Preventing Common Climbing Injuries: A Conversation with the Climbing Doctor

No sport is injury-free, but climbers are nagged by a specific breed of persistent injuries. We stress our tendons, contort our bodies, and fall all over the place. According to some studies, 75-90% of climbers will suffer an upper-body injury at some point.

Staying injury free ought to be one of our priorities, but it can be hard to know where to start and what to do.

To help navigate, I got on the phone with Dr. Jared Vagy, DPT — also known by his alter-ego, The Climbing Doctor. Vagy has worked with some of the world’s top climbers, and he’s one of the leading voices in climbing-specific therapy. I asked him what climbers need to know about staying healthy, and what to do if you have an injury.

Where do climbers tend to get injured?

“The most common regions that I see are the shoulder and the hand/wrist/finger area,” says Vagy. “The majority of climbing injuries (I believe over 40% of them) are in the wrist and the hands. But the majority of those injuries are caused by poor mechanics elsewhere.”

This is one of Vagy’s central tenets — the place where you feel pain may not be the place that’s causing the problem. “The climber may come in with finger pain but we’ll see that their shoulder blade isn’t very stable on that side…so maybe that’s a reason.” This is why therapy is both individualized and holistic: to treat the problem, you have to go back to the source.

Injuries, just like climbers, are unique. Vagy says he gets a fairly even mix of acute (sudden) and chronic (long-term) injuries, but that different climbers tend to come in with very different needs.

So, who injures what?

“I think the biggest change [in the climbing world] is that the culture isn’t as homogenized as it used to be,” Vagy says. Different subsets of climbers can have very different value systems (if you need proof, have a read through the comments here). This shows up in our injury patterns too.

At first, Vagy says he saw a lot of older climbers hunched from years on the wall. Eventually he started seeing hardcore sport climbers who showed rounded spines due to all the belaying involved. Now he’s seeing a new generation of competition climbers, who tend to be more balanced: “They need to be able to push, pull, change, turn, and get into these crazy positions. So they’re starting to look a little different.”

For many climbers, training is the root of the problem. “There are a lot of climbers who are more psyched on training for climbing than they are on climbing,” says Vagy. “Those are the ones that actually hurt themselves more training than they do on the wall…Oftentimes my advice to them is…all right, well do you want to just climb more and maybe not climb as intensely?” For climbers who hate backing off or losing their hard-earned gains, this can be tough medicine to swallow.

Other climbers are still learning to handle themselves on the wall. “For a lot of them it’s going to be technique-based,” says Vagy. Until you learn to move efficiently and with sound technique, your body can suffer. For these climbers, Vagy often recommends that they get some footage of themselves climbing in the gym. If you can learn to correct your technique, your injuries may ease — and you’ll be a better climber, too.

Of course, there are some constants. For almost all climbers, Vagy sees similarities: highly developed flexor muscles in the wrist and forearm, large bicep muscles, and a bias toward the muscles that rotate your arm bones inward. “There are definitely some asymmetries there,” he says. Mitigating these asymmetries can be an important step in injury prevention and wellness.

Full crimping everything (especially while training) is a great way to strain your tendons.

Okay, so I’m injured, asymmetrical, and training too hard. What do I do?

Unfortunately, there’s no one-size-fits-all solution. “It’s tailored very specifically to their injury and their location of pain,” says Vagy of his therapy.

To make matters more difficult, climbing’s unique demands can make getting medical advice difficult.

“I’ll typically see people after they’ve worked with one, two, or sometimes even three medical professionals prior,” Vagy says. Doctors tend to focus on specific body parts, but a wider perspective is often required. “You can’t look at a climber like you look at any other patient or human being. You gotta start putting them in positions similar to climbing,” says Vagy. “My job is to say: ‘Oh, well what caused this? Or what’s leading to it?'”

If you can get specific, you can usually find a solution: “If you know the area of your pain, then you can then know exactly what exercises to do in what sequence.”

Great, I can tell you exactly where I’m hurting. What do I do now?

Most of the challenge of recovery and prevention is figuring out how to systematize your work.

On the training side, we’re pretty good at this. “Climbers have a pretty good, regimented training program…They know the sequences; there’s content out there,” says Vagy.

But when it comes to body care…not so much. “Climbers typically have no idea how to sequence their injury prevention program. They’ll know every single stretch and exercise and all these different things or components, but they have no clue how to sequence it,” Vagy says. “That, I’ve found, is actually more of an issue than knowing the stuff to do.”

So, the good news: most of the exercises and principles that you’ve learned are probably sound. You just have to learn how to put it all together.

To help out, Vagy designed what he calls “The Rock Rehab Pyramid.” The Pyramid works on four sequential principles: Unloading, Mobility, Strength, and Movement. The system is designed so that each step builds on the previous one.

The first step is to alleviate pain and strain that has already happened. For severe injuries, this means the most hated of all techniques: rest. “If you come in and you’re having resting pain…you’re not going to be doing a bunch of strength exercises,” says Vagy. There are a variety of ways to unload, like taping techniques and positioning work.

Once you’ve unloaded, you can work on getting flexibility and mobility back. Then you use that mobility to strengthen whatever was weakened. These steps usually involve some form of physical therapy and exercise, but it’s generally not too complicated. “Most climbers get three or four exercises [from me] and that’s it,” says Vagy. “They just have to do the moves religiously…And they need to do them in the very exact sequence that I give them. That’s way better than doing 25 things, and it’s going to get you better much quicker.” This is one of the keys to recovery: have a system (preferably a simple one) and stick to it.

Finally, once you’ve built up mobility and strength, you can return to the wall. The important part is to return with sound movement — don’t repeat the mistakes that got you injured in the first place.

For a more detailed look at the pyramid, check out the video below:

Okay, great. How do I figure out what exercises are best for me?

If you’re not a professional (or you don’t have access to one), it can be a little tough to build your own program of exercises. If you do good research and design a system based on the principles outlined above, you’re probably on the right track. I asked Vagy if there were any things that would help most climbers, and this is what he told me:

Injury Prevention

“For injury prevention, you’ve got to train those antagonist muscles. So, your finger and wrist extensors, your rotators that rotate your arm bone outward, and then the shoulder blade muscles that engage your shoulder blade.” Remember all those imbalances that we climbers are so prone to? It turns out that one of the best ways to prevent injury is to restore some balance. This seems obvious, but I know many climbers who don’t put much effort into antagonist training.

Plus, a balanced body is a happy body. We’ve all seen those climbers who are so asymmetrical that their chest and back look like they’ve switched places. Training antagonist muscles can improve posture and reduce pain.

Finger Overuse

“The big thing for the fingers…is that your finger extensors need to be strong,” says Vagy. The best way to do this? Go to the grocery store, buy some broccoli, and keep the rubber band that it came in (eat the broccoli, too). Engage the finger muscles by pressing out on the band.

You can personalize your training based on the type of climbing you do most. For boulderers, Vagy recommends statically holding the engagement for about 5 seconds. For sport climbers, bump to 7 seconds or so, and for trad climbers, 10-15 seconds.

Shoulder Issues

“Climbers are pretty cognizant of climbing technique, especially ones that have been climbing for a while,” Vagy says. “But they’re not so cognizant of the other 22 hours of the day.” The takeaway? You have to be good to your body off the wall, too. “Especially climbers that are students or have jobs: sit with good posture, bring your shoulders back…And then apply that to climbing. But don’t just go play your computer games slumped forward…and expect your shoulder to feel better.”

Elbow Injuries

“Think of the elbows as the walls of the house,” says Vagy. “Your foundation is gonna be the attachment from your elbows to the shoulder blade.” This means that the first step in diagnosing elbow injuries is to examine what your shoulders are doing and make sure you have good technique. You don’t want your shoulder blades to “wing” or protrude under load, and you want them stable when you’re reaching for the next hold. If you do have persistent elbow pain, Vagy recommends looking into eccentric exercises, in which you help your arm into a certain position and then lower it back slowly without help (usually with weights).

Nerve Injuries

Climbers tend to talk a lot about injuring muscles and tendons, but almost no one talks about nerves. This, says Vagy, is an oversight.

“Nerves run down our neck, through our chest, and then through our arms and into our fingers. Tight muscles can definitely compress the nerve,” he says. This is often the cause of forearm and wrist pain, which climbers often misdiagnose as a strained muscle or overused tendon.

There’s a simple way to tell if you have compressed nerves. Bring your arms out into a T, as far behind you as you can. Cock your wrists back so they’re extended back away from you, and then move your head back and forth from side to side. If you feel feel tension in your wrist, that’s not a muscle — it’s not possible for movement in your neck to change muscular tension in your wrist. It means that you have a tight or compressed nerve.

So what can you do? You can’t massage and stretch a nerve like you would a muscle. Traditional massage will just push the muscle down onto the nerve even harder, and nerves will lose bloodflow under sustained stretching.

Instead, massage by pulling instead of pushing. This can be done with the fingers, or you can pick up a set of massage suction cups online. To help loosen the area, don’t stretch statically — move smoothly in and out of a stretched position. Vagy tells me this is called a “nerve glide.”

That didn’t clarify my injury. What should I do?

See if you can figure out a way to build your own system based on research and the principles above. Alternatively, you can pick up Dr. Vagy’s book, Climb Injury-Free — it runs through the 10 most common climbing injuries and exactly what exercises you should use to heal. It also includes accounts from 30 or so of the world’s top climbers (including names like Adam Ondra, Hazel Findlay, Jonathan Siegrist, and Steph Davis) about their experiences with injury, prevention, and recovery.

Whatever your injury, make sure to listen to and take care of your body. “All climbers are high-level athletes,” says Vagy. We’re all putting severe, specific demands on our bodies when we step onto the wall, and in general our bodies do a pretty good job getting us up there. Make sure you show some love in return.

Dr. Jared Vagy, DPT runs his own practice in LA. You can find him (and more resources about climbing injuries) online at The Climbing Doctor.