reinjury
as
the
result
of
a
strenu-
ous
climbing
move.
The
IP
for
reinjury
for
falls
was
0.065
(95%
CI
—0.006
to
0.136);
the
IP
for
reinjury
for
repetitive
overuse
was
0.630
(95%
CI
0.49
to
0.77);
the
IP
for
reinjury
for
a
strenuous
move
was
0.304
(95%
CI
0.171
to
0.437).
Thus,
the
average
probability
of
sustain-
ing
at
least
one
reinjury
as
a
result
of
a
fall
was
6.5%
(95%
CI
—0.6%
to
13.6%);
the
average
probability
of
sustaining
at
least
one
reinjury
as
a
result
of
repetitive
overuse
was
63.0%
(95%
CI
49.0%
to
77.0%)
and
the
average
probability
of
sustaining
at
least
one
injury
as
a
result
of
strenuous
overuse
was
30.4%
(95%
CI
17.1%
to
43.7%).
Participants
who
had
sustained
a
previous
injury
were
more
likely
to
sustain
a
reinjury
p<0.001,
McNemar's
x
2
test)
with
the
relative
risk
of
reinjury
being
1.55
(95%
CI
1.34
to
1.80).
The
main
findings
in
relation
to
figure
1
show
the
fingers
were
the
most
common
site
of
reinjury
as
a
result
of
repetitive
overuse
(12
participants,
26%)
and
a
strenu-
ous
move
(8
participants,
17%).
There
was
a
significant
difference
between
the
observed
and
expected
frequencies
of
the
site
of
rein-
jury
including
multiple
reinjuries.
There
were
31
reinju-
ries
including
multiple
reinjuries
to
the
fingers
(x
2
=43.12,
df=5,
p<0.001).
Table
1
shows
the
correlation
coefficients
between
climbing
reinjury
and
climbing
behaviours.
Age
and
number
of
years
climbing
were
negatively
associated
with
reinjury
as
a
result
of
a
strenuous
move
(table
1).
Reinjury
as
a
result
of
a
fall
was
significantly
associated
with
(1)
solo
grade;
(2)
outdoor
sport
lead
frequency;
(3)
outdoor
sport
lead
grade;
(4)
indoor
sport
lead
grade.
Reinjury
as
a
result
of
repetitive
overuse
was
sig-
nificantly
associated
with
(1)
solo
grade;
(2)
outdoor
sport
lead
grade;
(3)
indoor
sport
lead
grade;
(4)
boul-
dering
frequency;
(5)
bouldering
grade.
Reinjury
as
a
result
of
a
strenuous
move
was
significantly
associated
with
(1)
outdoor
sport
lead
grade;
(2)
bouldering
grade.
Although
the
magnitude
of
the
associations
were
small,
they
were
statistically
significant.
DISCUSSION
This
secondary
analysis
represents
the
first
attempt
to
assess
previous
injury
as
a
risk
factor
for
reinjury
in
adult
rock
climbers
in
the
UK.
Previous
climbing
injury
studies
have
exclusively
recruited
participants
at
indoor
climbing
facilities,
8
climbing
events
3
and
through
postal
quesitonnaires.
9
The
participants
within
our
secondary
analysis
were
recruited
in
their
naturalistic
environment
at
a
variety
of
indoor
and
outdoor
climbing
venues
in
the
North
of
England
and
Scotland.
Thus,
we
believe
that
our
results
can
be
generalised
to
the
wider
climbing
population.
Reinjury
Reinjury
was
a
common
occurrence
with
36
of
101
parti-
cipants
experiencing
at
least
one
reinjury
with
the
average
probability
of
sustaining
at
least
one
reinjury
being
35.6%
(95%
CI
34.71%
to
36.8%).
Injury
inci-
dence
rates
are
often
expressed
in
sports
such
as
football
and
rugby
in
the
number
of
injuries
per
1000
h
of
exposure.
Incidence
rates
in
climbing
studies
have
been
reported
using
a
modified
version
of
this
method,
8
but
in
doing
so
this
may
misrepresent
the
statistic
as
calcula-
tions
do
not
accurately
account
for
time
spent
not
actively
climbing.
Climbers
spend
substantial
periods
of
time
mentally
preparing
for
routes,
warming
up
on
easier
climbs,
involved
in
climbing-related
activities
such
as
belaying
or
surveying
routes
as
well
as
resting
between
attempts.
We
suggest
that
frequency
counts
of
routes
ascended
and
the
performance
level
attained
in
terms
of
grade
may
be
more
informative,
as
they
allow
researchers
to
consider
both
exposure
and
loading
of
anatomical
structures.
Clinical
incidence
is
a
statistic
that
provides
informa-
tion
useful
for
estimating
resource
costs
for
healthcare
providers.
We
found
the
clinical
incidence
of
reinjury
to
be
1.78
per
climber
with
a
relative
risk
of
sustaining
a
reinjury
following
a
previous
injury
of
1.55.
We
were
unable
to
compare
either
the
clinical
incidence
or
the
relative
risk
of
reinjury
with
other
climbing
studies
due
to
paucity
of
literature
within
this
subject
area.
The
average
probability
of
sustaining
a
reinjury
through
repetitive
overuse
was
high,
63.0%
(95%
CI
49.0%
to
77.0%).
Reinjuries
sustained
through
repetitive
overuse
accounted
for
80.5%
of
the
total
reinjuries
reported
and
was
positively
associated
with
solo
grade,
bouldering
grade,
outdoor
sport
lead
grade
and
indoor
sport
lead
grade.
Individuals
who
performed
a
high
standard
were
more
likely
to
sustain
a
repetitive
overuse
reinjury,
and
we
suspect
that
this
was
due
to
subclinical
intratendinous
changes
leading
to
the
development
of
a
degenerative
tendinopathy.
Although
associations
were
Jones
G,
et
al.
BMJ
Open
Sport
Exerc
Med
2015;0:e000031.
doi:10.1136/bmjsem-2015-000031
3
0
o
44
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,
§
C
(
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0 0
1 /4
cP
•\io
roe
os
o
0
,
e e
CP
C\
.6
k
A
4
N
y
<
Strenuous
move
Repetitive
overuse
O
Fall
14
12
10
8
6
4
2
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Open
Access
Re-injury
Site
Figure
1
Frequency
and
location
of
fall,
strenuous
move
and
repetitive
overuse.
found
between
repetitive
overuse
injuries
and
individual
climbing
behaviours,
many
climbers
within
our
sample
operated
across
several
types
of
climbing
behaviour.
Repetitive
overuse
injuries
are
multifactorial
in
their
aeti-
ology,
and
it
may
be
that
exposing
oneself
to
a
particular
set
of
climbing
behaviours
elevates
individual
risk.
Therefore,
we
suggest
that
higher
frequencies
of
climbing
may
not
be
so
likely
to
occasion
a
repetitive
overuse
reinjury
in
participants
who
perform
at
relatively
moderate
levels
of
intensity
The
popularity
of
bouldering
has
increased
markedly
over
the
last
decade
and
together
with
indoor
sport
climbing
represents
the
competitive
elements
of
the
activity.
Both
bouldering
frequency
and
bouldering
Table
1
Correlation
coefficients
between
climbing
reinjury
and
climbing
behaviours
Reinjury
fall
Reinjury
strenuous
move
Reinjury
repetitive
overuse
Solo
grade
Pearson
correlation
0.246"
0.022
0.147t
Significance
(1-tailed)
0.002
0.403
0.048
N
130
130
130
Out
sport
lead
frequency
Pearson
correlation
0.140t
—0.034
—0.008
Significance
(1-tailed)
0.024
0.318
0.458
N
201
201
201
Out
sport
lead
grade
Pearson
correlation
0.219"
0.188t
0.1591
-
Significance
(1-tailed)
0.009
0.022
0.045
N
115
115
115
Indoor
sport
lead
grade
Pearson
correlation
0.1381
-
0.087
0.1651
Significance
(1-tailed)
0.031
0.122
0.013
N
183
183
183
Bouldering
frequency
Pearson
correlation
—0.017
0.077
0.175"
Significance
(1-tailed)
0.406
0.139
0.007
N
201
201
201
Bouldering
grade
Pearson
correlation
0.081
0.189"
0.231"
Significance
(1-tailed)
0.156
0.009
0.002
N
158
158
158
*Correlation
is
significant
at
the
0.01
level
(1-tailed).
tCorrelation
is
significant
at
the
0.05
level
(1-tailed).
4
Jones
G,
et
al.
BMJ
Open
Sport
Exerc
Med
2015;0:e000031.
dol:10.1136/bmjsem-2015-000031
I
p
Open
Access
grade
were
positively
associated
with
repetitive
overuse
reinjuries.
This
may
be
attributed
to
large
volumes
of
bouldering
activity,
limited
recovery
between
bouts
of
activity
and
that
performance
is
often
at
the
limit
of
indi-
vidual's
physical
and
technical
ability.
In
contrast,
no
association
was
found
for
traditional
climbing.
Traditional
climbing
utilises
holds
of
varying
types
on
differing
angles
of
climbing
surface
with
climbers
gener-
ally
operating
at
a
lower
technical
standard
as
compared
with
their
individual
sport
climbing
or
bouldering
grade.
Therefore,
the
strain
and
load
on
musculoskeletal
structures
may
be
more
varied
and
reduce
the
develop-
ment
of
repetitive
overuse
syndromes.
The
number
of
reinjuries
as
a
result
of
a
fall
was
posi-
tively
associated
with
both
outdoor
and
indoor
sport
grade.
High-grade
sport
routes
are
often
steep
and
over-
hanging
in
nature.
Climbers
may
incur
injury
due
to
contact
with
the
climbing
surface
during
or
following
a
fall.
During
a
fall,
the
force
transmission
to
the
climbers'
body
can
vary
greatly
and
is
largely
dependent
on
the
relative
length
of
the
fall
as
compared
with
the
amount
of
rope
paid
out,
termed
fall
factor
However,
the
number
of
participants
who
sustained
a
reinjury
as
a
result
of
a
fall
was
low.
Site
of
injury
The
fingers
were
the
most
common
site
of
reinjury.
The
risk
of
recurrent
and
excessive
loading
of
the
fingers
and
their
limitations
as
weight-bearing
structures
has
been
established.2
9
11
12
All
climbing
behaviours
place
high
load
demands
on
the
fingers
and
their
associated
structures.
Climbers
often
use
the
'crimp'
hand
position
during
an
ascent
to
grip
the
climbing
surface.
In
this
position,
the
wrist
is
extended
to
improve
the
mechan-
ical
advantage
of
the
finger
flexors,
but
in
doing
so
para-
doxically
increases
injury
risk.
13
Research
evidence
links
the
high
load
forces
generated
during
the
crimp
grip
position
to
discreet
injuries
of
the
annular
pulley
system
within
the
fingers,
particularly
the
A2.
14
Damage
to
the
annular
pulley
system
is
considered
to
be
a
climbing-
specific
injury,
and
functional
deficit
with
regard
to
climbing
performance
may
depend
greatly
on
the
extent
of
damage
sustained,
but
remains
inconclusive.
A
progressive
warm
up
incorporating
progressive
loading
in
the
crimp
grip
hand
position
has
been
suggested
to
prepare
the
tendons
and
pulleys
of
the
fingers
for
the
maximal
forces
to
which
they
may
be
exposed.
15
Study
limitations
Further
investigation
is
required
to
confirm
the
inci-
dence,
and
patterning
of
reinjuries
in
climbing
popula-
tions
is
warranted.
It
is
important
to
recognise
some
methodological
limitations
when
assessing
these
findings.
Although
the
secondary
analysis
provides
new
informa-
tion
regarding
climbing
behaviour
and
previous
injury
as
a
risk
factor
for
reinjury,
the
cross-sectional
and
correl-
ational
basis
of
the
original
study
negates
causal
infer-
ences.
The
original
study
also
excluded
those
individuals
who
were
no
longer
actively
engaged
in
climbing
activity
which
may
have
been
due
to
injury.
This
may
bias
the
IP
and
clinical
incidence
rate
for
reinjury
rate
towards
a
lower
reported
value
than
is
actually
representative.
Summary
Climbing
continues
to
be
a
popular
sporting
activity,
and
as
participation
figures
increase,
so
does
the
likeli-
hood
that
a
high
proportion
of
climbers
may
sustain
a
repetitive
overuse
reinjury
of
the
upper
extremity.
Previous
injury
was
a
significant
risk
factor
for
reinjury,
particularly
of
the
fingers.
Future
research
adopting
a
prospective
design
would
shed
further
light
on
the
potential
effects
of
high
level
climbing
performance
and
subsequent
reinjury
occurrence.
Education
of
medical
and
climbing
populations
is
paramount,
so
that
these
findings
may
be
of
consideration
when
planning
rehabilitative
and
preventative
strategies.
Contributors
GJ
was
involved
in
writing
of
the
manuscript,
data
analysis
and
submission.
DL
was
involved
in
review
of
the
manuscript.
MIJ
is
the
manuscript
editor.
Competing
interests
None
declared.
Ethics
approval
Leeds
Beckett
University
Ethics
Committee.
Provenance
and
peer
review
Not
commissioned;
internally
peer
reviewed.
Open
Access
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is
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Access
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