Injury Prevention

Living and working in Laos

Growth plate fracture

Injury Prevention in Rock Climbing and Bouldering

By Volker and Isabelle Schöffl – Sportsmedicine Bamberg
Isabelle and Volker Schöffl are both active climbers and medical doctors. Both have done first ascents up to french 8b, many of them in Laos and Thailand.They are team physicians to the German Climbing team and Volker is a member of the MedCom IFSC and author of „One move too many“. They have done 100+ scientific papers on climbing medicine and are teaching world wide on this topic. They are right now working for an aid organization as doctors in Laos where they also were among the pioneers for Thakhek. 
Further information: www.sportsmedicine.rocks

With the increase in popularity and level in all climbing disciplines the topic of injury prevention becomes even more important. Also, the inclusion of climbing into the Olympic program of Tokyo will add to a further increase in training load and younger climbers peaking early in their climbing level. As Medical doctors, the authors adhere to evidence based medicine when available. This means that we rely on scientific data when determining the correct diagnosis and recommending treatment. In this article, we want to present data that has been published in scientific journals. It may very well be that a person on its own has not followed any of the recommendations we will present and still has not had any of the presented injuries, or he or she may have followed all the recommendations stated here and still have injured him- or herself. However, bear in mind that there is very little scientific research being conducted on injury prevention in sports overall and even less so in sports climbing.

Let´s look at this in two aspects: Prevention of acute trauma (e.g. injuries related to a fall) and prevention of overstrain.

Trauma: Acute trauma in climbing and bouldering is mostly happening to the foot and leg in consequence of a fall. With more modern climbing techniques, e.g. heel hooking new injuries advanced also. The following preventive matters are based on medical evidence:

• spotters and crash pads in bouldering (V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012)
• closed intersections of mats in indoor climbing (V. Schöffl & Schlegel, 2000) (V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012; V. R. Schöffl et al., 2013)
• dynamic belay technique (adolescents weight related!) (V. Schöffl, Hochholzer, et al., 2016, Schöffl et al. 2018)
• reasonable shoe size in climbing shoes (Buda et al., 2013; Killian et al., 1998; A. B. Morrison & Schöffl, 2007; V. Schöffl, Hochholzer, et al., 2016; V. Schöffl & Küpper, 2013; V. Schöffl et al., 2012; V. Schöffl & Winkelmann, 1999c; van der Putten & Snijder, 2001)
• proper training on belay techniques (DAV, 2012, 2014) (V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012; V. R. Schöffl et al., 2013)
• double check – partner check of knot, harness and belay device (DAV, 2012) (Robertson, 2012; V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012; V. R. Schöffl et al., 2013)
• use of a helmet in alpine (traditional) climbing (Nelson & McKenzie, 2009; V. Schöffl et al., 2012; V. Schöffl et al., 2010)
• general recommendations of route setting in first ascents (positioning of first bolts, top anchor chains at sport climbs, stainless steel bolts, etc.) (V. Schöffl, Hochholzer, et al., 2016)
• use of equipment with UIAA safety label (DAV, 2014; V. R. Schöffl et al., 2013) • warm up and cool down (V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012)
• ankle joint stabilising and posture training (Schweizer 2005)
• avoidance of muscular imbalance (Förster, Schöffl et al. 2008)
• fall training for boulderers (Schweizer, Bircher, Kaelin, & Ochsner, 2005) (V. R. Schöffl et al., 2013)
• no preventive finger taping (no injury present) (Woollings, McKay, Kang, et al., 2015)

In addition to the listed evidence based factors we think that posture training, core stability, equilibrium training and in certain medical conditions additional taping will help to prevent acute trauma.



Prevention of overstrain

Most of the acute climbing injuries we see in our climbing medical center are based on overstrain. This is based on the fact that many “standard” climbing injuries receive treatment in a medical unit close to the injury site, while we see many specific climbing injuries secondarily for expert advice. Overstrain injuries are mostly a result of performing a strenuous move or applying repetitive trauma on a certain body part (e.g. epiphyseal growth plate fractures) and are mostly on the upper extremity, mainly the hand and fingers. Medical science gives evidence for the following preventive matters:

• no preventive finger taping (if no injury is present) (Woollings, McKay, Kang, et al., 2015)
• warm up and cool down (V. Schöffl, Hochholzer, et al., 2016; V. Schöffl et al., 2012)
• finger warm up reduces risk of pulley ruptures (Schweizer A. 2001)
• more static moves than dynamic moves (Schöffl et al. 2016)
• reduced amount of high finger intensive bouldering (V. Schöffl & Schlegel, 2004)(I. Schöffl & Schöffl, 2015)
• avoidance of a constant use of the crimp grip position (Hochholzer & Schöffl, 2012; A. Morrison & Schöffl, 2012; I. Schöffl & Schöffl, 2017)

for Adolescents:

• neglect of campus board use in young climbers before closure of growth plates (A. Morrison & Schöffl, 2012)(Hochholzer & Schöffl, 2012; I. Schöffl & Schöffl, 2015, Hofmann, Schöffl et al. 2018)
• no training with additional weight (Hochholzer & Schöffl, 2012)
• reduced amount of high finger intensive bouldering (V. Schöffl & Schlegel, 2004)(I. Schöffl & Schöffl, 2015)
• avoidance of a constant use of the crimp grip position (Hochholzer & Schöffl, 2012; A. Morrison & Schöffl, 2012; I. Schöffl & Schöffl, 2017)
• gender and biological age related training (Hochholzer & Schöffl, 2012, 2013; A. B. Morrison & Schöffl, 2007; I. Schöffl & Schöffl, 2015; V. Schöffl, Hochholzer, et al., 2016; Woollings, McKay, Kang, et al., 2015)



The sports medical surveillance of young climbers must be improved and should be standardized. Injuries may have long term consequences (e.g. epiphyseal fractures) and require a special awareness. With the participation of climbing in the Olympic Games in 2020, this will be even more important, as training hours, load and amount will further increase. Further scientific evaluation of certain training aspects e.g. shoulder stability, core strength, overall muscular status, muscular imbalances, rehab techniques (black roll, fascial massages, yoga, acupuncture ring etc.) are necessary. Nevertheless, we need to point out that some ideas or devices sold in the internet, which claim to help reduce the risk of injuries still lack scientific evidence. While some companies provide scientific proof e.g. Vertics for their products others don’t. We believe it should be a responsibility of every company to undertake scientific studies in order to provide proof of their claims regarding injury prevention.
www.sportsmedicine.rocks

Recommended literature
Schöffl V, Lutter C, Woollings K, Schöffl I (2018) “Kids in Adventure and Extreme Sports: Too Risky?” Rock Climbing
Research in Sports Medicine (in press)
Schöffl V, Morrison A, Schöffl I, Küpper T (2012)
The epidemiology of injury in mountaineering, rock and ice climbing Med Sport Sci 58, 17-43 (Epub Jul 18. 2012)
Schöffl V, Hochholzer T, Lightner S (2016)
One move too many 3rd, revised edition
Sharp End Publishing, Boulder, CO, USA