1. Capsulitis

How Does Capsulitis Occur?

Capsulitis is the result of an overload of the joint. Mostly due to the high load a part of the middle finger joint experiences when crimping onto holds. This might trigger the joint cartilage which in turn provokes inflammation of the synovial fluid (the liquid inside your joints) which then leads to capsulitis.

What are the Symptoms of Capsulitis?

Pain around the joints, joint swelling, and movement limitations.

You are at risk if: you don’t take enough time to recover between training sessions and if you use the crimp position often at a high intensity.

Physiotherapy Indicated: depends on the stage of your injury. Acute injuries might be better treated with physiotherapy than chronic capsulitis.

Surgical Treatment: no but infiltrations might help.

Time to Heal: depends on how well you respond to your chosen treatment modality. Expect longer healing times

2. Epicondylitis

How Does Epicondylitis Occur?

Medial and lateral epicondylitis are overload injuries that provoke pain on the in- or outside of your elbow.

What Are the Symptoms of Epicondilitis?

Pain around the inner or outer elbow bone which can radiate into the hand. Pain can usually be provoked when lifting or extending/flexing the wrist or fingers against resistance.

You are at risk if: you’ve been taking too few breaks between training sessions for prolonged periods, have switched training intensity recently, and/or have been climbing over your limit.

Physiotherapy Indicated: yes.

Surgical Treatment: only when symptoms persist after trying conservative treatment for at least a year.

Time to Heal: up to a year.

3. Epiphysial Fracture in the Finger

How Does an Epiphyseal Fracture Occur?

An epiphyseal fracture is a fracture of the point where the tendons connect to the bone. In youth, these epiphyseal plates are soft and will only harden out when getting out of puberty. Thus, epiphyseal fractures typically occur in young elite athletes because they stress their musculoskeletal system close to or over their physical limit.

What are the Symptoms of an Epiphysial Fracture?

Recurring pain and swelling around the middle finger joint after climbing sessions. Usually worsens over time when not treated appropriately.

You are at risk if: you engage in elite climbing or climb and crimp often, and you’re between 10-16 years old.

Physiotherapy Indicated: yes.

Surgical Treatment: only if the fracture is dislocated. Drilling into the bone might also be an idea to stimulate the healing process.

Time to Heal: after 6-8 weeks (conservative treatment) of sports break you can return to climbing all be it gradually for weeks/months depending on your symptoms.

4. Knee Injury

How Does a Knee Injury Occur?

Knee injuries in climbing occur when falling from a boulder problem, when falling on a sport route, or when performing heel hooks, drop knees, and knee over toe moves. These movements are all high impact or incur large sheer and rotational forces on the knee joint. As result, your meniscus, anterior cruciate ligament, or medial collateral ligament can tear.

What are the Symptoms of Knee Injuries in Rock Climbers?

After an acute injury you’ll experience swelling in and around the knee. When one of your ligaments is torn, you’ll feel unstable and experience a lack of strength and mostly a reduction in mobility. When you tear a meniscus, you’ll more likely experience locking of the knee (being unable to move the knee until you unlock it by making small movements) and pain when rotating or bending the knee beyond a certain point.

You are at risk if: you don’t take your leg day(s) seriously if you take high falls when your technique fails, and/or when you try difficult moves when tired.

Physiotherapy Indicated: always but depending on the severity of your injury you should do surgery first.

Conservative or Surgical Treatment: with partial tears of ligaments surgery is (mostly) unnecessary. The meniscus’ outer 1/3 has sufficient blood supply so that it can heal by itself. If the tear is too big surgery might still be indicated. If there’s a tear in the other 2/3 of the meniscus and you have symptoms that don’t go away you can consider doing a meniscectomy to remove the part which provokes symptoms.

Time to Heal: 3-6 months

5. Lumbrical Injury

How Does a Lumbrical Injury Occur?

A lumbrical injury typically occurs when extending 1 or 2 fingers while bending the others. This is common practice when climbing on pockets.

What are the Symptoms of a Lumbrical Injury?

Pain when you reproduce the movement which started your symptoms.

You are at risk if: if you climb on pockets often.

Physiotherapy Indicated: yes.

Surgical Treatment: no.

Time to Heal: depends on the severity of the injury, anywhere from 4 weeks to 6 months.

6. Pulley Injury

How Does a Pulley Injury Occur?

A pulley injury of the finger occurs when you hold onto a crimp or a similar hold and you need to compensate for a sudden movement. Think of a foot slip, a hand slip, or when a hold breaks off. You’ll notice a sudden pain on the palmar side of your finger with or without a popping noise.

What are the Symptoms of a Pulley Injury?

A popping noise at the moment of injury, swelling at the sides of the finger joint.

You are at risk if you climb. All climbers are at risk for pulley injuries since climbing holds often require crimp positions that load the annular ligaments supernaturally.

Physiotherapy Indicated: yes, for loading program and in chronic cases with radial shockwave therapy. 

Surgical Treatment: only with a complete tear and with bowstringing of the flexor tendon. And, when conservative treatment hasn’t been started within 7 days after the accident.

Time to Heal: up to a year.

7. Shoulder Impingement​

How Does Shoulder Impingement Occur?

Shoulder impingement, or better shoulder pain, occurs as a result of overload. Since climbers spend a lot of time with their arms overhead the chance of overload is high. When you experience shoulder pain a variety of structures can be injured; the subacromial bursa, tendinopathy of the supraspinatus, the acromial-clavicular ligament, and/or the tendon of the long head of the biceps.

What are the Symptoms of Shoulder Impingement?

Painful arc (pain when raising the arm sideways between 110-150 degrees) and/or when raising the arm all the way overhead. Pull-ups, climbing, and putting on your jacket all might provoke symptoms.

You are at risk if you climb often, have postural issues (a rounded upper back commonly seen in climbers), and/or have muscle imbalances, particularly in the rotator cuff and trapezius muscles.

Physiotherapy Indicated: always.

Surgical Treatment: before yes, nowadays rarely with the good results with physiotherapy.

Time to Heal: 3 months up to a year.

8. SLAP-Injury

How Does a SLAP Injury Occur?

SLAP stands for Superior Labrum Anterior-Posterior which is a tear on top of your labrum, a ring of cartilage around your shoulder socket. The upper part can tear when your arm is overhead and you need to suddenly compensate for a slip and/or fall. This force might pull your arm upwards before your shoulder muscles can respond. When the force is high enough the tendon of the long head of the biceps will pull hard on your upper labrum and cause a tear. Otherwise, repeated microtrauma (more often in climbers >35) can also lead to a SLAP tear.

What are the Symptoms of a SLAP Injury?

Pain with overhead movements, an unstable sensation, and the feeling the shoulder might dislocate. You might also experience difficulties with doing dynamic movements while climbing.

You are at risk if: you’re 35 years and older, your shoulder muscles are weak if you climb on rock that breaks easily, and/or when you climb in conditions that make holds and footsteps slippery. In general, all overhead activities (like climbing and bouldering) make you susceptible to SLAP tears.

Physiotherapy Indicated: yes, either as a conservative treatment or following surgery.

Surgical Treatment: depending on the size of the tear, your complaints, and your climbing goals a surgery might or might not be the right decision for you.

Time to Heal: up to a year.

9. Spinal Injury

How Does a Spinal Injury Occur?

A spinal injury from climbing is usually the result of an accident. In bouldering, this can be due to ground falls and with sport climbing following a large fall slamming you onto the rock. In these cases, fractures are the most logical consequence. On rarer occasions, you can develop chronic spinal injuries in the form of osteoarthritis or herniated discs due to repetitive stresses.

What are the Symptoms of a Spinal Injury?

It depends on the type of back injury you’ll experience different symptoms. Accidents leading to fractures will provoke pain in the back itself. Injuries that lead to compression of the nerve roots can provoke referred pain down your arm/leg and can result in muscle weakness and sensory problems. With most back problems sitting and standing are often worse than lying and walking.

You are at risk if: if you climb badly bolted routes, do trad climbing, and climb high boulders.

Physiotherapy Indicated: always either as a conservative treatment or after you did spinal surgery.

Surgical Treatment: only if the structures can’t heal by themselves or are dislocated and repositioning and fixation.

Time to Heal: anywhere from 3-12 months.

10. Tenosynovitis

How Does Tenosynovitis Occur?

Tenosynovitis is an inflammation of the tendon sheath in the finger and is either a consequence of acute overload after heavy training or secondary to for example a pulley injury. Just like with a pulley injury, tenosynovitis is easier provoked in the crimp position.

What are the Symptoms of Tenosynovitis?

Swelling around the joint with pressure pain along the palmar side of the joint. Possibly with pain radiating into the lower arm.

You are at risk if: you train or crimp often, and/or don’t leave enough time for recovery.

Physiotherapy Indicated: yes if the symptoms are less than 6 weeks old.

Surgical Treatment: only if conservative treatment fails.

Time to Heal: 2 weeks to 4 months.

11. Torn Capsule

How Does a Torn Capsule Occur?

A torn capsule is the consequence of an accident involving a hard pull on a 1-finger pocket or a sharp edge.

What are the Symptoms of a Torn Capsule?

Swelling around the joint, limited range of motion, and instability.

You are at risk if: you climb on pockets or sharp edges. Furthermore, if you are 30-40+ years old your ligaments lose some of their stretch capacity and can therefore tear easier.

Physiotherapy Indicated: yes, either as a primary line of care or post-surgery.

Surgical Treatment: only with complete ruptures.

Time to Heal: 6 weeks to 12 months.