Managing & Treating Climbing Injuries

Climber’s Elbow, Stiff Necks & Shoulders

It’s climbing season again, which means it’s time to prepare and get stronger for upcoming challenges.

Flexor digitorum profundus muscle. Ventral view of the deep muscles of the forearm. FDP is shown in blue.
Ventral view of the deep
muscles of the forearm.
FDP is shown in blue.

Recently, I’ve treated a number of avid rock climbers coming into the clinic with a sore forearm.

Upon further evaluation, they were experiencing what I would call “climber’s elbow.”  There was pain on the lateral aspect of their forearms (lateral epicondyle) and weakness and pain throughout the extensor carpi radialis longus and radialis brevis muscle and tendons. 

Consequently, their finger tendons (flexor digitorum superficialis and profundus) were also being over worked and sore and needed to take time off climbing – That’s no good!

Assessing the issues

Upon further evaluation, they all had restricted mobility in their neck and entire spine and a couple of them at one point in the past have had bad whiplash, or some degree of it where they couldn’t even move their necks for a few days. 

On assessment, the spinal segments of specific spinal vertebral joints were locked and some of the major muscles that attach from the neck to the shoulder were either in a hyper-toned state or were in spasm and had shortened considerably. Overall, the biomechanics and the range of motion in the neck and shoulder were not even close to optimal and the whole upper quadrant, arm strength and mobility were deficient.

Primary approach to treatment

The approach to these types of injuries involves treating the body as a whole in how the fingers / hands work together with the shoulder, neck and the rest of the spine. A stiff and weak neck  will ultimately cause posture compensations when climbing; which will then lead to an abnormal increase in use of power through the shoulders and also the forearms and fingers.

Any slight tweaks in the shoulder like temporary rotator cuff impingement can lead to increased scar tissue in the shoulder capsule and then altered mechanics in movement. 

With altered mechanics in the shoulder, the forearm then will need to be utilized more and more power is applied through the finger tendons which lead to various issues of tendinopathies, tenosynovitis, ligament sprains and annular pulley strains / tears (annular pulley tears can sideline you from climbing from several weeks to quite possibly several months to a year depending on the severity of the tear).


Sternocleidomastoid muscle. Muscles of the neck. Lateral view.
Muscles of the neck. Lateral view.

Neck and Shoulder

With Manual therapy, we can ‘unlock’ the spinal segments of the neck facet joints utilizing gentle mobilization techniques to restore its mobility. Gentle stretching and mobility exercises can then be use to safely increase the flexibility of the muscles and soft tissue and to reinforce the gains in joint mobility. Specific core strengthening exercises can then be used to progress static and dynamic strength.

Scar tissue also usually builds up in either the front or back capsule of the shoulder from the impingement syndrome. 

Using gentle joint mobilization and soft tissue techniques, we can free up the shoulder to restore a more optimal range of motion. 


The forearm muscles also need to be released because the tightness actually puts a prolonged strain on the finger tendons thus not allowing them to fully recover from your repeated bouts of climbing. 

This is especially important for people that also sit in front of the computer typing for most of the day. In addition to restoring mobility, it is also extremely important to work on achieving muscle balance in the “whole upper quadrant” from the hand all the way up to the neck. 

Acute and Chronic Injuries.

If the injury in the hand or forearm is acute, cold baths 2’/2’ (2 minutes on / 2 minutes out) for 3-4 times twice per day is good to take the swelling down. 

If the injury is no longer acute (not hot and swollen) but still has residual swelling or continued joint tightness, then hot / cold contrast baths are ideal 2’/2’ (2 minutes hot / 2’ minutes cold) for 3-4 times twice per day. This is to help increase the blood flow and flush out the residual swelling that is there. 

Back to Climbing

As you get back into climbing, you need to be at least 75-80% strong in that whole upper quadrant and it’s recommended that you tape the fingers to give it support whether it’s a ligament or tendon injury or pulley strain, even if you no longer have any pain. 

It takes tendons and ligaments up to 4-6 weeks to fully strengthen and if you begin climbing too hard too soon, your muscles will get strong but your tendons, ligaments and pulleys will lag behind. 

Staying strong & Healthy

Do you want to stay healthy in order to send climbing projects or to just enjoy the rest of the climbing season injury free? Then the single one most important thing to staying injury free at this point 4-6 weeks post rehabilitation and climbing again is focusing on recovery. 

Recovery means keeping muscles loose and stretched out immediately after climbing, sports and activities and strengthening opposing muscles to the sport (climbing  – strengthening pectoralis major, triceps, deep neck flexor muscles and inner core stability strength). Also try implementing some cardio training (running and cycling); As this will increase your recovery overall, not to mention your body’s over endurance on longer climbs. Avoid over training (not taking enough rest days in between climbing sessions or doing too many heavy climbing sessions consecutively).

Wil Seto, Registered Physiotherapist Send Email 
BHSc(PT), BSc(Kin), Dip Sport PT, Dip Ortho PT, FCAMT, CG IMS
Wil has earned degrees in Bachelor of Kinesiology and Bachelor of Health Sciences Physiotherapy (B.H.Sc. PT) from McMaster University. He is a member of the Canadian Physiotherapy Association (MCPA) and a Fellow of the Canadian Academy of Manipulative Therapists (FCAMT). In addition, he completed post-graduate studies in Advanced Manual and Manipulative Physiotherapy (Dip. Manip. PT) and Sport Physiotherapy (Dip. Sport PT), and is certified in Intramuscular Stimulation (CG IMS).
Wil has been working for over 13 years as a Physiotherapist in the Lower Mainland. He brings a great sense of joy and passion in helping people recover from their injuries and getting them back in sync with their optimal health and maximum potential for sport, work or play. Wil has also been an avid rock climber for over 13 years and has a thorough understanding of what it takes to help you connect with how you really want to move again this climbing season!
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.