Shoulder Injuries and Prevention

The shoulder joint takes lot of punishment from climbing, especially in those obsessed with “V-hard” bouldering, steep terrain, and sport-specific training. A few of the common ailments among climbers are impingement, tendonitis, subluxation, and a tear of the rotator cuff. Given the complexity of the shoulder joint, a diagnosis can be difficult and will likely require expert consultation or an MRI to detect small tears of the rotator cuff and other subtle injuries.

Ok, let’s first look a Impingement Syndrome, Bursitis, and Tendonitis—these conditions are closely related and they are a common source of shoulder pain among athletes in sports that demand consistent, forceful overhead arm movements. Pain and inflammation often develop under the bony top portion of the shoulder, as a result of tendonitis and swelling of the bursa (a fluid-filled sac that provides cushion between the bone and surrounding tissues). Onset of pain is gradual over weeks and months, and may eventually lead to pain in the upper arm and difficulty sleeping on the arm or shoulder.

Diagnosis begins with a physical examination, including movement and strength testing to evaluate pain and weakness throughout the range of motion. X-rays and an MRI may be performed to rule out other causes of shoulder pain, such as arthritis, bone disease, and tears in the rotator cuff. Impingement Syndrome may be confirmed if injection of a small amount of anaesthetic relieves pain.

Treatment of these conditions begins with steps to reduce pain and inflammation: Icing for twenty minutes, three to 6 times per day, limited use of NSAIDS (such as ibuprofen and naprosyn), and cessation of climb and overhead hand movements. As pain subsides, gentle stretching and strengthening exercises can be introduced gradually—these rehabilitative exercises are essential to lower risk of injury relapse upon returning to climbing. In minor cases followed up by dedicated rehabilitation, a return to climbing may be possible in one to two months. More serious cases may require six months or more away from climbing, and perhaps even steroid injections or surgery.

Now let’s look at shoulder instability, a condition that’s become increasingly common among boulderers and high-end sport climbers, as well as individuals who engage in excessive fingerboard training. The condition develops gradually from long-term, repeated exposure to straight-arm hangs, gaston moves, and severe lock-offs, as well as from overzealous stretching or climbing on overhanging routes day after day or hard boulder problems without adequate rest and training of the stabilizing antagonist muscles. No matter the mechanism, constant stretching of the ligaments and a growing imbalance of the muscles that surround and stabilize the shoulder joint can lead to instability and risk of injury.

Dr. Joel Rohrbough has worked with many climbers and believes that a partial dislocation, known as subluxation, is the most common shoulder injury among climbers. This injury produces instability of the shoulder joint and manifests with pain from deep within or in back of the shoulder. In most cases the ball portion of the shoulder joint is levered forward during extreme movements with the elbow located behind the plane of the body. Furthermore, the force of the levering motion on the shoulder joint increases when the arm is extended with the elbow pointing outward (and extending behind the plain of the body), as in grabbing a high gaston hold or making a long reach on overhanging rock.

Fresh shoulder injuries should be treated with the two-phase process of resting until pain diminishes and then use of rehabilitative exercises to strengthen the rotator cuff muscle group. Climbing activity must be markedly reduced or eliminated while you engage in the rehabilitative process, and you should also avoid any overhead motion or other activity that causes pain in the shoulder. Anti-inflammatory medicine and ice applied twice daily are useful in reducing initial pain and swelling.

The common course of therapy begins with gentle stretching and strengthening of the shoulder, but with no exercises above the level of the shoulder. Perform internal and external rotation exercises with a light dumbbell and gradually increase the weight from one pound to five pounds over about a five-week period. Gradually, you can introduce some basic push-muscle exercises to strengthen the antagonist muscles–push-ups, dips, and shoulder presses with light dumbbells are good as long as they don’t produce any shoulder pain. Of course, rehabilitation is best guided by a professional physical therapist, and may take anywhere from two to six months before reintroducing climbing activities.

Unfortunately, a number of people with shoulder injuries ultimately require a surgical solution. The procedure may include removal of damaged tissue, repair of minor rotator cuff tears, or surgical tightening of affected ligaments and tendons. Surgery will be followed with long-term physical therapy; given a successful outcome, climbing activity may resume in six to twelve months.

In conclusion, it’s important to point out that taking steps to prevent injury is the best medicine for your shoulders and other body parts. Here are five tips to lower your injury risk:

#1. Don’t climb to exhaustion. Many injuries occur toward the end of a day of maximal climbing, and in particular when working an at-your-limit boulder problem or redpoint over and over and over.

#2. Don’t climb and train for climbing more than a total of 4 days per week. Overtraining is the ultimate bad investment in your climbing future because it will eventually get you injured.

#3. Train the antagonist muscles of the arms and torso to maintain muscle balance. Two days per week of moderate “push muscle” training is a great insurance policy, so dedicate a little time to sending a few sets of push-ups, dips, dumbbell shoulder presses, and reverse wrist curls.

#4. Regularly vary the type of climbing you engage in, in order to vary the wear and tear on your body. This is especially important for beginners and younger climbers who tend to focus on just sport climbing or bouldering. Remind yourself that diversifying your climbing is also a great investment in your technical abilities.

And #5. Focus on improving technique over maximizing strength. Obsessive training will end in injury. Conversely, improving technique will enable you to make the most of the strength you already possess. Remember that climbing is two-third technical and mental, and only one-third physical…so strive to become a complete climber…a true master of rock!

Copyright 2008 Eric J. Hörst. All rights reserved.