What are some of the common causes for shoulder injuries in climbers?
With the growing popularity of climbing, both indoors and out, there are a growing number individuals developing overuse injuries associated with this activity. As many front range climbers know all too well, training has become a huge part of this once fringe activity. With the popularity of climbing gyms, newer climbers are getting stronger and progressing faster. In addition, many weekend warriors are now training multiple days in the gym in addition to their outdoor climbing. This quick progression and increased volume of climbing can lead to many overuse injuries.
One of the most common overuse injuries I’ve seen amongst climbers is shoulder impingement. So what is shoulder impingement? In simple terms, shoulder impingement is a condition that occurs when the bone of the upper arm, the humerus, compresses the rotator cuff against the top of the shoulder blade, at the acromion process. This condition is termed subacromial impingement. With repetitive overhead motions, this compression creates irritation and inflammation in the muscle being compressed leading to pain, loss of function, and possible tearing of the muscle if left untreated.
Common symptoms of shoulder impingement include:
Pain with overhead reaching
Pain with reaching behind your back (reaching for your chalk bag)
Pain in the front or top of the shoulder that may radiate down the arm
Pain with sleeping on affected side
Shoulder/arm weakness
So why are climbers susceptible to shoulder impingement?
With the repetitive nature of overhead reaching and pulling, climbers have a high likelihood of overdevelopment of large muscle groups such as the latissimus dorsi, rounded shoulder posture due to tight pectoral muscles and weak scapular stabilizers, and weakness in the small stabilizers muscles of the shoulder. These imbalances are also common with newer climbers utilizing improper techniques with hang board training, poor engagement of the scapular muscles when hanging from the arms, and quick progression into high volume and high intensity climbing.
So what should you do if you have pain similar to that described above?
An important first step is rest and activity modification. While no climber, myself included, wants to be told to take rest days, continued climbing through pain can leading to further pain, inflammation, and loss of function. If symptoms are minor and your are continuing to climb, some aggravating positions to avoid can include:
Thumbs down hand jams and finger locks
Large dynamic movements leading to excessive forces on one or both arms
Steep overhanging routes
Any position in which the elbow comes above the hand which often occurs with gastons
Hanging in rest positions or on hang board and allowing your shoulders to shrug towards your ears
In order to speed up the recovery process, proper evaluation by a physical therapist will help to identify the condition, its cause, and provide the guidance necessary to create an effective treatment plan. Physical therapists can utilized techniques including soft tissue and joint mobilization, cupping, dry needling, and develop appropriate corrective exercise routines to normalize the mechanics of the shoulder. These techniques can help to speed the recovery process and avoid long term issues that can develop from chronic shoulder impingement.
In the event of minor shoulder pain that has recently develop and resolves quickly after completion of activity, some simple mobility and strengthening exercises may be an effective self treatment. Some good starting points are:
Using a lacrosse ball, theracane, or theragun to loosen the muscles of the back of the shoulder, along the shoulder blade, and the pectoralis muscles
Pectoralis stretches lying flat on your back or along a foam roller with arms out to the side to open the chest and avoid rounder shoulder posture
Resistance band exercises with a focus on shoulder external rotation in a pain free range
T, Y, and I exercises lying on your stomach or utilizing and exercise ball to strengthen muscles the stabilize the shoulder blades
Ensuring engagement of the scapular muscles when performing dead hangs or resting on a route – very important to avoid your shoulders shrugging up to your ears with either of these activities.
As most climbers know, the only thing better than climbing is more climbing. With this basic understanding of what that annoying shoulder pain may be, the proper individuals to see for assessment and treatment, and simple self care exercises that can also be used to help prevent muscle imbalances means less time in pain and more time enjoying the amazing climbing the front range has to offer.