No pain no gain: a survey of use of healthcare and reasons not to seek healthcare by Norwegian climbers with chronic injuries

Painfully ignorant? Impact of gender and aim of training on injuries in climbing

Introduction

Climbing has evolved from an obscure outdoor sport to a predominantly indoor sport with the rise of mainstream climbing on artificial walls. Reported climbing-related injuries were predominantly chronic and may be avoided with proper planning of training. All climbers, regardless of age and gender, are training on the same routes and perform similar movements; however, few studies have investigated gender-specific injuries in climbing.

Objectives

Assess the distribution of chronic climbing injuries in an international population with gender-specific analyses and assess the impact of the person's training focus or aim of training on those injuries.

Methods

A cross-sectional survey using a web-based item-driven questionnaire was created and promoted using social media and several climbing media stakeholders. All climbers engaged in either sport climbing, bouldering or traditional climbing were included.

Results

The survey received 1513 responses (877 men, 427 women and 9 not reporting gender), of which 50.3% (n=665; 51.4% men and 48.0% women) had experienced an injury in the past 12 months. There were significant differences in injuries in feet/ankle (p=0.014), neck (p=0.03), head (p=0.0001), shoulder (p=0.001), elbow (p=0.021) and fingers (p=0.003).

Conclusion

Over 50% of the climbers experienced an injury in the past 12 months. The most common injuries were to the shoulders (women) and fingers (men). There were significant differences between the genders regarding injury site and prevalence. The gender differences may be affected by the aim for training and the style of climbing.

Wrist Injuries in Climbers

BACKGROUND

Acute and chronic injuries to the wrist are among the most common sport-related complaints of climbing athletes but have not been extensively evaluated in this population. Therefore, it is important to categorize climbing injuries to the wrist, analyze risk factors, and assess treatment outcomes.

PURPOSE

To evaluate the distribution, outcomes, and influencing factors of wrist injuries in climbers.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Climbing athletes with wrist injuries who presented to our specialized sports medical center over the course of 4 years (2017-2020) were selected. All had prospectively completed questionnaires including their climbing-specific background (years of training, climbing level, training methods, etc). Injuries were analyzed (International Climbing and Mountaineering Federation [UIAA] grade and diagnosis), and treatment methods and outcomes were retrospectively assessed with a minimum follow-up of 2 years. Parameters included the climbing score, visual analog scale for pain score, Patient-Rated Wrist Evaluation (PRWE) score, and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score including the sport component (DASH-Sport) score before and after treatment as well as time to return to climbing.

RESULTS

A total of 69 patients (25 female, 44 male) with 78 wrist injuries were identified and analyzed. Of these, 7 injuries were bilateral, occurring at the same time, and 2 injuries were independent reinjuries to either the same or the contralateral side. In addition, 24 injuries (30.8%) were acute, while 54 (69.2%) were chronic. Overall, 2 injuries had a UIAA grade of 3; all others had a UIAA grade of 2. The most frequent injuries were synovitis of the ulnocarpal recess, ulnar impaction, bone marrow edema of the lunate, wrist sprains (joint capsular pain with stress, with no pathological finding on magnetic resonance imaging), and wrist ganglion cysts. Nonoperative treatment was performed for 61 of the injuries, while 17 were treated surgically. In 51 cases (65.4%), injuries healed without consequences; in 27 cases (34.6%), discomfort remained. The visual analog scale pain score decreased from 4.8 ± 1.9 before treatment to 0.7 ± 1.0 after treatment (P < .001), the PRWE score decreased from 53.6 ± 24.9 to 10.3 ± 13.1 (P < .001), the QuickDASH score improved from 53.0 ± 16.6 to 20.0 ± 20.2 (P < .001), and the DASH-Sport score improved from 82.0 ± 16.1 to 38.1 ± 23.5 (P < .001). The climbing score improved from 2.5 ± 1.1 to 4.3 ± 1.0 points (P < .001). The patient-reported number of days with pain was negatively correlated with changes in the PRWE score (r = -0.351; P < .001), QuickDASH score (r = -0.316; P = .007), and climbing score (r = -0.264; P = .025) as well as the number of days without climbing (r = -0.266; P = .025). The number of days without climbing was positively correlated with changes in the PRWE score (r = 0.369; P < .001).

CONCLUSION

Wrist injuries in climbers constituted a diverse set of diagnoses. Ulnar-sided injuries were most common, and many patients had >1 diagnosis. Outcomes for all treatment methods (surgery and nonoperative care) were favorable, but approximately one-third of climbers had persistent wrist discomfort after treatment, underscoring the need for accurate diagnoses and acute and expert care.

Self-Reported Injuries in Indoor Gym-Based Rock Climbers: A Retrospective Study of Predictors of Prolonged Injury and Seeking Medical Care

INTRODUCTION

Indoor climbing injuries are often related to overuse, and climbers choose between self-management and seeing a medical practitioner. This study evaluated predictors of prolonged injury and seeking medical care for indoor climbing injuries.

METHODS

A convenience sample of adult climbers from 5 gyms in New York City was interviewed about injuries over the past 3 y, because of which they stopped climbing for at least a week or saw a medical practitioner.

RESULTS

In total, 122 of 284 (43%) participants had at least 1 injury, for a total of 158 injuries. Fifty (32%) were prolonged, lasting at least 12 wk. Predictors of prolonged injury included older age (odds ratio [OR], 2.28, per 10-y increase; 95% CI, 1.31-3.96), hours per week spent climbing (OR, 1.14, per 1-h increase; 95% CI, 1.06-1.24), climbing difficulty (OR, 2.19, per difficulty group increase; 95% CI, 1.31-3.66), and years of climbing experience (OR, 3.99, per 5-y increase; 95% CI, 1.61-9.84). Only 38% of injuries were seen by a medical practitioner. Predictors of seeking care included prolonged injury (OR, 3.04; 95% CI, 1.39-6.64) and rope climbing preference (OR, 1.98; 95% CI, 1.02-3.82). The most common theme for seeking care was serious pain or interference with climbing or daily activities.

CONCLUSIONS

Despite prolonged injuries being common, especially in older, more experienced, and higher-level climbers, only a third of climbers with injuries seek medical care. Outside of injuries causing minimal pain or limitation, those who self-managed reported receiving advice from other climbers or online research as a prominent reason for that choice.

Top of the podium, at what cost? injuries in female international elite climbers

Objectives

Competitive sport climbing has made its way to the Olympic stage. This prestige has brought about route setting and training alterations which presumably affect injury epidemiology. Most of the climbing injury literature contains male climbers and lacks high performing athletes. Studies with both female and male climbers, rarely included separate analyses for performance level or sex. Therefore, injury concerns for elite female competitive climbers are impossible to discern. A former study examined the prevalence of amenorrhea in elite international female climbers (n = 114) and reported that 53.5% had at least one injury in the past 12 months, but injury details were excluded. This study's aim was to report these injury details and their associations with BMI, menstrual status and eating disorders of the cohort.

Methods

Online survey was emailed to competitive female climbers recruited through the IFSC database between June and August 2021. Data was analyzed using Mann-Whitney U, χ² and logistic regression.

Results

229 registered IFSC climbers opened the questionnaire and 114 (49.7%) provided valid responses. Respondents (mean ± SD; age = 22.9 ± 5 year) represented 30 different countries and more than half (53.5%, n = 61) reported an injury in the prior 12 months with the majority in shoulders (37.7%, n = 23) and fingers (34.4%, n = 21). Injury prevalence in climbers with amenorrhea was 55.6% (n = 10). BMI was not a significant predictor of injury risk (OR = 1.082, 95% CI: 0.89, 1.3; p = 0.440) while accounting for current ED over the past 12 months. However, the odds ratio for having an injury was doubled for those with an ED (OR = 2.129, 95% CI: 0.905, 5.010; p = 0.08).

Conclusion

With over half reporting recent injuries (<12 months) mostly to shoulders and fingers, development of new strategies for injury prevention in competitive female climbers are warranted. In addition, climbers with disordered eating behaviors and/or menstrual disturbances might be more prone to injury. More research in this population is required. Suitable screening to prevent these health issues and proper monitoring of these athletes are paramount to long-term athlete success.

Retrospective Analysis of Functional Pain among Professional Climbers

Climbing became one of the official Olympic sports in 2020. The nociplastic pain mechanism is indicated as important in professional sports. Functional pain, which has not been examined in climbers until now, can be an example of nociplastic pain. This study aimed to determine functional pain locations in climbers according to gender and dominant climbing style. Climbers (n = 183) and healthy subjects (n = 160) completed an online survey focused on functional pain occurrence in the head, spine, and upper limbs. The logistic regression showed that climbing predisposes one to functional pain at: Gleno-humeral joint (odds ratio (OR): 3.06; area under the curve (AUC): 0.635), elbow (OR: 2.86; AUC: 0.625), fingers (OR: 7.74; AUC: 0.733), all (p < 0.05). Among the climbers, the female gender predisposed one to pain at: GHJ (OR: 3.34; AUC: 0.638), thoracic spine (OR: 1.95; AUC: 0.580), and lumbosacral spine (OR: 1.96; AUC: 0.578), all (p < 0.05). Climbing predisposes one to functional pain development in the upper limb. While the male climbers mainly suffered from finger functional pain, the female climbers reported functional pain in the GHJ and the thoracic and lumbosacral spine. Further studies on functional pain occurrence are recommended.

Human-Factor Risk Mitigation in Outdoor Climbing Areas: Survey of Existing Policies in Regulated Climbing Areas

INTRODUCTION

Popular climbing areas in the United States are frequently on public lands under administrative purview of land management entities. During climbing, climbers may be subject to injury. This study aimed to describe existing climbing risk mitigation tactics used to protect climbers by oversight agencies responsible for these public climbing areas and to identify strategies perceived by the oversight agency to be successful.

METHODS

We identified publicly managed US bouldering, sport, or traditional climbing areas through a state-by-state search of Mountain Project. We assessed climbing-related visitation, injury, rescue, and risk mitigation strategies using a 10-item survey targeting land-use managers, rangers, outdoor recreation planners, and park managers. Quantitative analysis included univariate and multivariate analysis. Qualitative analyses of survey responses with thematic grouping of mitigation interventions were performed.

RESULTS

One hundred fifty-seven publicly managed US climbing areas were contacted, and 76 (48%) provided data. Thirty-six (47%) of those that provided data stated that programs are in place to reduce climbing-related injury. There were no associations between demographic variables and the presence of risk mitigation strategies. Four themes of climbing risk mitigation strategies emerged: coordination with climbing coalitions (25% of respondents), permitting (22% of respondents), publication of accident reports (22% of respondents), and preventative search and rescue (17% of respondents).

CONCLUSIONS

Nearly half of survey respondents reported having climbing risk mitigation programs. There is opportunity to assess the efficacy of risk mitigation strategies through intra-area and inter-area assessments. A centralized climbing injury database may prove useful for assessing the efficacy of and need for risk mitigation techniques.

Hospital Readmission After Climbing-Related Injury in the United States

INTRODUCTION

Rock climbing and mountaineering may result in injury requiring hospital admission. Readmission frequency after climbing-related injury is unknown. The aim of this study was to assess readmission frequency, morbidity, and mortality after admission for climbing-related injury.

METHODS

We performed a retrospective analysis of the 2012 to 2014 national readmission database, a nationally representative sample of all hospitalized patients. Rock climbing, mountain climbing, and wall climbing injuries were identified using International Classification of Diseases-Ninth Revision-Clinical Modification codes (E004.0). Outcomes evaluated included readmission frequency, morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. Data are presented as mean±SD.

RESULTS

A weighted-estimate 1324 inpatient admissions were associated with a climbing-related injury. Most patients were aged 18 to 44 y (64%), and 68% (n=896) were male. Isolated extremity injures were more common than other injuries (49%, n=645). Sixty-five percent (n=856) underwent a major operative procedure. Less than 1% of all climbing-related visits resulted in death. Within 6 mo of the index hospitalization, 2% (n=23) of the patients had at least 1 readmission, with a time to readmission of 9.9±6.6 (95% CI 4.5-15.4) d. Only female sex was associated with increased odds of readmission (odds ratio=5.5; 95% CI 1.5-20.1; P=0.01).

CONCLUSIONS

There is a very low frequency of readmissions after being admitted to the hospital for climbing-related injury. A considerable opportunity to describe the long-term burden of climbing-related injury exists, and further research should be done to assess injury burden treated in the outpatient setting.