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Injury Trends in Rock Climbing and Young Climbers (Read 10818 times)

jwi

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Interesting read (behind a pay-wall :( )
http://www.wemjournal.org/article/S1080-6032(14)00276-2/abstract

Two thing stood out to me : 1) A4 injuries are on the rise, and are now (2009-2012) more common than A2 injuries (compared to 1998-2001). Good. We're not just cruising on jugs anymore.

2)
Quote from: Schöffl et al
Our present study included 20 young climbers (13 male, 7 female) who were less than 14 years of age. Sixteen of these had symptoms of finger pain after and while climbing, with finger joint swelling but no acute trauma. Of these 16 climbers, 14 had an epiphyseal fatigue fracture on magnetic resonance imaging, 1 bilaterally. Thus, 14 of 20 injured young climbers (70%) up to age 14 had an epiphyseal fracture, making that fracture by far the most common climbing injury among young climbers. These numbers are alarming and need to be acknowledged by the national and international climbing bodies. Precautions need to be instigated, and prophylaxis increased. Campus board exercises are known to be one risk factor for epiphyseal fractures in young climbers, but others still need to be detected
(the emphasis is mine)

Climbing is becoming like east bloc gymnastics in the 80s. Start with a bunch of talented 10-year olds. Push them through dangerous forms of training that will give remarkable results for the few who don't get life long injuries. Fuck the rest.

In the unlikely case that someone cares what I think, I vote to not heavily publicise climbing performances of children under the age of 16.
« Last Edit: March 03, 2015, 02:01:22 pm by jwi »

Sloper

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Absolutely agree, I've been saying this sort of thing for years.

The idea that you need to be strong at 10 to be good when you're 20 is a dangerous one.

No problem or route is worth having crippled hands for life.  I wonder how the BMC will deal with this and make a clear policy statement to walls & via NICAS etc? Ru, any thoughts

slackline

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It would be essential to know how large a pool of participants <15 years old those 20 with injuries came from.

If its from a total of 100,000 participants over the study period then that is a pretty low incidence rate.

If its from a total of 100 participants over the study period then that is a pretty high incidence rate.

If it only occurs in the subset of participants who "train" or are "coached" on national teams then that too would be of great concern.

blamo

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The idea that you need to be strong at 10 to be good when you're 20 is a dangerous one.


I have often wondered if being strong at 10 can actually hurt your climbing later on.  I have seen lots of strong kids fall off the radar as they mature.  Our local junior climbing team is like a revolving door: most of the kids are excited, get strong, and then they quit...  Enough of my off topic rant.

Paul B

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Climbing is becoming like east bloc gymnastics in the 80s. Start with a bunch of talented 10-year olds. Push them through dangerous forms of training that will give remarkable results for the few who don't get life long injuries. Fuck the rest.

Funny you should say that as I had pretty much exactly the above described to me as "the Austrian Approach" to Youth training. Lot of injured kids but 1 Jakob Schubert:

:devangel:

abarro81

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I've heard of Macia's approach being described as being similarly 'blunt' (but this wasn't with respect to youth stuff in particular, and is 3rd hand rumour shizzle)

jwi

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Alex Megos is a good example. "Held back" (i.e. not allowed plyometric stuff or really hard "limit bouldering" and the like) until he was 18. With a training that was centered on giving him a good over all base to develop from when he became adult. That approach worked as well as any. It only took him 1 year to go from elite to world class.

Lets face it: It is much easier for a 15 year old to climb 8B than for anyone to climb 8C, or a 50 year old to do 8B. Any of these will get you in the mags, the latter two being impressive. The first not so much.

shark

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In the unlikely case that someone cares what I think, I vote to not heavily publicise climbing performances of children under the age of 16.

Including Ondra when he was on the rise and now Ashima ?

jwi

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No. Definitely not if it isn't new routes, or efforts that are on par with the best adults. Even then I'm sceptical.

Oldmanmatt

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Alex Megos is a good example. "Held back" (i.e. not allowed plyometric stuff or really hard "limit bouldering" and the like) until he was 18. With a training that was centered on giving him a good over all base to develop from when he became adult. That approach worked as well as any. It only took him 1 year to go from elite to world class.

Lets face it: It is much easier for a 15 year old to climb 8B than for anyone to climb 8C, or a 50 year old to do 8B. Any of these will get you in the mags, the latter two being impressive. The first not so much.

Hasn't this been normal for sometime?

There are extensive guidelines for training minors in a variety of sports, up to and including Olympic standards.
The crimp/campus/fingerboard issue has been know for some time and I'd be surprised if many (or any) coaches in the UK, would allow a child anywhere near it.

Still, I've not read the paper yet.

Prepubescent children rarely develop the muscle mass to cause serious damage. When they do, something is "off", be it a hormonal disorder or a more sinister "supplement" issue.
That can change rapidly as puberty hits, but we tend to use this:

http://pediatrics.aappublications.org/content/119/6/1242.full.html

To help mitigate that change.

Some kids are harder to handle, in that they train in secret and insist on finding a way around rest days.

There is a considerable difference between the ideological, pharmacological crap that was forced on East European children (who showed the supposed morphology of discipline X) and the way kids train in the UK today.
(And my late wife was one of them. A Romanian Gymnast until the revolution).

I've got a 14 year old girl under our care at the moment, who has started taking podiums in the Open Female category, at a local level. Given her drive and dedication, should we really be crushing that spirit?

Or managing and directing it?

Far better to teach her why we say she can't do X,Y or Z.
Bring her parents on side and teach them why they shouldn't buy her a BM2000 for Xmas.
Encourage them to take her for regular assessment by a competent Physio.
Encourage them to watch her diet, check she's not falling into that trap.
Schools now have a programme to monitor BMI (looking for both extremes) and will assist if notified of a potential/keen athlete.

We also train and coach two young lads from the Olympic sailing squad. Their coaches approached us as climbing is the most relevant form of training for competitive sailing outside of a dingy. They have improved dramatically over the last year.

Body weight, bar, floor and wall.
And, touch wood, no injuries yet.

Oldmanmatt

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Actually, there is a large cross over here to the other training threads.
Just because children are more susceptible to overuse injuries, doesn't make it a purely juvenile issue.
This converges with the "climbing specific only" versus the "cross over" training debates (such as the deadlifting thread).

Fingers are delicate.

They need rest.

Other chains and groups can be trained without overly engaging them (free weights, for example).

My tuppence worth?

All climbing and no play, makes Jack a sore boy.

Oldmanmatt

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Actually, there were 836 patients in this study of which only 20 were juveniles.
There are more than 20 kids "training" in my little wall.

There must be thousands across the country.

This was an Austrian study?
(Still can't get into the full text without paying..)

Where (I'd guess) youth participation is even higher than here?

And before you could tell if this is a climbing specific problem, you'd need to know the incidence within the general population, surely?

NB. I know question marks annoy you Alex, but I'm inviting correction where I've erred.

Fultonius

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We also train and coach two young lads from the Olympic sailing squad. Their coaches approached us as climbing is the most relevant form of training for competitive sailing outside of a dingy. They have improved dramatically over the last year.


I'm kind of surprised that this. I used to sail to a pretty decent level in Toppers and Lasers and I'd never have thought climbing would be a good crossover. However, I quit sailing at the age of 16 as I hated training for it (basic gym work, or going out doing sailing drills) so maybe climbing would have kept the tedium down and I might not have quit!  (Girls, beer and downhill mountianbiking were also involved in my exit...)


abarro81

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It's just a summary of all the climbing related patients that Volker Schoffl's clinic in Germany have had through their doors over a 2 years period (and compared with a similar period a decade previously), so it doesn't tell you anything about size of pool of participants or anything like that.
(For those with acadmic logins, use the link to it on science direct to get the pdf)

Oldmanmatt

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We also train and coach two young lads from the Olympic sailing squad. Their coaches approached us as climbing is the most relevant form of training for competitive sailing outside of a dingy. They have improved dramatically over the last year.


I'm kind of surprised that this. I used to sail to a pretty decent level in Toppers and Lasers and I'd never have thought climbing would be a good crossover. However, I quit sailing at the age of 16 as I hated training for it (basic gym work, or going out doing sailing drills) so maybe climbing would have kept the tedium down and I might not have quit!  (Girls, beer and downhill mountianbiking were also involved in my exit...)
Me too, but with Fireballs and Hobycats, I went onto bigger boats and Offshore racing instead though.

These lads spend a lot of time on the Trapeze, pulling ropes and essentially have similar Agonist/Antagonist relationships to climbers (which are pretty much the opposite of most sports people).

TheTwig

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Recent post on mountainproject by a 14 year old asking if he should be hangboarding and campusing 'to get strong'.......I could have cried. Most of the Americans just said fine whatever.  :wall:

slackline

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And before you could tell if this is a climbing specific problem, you'd need to know the incidence within the general population, surely?

If you wish to calculate the relative risk, yes.  You'd also need to know the incidence within the climbing population which the study doesn't report.

Oldmanmatt

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It's just a summary of all the climbing related patients that Volker Schoffl's clinic in Germany have had through their doors over a 2 years period (and compared with a similar period a decade previously), so it doesn't tell you anything about size of pool of participants or anything like that.
(For those with acadmic logins, use the link to it on science direct to get the pdf)
And before you could tell if this is a climbing specific problem, you'd need to know the incidence within the general population, surely?

If you wish to calculate the relative risk, yes.  You'd also need to know the incidence within the climbing population which the study doesn't report.

So, this is a less than informative report.

And the language used to describe the "Alarming" trends that the report highlights, is in fact, without context.

I have no doubt that certain types of training should be completely avoided for those still growing and that those modalities will injure the participant, should that tenet be ignored.

But, I don't see an argument for suppression of youthful climbers.

Font 8B at 15 is impressive.

Font 8B is impressive.

It's a "I wonder where this might go" achievement; an exciting portend of great things to come.

Or not.

Because there are a huge variety of reasons why a 15 year old might not continue to dizzying heights as a pro.

School, girls/boys, loss of interest, and on and on.

I'd be surprised if injury was the most common.


I fractured a vertebrae at 13. In a Judo class. Should we ban under 18's from competing in marshal arts?

Rugby?

How many more "life changing" injuries result from that game?

Life carries the risk of injury.

The only 100% effective method of preventing climbing related injuries is to not participate in climbing.

slackline

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The Understanding Uncertainty blog from David Spiegelhalter (Winton Professor for the Public Understanding of Risk at Cambridge University) has some good examples of how risk can easily be mis-communicated.

He's done a short video...



And there are of course longer lectures for those with the interest...



However, the report still has value in that it shows patterns in injuries over time at one specific place.  It has short comings, but virtually no work/research can't be improved upon.  It would be possible to do some crude (and therefore inaccurate) inferences by looking at participation within different age bands from the national equivalent of the BMC in order to derive crude incidence rates.

jwi

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Hey people, epiphyseal fatigue fracture in the fingers is really serious, we're talking lifelong problems. 16 kids in Germany with epiphyseal fatigue fracture from climbing is 16 to many. Estimates on risk is maybe not as important as understanding why they got it and how to prevent it.

slackline

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From the same authors...

Hochholzer T, Schöffl VR. (2005) Epiphyseal fractures of the finger middle joints in young sport climbers. Wilderness Environ Med. 16(3):139-42.

Quote
OBJECTIVE:

As competition climbing becomes increasingly popular, younger climbers are entering the sport, and some are among the top-level athletes. This early start combined with intensive training methods can lead to radiographic changes in the fingers and even osteoarthrosis. Since 1994, we have been observing an increasing number of nontraumatic epiphyseal fractures in young athletes.
METHODS:

Twenty-four cases of young climbers with nontraumatic epiphyseal fractures of the finger middle joints are presented.
RESULTS:

The average age of the climbers was 14.5 (+/- 0.9) years; 23 were boys, and 1 was a girl. Eight (33%) fractures were in an early stage, whereas in 16 (67%) a longer time interval elapsed between the onset of symptoms and the presentation for evaluation. All radiographs showed an epiphyseal fracture of the dorsal base of the middle phalanx of the finger; 20 patients presented a Salter-Harris III fracture and 4 presented a Salter-Harris II epiphysiolysis. An acute injury was not evident in any of the patients. All fractures were thus fatigue fractures caused by repetitive stress.
CONCLUSIONS:

Chronic finger pain in young and intensively training climbers must be carefully evaluated, and radiographic studies need to be performed. The risk of epiphyseal injuries must be minimized by eliminating intensive power training in the schedules of athletes of this age.

See also the related articles.

You would want to know both the absolute risk (how likely is it to occur within children who rock climb) and the relative risk (how much more likely is it to occur within children who climb compared to those who don't).

A few seconds searching on Google scholar led to the following article which give some impression on the incidence in children in general...

P. H. WORLOCK, M. J. STOWER (1986) The Incidence and Pattern of Hand Fractures in Children J Hand Surg Eur  11 no. 2 198-200

Quote
The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures. are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.


Of less relevance since it is looking at treatment outcomes...

N.J. Barton (1979) Fractures of the phalanges of the hand in children. The Hand 11 (2):134–143

Quote
Fractures of the phalanges of the hand were studied in 203 children. Fingertip fractures caused disability for three weeks but usually had good results. Comminuted fractures often took the form of longitudinal splitting. Epiphyseal fractures were mostly of the Salter type 2 and metaphyseal types and usually had good results: remodelling occurred in both planes at the base of the proximal phalanx but only in the sagittal plane at the base of the middle phalanx. Epiphyseal fractures at the base of the distal phalanx often had unsatisfactory results. Fractures of the neck of phalanx showed no remodelling at all and if deformity is not corrected it is probably permanent.

And more generally...

Hove LM (1993) Fractures of the hand. Distribution and relative incidence. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 27(4):317-319


Whilst I think more information/data would be useful I agree with Jonas, the incidence of these fractures due to fatigue/overuse in adolescents who don't climb is highly likely to be very low (this isn't contradicted by the above Worlock & Stower since they find that that is the most common injury at a given site and most were accute occurring at home or in fights, of which 53 epiphyseal fractures at metacrapals (n = 10) and phalanges (n = 43) from a population of 102841 children < 12 years old and most were "greenstick" fractures caused by acute stress, i.e. not fatigue/overuse).  Still need to know how many participants the reported number of climbing children comes from.

I'm too busy and not overly interested to dig any deeper.

Oldmanmatt

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Thanks Slackers.

To be clear, as stated previously, I'm NOT in favour of plyometric training, or even power training in adolescent climbers.

I would posit that the evidence from a single clinic is probably tainted by local conditions. I'd like to know if that sample all trained in the same gym, or competed on the same circuit, or were known to each other and exchanged training beta etc etc.

Then there is this:

http://www.sgsm.ch/fileadmin/user_upload/Zeitschrift/50-2002-1/3-2002-1.pdf

From the Swiss national squad.

Sorry, tapatalk does not allow me to highlight the passage I'd like to, but this is certainly not the same conclusion as the paper cited above.

Quote:
Summary
Objectives. Based on reports of major overuse injuries in the fingers of adult elite rock climbers, we performed a cross-sectional study of young Swiss elite rock climbers to assess the finger injury patterns and search for possible risk factors.Methods. Twenty-nine 10- to 17-year-old nationally ranked rock climbers took part in the study.

Climbing and injury history was assessed by interview, followed by a clinical examination of the hands and antero-posterior and lateral radiographs of both hands. Injury pattern and possible predictors of injury were determined.

The climbers were divided into two groups:

group 1 included those with current pain in the finger (n = 21) and

group 2 was free of pain (n = 8).

Results.

Twenty-one of 29 climbers reported current or recurring pain in the fingers. Clinical findings among both groups consisted of swelling in the affected PIP/DIP joints, radio-ulnar laxity and/or an extension deficit in the affected PIP or DIP joints, and mild bowstringing of the pulley system. Radiologically there was one old flake fracture and four abnormalities of the epiphysis as a possible sign of a previous epiphyseal injury of the affected joints.

The only clinical finding among the injured climbers, which dis- criminated group 1 from group 2 was swelling of the proximal interphalangeal joints (chi-square, p < 0.05).

***Age, weight, general laxity, start of regular climbing training (age), climbing difficulty, increase in climbing difficulty per year, training volume during the last season, climbing technique and grip strength did not predict injury. ***
No severe injuries were found in this study.

Conclusion.

Young elite rock climbers are prone to finger pain as possible sign of injury or overuse.

**Despite extensive load appli- cation to the fingers of our young elite rock climbers, they do not show major injuries, even though pain is a common finding. **

Nevertheless, those with pain, swelling or a deficit of range of motion in the PIP or DIP joints of the finger should be evaluated to exclude intraarticular lesions such as epiphysiolysis as previously reported.

End quote.

Which would suggest (to me) that climb training can be managed, at an elite level, in adolescents.
« Last Edit: March 04, 2015, 11:04:39 am by Oldmanmatt »

slackline

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I would posit that the evidence from a single clinic is probably tainted by local conditions. I'd like to know if that sample all trained in the same gym, or competed on the same circuit, or were known to each other and exchanged training beta etc etc.

Sounds very much like what is sought is a Randomised Control Trial, although there may be ethical problems with undertaking a study where children are randomised to training regimes where there is some evidence of increased risk of injury, so perhaps more structured surveys with more detailed data on training regimes recorded and not just from those who are injured but those who are participating but currently injury free.

Unfortunately thats unlikely to happen since in the grand scheme of all medical problems encountered the burden of such problems is low.  This is not the same as saying its unimportant to those involved, its simply that there isn't enough money to go around to look at everything thats interesting.


Which would suggest (to me) that climb training can be managed, at an elite level, in adolescents.

Its a small study but the fact that only 8 out of 29 reported being pain free does not bode well in my opinion.  The authors also suggest careful monitoring of those with pain (i.e. most that are training at an "elite" level) to ensure there aren't fractures (i.e. X-rays etc.), who's going to pay for that?  Team BMC?  Parents?  NHS? Local Training Venues?

Hands are important for so many more things in life than just climbing and fucking them up at an early age is not a good idea as they're our primary mode of interacting with the environment.  Thus it seems perfectly sensible, and everyone posting in this thread seems to be in agreement on this for once and its something the BMC advocate too (as well as the UIAA), to not do intense finger training as a youngster.  All these studies seem to be doing is backing this advice up with some evidence.

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Quote from: Hochholzer T, Schöffl VR. (2005) Epiphyseal fractures of the finger middle joints in young sport climbers. Wilderness Environ Med. 16(3):139-42.
Epiphyseal fractures were mostly of the Salter type 2 and metaphyseal types and usually had good results: remodelling occurred in both planes at the base of the proximal phalanx but only in the sagittal plane at the base of the middle phalanx. Epiphyseal fractures at the base of the distal phalanx often had unsatisfactory results. Fractures of the neck of phalanx showed no remodelling at all and if deformity is not corrected it is probably permanent.

This study ^ suggests that overuse fractures to the growth plate of the PIP joint usually have good outcomes, whilst outcomes were usually 'unsatisfactory' in the case of the same injury to the growth plate of the DIP joint. Fractures to the neck of phalanx usually result in a permanent disability.

Which if true, suggests to me that the common refrain of 'kids should not do intensive finger training or hard climbing because it carries a risk of injury to the growth plates of their fingers' could be better defined.
If the biggest risk of long-term damage involves a subset of growth plate injuries, then might these types of injury be better avoided through thoughtful training design which reduce the risk of DIP joint injuires as far as possible while enabling talented/motivated kids to train their fingers in a thoughtfully structured way? I don't know how you could do this - I'm not a coach, but it seems sensible to teach all youngsters to climb/train open-handed as a matter of course before anything else. Rather than tell yongsters they can't use their body to do something - hang from a small edge, climb hard routes - it seems to me more sensible to teach them to use the body in the safest possible way.

If it is true that an overuse injury to the PIP growth plate usually results in a good healing outcome, then is this a risk worth accepting (I'm not saying it is)? And how does this level of risk compare with other sports that have child participation? All sport inherently involves a risk versus reward calculation, and we've slowly arrived at a point where the risk versus reward is well-defined for mainstream sports - helmets, pads, medical staff, training, age guidance etc. all exist in mainstream sports. The climbing community is still discovering injury mechanisms and healing outcomes.
« Last Edit: March 04, 2015, 01:54:25 pm by petejh »

jwi

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Pete, you're absolutely right when you're implying that there is lots of information on how to construct a safe training program for kids. And there are lots of coaches with a good track record on keeping their adepts injury free. Some of the climbers that seem to develop very fast at an age of 18-20 have a long background in training for climbing, and when their bodies are ready for it they can develop very fast.

I'm mostly worried that when media hype achievements that are trivial to reach if you start with a big enough cohort and a willingness to break some eggs, it will make parents/coaches/self-coched kids take very unsafe short cuts.

The way ascents are reported in the news, scores are tallied on eight-A.spew, etc turn climbing into a competitive sport without a governing body. This fills me with unease in so many ways.

 

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