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:
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:
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:
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.
Acromioclavicular Joint Separation
If you live on the Front Range of Colorado you probably know at least a few mountain bikers, if you are not one yourself. And if you talk to mountain bikers about their injuries you will start to see a trend: lots of collarbone injuries. Falling over the handlebars -- a right of passage among mountain bikers -- is a common culprit for collarbone injuries. The most common collarbone injury amongst mountain bikers is an AC joint separation.
AC joint separation occurs most commonly when a downward force is placed on the shoulder or upper arm, tractioning the arm from the body (including the clavicle). This occurs in biking with a crash onto the shoulder, or in football when a player takes a strong hit to the top of the shoulder. The joint at the end of the clavicle -- the acromioclavicular joint -- takes the most stress in this injury and the ligaments that hold the joint in place can tear.
Degree of Injury
AC joint separations are graded from I to VI depending on the type and severity of separation. In a Grade I sprain, the ligaments are minimally torn and normal activity can usually resume painfree within a few weeks. Grade II includes more ligament tearing and can result in a small bump deformity on the top of the shoulder, but usually heals within two months without functional deficit. Grade III sprains involve a complete tear of the ligaments and visible “step deformity” over the top of the shoulder. The “piano key sign” occurs with this grade of separation where you can push down on the raised collarbone and it will pop back up like a piano key. Grade III injuries can be treated surgically, especially if someone is concerned with their physical appearance, however, functional outcomes are roughly equal between those who undergo surgery or not. Grade IV-VI AC joint separations are rare, but more serious, and require surgery.
So what can you do if you separate your AC joint? In the short term you want to let it heal without injuring it again. Icing it is likely beneficial for at least the first week and taping over the joint with kinesiotape or a more rigid tape can help give a feeling of stability for a few months. Avoiding high contact sports until it’s completely healed will help prevent a worsening of the joint separation. As it starts to feel pain free, the strengthening phase begins. Because of the separation of the joint and tearing or stretching of ligaments, the shoulder joint will be inherently less stable; using muscular strength to support the AC joint becomes more important. Strengthening exercises include rotator cuff, shoulder blade, upper trap (top of shoulder), and chest strengthening to provide support all around the joint. A physical therapist can guide this strengthening phase over the course of a few weeks to a few months, depending on the severity of injury
As a rule of thumb, if there is a visible bump on the shoulder more than a quarter inch and/or pain lasting more than 2 weeks it is advised to get the injury evaluated by a physician or physical therapist to help grade the injury and guide recovery. If pain is severe or the separation is more than a half an inch then immediate medical attention is advised as surgical treatment for this injury, if needed, can be time sensitive.
Bob Cranny, PT