Painfully ignorant? Impact of gender and aim of training on injuries in climbing.

Introduction: Climbing has evolved from an obscure outdoor sport to a predominantly indoor sport with the rise of mainstream climbing on artificial walls. Reported climbing-related injuries were predominantly chronic and may be avoided with proper planning of training. All climbers, regardless of age and gender, are training on the same routes and perform similar movements; however, few studies have investigated gender-specific injuries in climbing. Objectives: Assess the distribution of chronic climbing injuries in an international population with gender-specific analyses and assess the impact of the person's training focus or aim of training on those injuries. Methods: A cross-sectional survey using a web-based item-driven questionnaire was created and promoted using social media and several climbing media stakeholders. All climbers engaged in either sport climbing, bouldering or traditional climbing were included. Results: The survey received 1513 responses (877 men, 427 women and 9 not reporting gender), of which 50.3% (n=665; 51.4% men and 48.0% women) had experienced an injury in the past 12 months. There were significant differences in injuries in feet/ankle (p=0.014), neck (p=0.03), head (p=0.0001), shoulder (p=0.001), elbow (p=0.021) and fingers (p=0.003). Conclusion: Over 50% of the climbers experienced an injury in the past 12 months. The most common injuries were to the shoulders (women) and fingers (men). There were significant differences between the genders regarding injury site and prevalence. The gender differences may be affected by the aim for training and the style of climbing.

The Connection Between Resistance Training, Climbing Performance, and Injury Prevention.

BACKGROUND: Climbing is an intricate sport composed of various disciplines, holds, styles, distances between holds, and levels of difficulty. In highly skilled climbers the potential for further strength-specific adaptations to increase performance may be marginal in elite climbers. With an eye on the upcoming 2024 Paris Olympics, more climbers are trying to maximize performance and improve training strategies. The relationships between muscular strength and climbing performance, as well as the role of strength in injury prevention, remain to be fully elucidated. This narrative review seeks to discuss the current literature regarding the effect of resistance training in improving maximal strength, muscle hypertrophy, muscular power, and local muscular endurance on climbing performance, and as a strategy to prevent injuries. MAIN BODY: Since sport climbing requires exerting forces against gravity to maintain grip and move the body along the route, it is generally accepted that a climber`s absolute and relative muscular strength are important for climbing performance. Performance characteristics of forearm flexor muscles (hang-time on ledge, force output, rate of force development, and oxidative capacity) discriminate between climbing performance level, climbing styles, and between climbers and non-climbers. Strength of the hand and wrist flexors, shoulders and upper limbs has gained much attention in the scientific literature, and it has been suggested that both general and specific strength training should be part of a climber`s training program. Furthermore, the ability to generate sub-maximal force in different work-rest ratios has proved useful, in examining finger flexor endurance capacity while trying to mimic real-world climbing demands. Importantly, fingers and shoulders are the most frequent injury locations in climbing. Due to the high mechanical stress and load on the finger flexors, fingerboard and campus board training should be limited in lower-graded climbers. Coaches should address, acknowledge, and screen for amenorrhea and disordered eating in climbers. CONCLUSION: Structured low-volume high-resistance training, twice per week hanging from small ledges or a fingerboard, is a feasible approach for climbers. The current injury prevention training aims to increase the level of performance through building tolerance to performance-relevant load exposure and promoting this approach in the climbing field.

A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury.

INTRODUCTION: Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS: A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS: No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS: We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.

Prevalence of amenorrhea in elite female competitive climbers.

Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers. Methods: An anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months. Results: A total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m2 and 19.9 ± 2.4 kg/m2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively). Conclusion: This study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.

What factors are associated with health-related quality of life among patients with chronic musculoskeletal pain? A cross-sectional study in primary health care.

BACKGROUND: Chronic musculoskeletal pain (CMP) affects daily life function and is the most prevalent disorder in primary health care. The primary objective was to examine demographic factors and pain characteristics associated with reduced health-related quality of life (HRQoL) among patients in primary care reporting CMP. Our secondary objective was to compare HRQoL in patients with and without CMP. METHOD: This cross-sectional study was conducted in Trondheim, Norway. Twenty randomly selected GPs, and their listed patients aged 21-58 were invited to participate. Self-reported CMP data was collected using online questionnaires. HRQoL was measured by the 15D questionnaire, total score of 0.9 was used as cut-off for clinical reduced HRQoL. RESULTS: A total of 969 patients (650 females) were recruited from six GPs' patient lists, mean age 45.6 (SD 10.1). CMP was reported by 517 (53%). Factors significantly associated with reduced HRQoL were gender (OR 2.0, 95% CI 1.2, 3.4), disability pension (OR 26.6, 95% CI 3.1, 228.0), mood (OR 1.3, 95% CI 1.1, 1.6), relations with other people (OR 0.8, 95% CI 0.6, 0.9), sleep (OR 1.2, 95% CI 1.0, 1.3) and enjoyment (OR 1.2, 95% CI 1.0). CMP patients had significantly lower total HRQoL score compared to patients without CMP (Between group difference 0.08, 95% CI 0.07-0.09). Half of the CMP patients reported a HRQoL score < 0.9 compared to 14% in the no CMP group. CONCLUSIONS: Being female, receiving disability pension, and several psychosocial factors were found highly associated with reduced HRQoL in CMP patients, whereas pain characteristics were not. Patients with CMP reported statistically and clinically significant lower HRQoL than patients without CMP. Due to low response rate the conclusions must be handled with caution. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02020772).

No pain no gain: a survey of use of healthcare and reasons not to seek healthcare by Norwegian climbers with chronic injuries.

OBJECTIVES: To assess the use of healthcare, and reasons not to seek healthcare, by climbers with a chronic injury. METHOD: Retrospective survey. SETTING: Web-based questionnaire. PARTICIPANTS: 667 active climbers (385 with chronic injuries). OUTCOME MEASURE: Use of healthcare (including reasons not to seek healthcare if the patient was not attended by health professionals), performance level in sport climbing, onset of a climbing-related injury, site of injury, preferred style of climbing and gender differences. RESULT: Of the 667 respondents, 385 had experienced a chronic injury in the past 6 months. Climbers with a chronic injury are reluctant to seek healthcare, and male climbers are less likely to seek healthcare than female climbers. The two most frequent reasons not to seek healthcare were: (1) an assumption that the injury was not serious enough (70%) and (2) a belief that a health professional could not help (60%). Only one in five of the climbers with a finger injury sought healthcare. The more experienced climbers were less likely to seek healthcare than recreational climbers. CONCLUSION: Use of healthcare among climbers with a chronic injury is limited and injured climbers self-assess the injury before seeking medical aid. Experience is a strong predictor for not seeking healthcare after an injury. These findings open up the possibility that some of those who do not seek healthcare after self-assessing the injury are underestimating the seriousness of the injury due to lack of confidence in the health professionals' abilities to help treating chronic climbing related injuries.

Lean and mean? Associations of level of performance, chronic injuries and BMI in sport climbing.

OBJECTIVES: To assess possible associations between performance level (achieved level of difficulty), chronic injuries and body mass index (BMI) in sport climbing. METHOD: Retrospective survey. SETTING: Web-based questionnaire. PARTICIPANTS: 667 active climbers (385 reported having chronic injuries). OUTCOME MEASURE: BMI, performance level in sport climbing, onset of a climbing-related injury, preferred style of climbing, education, gender. STATISTICS: Descriptive statistics and general linear model(GLM) performed with SPSS V.25 for windows. RESULT: No associations were found between level of performance in sport climbing, onset of a climbing-related injury, preferred style of climbing, education, gender and BMI. CONCLUSION: BMI is not associated with climbing-related chronic injury or level of performance in climbing. The average BMI of climbers up to the elite level is similar to that of a lower rate of performance. CLINICAL RELEVANCE: The findings in this study suggest that there is no need for maintaining a low BMI to be able to reach elite levels in climbing.

Self-reported chronic injuries in climbing: who gets injured when?

OBJECTIVES: To assess self-reported chronic injuries in climbing and possible connections with gender, experience and style of climbing. METHOD: Retrospective survey. SETTING: Web-based questionnaire. PARTICIPANTS: 667 active climbers (385 with chronic injuries, 289 males and 96 females). MAIN OUTCOME MEASURE: Climbers who had experienced at least one chronic injury during the last 6 months. RESULT: About 2/3 of male outdoor climbers had experienced a chronic injury. The three most frequent sites of injury were fingers (41.3%), shoulders (19.4%) and elbows (17.7%). The most frequent injury for the females were fingers (29.2%), shoulder (21.9%), wrist (12.5%), elbow (11.5%) and foot/ankle (10.4%). The most frequent injuries for the male were fingers (45.3%), elbow (19.7%) and shoulder (18.7%). Respondents who preferred outdoor climbing were more prone to injury than others. CONCLUSION: Fingers were the most prevalent site of injury regardless of level of experience, gender and whether level of expertise is reported in terms of bouldering or route climbing. There seems to be a gender difference in respect of site of injury prevalence and a different prevalence of injuries according to style of climbing and different levels of expertise. Furthermore, the use of the suggested way of reporting levels of expertise to compare between bouldering and route climbing seems to be robust with no huge differences in terms of incidence level of different injuries.

Addressing the elephant in the room: a possible new way to increase patient adherence to medical advice.

Lack of patient adherence to medical advice (PAMA) is recognized as an area of interest. None of the previous initiatives to improve PAMA, such as patient centered care and shared decision making, have proved to be successful in terms of improving patient adherence. The aim of the present study is to assess beliefs about priorities in public health care, and adherence to medical advice, to establish a novel approach to increase PAMA. The present study is based on responses to two questions in an experimental survey from the Norwegian Citizen Panel, addressing people's attitudes to priorities in public health care and adherence to medical advice. The questions on priorities in the health care sector are organized into six groups. The questions on adherence are organized into three groups. All questions are answered on a 7-point Likert scale. This study is the first to use experimental surveys to assess PAMA. The results indicate that if health care providers refer to national expertise and patient organizations' recommendations on a given treatment, PAMA could improve. Although technical and methodological interventions in health care have, to some extent, improved PAMA, medical adherence is still low. In the present study, it is shown that integrating either national expertise or collaborated messages with other health professions and patient organizations' recommendations in everyday care may help improve patients adherence to medical advice. A minor change in how treatment suggestions are presented could improve PAMA.

First overview on chronic injuries in sport climbing: proposal for a change in reporting of injuries in climbing.

BACKGROUND: Climbing as a youth sport is growing fast. This is mostly due to indoor walls for training attracting youngsters. With hard training from young ages it is vital to be able to pinpoint training regimes to avoid injuries in athletes. Furthermore, it is vital to know what injuries are most common in the sport to be able to prevent them. Such an overview on injuries does not exist to date. The aim of this overview is to summon the injuries described in published research and to extract the most common. METHOD: Two literature searches were conducted in PubMed, on 11 August 2013 and 19 August 2015. RESULT: The searches gave 1409 titles. All titles were carefully examined for the possible finding of descriptions of climbing-related chronic injuries. This led to the reading of 96 abstracts and then to a final inclusion of 47 papers of which 17 described chronic climbing-related injuries. We found descriptions of 45 chronic injuries in those 17 papers. DISCUSSION: Owing to methodological differences, lack of reporting strategies and non-use of control groups in the included papers, it is not possible to conclude on which groups of climbers are more prone to injuries or to state which injuries are the most prevalent among climbers.

Perceived quality of health care services among people with osteoarthritis - results from a nationwide survey.

OBJECTIVE: To assess the perceived quality of care received by people with osteoarthritis (OA) in Norway and explore factors associated with the quality of care. METHODS: A national survey in which members of the Norwegian Rheumatism Association with OA registered as their main diagnosis completed a questionnaire. The perceived quality of care was reported on a 17-item OsteoArthritis Quality Indicator questionnaire, covering both pharmacological and non-pharmacological aspects of OA care. In addition, the four-page questionnaire covered areas related to demographic characteristics, the location and impact of the OA, and utilization and satisfaction with health care services. The quality of care is calculated as pass rates, where the numerator represents the number of indicators passed and the denominator represents the number of eligible persons. RESULTS: In total, 1,247 participants (response rate 57%) completed the questionnaire. Mean age was 68 years (standard deviation 32) and 1,142 (92%) were women. Respondents reported OA in hand only (12.4%), hip only (7.3%), knee only (10.4%), in two locations (42%) or all three locations (27%). The overall OsteoArthritis Quality Indicator pass rate was 47% (95% confidence interval [CI] 46%-48%), and it was higher for pharmacological aspects (53% [51%-54%]) than for non-pharmacological aspects of care (44% [43%-46%]). The pass rate for the individual quality indicators ranged from 8% for "referral for weight reduction" to 81% for "receiving advice about exercises". Satisfaction with care was strongly associated with perceived quality. The pass rate for those who were "very satisfied" was 33% (25%-40%) higher than those who were "very unsatisfied" with care. CONCLUSION: While the OA patient seems to be rather satisfied with the perceived OA care, there is still room for improvement in the quality of care. Although the quality of care in the present study is somewhat higher than in other studies, less than 50% of the recommended care has been provided.

Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey.

BACKGROUND: Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care. METHODS: A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables. RESULTS: A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate. CONCLUSION: Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.