Bouldering/Injuries

Injury Modifications

11 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Ankle Sprain

Ankle injuries are unique in bouldering because they often occur from FALLING rather than the climbing itself. Landing mechanics, crash pad positioning, and fall height all influence ankle injury risk. Unlike sport climbing, bouldering involves repeated falls from height onto crash pads, making ankle injuries one of the most common acute injuries in the sport.

Warning Signs

  • ⚠Swelling increasing
  • ⚠Pain getting worse
  • ⚠Ankle giving way
  • ⚠Unable to bear weight

Red Flags - Seek Immediate Care

  • ●Significant deformity - possible fracture/dislocation, ER evaluation
  • ●Unable to bear weight after 4 steps - X-ray needed (Ottawa rules)
  • ●Bone tenderness at specific points - X-ray needed
  • ●Numbness or tingling in foot
  • ●Foot turning cold or pale

When to Seek Professional Care

  • →Any red flag symptoms
  • →Unable to bear weight
  • →Significant swelling and bruising
  • →Suspect high ankle sprain (pain above ankle)
  • →Not improving after 2 weeks
  • →Recurrent ankle sprains

General Principles

  • •Fall practice is injury prevention - learn to fall well
  • •Crash pad positioning is as important as climbing technique
  • •Ankle bracing significantly reduces re-injury risk after sprain
  • •Indoor falls are lower risk than outdoor falls
  • •Spotter positioning can prevent ankle injuries

Contraindicated Movements

Falling from height (all severities until cleared)Dynamic climbing moves requiring high fall riskOutdoor bouldering (unpredictable landings)Limit climbing (high falls, commitment)Heel hook intensive problems (risk of uncontrolled rotation)

Recommended Exercises

Resistance band ankle strengthening (4 directions)

3 sets × 15 reps

Restores strength in eversion/inversion/plantar/dorsiflexion

Single leg balance

3 sets × reps

Proprioceptive training prevents re-injury

Single leg balance on unstable surface

3 sets × reps

Advanced proprioception

Calf raises (progress to single leg)

3 sets × 15 reps

Restores push-off strength

Alphabet ankle exercises

2 sets × 1 reps

Full range of motion through ankle

Lateral hops (late stage)

3 sets × 10 reps

Functional power return

Return to Full Training

Criteria:

  • ✓Full pain-free range of motion
  • ✓No swelling after activity
  • ✓Single leg hop test equal to other side
  • ✓Completed progressive return
  • ✓Comfortable with landing on both feet

Progression:

  1. 1.Week 1-2: RICE, ROM exercises, no climbing
  2. 2.Week 3-4: Hangboard, very low traversing, top rope
  3. 3.Week 5-6: Controlled low bouldering, downclimb only
  4. 4.Week 7-8: Gradual introduction of higher problems, easy falls
  5. 5.Week 9+: Return to normal with brace

Elbow

MildModerateSevere

When to Seek Professional Care

  • →Pain lasting more than 4 weeks despite modification
  • →Pain that worsens throughout session
  • →Night pain
  • →Locking or catching sensation
  • →Significant weakness

General Principles

  • •Elbow injuries in climbers typically develop gradually from overuse
  • •Pain usually indicates weeks/months of accumulated damage
  • •Complete rest rarely helps - eccentric loading is treatment
  • •Antagonist weakness often contributes to elbow issues
  • •Grip intensity directly affects elbow stress

Contraindicated Movements

Lock-offs (especially deep)UnderclignsDynamic moves to small holdsHeavy crimpingCampus board

Recommended Exercises

Tyler twist (flexbar)

3 sets × 15 reps

Gold standard eccentric exercise for medial epicondylitis

Reverse wrist curls

3 sets × 15 reps

Strengthens wrist extensors for balanced forearm

Forearm pronation/supination

2 sets × 15 reps

Builds rotational forearm strength

Tricep strengthening

3 sets × 12 reps

Balances pulling-dominant climbing muscles

External rotation work

3 sets × 15 reps

Strengthens shoulder rotators to reduce elbow compensation

Return to Full Training

Criteria:

  • ✓Pain-free gripping
  • ✓No pain with climbing warm-up
  • ✓Can complete volume session without flare
  • ✓Morning stiffness resolved
  • ✓Strength symmetry restored

Progression:

  1. 1.Week 1-2: Eccentric rehab only
  2. 2.Week 3-4: Add easy climbing, open hand
  3. 3.Week 5-6: Increase volume, add half-crimp
  4. 4.Week 7-8: Return to moderate sessions
  5. 5.Week 9+: Gradual return to full training

Finger Pulley

Warning Signs

  • ⚠Pain when crimping
  • ⚠Swelling at base or middle of finger
  • ⚠Pain with pressure on pulley location
  • ⚠Weakness in finger strength
  • ⚠Bowstringing (visible bump when making fist)

Red Flags - Seek Immediate Care

  • ●Visible bowstringing (bump when making fist) - COMPLETE RUPTURE, needs ultrasound and specialist
  • ●Heard/felt pop during climbing - likely significant tear, stop climbing
  • ●Unable to make a fist - significant injury
  • ●Multiple fingers affected from one incident - may indicate severe injury
  • ●Swelling not improving after 1 week - needs imaging
  • ●Finger deformity - possible fracture or dislocation

When to Seek Professional Care

  • →Any bowstringing - indicates complete rupture
  • →Heard/felt a pop during climbing
  • →Significant swelling
  • →Pain that doesn't improve after 1 week of rest
  • →Unable to make a fist without pain
  • →Previous pulley injury in same finger

General Principles

  • •Pulley injuries are the most common climbing injury
  • •Grading requires proper diagnosis - ultrasound is gold standard
  • •Bowstringing = complete rupture = see doctor immediately
  • •Partial tears can heal with conservative treatment
  • •Return too early = chronic problems or re-injury

Contraindicated Movements

Crimping (half or full crimp)Hangboard trainingCampus boardDynamic moves on small holdsPockets (especially 2-finger)

Return to Full Training

Criteria:

  • ✓No pain with full-strength crimp
  • ✓Symmetrical strength between hands
  • ✓Passed progressive loading tests
  • ✓2+ weeks of moderate climbing without pain
  • ✓Cleared by PT if Grade 2+

Progression:

  1. 1.Phase 1: Easy climbing, open hand only
  2. 2.Phase 2: Add half-crimp on easy terrain
  3. 3.Phase 3: Volume at moderate grades
  4. 4.Phase 4: Limit sessions (careful)
  5. 5.Phase 5: Return to full training

Heel Hook Knee

Heel hooks are a powerful climbing technique that places significant rotational stress on the knee. When the heel is placed on a hold and the body rotates or pulls hard, the knee can be subjected to forces similar to those that cause ACL and meniscus injuries. Knee injuries from heel hooks are increasingly common as climbing grades push harder and heel hooks become more prevalent.

Warning Signs

  • ⚠Knee swelling after climbing
  • ⚠Clicking or catching in knee
  • ⚠Feeling of instability
  • ⚠Pain with deep knee flexion
  • ⚠Locking of knee

Red Flags - Seek Immediate Care

  • ●Felt pop with immediate swelling - POSSIBLE LIGAMENT TEAR, seek evaluation
  • ●Knee locking (cannot straighten) - POSSIBLE MENISCUS INJURY, needs evaluation
  • ●Gross instability - LIGAMENT INJURY likely, orthopedic evaluation
  • ●Unable to bear weight - significant injury, needs evaluation
  • ●Rapid swelling within hours - significant injury

When to Seek Professional Care

  • →Felt pop during heel hook
  • →Significant swelling
  • →Knee feels unstable
  • →Locking or catching
  • →No improvement after 2 weeks of rest

General Principles

  • •Heel hooks put the knee in vulnerable rotational positions
  • •Knee strength and flexibility help protect against injury
  • •Don't force heel hooks when knee feels vulnerable
  • •Hip flexibility reduces knee compensatory stress
  • •Warm up thoroughly before aggressive heel hooking

Recommended Exercises

Quad strengthening (squats, leg press)

3 sets × 15 reps

Strong quads protect the knee

Hamstring strengthening

3 sets × 15 reps

Hamstrings help control knee rotation

Hip abductor strengthening

3 sets × 15 reps

Reduces valgus stress on knee

Hip flexibility work

3 sets × reps

Hip mobility reduces knee compensation

Single leg balance

3 sets × reps

Proprioception and stability

Impact Injuries

Impact injuries are unique to bouldering compared to roped climbing - every fall ends with impact. While crash pads absorb much of the force, falls still cause injuries to lower extremities, spine, and occasionally upper body. The nature of bouldering (repeated falls from height) means impact injuries are inevitable. Proper fall technique and pad setup are essential injury prevention.

Warning Signs

  • ⚠Pain not improving
  • ⚠Swelling persisting
  • ⚠Weakness
  • ⚠Bruising spreading

Red Flags - Seek Immediate Care

  • ●Unable to bear weight after fall - POSSIBLE FRACTURE, needs X-ray
  • ●Visible deformity - FRACTURE or DISLOCATION, ER
  • ●Severe back pain after fall - EVALUATE FOR SPINE INJURY
  • ●Head impact with any confusion/LOC - CONCUSSION, follow protocol
  • ●Numbness or weakness after landing - possible nerve injury
  • ●Severe pain out of proportion - compartment syndrome possible (rare)

When to Seek Professional Care

  • →Unable to use injured part
  • →Visible deformity
  • →Severe pain
  • →Head injury
  • →Symptoms not improving

Recommended Exercises

Ankle strengthening

3 sets × 15 reps

Resilience to landing stress

Fall practice at low height

sets × reps

Motor pattern for safe landing

Hip and knee mobility

sets × reps

Better shock absorption

Core strengthening

sets × reps

Spine protection on landing

Knee

Knee injuries in bouldering often result from heel hooks, drop knees, high steps, and landing impacts. Modern competition climbing emphasizes dynamic movement and heel hooks, increasing knee stress. Proper technique, strength, and awareness of landing mechanics are essential for prevention.

Warning Signs

  • ⚠Knee giving way or feeling unstable
  • ⚠Locking or catching
  • ⚠Increasing swelling
  • ⚠Pain getting worse despite rest
  • ⚠Clicking with pain

When to Seek Professional Care

  • →Heard or felt pop during climbing
  • →Significant swelling
  • →Knee gives way during walking
  • →Unable to fully straighten or bend
  • →Locking or catching sensation
  • →No improvement after 2 weeks of rest
  • →History of previous knee injury

General Principles

  • •Heel hooks stress the knee differently than most activities - build tolerance gradually
  • •Drop knees require hip mobility to reduce knee stress
  • •Landing technique matters - learn to absorb impact properly
  • •Knee strength and hip mobility are protective
  • •Pad positioning and awareness prevent landing injuries
  • •Competition climbing's heel hook emphasis has increased knee injuries

Contraindicated Movements

Aggressive heel hooks when symptomaticDeep drop knees under loadHigh steps to poor footholdsJumping down from heightDynamic moves with loaded knee on pivot

Recommended Exercises

Terminal knee extensions (TKEs)

3 sets × 15 reps

Strengthens VMO for patellar tracking

Single leg Romanian deadlifts

3 sets × 10 reps

Builds hamstring and hip stability

Lateral band walks

3 sets × 15 reps

Strengthens hip abductors for knee stability

Hip 90/90 stretches

2 sets × 60 reps

Hip mobility reduces knee stress in drop knees

Pigeon stretch

2 sets × 60 reps

Hip external rotation mobility

Nordic curl progressions

3 sets × 6 reps

Eccentric hamstring strength protects knee

Step downs (controlled)

3 sets × 10 reps

Builds control in knee flexion

Rotator Cuff

Rotator cuff injuries in climbing occur from the high overhead demands of the sport. Climbing requires significant shoulder stability, especially during dynamic moves, lock-offs, and compression movements. The rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor) provides dynamic stability to the shoulder. Climbing stresses these muscles through repetitive overhead pulling and unstable positions.

Warning Signs

  • ⚠Weakness persisting or worsening
  • ⚠Night pain (waking from pain)
  • ⚠Unable to reach overhead without pain
  • ⚠Clicking or catching in shoulder
  • ⚠Pain not improving with rest

Red Flags - Seek Immediate Care

  • ●Sudden severe weakness (can't lift arm) - POSSIBLE COMPLETE TEAR, urgent evaluation
  • ●Shoulder looks deformed or squared off - possible dislocation
  • ●Unable to move shoulder at all - significant injury
  • ●Numbness or tingling down arm - nerve involvement
  • ●Significant swelling - may indicate significant injury

When to Seek Professional Care

  • →Significant weakness
  • →Night pain
  • →No improvement after 4-6 weeks of rest and exercises
  • →History of dislocation
  • →Concern for tear

General Principles

  • •Rotator cuff health is essential for climbing longevity
  • •Strengthening is usually more important than stretching
  • •Scapular stability affects rotator cuff function
  • •Gradual return is important - shoulder injuries reoccur easily
  • •Complete tears may need surgical repair

Recommended Exercises

External rotation with band

3 sets × 15 reps

Key rotator cuff strengthening

Y-T-W raises

3 sets × 10 reps

Lower trapezius and rotator cuff strengthening

Scapular push-ups

3 sets × 15 reps

Serratus anterior strength

Face pulls

3 sets × 15 reps

Posterior shoulder and external rotator strengthening

Prone I-Y-T raises

3 sets × 10 reps

Posterior shoulder in climbing-relevant position

Side-lying external rotation

3 sets × 15 reps

Isolated rotator cuff strengthening

Shoulder

MildModerateSevere

When to Seek Professional Care

  • →Pain lasting more than 2 weeks
  • →History of dislocation
  • →Significant weakness
  • →Night pain
  • →Numbness or tingling in arm

General Principles

  • •Shoulder injuries in climbers often result from imbalance (too much pulling)
  • •Antagonist training is both prevention and treatment
  • •Scapular control is often the root issue
  • •Don't climb through shoulder pain - it compounds quickly

Contraindicated Movements

Gastons (wide reaching moves)Dynamic movesCampus boardMoves requiring overhead reach under loadLock-offs at full extension

Recommended Exercises

Band pull-aparts

3 sets × 20 reps

Activates mid-back to balance climbing-dominant pulling

Face pulls

3 sets × 15 reps

Strengthens external rotators and rear delts

External rotation (side-lying or cable)

3 sets × 15 reps

Directly strengthens rotator cuff for stability

Scapular pushups

3 sets × 15 reps

Improves scapular control for better shoulder mechanics

Shoulder CARs

2 sets × 5 reps

Maintains full shoulder range of motion

Dead hangs (if pain-free)

3 sets × 30 reps

Decompresses shoulder and builds grip endurance

Return to Full Training

Criteria:

  • ✓Pain-free ROM in all directions
  • ✓No pain reaching overhead
  • ✓Can do 10 pushups without pain
  • ✓External rotation strength restored
  • ✓2+ weeks of climbing without flare

Progression:

  1. 1.Week 1-2: Rehab exercises only
  2. 2.Week 3-4: Add easy climbing, vertical walls
  3. 3.Week 5-6: Add slight overhangs
  4. 4.Week 7-8: Return to full wall angles
  5. 5.Week 9+: Gradual return to dynamic moves

Skin Management

Skin is a limiting factor in climbing. Flappers, split tips, and raw skin can end sessions and require days to heal. Good skin management is the difference between consistent training and forced rest days. Prevention through callus management and proper care is far more effective than treating damage.

Warning Signs

  • ⚠Redness spreading beyond wound (infection)
  • ⚠Pus or unusual discharge
  • ⚠Increased pain after initial day
  • ⚠Wound not healing after a week
  • ⚠Red streaks extending from wound

When to Seek Professional Care

  • →Signs of infection (spreading redness, pus, fever)
  • →Deep puncture wounds
  • →Wounds that won't stop bleeding
  • →No healing after 1-2 weeks
  • →Climbing-related infection concerns

General Principles

  • •Skin is weaker when wet - avoid climbing in high humidity
  • •Too much callus = flappers; too little = raw skin
  • •Filing calluses 1-2x per week keeps them optimal
  • •Best time to file is after climbing when skin is warm
  • •Hot water softens calluses too much - use cold/lukewarm
  • •Moisturize at night, never before climbing
  • •Stop climbing when skin is getting thin - one more problem isn't worth 3 days off

Contraindicated Movements

Continuing to climb with active flapperAggressive slopers when skin is thinHigh volume when skin is compromisedClimbing on wet/humid days when prone to flappers

Recommended Exercises

Callus filing routine

1 sets × 1 reps

Regular maintenance prevents flappers

Post-session skin check

1 sets × 1 reps

Catch hot spots before they become flappers

Nightly moisturizing

1 sets × 1 reps

Keeps skin elastic and prevents splits

Pre-session skin assessment

1 sets × 1 reps

Adjust session based on skin condition

Tfcc Wrist

The Triangular Fibrocartilage Complex (TFCC) is a cartilage structure on the pinky side of the wrist that stabilizes the wrist joint. In climbing, TFCC injuries occur from weight-bearing on the wrist in extension (mantles), rotation under load, and impact from falls. TFCC injuries are increasingly common in climbing as the sport progresses to more powerful, dynamic movements requiring wrist strength.

Warning Signs

  • ⚠Pain worsening despite rest
  • ⚠Clicking or catching in wrist
  • ⚠Weakness developing
  • ⚠Swelling in wrist

Red Flags - Seek Immediate Care

  • ●Wrist deformity after fall - possible fracture or dislocation, ER evaluation
  • ●Unable to move wrist at all - significant injury, needs evaluation
  • ●Numbness in hand - possible nerve involvement
  • ●Significant swelling with limited motion - needs medical evaluation

When to Seek Professional Care

  • →Pain not improving after 4-6 weeks of rest
  • →Significant weakness
  • →Clicking or mechanical symptoms
  • →Affecting daily activities
  • →Concern for tear requiring surgical evaluation

General Principles

  • •TFCC injuries are often slow to heal
  • •Mantle technique modification is often necessary
  • •Wrist bracing can help during activity
  • •Strengthening is important for recovery
  • •May need imaging (MRI arthrogram) for diagnosis

Recommended Exercises

Wrist pronation/supination with light weight

3 sets × 15 reps

Strengthens forearm rotators

Ulnar/radial deviation with resistance

3 sets × 15 reps

Wrist stability exercises

Eccentric wrist extension

3 sets × 15 reps

Tendon strengthening

Grip strengthening

3 sets × 15 reps

Overall wrist stability

Ball squeezes

3 sets × 15 reps

General grip and forearm conditioning

Wrist

Wrist injuries in climbing often involve the TFCC (triangular fibrocartilage complex), which provides stability on the pinky side of the wrist. These injuries commonly result from compression moves (mantles), falls onto outstretched hands, and extended wrist positions under load (slopers, gastons). Early intervention prevents chronic issues.

Warning Signs

  • ⚠Clicking or catching in wrist
  • ⚠Increasing pain despite rest
  • ⚠Weakness in grip
  • ⚠Numbness or tingling in hand
  • ⚠Pain at rest
  • ⚠Instability feeling

When to Seek Professional Care

  • →Pain not improving after 2 weeks of rest
  • →Clicking, catching, or instability
  • →Significant weakness
  • →Pain with daily activities
  • →History of wrist injury
  • →Numbness or tingling

General Principles

  • •Wrist position matters - avoid extreme extension under load
  • •TFCC injuries are common from mantles, slopers, and gastons
  • •Falling on outstretched hands is a major injury mechanism
  • •Powering through wrist pain often leads to chronic problems
  • •Wrist strength and mobility work is protective
  • •Taping and bracing can help during return to climbing

Contraindicated Movements

Mantles (high compression on extended wrist)Full-pressure slopers with wrist extendedGastons that stress pinky side of wristDynamic moves landing on open handsCampus boardAny move causing sharp wrist pain

Recommended Exercises

Wrist circles (both directions)

2 sets × 10 reps

Maintains mobility, warms up wrist

Wrist flexion/extension stretches

2 sets × 30 reps

Maintains flexibility

Pronation/supination with light weight

3 sets × 15 reps

Builds rotational strength

Wrist curls (light weight)

3 sets × 15 reps

Strengthens wrist flexors

Reverse wrist curls

3 sets × 15 reps

Strengthens wrist extensors

Rice bucket exercises

1 sets × 5 reps

Comprehensive wrist and forearm conditioning

Finger extensor work (rubber band)

3 sets × 20 reps

Balances grip work, supports wrist