S4, E3: Overcoming Fear and Pain in Climbing – Riley Hess

If you would like to listen to the entire interview with Riley Hess, check out the podcast. If you want to watch the interview, click the YouTube link or any of the timestamps above. If you would like to read a concise recap of key interview topics and questions, check out the excerpt from the interview below.

Overcoming Fear and Pain in Climbing: A Journey to Rebuilding Confidence With Riley Hess, PT Student and Climber

Pain and fear are two of the most under-addressed obstacles in climbing recovery. While most climbers understand how to rehab a tissue injury, far fewer know what to do when the pain lingers long after healing — or when fear of re-injury keeps them off certain moves entirely.

In this Q&A, PT student and climber Riley Hess explores the science behind persistent pain, the concept of central sensitization, and two practical frameworks — graded exposure and expectancy violation — that climbers can use to rebuild confidence and return to full movement.

Can you tell us a little about yourself and what brought you to this topic?

I just graduated from PT school at MCPHS University in Massachusetts and will be heading into acute care — which is a little different from what I originally expected, but that’s the exciting part about PT. I’ve been climbing for about six years, mostly bouldering in Massachusetts and New Hampshire.

Over the course of climbing, I’ve had my fair share of injuries, and I’ve been around a lot of other climbers dealing with the same. There was always this recurring theme of chronic pain that people didn’t know how to overcome. Pain is such a nuanced topic, and it’s still a relatively new area within PT. That combination — climbing and pain science — is really what drove this article.

What’s your personal experience with persistent pain in climbing?

This is definitely a personal account. I was doing a dyno in the gym — one too many attempts on already fatigued tissues — and felt that pop in my wrist along with a burning sensation. I knew right away it had something to do with my TFCC.

That was a long road, and I still get pain in my wrist with sloping movements, five-plus years later. I know things have changed structurally, but I also know this shouldn’t still be painful. It’s always in specific positions — slopey holds, movements with more wrist demand. So it raised the question: am I staying away from those moves because I’m genuinely at risk, or is it fear? Is my brain telling me not to go there even when it’s actually safe?

The more I train that position, the better I tolerate it. I’m essentially conditioning myself — slowly returning to that range, getting stronger, and letting my brain adapt to the fact that it’s safe. That process is what this article is really about.

Can you explain central sensitization for climbers who may not be familiar with it?

Pain is a protective mechanism. In a normal injury, the damaged tissue sends pain signals while healing, and once it heals, those signals fade. You rupture a pulley, it hurts while it’s healing, and once it’s recovered, the pain resolves. That’s the typical response.

With persistent pain, something else happens. The nervous system becomes highly sensitized to the same stimuli that caused the original pain — even after the tissue has healed. That’s central sensitization. Small inputs produce a disproportionately large pain response.

The analogy I use is a car alarm. Normally, your alarm goes off if someone hits your car. With central sensitization, it goes off when a leaf touches it. The stimulus is tiny, but the response is the same intensity as the original. After about three months, the brain’s map of that body part starts to become less precise, and persistent pain becomes more entrenched. At that point, we need to address not just the tissue, but the nervous system itself.

What should a climber do if they’ve healed from an injury but still have persistent pain?

The first thing — and this is counterintuitive — is don’t stop climbing, and don’t avoid the movements that caused the original injury. Avoidance leads to weakness in that area, which can perpetuate the pain cycle. You can get stuck in a loop where you never return to where you want to be.

Instead, approach it in a calculated way: deliberately expose yourself to the movements that are causing discomfort or fear. There are two main frameworks for doing this — graded exposure and expectancy violation.

Can you walk us through graded exposure?

Graded exposure is a step-by-step process of getting more comfortable with a movement over time. Think of it as dipping your toes in before fully submerging — progressively working your way back up to the level you were at before. It’s especially useful for someone who’s nervous about a specific movement because you can meet them exactly where they are and build from there.

In practice, this might look like starting on a fingerboard with a larger edge and partial body weight, and gradually increasing the load as tolerance improves. You’re building tissue capacity and brain confidence simultaneously, in a controlled environment.

How is expectancy violation different?

Expectancy violation comes from psychology and is more direct. Rather than a stepwise progression, you place yourself as close as possible to the situation that caused the original injury or fear — safely — in order to challenge and disrupt the fear response.

The key mechanism is creating a mismatch: your brain predicts something bad will happen, you do the movement, and it doesn’t. Over repetitions, that prediction gets updated. You start to uncouple the association between the movement and danger.

A clear climbing example is lead falls. If a climber is afraid of falling, you get them on the wall and have them fall — progressively and safely. They fall, they’re fine, and the brain starts to learn that falling isn’t automatically catastrophic. For a pulley injury, this might mean returning to the same type of hold the injury happened on, perhaps with better feet or a larger edge at first, and performing the movement until the expectation of pain no longer matches the actual outcome.

How do the two approaches compare — when would you use one over the other?

Graded exposure is the step-by-step version; expectancy violation is the more direct approach. The right choice depends on the person. Some climbers do better with a careful, progressive build-up. Others respond better to confronting the scenario head-on.

You can also scale expectancy violation — you don’t need to start on a six-millimeter edge on a steep overhang. Begin with a larger hold, better feet, a less demanding wall angle, and work from there. The goal in both approaches is to challenge what you expect to happen, and prove to yourself that the outcome is different from what you feared.

Can you describe the fear acquisition and extinction model?

Fear is learned. We don’t emerge from the womb afraid of certain movements — we learn to fear them through experience. A climber does a dyno, lands awkwardly, and injures their Achilles. From that point, dynamic movements register as a threat.

To unlearn that — what we call fear extinction — you need repetitions of the movement without the feared outcome occurring. Once the Achilles is healed and rehab is progressing well, you begin reintroducing dynamic movements through graded exposure or expectancy violation. Over time, the repetitions create an uncoupling: dynamic movement no longer predicts injury. The threat is extinguished, and the climber can move forward with confidence.

How easy is it to actually apply this in practice?

It’s hard. It takes time and persistent effort. The brain is well-programmed to stop you from doing things it believes might cause harm, and that protection doesn’t turn off easily. From my own experience with slopers, it’s taken quite a while — and it’s still something I work on.

With strength training or mobility work, progress tends to be fairly linear — do the reps, do the sets, and results follow. With the brain, it doesn’t always work that way. Progress can feel inconsistent, which makes it harder to stay motivated. Having a framework helps, but applying it consistently when things aren’t improving quickly is the real challenge.

What practical tips do you have for climbers managing persistent pain?

Keep a log. It’s hard to perceive gradual improvement when you’re in the middle of the process, but a written record makes progress concrete. Before a session, write down the movement you’re working on, what you expect to happen, and your anticipated pain level on a scale of zero to ten. Then do it, and record what actually happened. Over time, you’ll see the gap between expectation and outcome narrowing — a predicted four out of ten becomes a one out of ten. That visible progress matters enormously for motivation.

Belief is a critical component. If you don’t believe the approach is working, buy-in erodes and progress stalls. The log helps bridge that gap by showing you concretely that things are shifting, even when it doesn’t feel that way in the moment.

Any final thoughts for climbers dealing with persistent pain?

Two things. First: keep going. It will get better. Second: work toward independence. It’s valuable to work with a physical therapist to learn the tools and understand the framework, but eventually you want to remove those training wheels. You want to be able to manage these movements and situations on your own — because the real-world climbing environment doesn’t come with a clinician beside you.

The more accountability you take and the more you apply what you’ve learned independently, the better set up you are for long-term success. And when you go back to that journal later and compare how your wrist feels on a sloper now versus when you first got hurt — things have changed quite a bit. Sometimes it just takes time to see it.

Final Thoughts

Pain and fear in climbing are more connected than most climbers realize. Understanding why persistent pain happens — and having a concrete framework for addressing it — can make the difference between staying stuck and returning to full confidence on the wall. Graded exposure and expectancy violation aren’t quick fixes, but with patience, consistent effort, and a willingness to challenge your own expectations, progress is absolutely possible.

Where can we find more information?

To connect, you can reach Riley at rileydhess@gmail.com or via Instagram @riley.dh.