Rock Climbing


  • Rock climbing popularity and access have opened the sport up to climbers of all ages.

    • Beginning with Tokyo 2020, sport climbing included in Summer Olympic Games

    • International Federation of Sports Climbing (IFSC) organizes senior and junior World Championships, World Cup, and international events

  • Climbing requires strength, endurance, flexibility, agility, and courage

  • Equipment advances have made climbing safer

  • Overuse and climbing-specific injuries pose challenges to climbers and providers

    • Increase in adolescent overuse injury patterns


  • A 2015 systematic review in British Journal of Sports Medicine evaluated risk factors for injury:

    • Age, years of climbing experience, highest climbing grade achieved, high climbing intensity score, lead climbing, previous injury

    • No conclusive data regarding injury prevention

  • Type of climb

    • Competition climbing: route climbing, speed climbing, bouldering

    • Indoor climbing is safer and more controlled, but adds risk for overuse, particularly to fingers.

    • Risk of death and serious injury greater in mountaineering ( Table 99.1 )

      Table 99.1
      Accidents And Injuries In North American Mountaineering And Rock Climbing
      Modified from Williamson JE. Accidents in North American Mountaineering . Golden: American Alpine Club, Inc.; 2006:97–98.
      Year Accidents Reported Injured Fatalities
      2005 111 USA 85 USA 34 USA
      19 Canada 14 Canada 7 Canada
      1951–2005 6111 USA 5158 USA 1373 USA
      958 Canada 715 Canada 292 Canada

    • 3.1 injuries per 1000 climber hours in sport competitions ( Table 99.2 )

      Table 99.2
      2005 World Championships In Rock Climbing Injury Risk
      Modified from Schoffl VR, Kuepper T. Injuries at the 2005 World Championships in rock climbing. Wilderness Environ Med . 2006;1(3):187–190, used with permission.
      Year 2005
      Climbers 443
      Countries 55
      Climbing days 520
      Acute medical issues 18
      Serious medical issues 4 (zero deaths)
      Injury rate per 1000 climbing hours 3.1

  • Equipment

    • Regular inspection and replacement of damaged or expired equipment

      • Follow manufacturer’s recommendation for soft and metal gear replacement

    • Proper use of protection

  • Skill level

    • Elite climbers on more difficult climbs carry higher risk of overuse and exposed falls.

    • Most injuries occur at or below the climber’s usual level.

    • Greater risk in male climbers who climb harder routes, have been climbing more than 10 years, and lead climb more than top rope climb.

  • Environmental

    • Falling rocks

    • Isolation, weather, heat, cold (see Chapter 21: “Exercise in the Heat and Heat Illness” and Chapter 22: “Exercise in the Cold and Cold Injuries”)

    • Altitude (see Chapter 23: “Altitude Training and Competition”)

    • Plants and animals/insects

General Principles


  • Belayer: Controls the rope for a climber, uses a belay device

  • Rappel: To descend on the rope, regulating the rate with an ATC, figure 8 , or other device

  • Pro: Protection, specialized equipment attaching rope to mountain or surface

  • Top rope: Rope placed through chains or metal loops at the top of a climb, alleviating the need to place protection

  • Lead climber: Assumes highest risk by “clipping-in” rope to protection on the way up. Subsequent climbers ascend using the top rope.

  • Problem: A term used in bouldering (see later) to describe a challenging route or segment that is worked on to mastery, often at lower heights and without a rope

Types of Climbing ( Fig. 99.1 )

Free Climbing (Traditional Rock Climbing, “Trad”)

  • Climbing without pulling or hanging on gear, rope, or stepping on anchors

    • True rock climbing, rope simply used as protection for falls

    Figure 99.1, Types of climbing.

  • Pro (protection) used for safety

    • Passive: nut/stopper/chock, hex, tricam ( Fig. 99.2 )

      Figure 99.2, Climbing equipment.

    • Active: “cam,” spring-loaded camming device (see Fig. 99.2 )

  • Climbers ascend a single or multiple pitches, or 20- to 50-meter climbing sections

    • Gear and ropes “cleaned,” or removed and carried to next pitch

    • Climbers belay up and either rappel down each pitch or walk off the top (hike down another route)

Sport Climbing

Outdoor (SEE FIG. 99.1 )

  • Established routes, often with ratings and maps

  • Fixed protection—inspect for safety (should not be loose or spin)

    • Bolts: anchored often at 2- to 4-meter intervals, lead climbers clip in as they pass, ideally placed strategically to prevent ground falls

    • Chains: chains or welded loops anchored to the rock at the top


  • “Rock gyms”

  • Molded holds and bolts attached to climbing walls, ropes provided and maintained by gym

  • Risk of overuse injury, as climbers can do multiple routes

  • Skills augmented in a safe environment


  • Often requires travel to austere environments in remote areas (see Chapter 24: “Travel Considerations for the Athlete and Sports Medical Team”)

  • Variable techniques, from hiking to rock and ice climbing, often over multiple days

  • Single push expeditions becoming more common and popular

  • Injury risk:

    • Serious injury or death from falls, usually related to fatigue and human error

    • Minor injuries magnified by remoteness

  • Environmental risks


  • Indoor or outdoor (see Fig. 99.1 )

  • Problems, usually 3–4 meters high, contain traverses and overhangs, repeated to completion

  • Spotting (partner standing below to protect from serious injury from falls) and mats prevent many lower extremity injuries

  • Finger overuse injuries common

  • Indoor and outdoor bouldering carry similar injury risk


  • Descent from cliffs using rappel devices ( Fig. 99.3 )

    Figure 99.3, Rappelling from multiple pitch climb.

  • Rate of descent controlled via friction between rope and device by holding rope behind back

    • Use of gloves prevents friction burns.

  • A prusik cord or a second rope can be attached with a belayer at the top or bottom for redundant safety measures.


  • Descent into canyons or slots

    • Limited access and stretches without escape routes

  • Combination of hiking, rappelling, climbing, swimming, camping, exploring, and courage

  • “Pots” and “keepers,” deep rock pockets, pose great danger to inexperienced explorers

  • Pack rafting—canyoneering down to a river (such as the Colorado River in the Grand Canyon), floating down in a personal raft, then hiking or climbing out

  • Flash floods pose great danger


  • Cave explorers refer to less experienced counterparts as “spelunkers”

  • Requires horizontal and vertical movement through caves with extensive use of ropes for pitches, crawling, and squeezing through narrow openings

  • Experienced guides and terrain study

  • Possible digging and diving (scuba diving for intense cavers, see Chapter 83: “Scuba Diving”).

  • Excellent light sources, specialized equipment, redundant safety measures essential

Solo Climbing

  • No ropes or gear

  • Highest risk of injury or death

  • Unencumbered speed without ropes and gear, “street cred”

    • Excellent example in 2018 film, Free Solo

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