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Upper-extremity Injuries in Recreational Climbers: Injury Patterns and Treatment
Stella den Hengst, BSc
1, Emily Powis, BS
2,3, Carrie Cooper, DPT
4, Shawn Diamond, MD
5; Krystle R. Tuaņo, MD
6(1)Erasmus Medical Center, Rotterdam, Netherlands, (2)Harvard Medical School, Boston, MA, (3)Massachusetts General Hospital, Boston, MA, (4)Doctor of Physical Therapy, Salt Lake City, UT, (5)Texas Tech, El Paso, TX, (6)Massachusetts General Hospital | Harvard Medical School, Boston, MA
Introduction: Rock climbing's growing popularity, especially following its Olympic debut in 2020, has led to an increase in upper extremity injuries, particularly involving the hands and fingers. However, injury risk factors, treatment strategies, and patterns of seeking and receiving sport-informed medical care remain poorly studied the perspectives of both recreational climbers and hand specialists. This study integrates insights from climbers and hand healthcare providers to assess injury prevalence, risk factors, and clinical preparedness.
Materials & Methods: Two cross-sectional, retrospective surveys were conducted. The first targeted adult recreational climbers via social media and email lists (July-December 2024), assessing demographics, climbing experience, injury history, and medical care. The second, distributed through the American Association for Hand Surgery (AAHS), examined climbing-specific injuries encountered in hand providers' practices. Both surveys collected anonymous responses using REDCap.
Results: Among 745 recreational climbers (35% female, mean age 34, 94% bouldering, 72% lead climbing), 77% reported at least one injury, most commonly to the fingers and hands (70%). Crimpy holds (20%) and overhang moves (18%) were frequent mechanisms. Common injuries included joint pain or swelling (47%), pulley injuries (47%), and flexor tendon injuries (14%). Risk factors included nicotine use (OR 3.09, p<0.01), climbing for 4-10 (OR 3.37, p<0.01) or >11 years (OR 2.41, p<0.01), warmups >30 minutes (OR 2.084, p=0.03), intermediate lead level (OR 1.50, p=0.04), and fingerboard training (OR 2.109, p<0.01). Conversely, cardio (OR 0.63 p=0.01) and campus board training (OR 0.59, p=0.02) were protective (Table 1). Notably, 44% of climbers relied on online resources for treatment guidance and 47% consulted a physician.
In parallel, 85 physicians completed the survey, including 73% hand surgeons (general, orthopaedic, or plastic), 5% occupational therapists, 18% physical therapists, and 4% sports medicine doctors. Most providers (63%) reported treating 1-5 climbers annually, with pulley injuries (82%), finger joint pain/swelling, (69%), and joint sprains (49%) being most common. While 79% incorporated sport-specific knowledge into treatment, only 39% felt they had adequate sport-specific knowledge, and 25% thought adequate resources were available for patients. Over three-quarters (77%) had personal climbing experience.
Conclusions: Two complementary surveys of recreational climbers and hand providers revealed a high prevalence of finger injuries, frequent self-management among climbers, and a widespread perception among providers of insufficient sport-specific knowledge and inadequate resources for patient care. These findings highlight the need for targeted education and accessible, evidence-based guidelines to improve prevention and treatment of climbing-related injuries.
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