Scand J Med Sci Sports 2009: 19: 850–856
doi: 10.1111/j.1600-0838.2008.00851.x
Rock climbing injury rates and associated risk factors in a general
climbing population
S. Backe1, L. Ericson1, S. Janson1, T. Timpka2
1
Division of Public Health Sciences, Karlstad University, Karlstad, Sweden, 2Department of Medical and Health Sciences, Linköping
University, Linköping, Sweden
Corresponding author: S. Backe, Division of Public Health Sciences, Karlstad University, S-651 88 Karlstad, Sweden. Tel:
146 739 856 245, Fax: 146 547 002 220, E-mail: Stefan.backe@kau.se
Accepted for publication 4 June 2008
The objective was to examine injury rates and associated
risk factors in a representative sample of climbers. A
random sample (n 5 606) of the Swedish Climbing Associa-
tion members was sent a postal survey, with an effective
response rate of 63%. Self-reported data regarding climb-
ing history, safety practices and retrospective accounts of
injury events (recall period 1.5 years) were obtained. De-
scriptive statistical methods were used to calculate injury
incidences, and a two-step method including zero-inflated
Poisson’s regression analysis of re-injuries was used to
determine the combination of risk factors that best ex-
plained individual injury rates. Overall, 4.2 injuries per 1000
The popularity of climbing has increased dramati-
cally worldwide in recent years, both as a recrea-
tional physical activity and as a competitive sport
(International Mountaineering and Climbing Fed-
eration, UIAA, 2007). In ‘Sweden, the number of
participants has increased by 90% in the last 5 years
(Swedish Climbing Association, 2005). Climbing can
be performed outdoors or indoors, and a member of
a climbing club can partake in a number of relatively
different climbing activities, e.g. the competitive
forms, such as bouldering and sports climbing, or
the recreational traditional (trad) climbing, ice climb-
ing and mountaineering (alpine) disciplines (Long,
2003). However, most existing epidemiological
studies reporting climbing injury patterns have been
performed in specific climbing environments and
populations. This research, mainly reporting from
indoor climbing, has reported that overuse injuries
(tendonitis, carpal tunnel syndrome and stress
factures), particularly to the fingers and wrists, ac-
count for 75–90% of climbing injuries (Bollen, 1988;
Limb, 1995; Rooks, 1997; Schöffl & Winkelmann
1999; Patrick, 2001; Martinoli et al., 2005; Jones
et al., 2007). Climber’s finger, an A2 pulley rupture
of the ring finger, has been described as being
particularly prevalent among elite competition clim-
850
& 2009 John Wiley & Sons A/S
climbing hours were reported, overuse injuries accounting
for 93% of all injuries. Inflammatory tissue damages to
fingers and wrists were the most common injury types. The
multivariate analysis showed that overweight and practicing
bouldering generally implied an increased primary injury
risk, while there was a higher re-injury risk among male
climbers and a lower risk among the older climbers. The
high percentage of overuse injuries implies that climbing
hours and loads should be gradually and systematically
increased, and climbers regularly controlled for signs and
symptoms of overuse. Further study of the association
between body mass index and climbing injury is warranted.
bers (Bollen, 1990; Bollen & Gunson, 1990; Rohr-
bough et al., 2000; Schöffl et al., 2003; Schöffl &
Kuepper, 2006). There are few studies that have
taken into account actual exposure to climbing,
thus allowing calculation of injury incidences. How-
ever, Schöffl and Kuepper (2006) report 3.1 injuries
per 1000 climbing hours among the 443 competitors
at the 2005 World Championships. Traumatic climb-
ing injuries, excluding pulley ruptures, are dominated
by lower extremity lesions, and have commonly
resulted from falls while leading an outdoors climb
on natural rock (McLennan & Ungersma, 1982;
Schussman & Lutz, 1982; Bowie et al., 1988; Addiss
& Baker, 1989; Malcolm, 2001; Monasterio, 2005).
Studies of associations between climbing experience
and injury risk have shown differing results. Bowie
et al. (1988) and Monasterio (2005) found, in con-
trast to some high-altitude mountaineering epide-
miological studies (McLennan & Ungersma, 1982;
Schussman & Lutz, 1982), that climbers with a
relatively long climbing experience were more fre-
quently injured. Recent studies in sports and tradi-
tional climbing have reported the same tendencies
(Paige et al., 1998; Gerdes et al., 2006).
With the increasing popularity of climbing, it is
unsatisfying that only a few epidemiological studies
 Rock climbing injury rates and associated risk factors
of general climbing populations are available. The
aim of this study is to examine the rates and
associated factors for sustaining climbing injuries in
a random sample of climbers who were members of a
club associated with a national climbing association.
The study also seeks to identify rock climbers’ formal
climbing and first aid training and their safety-related
practices.
Materials and methods
A cross-sectional retrospective study design was used to
examine self-reported injury rates in a random sample of
Swedish organized climbers. For the purpose of the study,
climbing was sub-divided into bouldering, rock (trad) climb-
ing, sports climbing and alpinism.
Injury definition
Injuries that occurred while participating in a climbing activity
indoors or outdoors and that resulted in an injury treatment
intervention (medical treatment, hospitalization and/or dis-
continuation and rest from climbing) were included. Trau-
matic injuries were characterized by acute onset, while overuse
injuries were defined by repeated microtrauma without a
single identifiable event (Fuller et al., 2006). A climbing
incident was defined as a distinct event that occurred while
participating in a climbing activity indoors or outdoors and
that could have resulted in an injury, but where injury was
avoided at the last moment or escaped by a close margin.
Data collection
In 2005, 6067 individuals were members of a Swedish climbing
club. Of these, 53.4% were male seniors, 21% female seniors,
13.1% male juniors, and 12.5% female juniors (Swedish
Climbing Association, 2005). During May–June 2006, a postal
survey asking for data regarding the 2005 climbing season was
distributed to a random sample (n 5 606) of climbers, com-
prising 10% of the members of the Swedish Climbing Asso-
ciation. The survey was resent to the non-respondents. All
participants and, where applicable, their parents, received
written information about the study and gave written, in-
formed consent. The consent could be withdrawn at any time
during the study without specifying the reason. All collected
data were treated confidentially. The survey asked for infor-
mation about the sportsperson (sex, age, height and weight),
climbing history, amount of time spent on climbing per year,
injury prevention practices and retrospective accounts of
injury events (type of injury, which month the injury occurred,
body part involved, treatment received and type of climbing
activity during injury). The questionnaire contained predomi-
nantly closed items (‘‘tick the box’’ format). The face validity
of the survey questions was assessed by a physiotherapist and
a panel of local rock climbers. Two questions were used to
collect information regarding the individuals’ exposure to
climbing: how many climbing sessions (practice and competi-
tion) the climber had participated in each month and in total
during the past 12 months, and how many hours active
climbing (not including time for transportation or checking
the equipment) was spent per session.
Statistical analysis
To ensure accuracy, all data were entered on two independent
s
occasions using SPSS Data Entry for Windows. The Orchard
Sports Injury Classification System (Orchard, 1995) was used
to classify the injury data by type and location. SPSS 14.0
(SPSS Inc., Chicago, IL, USA, 2005) was used for the
statistical analyses. Descriptive statistical methods were used
to calculate incidence rates and confidence intervals. There-
after, regression analyses were performed to identify risk
factors associated with climbing injury. Several regression
models were considered for the multivariate analyses, e.g.
ordinary count models (Poisson’s or negative binomial regres-
sion) and zero-inflated Poisson’s regression (McCullagh &
Nelder, 1983). We chose to use a two-step method where zero-
inflated Poisson’s regression models were used in the second
step to analyze risk for re-injury among the primarily injured
climbers. The reason was that the count data in the study were
highly non-normal and that excess of zeros (representing non-
injured climbers) are not well estimated by traditional multi-
variate methods. The following variables were included in the
analyses: time exposed to climbing per year (continuous
variable), body mass index (BMI) (continuous variable), sex
(female/male), age group (o20/20–45/461), type of climbing
practiced (trad/sport/bouldering), and years of climbing ex-
perience (0–4/5–9/101). Statistically significant variables were
those with P-values o0.05% or 95% confidence intervalssthat
excluded unity. The data were analyzed using the STATA SE
program version 10.2.
Results
A total of 37 questionnaires were returned unan-
swered due to an incorrect address, and nine indivi-
duals had left climbing. 355 (63.4%) of the remaining
560 questionnaires were returned answered. A tele-
phone survey (three calling attempts) directed to
50% (102/205) of the non-responders was answered
by 64 individuals. These climbers reported a large
variety of reasons for not having returned the ques-
tionnaires, the most frequent being lack of time. The
dropout analysis did not reveal any notable differ-
ences in terms of sex or age (o20 and 201) between
participants and non-participants.
Men comprised 70% of the respondents and the
mean age was 30 years (range 9–67) (Table 1). The
respondents reported climbing on average 75 days
per year (range 3.5–260). More females (70%) than
males (46%) were novice climbers, and a higher
percentage of females (34%) than males (15%)
were juniors (age o20 years). In all, 74.6% of the
participants had taken part in a climbing course,
85% of which were held by an authorized instructor.
Very few (13%) had participated in a first aid course
or in a climbing rescue course.
The total recorded exposure to climbing was
49 986 h (females contributing 11 921 h and males
38 065 h). In total, 208 injuries were reported, corre-
sponding to 4.2 injuries per 1000 climbing hours
(Fig. 1). One hundred and six climbers (30%)
reported at least one injury, the proportion injured
851
Backe et al.
Table 1. Baseline characteristics of the study participants (n 5 355) being higher for male climbers (34.5%, 95% CI:
28.6%, 40.4%) than for females (18.9%, 95% CI:
Baseline characteristic Percent (n)
11.4%, 26.3%).
Female Male Total The primary analysis showed an increased risk for
(n 5 106) (n 5 249) (n 5 355) sustaining a climbing injury for climbers with a
higher BMI (b 0.046, Po0.015) and for those parti-
Age group
o20 34.0 (36) 15.0 (37) 21.0 (73) cipating in the bouldering discipline (b 0.300,
20–45 59.0 (63) 77.0 (191) 72.0 (254) Po0.047). In the zero-inflated Poisson’s regression
461 7.0 (7) 8.0 (19) 7.0 (26) analysis of risk factors for re-injury, significant
Total 100.0 (106) 100.0 (247) 100.0 (353) differences in injury incidence were found between
2
Body mass index (kg/m )
o18.5 16.0 (17) 5.7 (14) 8.8 (31) the sexes and age groups. Being male was associated
18.5–24.9 81.1 (86) 84.2 (208) 83.3 (294) with a higher re-injury risk (b 0.574, Po0.019) and
 25.0 2.8 (3) 10.1 (25) 7.9 (28) a lower injury risk was observed for the two oldest
Total 100.0 (106) 100.0 (247) 100.0 (353) age groups (Table 2). Tendencies could be observed
Climbing experience
Novice (0–4 year) 70.0 (74) 46.0 (115) 53.2 (189) toward a lower re-injury risk among the more
Experienced (5–9 year) 24.0 (26) 26.0 (64) 25.4 (90) experienced climbers and a higher re-injury risk
Veteran (101 years) 6.0 (6) 28.0 (70) 21.4 (76) among climbers with a higher BMI.
Total 100.0 (106) 100.0 (249) 100.0 (355)
Overuse injuries accounted for 93% of all injuries,
Type of climbing (first choice)
Sport climber 52.0 (55) 38.0 (95) 42.4 (150) and 28% of the participants reported at least
Rock/traditional climber 25.0 (27) 34.0 (84) 31.4 (111) one such injury. Fingers and wrists were the most
Bouldering 21.0 (22) 24.0 (60) 23.1 (82) common anatomical location for overuse injuries
Alpine/ice climber 2.0 (2) 4.0 (9) 3.1 (11)
Total 100.0 (106) 100.0 (248) 100.0 (354)
(Table 3). The quotient between upper limb injuries
and lower limb injuries was the highest in traditional
climbing, with a ratio of 9:1 (n 5 36:4) in contrast
to 5:1 (n 5 54:11) for sports climbing. However,
upper limb injuries, especially to the fingers and
wrists, were also the most common overuse injuries
355 climbers (249 male & 106 female)
14 traumatic injuries and 194 overuse
among climbers who often practiced sports climbing
injuries in 49 986 climbing-hours or bouldering.
Traumatic injuries constituted only 7% of all
106 injured climbers (29.9 %) 249 uninjured climbers (70.1 %) injuries and only 4% of the climbers reported having
(86 male & 20 female) (163 male & 86 female)
sustained traumatic injuries during the 2005 season.
Of the traumatic injuries, 50% involved the lower
53 climbers (14.9 %) 53 climbers (14.9 %) extremities (foot, toe and ankle), while upper extre-
(44 male & 9 female) (44 male & 11 female)
with a single injury with multiple injuries* mities accounted for 36%. The most common type
was ligament injuries (36%), followed by contusions
15 climbers (4.2 %) 16 climbers (4.5 %) 22 climbers (6.2 %) and lacerations (29%), while fractures constituted
(12 male & 3 female) (12 male & 4 female) (18 male & 4 female) 21%. In terms of the type of traumatic injury and
with >3 injuries with 3 injuries with 2 injuries
type of climbing, joint and ligament injuries domi-
* 40 injury events with > 1 sustained injury were reported
nated in bouldering (80%), while contusions and
Fig. 1. Overview of the injury patterns in a random sample laceration dominated in rock climbing (75%). Nearly
of climbers (n 5 355) during the season 2005. all climbers (85%) who had sustained a traumatic

Table 2. Risk factors for re-injury displayed by odds ratios from Z-inflated Poisson’s regression analyses

Risk factors b OR 95% CI P

Time climbing per year 0.00063 1.0006 0.99–1.00 0.439

Body mass index (kg/m2) 0.065 1.07 0.98–1.16 0.121
Sex (male) 0.574 1.77 1.10–2.87 0.019
Age group (20–45) 0.804 0.45 0.26–0.76 0.003
Age group (461) 1.684 0.18 0.08–0.45 0.000
Type of climbing (sport) 0.089 0.91 0.56–1.48 0.719
Type of climbing (bouldering) 0.363 1.44 0.91–2.28 0.122
Years of climbing (5–9) 0.063 0.94 0.61–1.45 0.775
Years of climbing (101) 0.451 0.64 0.40–1.02 0.060
Goodness of fit Log likelihood 5 294.35 w2 5 22.71

The categories female, age group o20, rock (trad) climbing, 0–4 years of climbing were used as reference.

852
 Rock climbing injury rates and associated risk factors
Table 3. Anatomical location of injuries in numbers (percent) displayed by injury type and type of climbing

Injury type injury location Overuse injury All overuse injuriesTraumatic injury All traumatic injuriesTotal

Rock Sport BoulderingAlpine Rock Sport Bouldering

Upper limbs
Shoulder 5 (12) 10 (14) 7 (12) 0 (0) 22 (13) 0 (0) 0 (0) 0 (0) 0 (0) 22 (12)
Upper arm 12 (29) 15 (21) 18 (30) 1 (33) 46 (26) 1 (17) 1 (33) 0 (0) 2 (14) 48 (26)
Elbow/forearm 0 (0) 0 (0) 0 (0) 0 (0)
Hand/finger/wrist 19 (46) 29 (41) 24 (41) 1 (33) 73 (42) 2 (33) 1 (33) 0 (0) 3 (21) 76 (40)
All upper limb injuries 36 (87) 54 (76) 49 (83) 2 (67) 141 (81) 3 (50) 2 (67) 0 (0) 5 (36) 146 (78)
Lower limbs
Knee 1 (2) 5 (7) 2 (3) 1 (33) 9 (5) 0 (0) 0 (0) 0 (0) 0 (0) 9 (5)
Lower leg 1 (2) 0 (0) 2 (3) 0 (0) 3 (2) 1 (17) 0 (0) 0 (0) 1 (7) 4 (2)
Foot/toe/ankle 2 (5) 6 (8) 3 (5) 0 (0) 11 (6) 1 (17) 1 (33) 4(80) 6 (43) 17 (9)
All lower limb injuries 4 (9) 11 (15) 7 (12) 1 (33) 23 (13) 2 (33) 1 (33) 4 (80) 7 (50) 30 (16)
Head /neck
Head/face/neck 1 (2) 4 (6) 1 (2) 0 (0) 6 (3) 1 (17) 0 (0) 0 (0) 1 (7) 7 (4)
All head/neck injuries 1 (2) 4 (6) 1 (2) 0 (0) 6 (3) 1 (17) 0 (0) 0 (0) 1 (7) 7 (4)
Trunk
Sternum/abdomen 0 (0) 2 (3) 2 (3) 0 (0) 4 (2) 0 (0) 0 (0) 0 (0) 0 (0) 4 (2)
Lower back 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (20) 1 (7) 1 (1)
All trunk injuries 0 (0) 2 (3) 2 (3) 0 (0) 4 (2) 0 (0) 0 (0) 1 (20) 1 (7) 5 (3)
Total 41 (100)71 (100)59 (100) 3 (100)174 (100) 6 (100)3 (100)5 (100) 14 (100) 188 (100)

Table 4. Number (percent) of traumatic climbing injury events and Furthermore, being male, having a relatively high
incident events displayed by causes (the respondents could provide BMI and participating in bouldering were associated
several causes) with an increased injury risk. The mean age of
Self-reported causes Injury Incident Total climbers who completed our survey (30 years) and
events events their exposure to climbing (on average 75 sessions
per year) were similar to the data reported from the
n % n % n % previous studies (Bowie et al., 1988; Paige et al.,
External causes 6 20.7 7 12.7 13 15.5
1998; Gerdes et al., 2006; Jones et al., 2007). How-
(weather falling rocks) ever, comparisons of other baseline data showed
Human mistakes 12 41.4 22 40.0 34 40.5 differences. Of our respondents, 30% were female
Fatigue or dread 3 10.3 7 12.7 10 11.9 in contrast to only 12–20% in other reports (Bowie et
Equipment or safety 5 17.2 12 21.8 17 20.2
bolt failure al., 1988; Paige et al., 1998; Gerdes et al., 2006; Jones
Other (ignorance) 3 10.3 7 12.7 10 11.9 et al., 2007). Furthermore, most respondents (53%)
Total 29 99.9 55 99.9 84 100.0 had been climbing o5 years, while other survey
studies report a higher level of climbing experience
among the participants. A possible explanation for
injury had received medical attention, while 15% of these differences is that the previous studies may not
the injured climbers required hospitalization. The have captured representative samples from the gen-
main underlying factors reported by the climbers to eral climbing population, preferring instead to
explain the traumatic injuries and incident events recruit participants from climbing websites (Paige
were human factors (mistakes or lapses in concentra- et al., 1998; Gerdes et al., 2006) or popular climbing
tion) (40%), followed by equipment failure (20%) venues (Bowie et al., 1988; Jones et al., 2007).
(Table 4). The majority of these injuries and incidents Climbing has physiologically been characterized
had occurred on rock ledges or rock faces (64%). by sustained and intermittent (isometric) forearm
muscle contractions, and the stereotype for an elite
climber has been an athlete small in stature, with low
Discussion percentage body fat and body mass (Sheel, 2004;
Giles et al., 2006). No conclusive scientific evidence is
The aim of this study was to examine injury rates and available regarding associations between reduction in
risk factors in a representative sample of climbers share of body fat or possession of specific physical
associated to a national climbing association. We characteristics and improvement in climbing perfor-
found that overuse injuries accounted for the vast mance (Mermier et al., 2000; Sheel, 2004; Caine et
majority (93%) of the total injuries, and that these al., 2006; Giles et al., 2006). In light of these findings,
injuries predominantly involved the upper limbs. our observation of an association between BMI and

853
Backe et al.
climbing injury is noteworthy. One possible explana-
tion is related to the source of participants and the
study design. Earlier studies that have analyzed the
impact of BMI have been based on homogenous
populations, mainly elite-level competitive climbers
being small in stature and having low levels of body
fat. In our study, the climber’s BMI was more
approaching a normal distribution. Also, we found
that a higher BMI was related to an increased injury
risk for climbers who participated in bouldering.
This can be explained by the nature of competitive
disciplines, as they are designed to challenge the
climbers’ ability to ascend particularly difficult routes
that often have small footholds and handholds.
Furthermore, even though bouldering is considered
to be the ‘‘easiest’’ climbing discipline, the competi-
tive environment may still inspire novices to attempt
routes beyond their capability and repeat strenuous
moves, potentially resulting in overuse injuries.
Our results agree with the recommendations that
parents and coaches should be made aware that
practice schedules designed for experienced competi-
tive athletes in a variety of upper extremity weight-
bearing sports are inappropriate for novices, and in
particular adolescents whose bones and ligaments are
not fully developed (Dennis et al., 2005; Caine et al.,
2006; Magra et al., 2007; Morrison & Schöffl, 2007).
Step-wise increase and versatile training schemes
with an emphasis on skills and diversity of climbing
routes (Morrison & Schöffl, 2007) as well as warming
up and taping the fingers between the joints
have previously been suggested to prevent ruptures
(Bollen, 1990; Bollen & Gunson, 1990; Rooks, 1997),
although no clear evidence has yet been established
regarding the preventative value of taping the fingers.
However, Schöffl et al. (2003) have reported that
injured climbers benefit from post-injury therapeutic
finger taping for at least 12 months during climbing
activity (Schöffl et al., 2003), and Schweizer (2000)
has shown that taping over the distal end of the
proximal phalanx decreased bowstringing by 22%.
Despite inconclusive evidence regarding the efficiency
of preventative taping, the experiences from other
sports burdened with overuse injuries (Dennis et al.,
2005) lead us to propose that climbing injury pre-
vention should be based on the climbing load being
systematically combined with rest, starting at a
novice level. The number of practice days per week
in harmony with the bodily adaptation of the clim-
ber, and the load and repetitions during each prac-
tice, should be adapted to the climber’s age and
climbing experience. In addition, climbers, especially
novices, should be taught to recognize early signs and
symptoms of overuse injuries, i.e. early morning
stiffness and fine motor deficits. Before such general
recommendations can be issued by climbing associa-
tions, further studies are warranted of specific asso-
854
ciations between injury rates and weekly climbing
load. Moreover, based on the notion that incidents
and traumatic injuries largely occur due to human
mistakes, educational intervention should include
theoretical and practical training on safety practices
including first aid and climbing rescue techniques.
Organized regular incident registration ‘‘on the
spot’’, for instance through a website, collecting
data on when, where, how these incidents and
injuries occur would provide an opportunity for
analysis and rapid debriefing about what went wrong
and what can be learnt to prevent similar events from
occurring again.
Several important limitations must be considered
when interpreting the results of our study. Firstly, the
cross-sectional study design does not allow one to
determine specific cause–effect relationships between
risk factors and climbing injury, or to distinguish
between re-injuries and new injuries. However, the
aim of this study was to explore the rates and
associated factors for sustaining climbing injuries,
not to precisely determine the mechanisms involved
in the cause–effect relationship. Secondly, because it
is probable that non-injured climbers were over-
represented among the non-participants, it is likely
that the injury incidences and proportions reported in
the study over-estimate the actual injury risk. Thirdly,
traumatic injuries, such as pulley ruptures, are diffi-
cult to diagnose without ultrasound and magnetic
resonance imaging (MRI). Unfortunately, we did not
ask the respondents whether their overuse injury had
been verified by such diagnostic methods. Thereby,
traumatic pulley ruptures may have been misclassified
as overuse injuries. Fourthly, the array of injury
events reported for the 12-month study period cov-
ered a maximal recall period of 1.5 years, from
January 2005 through June 2006. In retrospective
surveys, both underreporting due to memory decay
and over-reporting due to telescoping may bias the
analyses (Harel et al., 1994; Mock et al., 1999;
Petridou et al., 2004). Other studies have demon-
strated acceptable reliability in self-administered
reports of specific sports injury details, such as the
body part injured, while self-administered reports
concerning the severity of the injury do not corre-
spond to medical record data (Valuri et al., 2005).
Therefore, data on injury severity were not collected in
our study. In view of these remarks and based on the
narrative data surrounding the circumstances deliv-
ered by respondents, we believe that our self-report
sports injury recall data are sufficiently reliable.
Perspectives
In this study of a representative sample of climbers,
the overall injury incidence was found to be 4.2
 Rock climbing injury rates and associated risk factors
injuries per 1000 climbing hours, which is slightly
higher than recently reported from indoor elite
climbing (Schöffl & Kuepper, 2006). However, the
proportion of injured climbers in the sample was
lower (30%) than the 50% proportion reported from
a study based on convenience sampling from indoor
and outdoor climbing venues (Jones et al., 2007).
These discrepancies can be attributed to differences
in the selection of study populations and in
non-participation, and imply that prospective epide-
miological studies of broad climbing populations are
warranted. Overuse injuries accounted for 93% of all
injuries, and male climbers with a relatively high
BMI who participated in the bouldering climbing
discipline had an increased injury risk. These results
imply that climbing hours and loads should be
gradually and systematically increased, and climbers
regularly controlled for signs and symptoms of over-
use. Further study of the association between BMI
and climbing injury is warranted. Also, studies with
emphasis on age, climbing level, disciplines and
individual athlete-hours exposures are needed in
order to attain wider knowledge concerning injuries
among climbers.
Key words: rock climbing, general climbing popula-
tion, associated risk factors, injury, safety.
Acknowledgements
We gratefully acknowledge the cooperation of the Swedish
Climbing Association, Mikael Svensson for statistical advice,
Finn Nilsson for correcting the vocabulary and the Swedish
Rescue Services Agency for funding of the researcher.

References
Addiss DG, Baker SP. Mountaineering
and rock-climbing injuries in US
national parks. Ann Emerg Med
1989: 18: 975–979.
Bollen SR. Soft tissue injury in extreme
rock climbers. Br J Sports Med 1988:
22: 145–147.
Bollen SR. Injury to the A2 pulley in
rock climbers. J Hand Surg 1990: 15B:
268–270.
Bollen SR, Gunson CK. Hand Injuries
in competition climbers. Br J Sport
Med 1990: 24: 16–18.
Bowie WS, Hunt TK, Allen HA. Rock-
climbing injuries in Yosemite
National Park. West J Med 1988: 149:
172–177.
Caine D, DiFiori J, Maffulli N. Physeal
injuries in children’s and youth sports:
reasons for concern? Br J Sports Med
2006: 40: 749–760.
Dennis RJ, Finch CF, Farhart PJ. Is
bowling workload a risk factor for
injury to Australian junior cricket fast
bowlers? Br J Sports Med 2005: 39:
843–846.
Fuller CW, Ekstrand J, Junge A,
Andersen TE, Bahr R, Dvorak J,
Hägglund M, McCrory P, Meeuwisse
WH. Consensus statement on injury
definitions and data collection
procedures in studies of football
(soccer) injuries. Scand J Med Sci
Sports 2006: 16: 83–92.
Gerdes EM, Hafner JW, Aldag JC.
Injury patterns and safety practices of
rock climbers. J Trauma 2006: 61(6):
1517–1525.
Giles LV, Rhodes EC, Taunton JE. The
physiology of rock climbing. Sports
Med 2006: 36(6): 529–545.
Harel Y, Overpeck MD, Jones DH,
Scheidt PC, Bijur PE, Trumble AC,
Anderson J. The effects of recall on
estimating annual nonfatal injury
rates for children and adolescents.
Am J Public Health 1994: 84: 599–
605.
International Mountaineering and
Climbing Federation (UIAA). 2007.
Statistics available from http://
www.theuiaa.org/history.html
(accessed: January 3, 2008).
Jones G, Asghar A, Llewellyn DJ. The
epidemiology of rock climbing
injuries. Br J Sports Med. Published
online December 7, 2007: 1–16.
Limb D. Injuries on British climbing
walls. Br J Sports Med 1995: 29:
168–170.
Long J. How to rock climb, 4th edn.
Guilford, Connecticut: Globe Pequot
Press, 2003.
Magra M, Caine D, Maffulli N. A
review of epidemiology of paediatric
elbow injuries in sports. Sports Med
2007: 37(8): 717–735.
Malcolm M. Mountaineering fatalities
in Mt Cook National Park. NZ Med J
2001: 114: 78–80.
Martinoli C, Bianchi S, Cotten A.
Imaging of rock climbing injuries.
Semin Musculoskelet Radiol 2005:
9(4): 334–345.
McCullagh P, Nelder JA. Generalized
linear models. London, UK:
Chapman & Hall, 1983.
McLennan JG, Ungersma J. Mountain-
eering accidents in the Sierra Nevada.
Am J Sports Med 1982: 11: 160–163.
Mermier CM, Janot JM, Parker DL,
Swan JG. Physiological and
anthropometric determinants of
sports climbing performance. Br J
Sports Med 2000: 34: 359–366.
Mock C, Acheampong F, Adjei S,
Koepsell T. The effect of recall on
estimation of incidence rates for
injury in Ghana. Int J Epidemiol
1999: 28: 750–755.
Monasterio E. Accident and fatality
characteristics in a population of
mountain climbers in New Zealand.
NZ Med J 2005: 118: 1–8.
Morrison AB, Schöffl VR. Physiological
responses to rock climbing in young
climbers. Br J Sports Med 2007: 41:
852–861.
Orchard J. Orchard sports injury
classification system (OSICS). Sport
Health 1995: 11: 39–41.
Paige TE, Fioree DC, Houston JD.
Injury in traditional and sport rock
climbing. Wilderness Environ Med
1998: 9: 2–7.
Patrick P. Orthopaedic problems in
sport climbing. Wilderness Environ
Med 2001: 12: 100–110.
Petridou E, Dessypris N, Frangakis CE,
Belechri M, Mavrou A, Trichopoulos
D. Estimating the population burden
of injuries: a comparison of
household surveys and emergency
department surveillance.
Epidemiology 2004: 15(4): 428–432.
Rohrbough JT, Mudge MK, Schilling
RC. Overuse injuries in the elite rock
climber. Med Sci Sports Exerc 2000:
32(8): 1369–1372.
Rooks MD. Rock climbing injuries.
Sports Med 1997: 23: 261–270.
Schöffl V, Hochholzer T, Winkelmann
HP, Strecker W. Pulley injuries in

855
Backe et al.
rock climbers. Wilderness Environ
Med 2003: 14: 94–100.
Schöffl V, Winkelman HP. Unfallstatistik
an ‘‘Indoor-Kletterlagen’’.
Sportververletz Sportschaden 1999:
13: 14–16.
Schöffl VR, Kuepper T. Injuries at the
2005 World Championships in rock
climbing. Wilderness Environ Med
2006: 17(3): 187–190.
Schussman LC, Lutz LJ.
Mountaineering and rock-climbing
856
accidents. Physician Sports Med 1982:
10: 53–61.
Schweizer A. Biomechanical
effectiveness of taping the A2 pulley in
rock climbers. J Hand Surg. [Br] 2000:
25(1): 102–107.
Sheel AW. Physiology of sport rock
climbing. Br J Sports Med 2004: 38:
355–359.
Swedish Climbing Association. 2005.
Statistics available from http://
www.klatterforbundet.se/
skf_info.php?id=16&sid=53&
subsida=1 (accessed: January 3,
2008).
Valuri G, Stevenson M, Finch C, Hamer
P, Elliott B. The validity of a four
week self-recalls of sports injuries.
Injury Prevent 2005: 11: 135–137.
Wright DM, Royle TJ, Marshall T.
Indoor rock climbing: who gets
injured? Br J Sports Med 2001: 35:
181–185.