Recommendations for Rock Climbers Navigating Chronic Pain

Rock climbing is a physically and mentally demanding sport that can often be accompanied by painful experiences. The hands and feet are subject to significant moment arms through their slender tissues, while the forearms regularly experience painfully high levels of ischemia¹. Despite this familiarity with pain, rock climbing’s popularity has been on the rise since it was inaugurated as an Olympic competition in 2020, attracting more recreational participants than ever before². In some cases, however, pain persists longer than the damage that caused it, dampening climbers’ function and quality of life. This article aims to put forth evidence-based recommendations aimed at empowering recreational rock climbers to navigate the challenge of chronic pain.

Pain can be viewed as the subjectively unpleasant experience associated with actual or perceived tissue damage. Clinicians differentiate pain from nociception (i.e., the body’s somatosensory input conveying pathological disruption) because pain can occur in the absence of tissue damage. In many cases of persistent pain, the injury that originally induced the painful experience has since healed. Yet the subjective experience of pain may continue through a variety of mechanisms, most notably those related to central sensitization. Broadly, central sensitization describes an enhanced synaptic efficacy of transmission along the pain processing pathways, resulting in hyperalgesia and allodynia. Although these unfortunate presentations can be treated, their impact is still pervasive globally. Chronic pain impacts nearly one in five Americans, with chronic back pain rising as one of the greatest healthcare challenges in the world³.

While the prominence of chronic pain has only grown in recent decades, less is known about persistent pain among rock climbers. However, the impact of chronic pain can be estimated based on the prevalence of acute and overuse injuries. A study conducted by Alex Folkl analyzed 439 rock climbers who collectively reported 863 climbing-related injuries⁴. Nearly a quarter (22%) of the climbers reported injury-related pain that limited their function for 11-20 days out of each month, while another 19% stated that their pain and functional limitations were present for more than 20 days each month. Furthermore, the injuries were changing the way the respondents climbed. If a climber’s motor adaptation led to suboptimal loading, there may be a greater potential for further injuries and persistent pain presentations that are more difficult to treat⁵.

How is chronic pain treated? Dr. Moseley is a respected pain researcher and physical therapist who suggests two tactics⁶. The first is to decrease the threatening input, or the patient’s perception of threat to the painful region. This can be done through inhibiting nociceptive mechanisms, such as with manual therapy, or through non-nociceptive mechanisms, such as pain-neuroscience education. Education is important as it can impact how patients perceive certain variables associated with their pain experience. Secondly, Moseley recommends to desensitize the pain-processing pathways through a system of functional and motor baselines. Essentially, clinicians are tasked with finding the level of input that the patient can tolerate without experiencing pain, and to prescribe high-repetition interventions below that level. Commonly the intensity of this baseline is low in chronic pain cases, so high volume is important to counteract the mechanisms of central sensitization. To achieve adequate training stimuli, Moseley recommends patients to utilize a progression diary and training alarm, and for their clinicians to facilitate self-efficacy through education and encouragement.

Moreover, there may be significant differences in the management of persistent pain among rock climbers based on skill level. Jessica McDouggall’s research into the pain modulation capacity of non-elite and elite rock climbers suggested that elite climbers not only have a higher pain tolerance but also experience less anxiety when assessing a potentially painful climb⁷. Although the study found differences in pain perception between elite and non-elite climbers, no relationship was found between pain perception and varying coping strategies or appraisals. This indicates that there is no universal recommendation for lowering anxiety related to potentially painful climbs. Rather, the best strategy is the one that promotes the most confidence and optimism for the individual climber. This optimal strategy must be found bilaterally with both the patient and clinician perspectives valued.

Despite the viable treatment options to combat persistent pain, clinicians are unable to assist patients who don’t seek care. Avoiding treatment for chronic pain may be especially prevalent in rock climbers. One study examining 667 active climbers found that although 385 experienced a chronic injury in the past 6 months, only 52.7% of the injured recreational climbers sought healthcare⁸. The portion of those who avoided health care rose to 73.4% for the injured climbers considered to be experienced. The most commonly reported reasons for not seeking the help of a clinician was an assumption that the injury wasn’t serious enough, and that the health professional wouldn’t have the expertise to effectively treat a rock climbing injury. This data suggests that physical therapists can better market their services and competence with rock climbing injuries to more effectively help climbers dealing with persistent pain.

To conclude, chronic pain is prevalent and disruptive to rock climbers pursuing a high quality of life through recreation. Chronic pain is treatable through interventions that address the physiological and psychological underpinnings of maladaptive pain experiences. A higher self-efficacy with managing pain and overcoming anxiety related to painful climbs are positively correlated with function and recreational skill. However, rock climbers may be unwilling to develop these skills and seek healthcare due to assumptions about injury severity and clinician competence. Therefore, physical therapists and other healthcare professionals may be able to more effectively address persistent pain issues in rock climbing populations by investing in marketing strategies to highlight their expertise and successes around rock-climbing related persistent-pain states.

Author Bio:

Preston G. Ellington is a passionate lifelong learner who finds fulfillment through uplifting and empowering the environments, situations, and people that he encounters. An aspiring physical therapist with experience in strength & conditioning, orthopedic exercise, and wellness coaching. Student of Physical Therapy at Western Carolina University, and Interprofessional Coordinator for the MAPHealth Pro Bono Clinic. LinkedIn || Blog

Resources:

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