Sport climbing: medical considerations for this new Olympic discipline

Strobe training as a visual training method that improves performance in climbing

Introduction

Strobe training is a form of visual training where the athlete has to practice during intermittently dark conditions. Strobe training improves visual, perceptual, and cognitive skills, which will enhance athletic performance. Strobe training can influence multiple training components in climbing: psychological, tactical, physical, and technical training.

Materials and methods

The study was conducted on 17 elite climbers from Romania (10 male and 7 female), representing the entire National Youth Climbing Team. The research group was divided into a control group (n = 8) and an experimental group (n = 9). The used instruments were the Cognitrom battery (for cognitive skills, such as spatial skills and reactivity), the Witty SEM system (for motor-cognitive skills, such as cognitive agility, visual processing speed, and visual memory), and the International Rock Climbing Research Association (IRCRA) performance-related test battery for climbers (climbing-specific motor skills). The experimental group had 20 strobe training sessions, which took place during one calendar year, as an additional session to their climbing schedule done with their principal trainer. The strobe session was once a week, depending on the periodization of the macrocycle (preparatory, competitional, and transition periods). The control group and the experimental group had similar climbing training sessions during the 1-year macrocycle in terms of intensity and volume of their training.

Results

Strobe training improved on-sight performance (d = 0.38) and red-point performance (d = 0.36). Strobe training improved the majority of cognitive skills [all spatial skills (d = 1.27 for mental image transformation; d = 1.14 for spatial orientation; d = 1.59 for image generation) and simple reaction time (d = 0.99)]. Strobe training improved all motor-cognitive skills (d = 0.16 for visual memory; d = 1.96 for visual memory errors; d = 1.39 for visual processing speed; d = 1.94 for visual processing errors; d = 1.30 for cognitive agility). Strobe training improved many climbing-specific parameters (flexibility and upper body strength) (d = 0.44 and d = 0.47 for flexibility parameters; d = 0.50 to 0.73 for upper body strength parameters).

Discussion

Strobe training is an effective training method for enhancing performance that should be used on more experienced climbers. It acts more on spatial skills, rather than on reactivity skills, developing the visual-motor coordination system. Strobe training has greater effects on climbers aged below 16 years, as youth athletes rely more on visual input compared to adults. The improvement in climbing-specific variables was due to the additional climbing session done weekly. Strobe training acts more on the cognitive component of training than on the motor component of training in climbing.

Comparison of 3T and 7T magnetic resonance imaging for direct visualization of finger flexor pulley rupture: an ex-vivo study

OBJECTIVE

To compare image quality and diagnostic performance of 3T and 7T magnetic resonance imaging (MRI) for direct depiction of finger flexor pulleys A2, A3 and A4 before and after artificial pulley rupture in an ex-vivo model using anatomic preparation as reference.

MATERIALS AND METHODS

30 fingers from 10 human cadavers were examined at 3T and 7T before and after being subjected to iatrogenic pulley rupture. MRI protocols were comparable in duration, both lasting less than 22 min. Two experienced radiologists evaluated the MRIs. Image quality was graded according to a 4-point Likert scale. Anatomic preparation was used as gold standard.

RESULTS

In comparison, 7T versus 3T had a sensitivity and specificity for the detection of A2, A3 and A4 pulley lesions with 100% vs. 95%, respectively 98% vs. 100%. In the assessment of A3 pulley lesions sensitivity of 7T was superior to 3T MRI (100% vs. 83%), whereas specificity was lower (95% vs. 100%). Image quality assessed before and after iatrogenic rupture was comparable with 2.74 for 7T and 2.61 for 3T. Visualization of the A3 finger flexor pulley before rupture creation was significantly better for 7 T (p < 0.001). Interobserver variability showed substantial agreement at 3T (κ = 0.80) and almost perfect agreement at 7T (κ = 0.90).

CONCLUSION

MRI at 3T allows a comparable diagnostic performance to 7T for direct visualization and characterization of finger flexor pulleys before and after rupture, with superiority of 7T MRI in the visualization of the normal A3 pulley.

Risk factors and injury prevention strategies for overuse injuries in adult climbers: a systematic review

Introduction

Climbing is an increasingly popular activity and imposes specific physiological demands on the human body, which results in unique injury presentations. Of particular concern are overuse injuries (non-traumatic injuries). These injuries tend to present in the upper body and might be preventable with adequate knowledge of risk factors which could inform about injury prevention strategies. Research in this area has recently emerged but has yet to be synthesized comprehensively. Therefore, the aim of this study was to conduct a systematic review of the potential risk factors and injury prevention strategies for overuse injuries in adult climbers.

Methods

This systematic review was conducted in accordance with the PRISMA guidelines. Databases were searched systematically, and articles were deemed eligible based upon specific criteria. Research included was original and peer-reviewed, involving climbers, and published in English, German or Czech. Outcomes included overuse injury, and at least one or more variable indicating potential risk factors or injury prevention strategies. The methodological quality of the included studies was assessed with the Downs and Black Quality Index. Data were extracted from included studies and reported descriptively for population, climbing sport type, study design, injury definition and incidence/prevalence, risk factors, and injury prevention strategies.

Results

Out of 1,183 records, a total of 34 studies were included in the final analysis. Higher climbing intensity, bouldering, reduced grip/finger strength, use of a "crimp" grip, and previous injury were associated with an increased risk of overuse injury. Additionally, a strength training intervention prevented shoulder and elbow injuries. BMI/body weight, warm up/cool downs, stretching, taping and hydration were not associated with risk of overuse injury. The evidence for the risk factors of training volume, age/years of climbing experience, and sex was conflicting.

Discussion

This review presents several risk factors which appear to increase the risk of overuse injury in climbers. Strength and conditioning, load management, and climbing technique could be targeted in injury prevention programs, to enhance the health and wellbeing of climbing athletes. Further research is required to investigate the conflicting findings reported across included studies, and to investigate the effectiveness of injury prevention programs.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42023404031).

A Biomechanical Analysis of the H-Taping Method Used by Rock Climbers as Prophylactic or Stabilizing Fixation of Partial A2 Pulley Tears

PURPOSE

Rock climbing can lead to upper-extremity injuries, such as A2 pulley ruptures, leading to the bowstringing of the flexor tendons. Climbing finger positions are specific and can put undue stress on the pulley systems. This causes severe hand dysfunction and is a difficult problem to treat, and prevention is important. Using a cadaveric, experimental model, we evaluated the effectiveness of the H-taping method, commonly used by rock climbers, to prevent and treat A2 pulley tears.

METHODS

Using fourteen matched pairs of fresh-frozen cadaveric hands with forearms, four experiments were conducted with 56 paired comparisons evaluating the failure force, fingertip force, and mode of failure (112 total tests). Comparisons were as follows: index fingers- intact versus 50% distal A2 pulley tears without H-taping (control); ring fingers- intact versus H-taping as a prophylactic for A2 pulley tears; little fingers- 50% distal A2 pulley tears with H-tape versus without tape; and middle fingers- H-taping as a prophylactic versus H-taping as a stabilizing treatment of torn pulleys.

RESULTS

The mean index finger failure force was significantly higher in intact vs torn A2 pulleys (control). Failure force for intact H-taped fingers was significantly higher than torn H-taped fingers, but no other finger comparisons for failure force were significant. There were no significant findings in comparison of mean fingertip force values in any of the experiments.

CONCLUSIONS

We found that H-taping is not effective as prophylaxis against A2 pulley ruptures or as a stabilizing treatment method for partially ruptured pulleys.

CLINICAL RELEVANCE

While H-taping has not been recommended as prophylaxis for preventing A2 pulley ruptures, the climbing community has embraced this technique as a preventative measure. The present study provides biomechanical evidence against H-taping for this purpose. Furthermore, it does not appear to aid in increasing fingertip force after injury.

Evaluation of finger cartilage composition in recreational climbers with 7 Tesla T2 mapping magnetic resonance imaging

Purpose

Sport climbing may lead to tissue adaptation including finger cartilage before apparent surface damage is detectable. The main aim was to assess finger cartilage composition with T2 mapping in young, active climbers and to compare the results to a non-climbers' collective. A secondary aim was to compare whether differences in cartilage T2 times are observed between older vs. younger volunteers.

Methods and materials

7 Tesla MRI of the fingers Dig.2-4 was performed using a multi-echo spin echo sequence. Manual segmentation of 3 ROIs at the metacarpal heads, 1 ROI at the base phalanx and 1 ROI at the proximal interphalangeal joint was performed. Included were 13 volunteers without history of trauma who are regularly performing climbing activities as a recreational sport (>20 h/month). These were age-matched with 10 control subjects not performing climbing activities.

Results

Mean age was 32.4 years for the climbing group and 25.8 years for the controls. Mean T2 values for the 5 different ROIs were 42.2 ± 7.8 msec for climbers and 41.4 ± 6.8 msec for non-climbers. No significant differences were observed for T2 values between both groups. However, higher age had a significant impact on T2 values for all assessed ROIs (higher age 44.2 ± 9.5, younger age 32.9 ± 5.7, p = 0.001).

Discussion

This study evaluated the cartilage composition of young, engaged climbers with a T2 mapping MRI technique with the purpose to depict early onset joint changes. No negative impact on cartilage composition due to the sport activity was found, whereas age-related effects on the cartilage seemed to be more prominent.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB)

INTRODUCTION

Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

METHOD AND ANALYSIS

This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

ETHICS AND DISSEMINATION

The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER

NCT05587270.

Change in grip strength, hang time, and knot tying speed after 24 hours of endurance rock climbing

Background

Non-professional climbers are increasingly attempting long routes in a single day. Many suffer injury or rely on search and rescue teams when they become too fatigued to finish. Predicting fatigue is difficult, and existing studies have only studied climbers over durations less than an hour, while many outdoor multipitch climbs require more than an hour of climbing.

Objectives

To determine how strength, endurance, and dexterity reflect fatigue after 24 h of continuous climbing.

Methods

Volunteer competitors completed measurements of grip strength, static hang time to failure, and time to tie a figure-eight follow-through knot. Measurements were taken during the registration period before the competition and again within an hour after the competition ended. Measurements were compared using the paired t-test. Subgroup analysis was applied to competitors by division. Linear regression was applied to determine the relationship between vertical feet climbed and the number of routes climbed during the competition on each metric.

Results

Thirty-six total climbers (average age 29.4 years old) completed pre- and post-competition measurements. After 24 h of climbing (n = 36), mean grip strength decreased by 14.3-15 lbs or 14.7%-15.1% (p < 0.001) and static hang time decreased by 54.2 s or 71.2% (p < 0.001). There was no significant change in time to tie a figure-eight-follow-through knot. Grip strength and hang time decreases were significant in climbers with outdoor redpoints of 5.10a and above. Hang time decreased by 5.4 s per 1,000 vertical feet climbed (p = 0.044).

Conclusion

Climbers can expect to experience a 14.7%-15.1% decrease in grip strength and 71.2% decrease in static hang time after 24 h of continuous climbing. These changes may make it difficult to climb consistently over a long objective, and climbers can use these measures at home to train for longer climbing routes. Future studies on shorter climbing intervals can help determine rates of decline in performance measures.

High-resolution ultrasound tendon-to-bone distances in partial and complete finger flexor A2 pulley ruptures simulated in human cadaver dissection: toward understanding imaging of partial pulley ruptures

Introduction: The A2 pulley tear is the most common injury in rock climbing. Whereas complete A2 pulley ruptures have been extensively researched, studies focused on partial A2 pulley ruptures are lacking. A2 pulleys rupture distally to proximally. High-resolution ultrasound imaging is considered the gold-standard tool for diagnosis and the most relevant ultrasound measurement is the tendon-to-bone distance (TBD), which increases when the pulley ruptures. The purpose of this study was to establish tendon-to-bone distance values for different sizes of partial A2 pulley ruptures and compare these values with those of complete ruptures. Material and methods: The sample consisted of 30 in vitro fingers randomly assigned to 5 groups: G1, no simulated tear (control); G2, simulated 5 mm tear (low-grade partial rupture); G3, simulated 10 mm tear (medium-grade partial rupture); G4, simulated 15 mm tear (high-grade partial rupture); and G5, simulated 20 mm or equivalent tear (complete rupture). A highly experienced sonographer blinded to the randomization process and dissections examined all fingers. Results: The tendon-to-bone distance measurements (medians and interquartile ranges) were as follows: G1, 0.95 mm (0.77-1.33); G2, 2.11 mm (1.78-2.33); G3, 2.28 mm (1.95-2.42); G4, 3.06 mm (2.79-3.28); and G5, 3.66 mm (3.55-4.76). Significant differences were found between non-torn pulleys and simulated partial and complete pulley ruptures. Discussion: In contrast, and inconsistent with other findings, no significant differences were found among the different partial rupture groups. In conclusion, the longer the partial pulley rupture, the higher the tendon-to-bone distance value. The literature is inconsistent regarding the tendon-to-bone distance threshold to diagnose a partial A2 pulley rupture. The minimum tendon-to-bone distance value for a partial rupture was 1.6 mm, and tendon-to-bone distance values above 3 mm suggest a high-grade partial pulley rupture (15 mm incision) or a complete pulley rupture.

Sport-specific performances in elite youth sport climbers; gender, age, and maturity specifics

Study aim: The increase in the number of professional climbers led to the development of climbers since early age. Therefore, the average age of elite climbers has decreased over the last decade. Consequently, age and maturity specifics should be investigated with the influential factors in climbing. This research aimed to investigate the forearm muscle strength in youth sport climbers and determine the gender, age, and maturity status as factors of influence on forearm muscle performance in elite youth climbers.

Materials and methods: This research included 18 elite sport climbers (Croatian National team members), divided into two age groups: younger (aged 13–15 years) and older (aged 16–18 years). Variables included anthropometric indices (body mass, body height, body fat percentage, ape index), handgrip strength, and climbing-specific forearm strength.

Results: Climbers did not differ between age groups in the studied variables. Also, no significant correlations were found among anthropometric/body-built indices and forearm muscle performances, with age and maturity offset. However, when gender stratified, there were associations between forearm capacity in sitting position and maturity offset in girls (r = 0.73; p < 0.05) but not in boys.

Conclusion: Results could be explained by the assumption that each subsequent generation is better than the previous one. Also, the associations between performance variables and biological age in girls are probably related to girls’ earlier maturation and specificity of sports selection. Forearm muscle capacities are a crucial determinant of success in sports climbing, and a good assessment of these muscle groups could serve as a tool for sport-specific selection.

Evaluation of Supplement Use in Sport Climbers at Different Climbing Levels

The lack of specific recommendations on the use of supplements for sport climbers may be the reason for their misuse by athletes of this discipline. This study aimed to evaluate choices of dietary supplementation, the reasons for taking them, and the source of information on supplementation among sport climbers at different levels. In addition, how climbers subjectively evaluated the impact of their diets in supporting selected aspects of climbing training was evaluated. We enrolled 110 regular sport climbers (40 women and 70 men) from Wroclaw, Poland, who completed a validated questionnaire, assessing their use of dietary supplements, attitudes towards the influence of diet on sports performance, and climbing level. Their anthropometric measurements were also collected. Participants regarded diet as an important element of sports performance. Sport climbers indicated the Internet to be the main source of information on supplements. Health maintenance and improvement of recovery were the most frequently chosen reasons for taking dietary supplements. The most common supplements were isolated protein, vitamin C, vitamin D, magnesium, and amino acid blends. However, participants rarely used supplements suggested as beneficial for sport climbing performance. Therefore, developing recommendations for supplementation in sport climbing and promoting this should be an elementary part of the preparation for climbing training.

A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.

Head Injuries in Rock Climbing: A Scoping Review

Rock climbing was recognized as a sport at the 2020 Tokyo Olympics. Despite its increasing participation, there is no knowledge synthesis of head injuries (HIs), defined as any injury to the head, associated with climbing, making it challenging for clinicians to provide evidence-based care. Our aim was to synthesize HI literature within rock climbing and identify knowledge gaps. Six databases (Medline, Embase, Sports Medicine & Education Index, SPORTDiscus, CINAHL, and Cochrane) were searched. Two reviewers screened 345 studies and 31 studies were selected for data abstraction. We found the quality of individual studies mainly "fair" to "good." Both HI and traumatic brain injury (TBI) had inconsistent definitions and categorization. The HIs represented between 0 to 36% of reported climbing injuries. Between 11 to 100% of HIs were TBIs, defined as an HI with permanent or temporary neurological sequelae. The most common causes of HIs were outdoor falls and falling objects. Climbing-specific factors associated with the causes were infrequently examined in the literature. Data sources of safety practices were incomplete. Overall, there was a lack of literature examining HIs, mechanisms of injury, and safety practices associated with climbing. To improve the tracking of HIs in climbing, we suggest the use of consistent reporting standards and the creation of a climbing injury surveillance system.

Evaluation of Influencing Factors on the Maximum Climbing Specific Holding Time: An Inferential Statistics and Machine Learning Approach

Handgrip strength (HGS) appears to be an indicator of climbing performance. The transferability of HGS measurements obtained using a hand dynamometer and factors that influence the maximal climbing-specific holding time (CSHT) are largely unclear. Forty-eight healthy subjects (27 female, 21 male; age: 22.46 ± 3.17 years; height: 172.76 ± 8.91 cm; weight: 69.07 ± 12.41 kg; body fat: 20.05% ± 7.95%) underwent a maximal pull-up test prior to the experiment and completed a self-assessment using a Likert scale questionnaire. HGS was measured using a hand dynamometer, whereas CSHT was measured using a fingerboard. Multiple linear regressions showed that weight, maximal number of pull-ups, HGS normalized by subject weight, and length of the middle finger had a significant effect on the maximal CSHT (non-dominant hand: R²_corr = 0.63; dominant hand: R²_corr = 0.55). Deeper exploration using a machine learning model including all available data showed a predictive performance with R² = 0.51 and identified another relevant parameter for the regression model. These results call into question the use of hand dynamometers and highlight the performance-related importance of body weight in climbing practice. The results provide initial indications that finger length may be used as a sub-factor in talent scouting.

Effect of Indoor Climbing on Occupational Self-Efficacy and Employability: Results of a 10-Month Randomised Controlled Study of Persons with Intellectual Disability

(1) Background: Indoor climbing has different effects at various levels, including physical, psychological, and social ones. It is of high interest to assess whether social skills developed through climbing can be transferred to another environment, such as the working environment. This study investigates the effects of indoor climbing on employability and occupational self-efficacy of people with intellectual disability, who possess lower levels of social competences in general. (2) Methods: A randomised controlled study (RCT) experimental study design with three groups was formed-one intervention (IG) and two control groups (CGI&II). For 10 months, the IG went climbing (two times per week), whereas the first CG followed a sports programme and the second CG served as controls. (3) Results: IG participants showed significant improvement in mental and somatic health over time. Regarding occupational self-efficacy, females had a significantly lower mean. Nevertheless, only the IG's female participants mean increased significantly over time. (4) Conclusions: Indoor climbing can be effective for improving occupational health and can be beneficial for specific groups; however, additional research is needed to further specify the influence of indoor climbing on a wider variety of aspects of the life of people with intellectual disability.

To tape or not to tape: annular ligament (pulley) injuries in rock climbers-a systematic review

Background

Popularity of rock climbing is steadily increasing. With its inclusion in the Olympic Games this will likely continue. Injuries from rock climbing are also increasing. The most common injury is to the flexor pulley system, consisting of the finger flexors and five annular ligaments (pulleys). Treatment of this injury includes taping of affected fingers, but evaluation of this treatment was previously lacking. The aim of this review was therefore to assess whether taping is associated with better outcomes than non-taping. A secondary aim was to present treatment recommendations or areas for future research.

Methods

Systematic searches of PubMed, Scopus, SPORTDiscus, Cochrane Library, PEDro and CINAHL. Free text searches of Google Scholar. Citation searching. No restrictions to language, date of publication or study design. Included studies were assessed using Cochrane scale for clinical relevance, by two independent authors. Results were presented in narrative synthesis. Certainty of evidence (GRADE) was assessed by three authors. Review was done according to PICO-protocol and reported according to PRISMA-guidelines.

Results

After removing duplicates, 595 records were identified. Eight studies and one case report (in nine articles, one poster) were included, consisting of 206 rock climbers, four non-climbers, 23 pairs of cadaver hands. Clinical relevance ranged from 0 to 5 (median 2). Evidence of low to moderate certainty suggests that taping might reduce bowstringing of the finger flexor tendons by 15–22%. Evidence regarding pain, time for return to sports, shearing forces against pulleys, pulley ruptures and maximum voluntary contraction (MVC) were all regarded as “very low”, “very low to low” or “low”, and were not considered reliable. Evidence of moderate certainty suggests that taping has no effect on MVC or muscle activation in uninjured rock climbers. No adverse effects of taping were reported.

Conclusion

Low to moderate evidence suggests that taping might reduce bowstringing of the finger flexor tendons. Moderate evidence suggests that taping has no effect on MVC or muscle activation in uninjured climbers. For other outcomes more studies evaluating the effects of taping are needed.

Trial registration: PROSPERO CRD42021241271, date of registration: 18-04-2021.

[Bouldering: a sport with a high risk of intraarticular fractures]

Bouldering is a famous new sport with an increasing number of athletes. It became an Olympic sport in 2020. As no major sports equipment is required, everybody can take up bouldering even with little knowledge. However, despite the low climbing height there is a high risk of severe joint injuries, especially in the lower limb. Increasing numbers of climbers have led to an increase in injuries. New floor designs are supposed to reduce these risks. Improved documentation and specific research in bouldering should provide more insight into risks, injury patterns and prevention.

Attitudes towards disordered eating in the rock climbing community: a digital ethnography

BACKGROUND

Rock climbing is an antigravitational sport in which a low body weight may intuitively seem beneficial. A small number of studies have found an increased prevalence of disordered eating among adolescent and adult climbers. However, to date there has been no qualitative research into the attitudes towards disordered eating and body image in the rock climbing community.

METHODS

This explorative study employed a netnographic approach with the aim of understanding how topics related to food, dieting, and disordered eating in the climbing community are addressed in online conversations. Discussion forums on nine major climbing websites as well as three climbing-related forums on the online community Reddit were searched for posts and comments related to the research question. The collected data were then assessed through thematic analysis, generating a number of themes and subthemes.

RESULTS

Five overarching themes, labelled "Is there a problem?", "Subjective experiences", "Why and how is weight an issue?", "The importance of context", and "What can be done?", were identified among the forum posts. Most forum users acknowledge that eating disorders are indeed a problem relevant to the climbing community, although a significant minority disagrees. While the assumed benefits of a low weight are clearly a dominant idea among climbers, weight may have become less important over time. Forum users also attest to ways in which climbing may in fact be helpful in fostering a positive body image, such as highlighting performance over aesthetics or emphasizing wholesome community values.

CONCLUSIONS

This study demonstrates that the topic of disordered eating and negative body image is far from a blind spot or a "dark secret" within the rock climbing community, as is sometimes claimed. An undue focus on low body weight among climbers must be balanced by proper nutritional advice and healthy role models, not least for young climbers who may feel pressured to lose weight as a quick but short-sighted way to boost performance. Clinicians should be aware of the prevailing 'weight talk' in the climbing community and be attentive to negative body image and disordered eating in their patients.

Upper Extremity Injuries in Rock Climbers: Diagnosis and Management

Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.

Cortical Bone Thickness, Base Osteophyte Occurrence and Radiological Signs of Osteoarthritis in the Fingers of Male Elite Sport Climbers: A Cross-Sectional 10-Year Follow-Up Study

Background: Sport climbing places high mechanical loads on fingers. In 2012, our research group demonstrated adaptations of climbers’ cortical bones with the presence of osteophytes compared to non-climbing controls.

Objectives: 1) To investigate 10-year changes in cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis in the fingers of elite male sport climbers with more than 25 years of climbing history and 2) to compare cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis between male sport climbers and age-matched controls at the 10-year follow-up.

Methods: All 31 elite sport climbers who participated in both the baseline and 10-year follow-up assessments (follow-up rate 100%) were examined by means of X-rays. Cortical bone thickness, presence of osteophytes and signs of osteoarthritis according to Kellgren-Lawrence were obtained and compared to the baseline values 10 years earlier and to age-matched controls at the follow-up (n = 15).

Results: Significantly increased cortical bone thickness over the past 10 years was observed in climbers (mean absolute difference with 95% CI:0.98 mm (0.77 mm, 1.19 mm); p <0.001). Moreover, compared to age-matched controls, climbers had significantly thicker cortical bone at the 10-year follow-up (mean absolute difference with 95% CI:0.86 mm (0.61 mm, 1.12 mm); p <0.001). In climbers, osteophytes and clear signs of osteoarthritis were mainly seen in DIP joints. Signs of osteoarthritis according to Kellgren-Lawrence were more prevalent than 10 years before in most joints. In lateral radiographs, base osteophytes were not significantly more prevalent than 10 years before in most of the joints. The percentage of climbers who had osteophytes in any DIP (PIP) joint increased from 93.5% (67.7%) at baseline to 100% (74.2%) at the 10-year follow-up. The percentage of climbers who had clear signs of osteoarthritis according to Kellgren-Lawrence in any DIP (PIP) joint increased from 12.9% (9.7%) at baseline to 74.2% (64.5%) at 10-year follow-up. Only a few such degenerative changes were found in age-matched controls.

Conclusion: An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce lifelong mechano-adaptation of the cortical bone thickness of all phalanges. At the 10-year follow-up, a further significant increase in radiographic signs of osteoarthritic changes was observed.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers

INTRODUCTION

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers.

METHODS

Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y^-1, prior to age 12 y (late specialization if after age 12 y).

RESULTS

Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups.

CONCLUSIONS

Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

Nonoperative Treatment of Finger Flexor Tenosynovitis in Sport Climbers—A Retrospective Descriptive Study Based on a Clinical 10-Year Database

Simple Summary

Finger flexor tenosynovitis is among the most frequent overuse injuries in sport climbers. Targeted therapy is currently based mostly on reports of the anecdotal practical experience of single centers rather than scientific investigations, as there is very little research available on this pathology. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis treatments in sport climbers by retrospectively asking patients about injury triggers, therapy contents and outcomes. All patients were initially treated conservatively, and only one of the patients needed further therapy in the form of a single injection with hyaluronic acid; none of them underwent further operative treatment. The average symptom duration was 30.5 weeks, and all patients were able to resume climbing, with approximately 75% of them regaining or exceeding their initial climbing level. These good to excellent outcomes and no correlation between particular therapy contents and therapy outcome suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations from this study.

Abstract

The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.

Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial

OBJECTIVES

Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT.

DESIGN

We conducted a randomized, controlled, assessor-blinded non-inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79).

METHODS

Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ-9) at the beginning and end of the treatment phase as well as one year after the end of treatment.

RESULT

In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT -8.06, 95% CI [-10.85, -5.27], p < .001; CBT -5.99, 95% CI [-8.55, -3.44], p < .001). The non-inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15).

CONCLUSION

Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression.

PRACTITIONER POINTS

Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body-related interventions are still underrepresented in current treatments for depression. Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall. The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT). Additionally the 10-weeks BPT-programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health-related quality of life, coping, body image, self-efficacy, and global self-esteem.

Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial

BACKGROUND

Recent studies have suggested that therapeutic climbing/bouldering may have positive effects on perceived self-efficacy. Nevertheless, there is still an urgent need for high-quality studies, as many existing studies have suffered from methodological problems. Therefore, the current work was aimed at investigating the effect of a manualized bouldering psychotherapy (BPT) on perceived self-efficacy in people with depression, compared with a home-based physical exercise program (EP) and state-of-the-art cognitive behavioral group therapy (CBT).

METHODS

In a prospective, multicenter, randomized controlled trial, 233 people with depression were randomly assigned to one group (BPT, EP, or CBT). Perceived self-efficacy was assessed at baseline (t0) and directly after the 10-week intervention period (t1) with the GSE. In addition, depression was assessed with the PHQ-9 and the MADRS. We computed t tests, analyses of variance (ANOVAs), confounder-adjusted hierarchical regression analyses, mediation analyses, and several sensitivity analyses.

RESULTS

BPT participants showed a significantly larger increase in perceived self-efficacy on the GSE compared with the EP (an increase of 3.04 vs. 1.26 points, p = .016, Cohen's d = 0.39). In the confounder-adjusted hierarchical multiple regression analysis, group allocation (BPT vs. EP) was found to be the only significant predictor of the postintervention GSE score (β = .16, p = .014) besides the baseline GSE score (β = .69, p < .001). No differences were found between BPT and CBT participants regarding the effect on perceived self-efficacy. Only in the CBT group, the relationship between depression at baseline and postintervention was partially mediated (23%) by perceived self-efficacy.

CONCLUSIONS

Participation in the manualized BPT in a group setting leads to a clinically relevant enhancement of perceived self-efficacy in people with depression. This effect is superior to that of physical exercise alone. The results provide also initial indications that BPT is comparable to CBT in enhancing perceived self-efficacy, suggesting a strong case for a broader use of BPT as a supplement to existing health services. Future studies should focus on the modes of action of BPT and its effect on perceived self-efficacy in people with other mental or physical disorders. Trial registration ISRCTN12457760, registered partly retrospectively, 26 July 2017.

MRI of Finger Pulleys at 7T-Direct Characterization of Pulley Ruptures in an Ex Vivo Model

The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations.

Biomechanical technology of injury prevention in the training of specialists in physical education and sports

Purpose: to develop and experimentally test the biomechanical technology of injury prevention of future specialists in physical education and sports in the process of professional training (rock climbing for example). Material and Methods. The participants of this study were 84 male students engaged in amateur climbing aged 18-19 years. All athletes were also students of physical education faculties of Ukrainian universities; 40 athletes were in the experimental group and 44 athletes were in the control group. The biomechanical technology for injury prevention in the training of specialists in physical education and sports has been developed on rock climbing  for example. Developed biomechanical technology for injury prevention contains 3 areas: 1 - theoretical; 2 - analytical; 3 - practical. Injury risk (incidence) was defined as the number of injuries to the total number of athletes in the analyzed group. Relative risk (incidence rate ratio) was determined by the ratio of risk in the control group to the risk in the experimental group. The chance of injury was defined as the ratio of the number of injuries to the number of uninjured athletes in the analyzed group. The relative chance (Odds Ratio) was defined as the chances of injury in the control group to the chances of injury in the experimental group. These indicators were determined separately for low, medium and severe finger injuries. Results. The applied technology of injury prevention significantly influences the reduction of the number of injuries of athletes – future specialists on the physical education and sports (on rock climbing for example). It is established that the application of the developed technology of injury prevention reduces the risk of finger injuries: low complexity – in 2.364 times (95% CI = 0.925-6.041, P> 0,05) times; medium complexity – in 3.333 times (95% CI = 1.001-11.096, P (Fisher) = 0.030); high complexity – in 8.182 times (95% CI = 1.084-61.749, P (Fisher) = 0.011). Conclusions. The application of the developed biomechanical technology of injury prevention in the process of training specialists in physical education and sports significantly reduces the risk of injury to students.

Coaches' Attitudes Toward Campus Board Training in Adolescent Climbers in the United States

INTRODUCTION

Campus board training in adolescent climbers is controversial. Evidence, albeit limited, suggests this type of training may lead to the development of finger epiphyseal stress fractures. The purpose of the present study was to investigate coaches' attitudes toward campus board training in the United States.

METHODS

Surveys were sent to 116 coaches at gyms across the United States with affiliated adolescent climbing teams. Outcomes collected included demographic information, training time, campus board use prevalence, coaches' attitudes toward campus board use, and willingness to participate in future research.

RESULTS

Seventy-three coaches representing 3090 adolescent climbers completed the survey. Forty-six coaches (63%) reported using full weight (no foot contact) campus board training in some or all of their climbers. A variety of factors were cited by coaches when deciding which climbers should or should not use the campus board, including physical maturity, climbing ability, and age, among others.

CONCLUSIONS

Climbing coaches in the United States disagree on the use of campus board training in adolescent climbers. Some coaches avoid using this training modality entirely, whereas others believe certain climbers can use it safely. There is lack of consensus in determining who those certain climbers are.

Finger Flexor Pulley Injuries in Rock Climbers

Finger flexor pulley system injuries are the most common overuse injury in rock climbers. These injuries occur rarely outside of rock climbing, owing to the sport's unique biomechanical demands on the finger. As rock climbing continues to grow and earn recognition as a mainstream sport, an understanding of how to diagnose and treat these injuries also has become important. Our purpose is to describe current concepts in anatomy, biomechanics, clinical evaluation, imaging, prevention, and treatment strategies relating to finger flexor pulley system injuries. Our literature search was performed on PubMed with MeSH terms and keywords as subject headings to meet the objectives of this review. The "crimp grip" used in rock climbing is the mechanism for these injuries. The A2, A3, and A4 pulleys are at the highest risk of injury, especially when loaded eccentrically. Physical examination may reveal clinical "bowstringing," defined as the volar displacement of the flexor tendons from the phalanges; however, imaging is required for characterization of the underlying injury. Ultrasound is highly sensitive and specific for diagnosis and is recommended as the initial imaging technique of choice. Magnetic resonance imaging is recommended as an additional imaging study if ultrasound is inconclusive. Properly warming up increases the amount of physiologic bowstringing and is thought to prevent injury from occurring. Pulley injuries may be classified as grade I through IV. Conservative treatment, including immobilization, the H-tape method, and the use of a protective pulley splint, is recommended for grade I to III injuries. Surgical repair is reserved for grade IV injuries that are not amenable to conservative treatment.

Acute Hamstring Muscle Tears in Climbers-Current Rehabilitation Concepts

Acute hamstring injuries are often caused by the heel hook technique. This technique is unique to climbing and causes injury to muscular and inert tissues of the posterior thigh. The heel hook is used by climbers during strenuous ascent on overhanging walls and when crossing difficult terrain. The technique reduces the amount of upper body strength required during strenuous climbing because the climber's center of mass is retained within the base of support. The heel hook is stressful collectively for the hamstring muscle group and musculotendinous junction. Depending on injury severity, both conservative and surgical methods exist for the management of hamstring injuries. Contemporary approaches to rehabilitation primarily advocate the use of eccentric muscle strengthening strategies because of high rates of elongation stress associated with sprinting and team sports. However, there is reason to doubt whether this alone is sufficient to rehabilitate the climbing athlete in light of the high degree of concentric muscle strength required in the heel hook maneuver. This review examines the contemporary rehabilitation and strength and conditioning literature in relation to the management of acute hamstring musculotendinous injuries for the climbing athlete. The review provides a comprehensive approach for the rehabilitation and athletic preparation of the climbing athlete from the initial injury to full return to sports participation.

Olympic competition climbing: the beginning of a new era-a narrative review

Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.

The Association of Finger Growth Plate Injury History and Speed Climbing in Youth Competition Climbers

INTRODUCTION

Finger growth plate injuries are the most common injury among youth climbers, and the association between these injuries and speed climbing, a mandatory discipline in the 2021 Olympics, has not been examined previously. Our primary purpose was to examine the demographic and training characteristics of adolescent competition climbers who reported a history of a finger growth plate injury compared to those who did not report a history of a finger growth plate injury. Our secondary purpose was to determine whether training characteristics differed between adolescent competition climbers who did and did not report speed climbing.

METHODS

Our study was a cross-sectional study design. We surveyed adolescent climbers who competed in the 2017 USA Climbing Sport and Speed Youth National Championships. Questions assessed climbing injury history and current rock-climbing training characteristics.

RESULTS

Two-hundred sixty-seven adolescent competition climbers, 14±3 (9-18) y of age (mean±SD with range), completed the survey. Those with a history of a finger growth plate injury reported greater approximate time spent speed climbing throughout the year (β=1.28, 95% CI 0.11-2.46, P=0.032) and training regularly on the International Federation of Sport Climbing speed wall (adjusted odds ratio=3.95, 95% CI 1.14-13.7, P=0.031).

CONCLUSIONS

Training regularly at practices on the speed wall was associated with a self-reported history of finger growth plate injuries among elite youth competition climbers. Speed climbing should be limited, especially during periods of rapid growth.

Effort Thrombosis Presenting as Unilateral "Pumped" Arm in a Climber

Upper extremity injuries are common among the growing population of climbers. Although conditions affecting musculoskeletal structures are the most common causes of symptoms, a comprehensive differential diagnosis is necessary to avoid the misdiagnosis of high-morbidity conditions in this patient population. We present a case of a climber with acute edema, erythema, and pain of the entire right upper extremity. After confirmation of an upper extremity deep vein thrombosis by ultrasound, and in the absence of secondary causes for his thrombotic process, he was diagnosed with effort thrombosis. The patient was treated acutely with anticoagulation, catheter thrombectomy, direct thrombolysis, and balloon angioplasty followed by surgical decompression of the subclavian vein. Owing to the importance of early diagnosis and initiation of treatment, it is critical to keep disorders affecting the upper thoracic vascular structures in consideration.

Prevalence of Disordered Eating Among International Sport Lead Rock Climbers

Disordered eating (DE) is characterized as a range of irregular eating patterns or behaviors, which may lead to pathological eating or a clinical eating disorder diagnosis. DE patterns are associated with a variety of negative health outcomes. The prevalence of DE is highest in female athletes who participate in aesthetic or weight dependent sports. Elite rock climbers tend to be strong, small and lean, but the prevalence of DE in rock climbers is unknown. The purpose of the present study was to assess DE prevalence in a large group of international rock climbers and to explore the relationship between sport rock climbing ability and DE. A web-based survey assessed both DE (Eating Attitudes Test-26) and climbing ability based on the International Rock Climbing Research Association's position statement on comparative grading scales. The survey was distributed to international climbing communities; 810 individuals attempted the survey; 604 completed all questions; 498 identified as sport lead climbers. The majority of sport lead climbers were lower grade/intermediate (57.8%), compared to advanced (30.7%) and elite/higher elite (11.4%), and male (76.9%). Forty-three sport lead climbers reported a score of 20 or above on the EAT-26 indicating an 8.6% prevalence of DE in this sample. Male climbers had a DE prevalence of 6.3% (24 of 383) and female climbers more than doubled that with 16.5% (19 of 115). Chi-square analysis revealed that DE was associated with climbing ability level [χ2 (2, n = 498, 8.076, p = 0.02)], and when analyzed by sex, only the female climbers had a significant relationship of DE with climbing ability [χ2 (2, n = 115, 15.640, p = 0.00)]. These findings suggest sport lead rock climbers are not immune to DE and that the risk is elevated in female climbers, particularly at the elite/high elite climbing ability level. Our research indicates further investigations are warranted to determine if and how disordered eating behaviors affect health and performance of adult rock climbers.

Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes

BACKGROUND

There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes.

PURPOSE

To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores.

RESULTS

Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5).

CONCLUSION

Increased attention should be placed on the climber's knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.

Joint Mobility Protection during the Developmental Age among Free Climbing Practitioners: A Pilot Study

Sport-climbing popularity increased intensely over the past years. Particularly, children's and adolescents' interest therein is constantly growing. Despite a large effort in preventing injuries and muscle overloads, a fine-tuned training for each sensitive phase of child development is still needed. The objective of the study was to evaluate an innovative training program aimed at the preservation of joint mobility during the developmental age. This article relies on the results of a steady training program allowing to retain joints integrity among the practice of sport climbing in children. Joint mobility changes have been monitored before and after a one-year training program in fifteen subjects aged between 8 and 18 years. Subjects were divided into three groups depending on age (Turgor Secundus, Proceritas Secunda and Turgor Tertius). The motor tests administered were the sit-and-reach test, coxo-femoral mobility test and scapula-humeral mobility test. Our results showed that one-year training improved joint mobility at each analyzed phase, suggesting that this training program could improve mobility and flexibility. Given the importance of joint mobility preservation for discipline-related injuries prevention and eventually recovering, it is essential to provide a specific training program as a route to approach sport climbing, and even more importantly, at an early age. This work represents a preliminary study in order to demonstrate both efficacy on the joint mobility and the requirement of our playful work to support the global sport-climbing workout.

Evaluation of Rock Climbing Related Injuries in Older Athletes

INTRODUCTION

With the growing enthusiasm from people of all ages about rock climbing and bouldering, adaptions and medical conditions of the older athlete have become increasingly important. We aimed to analyze injury demographics, distribution, and severity for the older rock-climbing athlete.

METHODS

During a 3-y period, we performed a single-center injury surveillance in athletes ≥35 y of age presenting with rock climbing-related injuries or complaints. A standard questionnaire and examination protocol were conducted.

RESULTS

A total of 198 patients (age 44.2±7.1 [35-77] y) (mean±SD, with range) with 275 independent injuries were recorded. Ninety percent of all injuries affected the upper extremity, 6% the lower extremity, and 4% other body regions. The Union Internationale des Associations d'Alpinisme injury scores were 2.0±0.3 (1-4), and no fatalities occurred. Acute injuries were observed in 32% and overuse injuries in 68% of all injuries. Among the overuse injuries, 47% were classified as degenerative overuse conditions. Athlete age did not significantly correlate with the development of overuse injuries and UIAA injury score, but subgroup analysis showed a weak correlation of the climber age with the development of degenerative conditions (P<0.05). The leading diagnosis of degenerative conditions was subacromial impingement syndrome of the shoulder.

CONCLUSIONS

Compared to younger athletes, older rock climbers demonstrate a higher proportion of overuse injuries, especially degenerative conditions. Profound knowledge of climbing injuries patterns and conditions in older rock climbers is crucial to prevent injuries among all age groups and to decrease the number of degenerative injuries.

Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review

Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.

ANALYSIS OF THE PREVALENCE OF INJURIES AND ASSOCIATED FACTORS IN BRAZILIAN CLIMBERS

ABSTRACT Introduction Many Brazilians became climbing enthusiasts in the 20th century, and the activity was recently included as an Olympic sport at the Tokyo 2020 Olympic Games. With the increase in the number of climbers seeking to beat personal and/or competitive records, the number of injuries has also increased. Objectives To verify the prevalence of injuries in Brazilian climbers, as well as their association with sociodemographic characteristics and sport performance. Methods A cross-sectional, descriptive and analytic observational study was conducted from March 2018 to May 2018 with the application of a virtual questionnaire for 266 Brazilian climbers. The statistical analysis was performed subsequently. Results The prevalence of injuries in Brazilian climbers was 71.8%. The main characteristics of the injuries that merited special attention were musculotendinous site (50.8%), sport climbing (22.0%), upper limb (50.3%) and mechanism of abrupt movement (20.4%). The most popular treatment was medical in combination with physiotherapy (34.5%), and time off was generally more than 30 days (50.3%). There was a significant association (p <0.05) of the injuries with age, gender, region of the country, BMI, level of education and involvement in other sports, as well as athletic and recreational category, climbing time, basic course certificate, warming up, monthly rock climbing and weekly indoor climbing frequency, and the climbing grade. Conclusion Due to the increase in the popularity of the sport and the high prevalence of climbers with a history of injuries, multiprofessional follow-up is needed to procure risk reduction programs and to enhance climbers’ awareness of the factors associated with these injuries. Level of Evidence III; Study of nonconsecutive patients, without consistently applied ‘’gold’’ reference standard.

Effects of New Zealand blackcurrant extract on sport climbing performance

PURPOSE

Blood flow to skeletal muscles and removal of metabolic by-products during a sport climb are essential to optimise performance and recovery. New Zealand blackcurrant (NZBC) extract has enhanced blood flow and performance in other exercise modalities. We examined the effect of NZBC extract on sport climbing performance and recovery.

METHODS

The study employed a double-blind, randomised, crossover design. Male sport climbers (n = 18, age 24 ± 6 years, height 179 ± 6 cm, mass 71.4 ± 7.8 kg, French grade 6a-8b) undertook 7 days supplementation of NZBC extract (600 mg day^-1 CurraNZ™ containing 210 mg anthocyanins) or a placebo (PL). Climbing ability was assessed through hang time (HT), pull-ups and total climbing time (TCT) in 3 intermittent climbing bouts on a Treadwall M6 rotating climbing wall to exhaustion with 20 min recovery between climbs. Heart rate (HR), blood lactate (BL), forearm girth (FG) and hand grip strength (HGS) were recorded.

RESULTS

NZBC extract had no effect on pull-ups but provided a trend for higher HT and significantly improved TCT (+23%) compared to PL (-11%) over three climbs. HR, BL, FG and HGS all indicated that 20 min was insufficient for physiological recovery between the three climbing bouts indicating accumulative fatigue regardless of supplement condition.

CONCLUSION

Despite indices of progressive fatigue across three bouts of climbing, NZBC extract facilitated not only a maintenance of TCT but an improved climbing endurance as compared with the PL condition. Blackcurrant anthocyanin-derived metabolites seem to affect physiological responses that facilitate sport climbing performance.

Assessment of Dietary Intake and Eating Attitudes in Recreational and Competitive Adolescent Rock Climbers: A Pilot Study

The dietary intake and eating attitudes of adolescent climbers has not previously been studied. To fill this knowledge gap, we administered three surveys to 22 rock climbers (13 males, 9 females, age 14.2 ± 1.9 years): climbing ability, three-day dietary recall, and Eating Attitude Test-26 (EAT-26). The majority (82%) of climbers did not meet their target energy intake (target = 2,471 ± 493 kcal·day⁻¹; actual = 1,963 ± 581 kcal·day⁻¹) (p = 0.003) and 86% of climbers consumed below their target carbohydrate intake (target = 283 ± 67 g·day⁻¹; actual intake = 226 ± 72 g·day⁻¹) (p = 0.009). Average dietary protein intake was 95 ± 51 g·day⁻¹, with the majority of climbers meeting their target intake of 88 ± 21 g (p = 0.580). Seventy-three percent of climbers consumed below their target dietary fat intake (target = 90 ± 21 g·day⁻¹; actual = 69 ± 20 g·day⁻¹) (p = 0.001). Average EAT-26 scores were 5.3 ± 4.1, indicating minimal risk of disordered eating attitudes/behaviors. There were no significant differences in boulderers vs. top rope climbers for energy/macronutrient intake, BMI, and EAT-26 score. There were no associations between energy intake and EAT-26 score (R² = 0.245, p = 0.271) or climbing ability and EAT-26 score (R² = p = 0.217). These data suggest that, with the exception of dietary protein intake, adolescent climbers fail to meet target dietary intakes, and exhibit minimal risk of disordered eating.

Rock Climbing Injuries Treated in US Emergency Departments, 2008-2016

INTRODUCTION

Previous research identified a trend for increasing numbers of injuries sustained while rock climbing. This study investigates whether that trend continued and describes characteristics of climbing injuries.

METHODS

The National Electronic Injury Surveillance System registry was searched for rock climbing injuries in US emergency departments in 2008 through 2016 among patients aged ≥7 y. Variables included each patient's age, diagnosis, injured body part, mechanism of injury, and disposition. Injuries were graded using International Mountaineering and Climbing Federation injury grades. National estimates were generated using sample weighting.

RESULTS

An estimated 34,785 rock climbing injuries were seen in emergency departments nationally, a mean of 3816 per year (SD 854). The median age of injured climbers was 24 y (range 7-77), with those aged 20 to 39 y accounting for 60% and males for 66%, respectively. Fractures (27%) and sprains and strains (26%) were the most common types of injuries. The most frequently injured body parts were lower extremities (47%), followed by upper extremities (25%). The most commonly fractured body part (27%) was the ankle. The knee and lower leg accounted for 42% of all lacerations and were 5.8 times as likely as lacerations to other body parts. Falls were the most common mechanism, accounting for 60% of all injuries.

CONCLUSIONS

This study reports continued increase in annual numbers of climbing injuries. Whether this is based on a higher injury rate or on a higher number of climbers overall cannot be stated with certainty because no denominator is presented to estimate the injury rate among climbers.

[Current state of the scientific literature on effects of therapeutic climbing on mental health - conclusion: a lot to do]

BACKGROUND

Therapeutic Climbing is applied in physiological as well as in psychological rehabilitation programs. Systematic reviews have been conducted, evaluating the physiological effects of therapeutic climbing. The aim of the following article is a review on existing literature about the psychological effects of climbing therapy.

METHODS

We searched the databases of PubMed, Scholar and ScienceDirect up to December 2017 in German and English language. Trials were included if they assessed psychological variables in climbing interventions.

RESULTS

Seven articles were included in the following review. Effectiveness of climbing therapy was studied in a) adult inpatients with mental disorders (n = 3), b) adult outpatients with mental disorders (n = 1), c) children with motoric deficits and disabilities (n = 2), d) healthy adults (n = 1). All trials had major methodological limitations. Control groups if present, were defined differently. Three trials assessed self-efficacy and revealed enhanced self-efficacy after the climbing intervention. No psychological differences were seen between aerobic exercise and climbing therapy in healthy adults. Acute positive affective changes were seen in in-patients with major depressive disorders after a climbing session compared to a relaxation session.

CONCLUSION

The effectiveness of climbing therapy on psychological outcomes remains unclear. Limited evidence with varying age groups (children and adults) and a high risk of bias shows enhanced self-efficacy through climbing therapy. There is a need for further studies in children and adults on psychological outcomes through climbing therapy, especially in comparison with aerobic activity interventions.

ACTN3 Genotype in Professional Sport Climbers

Ginszt, M, Michalak-Wojnowska, M, Gawda, P, Wojcierowska-Litwin, M, Korszeń-Pilecka, I, Kusztelak, M, Muda, R, Filip, AA, and Majcher, P. ACTN3 genotype in professional sport climbers. J Strength Cond Res 32(5): 1311–1315, 2018—The functional RR genotype of the alpha-actinin-3 (ACTN3) gene has been reported to be associated with elite sprint/power athlete status. Although large and rapidly increasing number of studies have investigated the associations between the ACTN3 genotypes and athletic performance in various sport disciplines, there is a lack of studies on the genetic predisposition in sport climbing, which was selected to be part of the next Summer Olympic Games in Tokyo 2020 with three subdisciplines (“lead climbing,” “speed climbing,” and “bouldering”). The aim of the study is to determine the frequency distribution of ACTN3 genotypes and alleles in professional lead climbers and boulderers. 100 professional sport climbers from Poland, Russia, and Austria were divided into 2 equal groups: professional boulderers and professional lead climbers were involved in the study. ACTN3 allele frequencies and genotypes were compared with 100 sedentary controls. Genotypes were determined using polymerase chain reaction–restriction fragment length polymorphism method. The percent distribution of RR genotype in the boulderers was significantly higher than in lead climbers and controls (62 vs. 26%; 33%, respectively; χ² = 17.230, p = 0.0017). The frequencies of ACTN3 R allele in boulderers differed significantly from lead climbers and controls (77 vs. 51%; 58%, respectively; χ² = 15.721, p = 0.0004). The proportion of the ACTN3 RR genotype is significantly higher in boulderers than in lead climbers and may be related to the specific type of predisposition to this subdiscipline.

Long-Term Radiographic Adaptations to Stress of High-Level and Recreational Rock Climbing in Former Adolescent Athletes: An 11-Year Prospective Longitudinal Study

BACKGROUND

In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport.

PURPOSE

While radiographic changes in long-term climbers are known, there are little data available on adolescent climbers. The question arises as to whether climbing at high levels at a young age leads to radiographic changes and possibly an early onset of osteoarthritis of the finger joints.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 19 members of the German Junior National Team (GJNT group) and 18 recreational climbers (RC group) were examined clinically and radiographically in 1999. In 2011, these climbers were re-examined (mean follow-up, 11.3 ± 1.2 years). Radiographs were evaluated using a standard protocol, searching for physiological adaptations such as cortical thickness of the middle phalanx and an increased adopted Barnett-Nordin index, as well as for early-onset osteoarthritic changes of the hand. In contrast to the Kellgren-Lawrence scale, subchondral sclerosis was added to the group of physiological, adaptive stress reactions and was not defined as osteoarthritis. Osteoarthritis was defined by a Kellgren-Lawrence grade ≥2.

RESULTS

Overall, 15 of 19 (follow-up rate, 78.9%) climbers in the GJNT group and 13 of 18 in the RC group (follow-up rate, 72.2%), with a mean age of 26.8 years, were examined at the 11-year follow-up. Five climbers (33%) in the GJNT group presented with a decreased range of motion for the finger joints, in contrast to only 1 climber (8%) in the RC group. Radiographic stress reactions of the hand were found in 80% of the GJNT group and 46% of the RC group, including cortical hypertrophy (GJNT: 73%; RC: 23%), subchondral sclerosis (GJNT: 80%; RC: 31%), a broadened proximal interphalangeal joint base (GJNT: 67%; RC: 38%), and a broadened distal interphalangeal joint base (GJNT: 53%; RC: 31%). Training intensity in 1999 and body weight in 1999 were significant for the development of radiographic stress reactions in 2011 (P < .05 for both). Signs of early-stage osteoarthritis were seen in 6 climbers: 4 (27%) in the GJNT group and 2 (15%) in the RC group. Significant statistical influences for the development of early-onset osteoarthritis were found for overall total training years (P = .024), use of campus board training in 1999 (P = .033), and climbing level (P = .030).

CONCLUSION

One-quarter of climbers who performed at a high level in their youth showed a "mild" form of osteoarthritis (Kellgren-Lawrence grade 2). In analyzing the training regimens of our climbers for longer than 10 years, we conclude that intensive finger training (eg, campus board training) can lead to early-onset osteoarthritis of the hand. We also demonstrate that a high Union Internationale des Associations d'Alpinisme (UIAA) climbing level correlates with the risk for early-onset osteoarthritis of the hand and therefore must be seen as a risk factor for developing early-onset osteoarthritis of the finger joints.