REF-613 · Schöffl, Popp, Küpper & Schöffl, 2015 (+ Grønhaug 2018; Schweizer 2001; Schöffl 2021) · Wilderness & Environmental Medicine, · Paper
Fingers are the most-injured site in climbing (52% of 911 injuries; pulleys most frequent, now more A4 than A2), shoulder second; almost all injuries UIAA grade 2 or lower; and 14 of 20 injured under-15s had an epiphyseal (growth-plate) fracture
Participants
n=911 independent climbing injuries in 836 patients, prospectively evaluated over a 4-year period at one institution.
Protocol
Prospective single-institution case series (from the abstract): 836 patients with 911 independent climbing injuries evaluated over a 4-year period with a standard questionnaire and examination protocol.
Recorded: body region, UIAA injury grade, acute vs overstrain injury, clinic vs emergency-department presentation, and climber age, climbing years and climbing level; results compared with the centre's 1998-2001 study.
Key Findings
833 injuries were upper-extremity, 58 lower. Severity: 17 UIAA grade 1, 881 grade 2, 13 grade 3, none higher.
380 acute injuries (359 seen in clinic, 21 via the emergency department) vs 531 overstrain injuries (all clinic) — overuse outnumbers acute.
Finger injuries = 52% of all injuries; shoulder the second most frequent location; pulley injuries the most frequent finger injury — and compared with the centre's 1998–2001 series, A4 pulley injuries now outnumber A2, shoulder injuries are more common, and epiphyseal fractures among young climbers are rising.
Of 20 injured climbers under 15, 14 had an epiphyseal fracture (mean age 14 y, range 12–15).
Male climbers were older, had more climbing years and climbed at a higher level; older, more experienced climbers had significantly more overstrain than acute injuries.
Not from this paper — Grønhaug 2018 (DOI 10.1136/bmjsem-2018-000406, checked against its abstract): web survey of 667 active climbers (385 with a chronic injury in the last 6 months); fingers the most prevalent chronic-injury site (41.3%), then shoulders (19.4%) and elbows (17.7%), regardless of experience, gender or bouldering vs route climbing.
Not from this paper — Schweizer 2001 (DOI 10.1016/S0021-9290(00)00184-6, checked against its abstract): in vivo measurements (16 fingers, 4 subjects) show the crimp grip bowstrings the flexor tendon over the A2 pulley, loading it about 3× the fingertip force (up to 116 N) — the mechanistic basis for crimp-related pulley injury; slope grip loads it less.
Not from this paper — Schöffl 2021 (DOI 10.1177/03635465211056956, checked against its abstract): finger epiphyseal growth-plate stress injuries are the most frequent sport-specific injury in adolescent climbers; 27 patients / 37 injuries (mean age 14.7 y, 66.7% competitive, 14 h/wk climbing-specific training), 36 of 37 from repetitive stress, 28 Salter-Harris III fractures — a diagnostic-therapeutic algorithm achieved osseous union in all cases.
Practical Application
In 911 prospectively recorded climbing injuries, 52% were finger injuries (pulleys first, A4 now ahead of A2), shoulders came second, overstrain outnumbered acute injuries 531 to 380, nothing exceeded UIAA grade 3 — and 14 of the 20 injured under-15s had a growth-plate fracture — so finger-load discipline for adults and growth-plate protection for adolescents are the two prevention priorities.
Screen/protect fingers first: conservative finger-load progression, warm up forearms/pulleys before hard crimping; prefer open/slope grips where the route allows (Schweizer); treat sharp finger pain or a "pop" as suspected pulley injury → stop, assess, refer.
Prehab shoulder & elbow (rotator-cuff/scapular, push-balance, forearm-extensor work) — shoulder is the second site here and in the survey data (not from this paper; the base's own practice for the exercise selection).
Youth policy: adolescents with open growth plates → avoid maximal fingerboard, campus, repeated hard crimping; keep finger loading submaximal; refer persistent finger pain for growth-plate imaging (Schöffl 2021: nearly all such injuries are repetitive-stress).
Reassure: in this series no injury exceeded UIAA grade 3 and the large majority were grade 2 — manageable with load discipline, not career-ending.
Limitations
Core epidemiology is a single-centre clinic series (referral bias) plus a self-report survey (recall bias) — good for injury *pattern*, weaker for population incidence. Mechanistic (4 subjects) and youth-algorithm (case series, level 4) supports are low-level evidence, not prevention trials; no "injuries prevented" figure claimed.
How this entry was checked and changed
Why this level
regraded 2026-09-27 from B: large observational series (836 patients / 911 injuries); supporting survey, mechanistic and youth studies labelled below
Content correction 2026-09-27
"Retrospective case series" -> the abstract states a prospective single-institution study; added n (911 injuries / 836 patients), body-region, severity, acute-vs-overstrain and under-15 epiphyseal counts from the abstract.
"majority low-grade" -> 881 of 911 were UIAA grade 2, 13 grade 3, none higher (stated as such, not as "low-grade"); added "more A4 than A2" and rising shoulder/epiphyseal trends.
Grønhaug 2018, Schweizer 2001 and Schöffl 2021 lines labelled "not from this paper" with their abstract-checked figures. Level B -> B+; Tier "mixed" -> Tier 1-4.
2026-09-28: added Protocol from the abstract (Europe PMC PMID 25712297).