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Abstract

Objective: To prospectively evaluate the injury risk and injury severity of climbers competing in the climbing World Cup series. Methods: In 2012 the International Federation of Sport Climbing (IFSC) implied, on demand of their Medical Commission, a medical injury and incidence surveillance system for their international events. All injuries and incidences were recorded, analyzed and classified. Climbing time was collected and injury rate per 1000 hours of sports performance calculated. Results: In total there were 1362 days (3405 h) of lead climbing, 1083 days (2707.5 h) of bouldering and 255 days (637.5 h) of speed climbing. Five injuries/medical incidences took place. All were grade 2 injuries. The overall injury/medical incidence risk was 0.74/1000 h of competition climbing. Both genders combined had a 0.29/1000 h injury/medical incidence risk for lead climbing, 1.47/1000 h for bouldering and zero for speed climbing. Conclusion: Indoor Competition Climbing showed a minor injury rate and the few injuries which occurred were of minor severity.
Medicina Sportiva
Med Sport 17 (4): 168-170, 2013
DOI: 10.5604/17342260.1081272
Copyright © 2013 Medicina Sportiva
ORIGINAL RESEARCH
168
INJURIES AND MEDICAL INCIDENCES DURING THE
IFSC 2012 CLIMBING WORLD CUP SERIES
Volker Schöffl1,2,3 (A-F), Eugen Burtscher1 (A,B,D,E), Francesco Coscia1 (A,B,D,E)
1Medical Commission of the International Federation of Sport Climbing (IFSC)
2Department of Traumasurgery, Friedrich Alexander University Erlangen-Nuremberg, Nuremberg, Germany
3Department of Sportorthopedics – Sportsmedicine, Klinikum Bamberg, Bamberg, Germany
Abstract
Objective: To prospectively evaluate the injury risk and injury severity of climbers competing in the climbing World Cup
series.
Methods: In 2012 the International Federation of Sport Climbing (IFSC) implied, on demand of their Medical Commission,
a medical injury and incidence surveillance system for their international events. All injuries and incidences were recorded,
analyzed and classified. Climbing time was collected and injury rate per 1000 hours of sports performance calculated.
Results: In total there were 1362 days (3405 h) of lead climbing, 1083 days (2707.5 h) of bouldering and 255 days
(637.5 h) of speed climbing. Five injuries/medical incidences took place. All were grade 2 injuries. The overall injury/medical
incidence risk was 0.74/1000 h of competition climbing. Both genders combined had a 0.29/1000 h injury/medical incidence
risk for lead climbing, 1.47/1000 h for bouldering and zero for speed climbing.
Conclusion: Indoor Competition Climbing showed a minor injury rate and the few injuries which occurred were of minor
severity.
Key words: rock climbing, sport climbing, climbing injury, sports injury, world cup
Introduction
Since the first international sport climbing World Cup
1989 in Snowmass, CO (USA) and the first official World
Championships 1991 in Frankfurt (Germany) climbing
competitions are gaining fast in popularity [1]. The first
international event had only two disciplines, lead climb-
ing and speed climbing. Bouldering, as athird discipline,
started with its own World Cup in 1999. Organizing body
of these international climbing events is the International
Federation of Sport Climbing, which was founded in 2007
[1]. Sport climbing already was ademonstrating sport for
the Olympics in Albertville 1992.
For an objective analysis of the climbing sport´s risk
prospective studies are necessary [2]. Up to date most
analysis of rock climbing injuries are either retrospec-
tive or do not exactly differ between the various sub
disciplines performed (e.g. indoor climbing, alpine or
traditional climbing) [2,3]. Only three studies [4-6] fo-
cus purely on indoor climbing and one on competition
climbing [7]. Afurther analysis is necessary to evaluate
not only one single competition [7] but awhole World
Cup season and is presented in this short report.
Methods
To gather exact information about the involved
injury risk of competition climbing in the World Cup
an injury surveillance system was implied through the
IFSC Medical Commission in 2012. All international
competitions of the IFSC are included. The competition
doctor in charge needs to complete an injury report,
which is included into the Jury President report. For all
injuries or medical incidents an additional injury form
must be completed, with the full data for afurther fol-
low up of the patient (injury outcome). All reports are
evaluated through the MedCom IFSC. For the present
analysis all 2012 World Cup events and the 2012 World
Championships were included. There were 10 events for
lead climbing, 7 for bouldering and 5 for speed climbing.
The climbing time for all events was collected through
the official results from the IFSC (www.ifsc.org). From
the collected number of competition days the climb-
ing hours were calculated, estimating one competition
day as 2.5 hours of climbing time. This estimation was
already further explained and used in prior studies [7]
and is based on the UIAA MedCom recommendation
for injury classification [8]. The respective injury risk
(including the risk of medical incidences) per 1000 h
of sports performance was calculated and the injuries
classified according to the UIAA MedCom classification
[8]. Nevertheless, as some acute presenting conditions
during aclimbing competition are based on overstrain/
overuse rather than on areal trauma the UIAA score
was further extended and grade 2 injuries were dis-
tinguished into grade 2a: grade 2 injury based on an
overuse and grade 2b: acute injury (climbing injury
score, see below). Injury location was reported using the
OSICS (Orchard Sports Injury Classification System)
body area character [9].
IFSC Climbing Injury Score (extended UIAA Med-
Com score [8])
0 No injury or illness
1 Mild injury or illness, no medical intervention nec-
essary, self-therapy (e.g. bruises, contusions, strains)
169
Schöffl V., Burtscher E., Coscia F. / Medicina Sportiva 17 (4): 168-170, 2013
2a Moderate severe injury based on overuse/overstrain.
Conservative therapy or minor surgery, outpatient
therapy, heals without permanent damage (e.g.
tendonitis, epicondylitis, capsulitis, impingement
syndrome)
2b Moderate severe acute injury or illness, not life
threatening, prolonged conservative or minor sur-
gery, outpatient therapy, doctor attendance within
ashort time frame (days), injury related work ab-
sence, heals without permanent damage (e.g. undis-
placed fractures, tendon ruptures, pulley ruptures,
dislocations, meniscal tear, minor frostbite)
3 Major injury or illness, not life-threatening, hospi-
talization, surgical intervention necessary, immedi-
ate doctor attendance necessary, injury-related work
absence, heals with or without permanent damage
(e.g. dislocated joint, fractures, vertebral fractures,
cerebral injuries, frostbite with amputations)
4 Acute mortal danger, polytrauma, immediate pre-
hospital doctor or experienced trauma paramedic
attendance if possible, acute surgical intervention,
outcome: alive with permanent damage
5 Acute mortal danger, polytrauma, immediate pre-
hospital doctor or experienced trauma paramedic
attendance if possible, acute surgical intervention,
outcome: death
6 Immediate death
Results
Overall 22 World Cups events took place in 2012
(lead: 10, bouldering 7 and speed 5). In total there
were 1362 days (3405 h) of lead climbing, 1083 days
(2707.5 h) bouldering and 255 days (637.5 h) of speed
climbing. All disciplines together had 2700 climbing
days, which calculates to 6750 climbing hours. 5 inju-
ries/events took place, which were 4 injuries and one
medical incidence (see Table 1). It is noticeable that in
incidence no.1 the climber fell in the first qualification
round and hit the wall with his chin. He was treated
in ahospital and received stitches to his chin wound.
Afterwards he was able to continue the competition;
which he actually won.
The overall injury/medical incidence risk was
0.74/1000 h of competition climbing. It was 0.54 in
male and 0.97/1000 h in female climbers. Both genders
combined had a0.29/1000 h injury/medical incidence
risk for lead climbing, 1.47/1000 h for bouldering and
zero for speed climbing. No higher than grade 2b
injuries occurred.
Discussion
Climbing and mountaineering sports are gaining
more and more public interest [2]. While outdoor
climbing has its great number of athletes also indoor
climbing is aconstantly raising sport, with many climb-
ers never ever even climbing outdoors. Various previous
studies analyzed the injury risk for different climbing
activities [2,3,6,10-18]. Objective reporting of injury
site and severity varied in most studies according to the
injury definition and methodology used [2,3,8,10]. This
creates differences in the injury and fatality results and
conclusions, which in turn makes inter-study compari-
sons difficult. In 2011 the UIAA Medical Commission
published its injury score as aconsensus paper, which
will help to increase inter-study comparability [8]. The
new score was already used in the study of Neuhof et al.
[10] and Schöffl et al. [6] and is part of several other on-
going studies. To further differ between overuse injuries
and acute injuries this score was extended for the present
evaluation. While most climbing studies demonstrated
aminor injury risk for sport climbing in comparison to
alpine climbing, little research is presented on indoor,
and especially on competition climbing [2,3,6].
Wright et al. [14] evaluated the frequency of over-
use injury during the indoor 1999 World Climbing
Championship (n=295) where 44% of the respondents
had sustained an overuse injury, 19% at more than one
site. Wright [14] found an independent correlation to
increased injuries (P < 0.01) when: climbing harder
routes, bouldering or leading versus top rope climbing,
and climbing >10 years. Multivariate analysis removed
the effect of sex as an independent predictor. Jones et
al. [12] similarly found increased numbers of overuse
injuries or injuries caused by strenuous moves, and less
from fall related injuries than in traditional and outdoor
sport climbing [15,17,19,20]. Three large-scale studies
[4-6] analysed indoor climbing injuries. Limb’s survey
reported 55 accidents, from 1.021 million climbing wall
visits, and no fatalities [5]. Schöffl and Winkelmann
prospectively surveyed 25.163 registrants at ten climb-
Table 1. Injuries and medical incidences of the 2012 Sport Climbing World Cup
Number Gender Discipline Injury OSICS [9] IFSC Climbing
Injury Score
1 M Lead chin contusion, skin laceration H 2b
2 F Boulder ankle sprain A 2b
3 F Boulder dehydration X 2b
4 F Boulder suspected ACL tear K 2b
5 M Boulder ankle sprain A 2b
(M = male, F = female, ACL = anterior cruciate ligament)
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Schöffl V., Burtscher E., Coscia F. / Medicina Sportiva 17 (4): 168-170, 2013
Authors’ contribution
A – Study Design
B – Data Collection
C – Statistical Analysis
D – Data Interpretation
E – Manuscript Preparation
F – Literature Search
G – Funds Collection
ing walls [4]. Only four significant injuries (NACA 3)
were found and no fatalities; the injury-risk per visit was
0.016% or 0.079 injuries/1000 h of performance [4]. Jus t
recently Schöffl et al. published their data on aprospec-
tive analysis of 515.337 indoor climbing wall visits in
5 years [6]. Thirty climbing injuries were recorded, 22
were in male and 8 in female climbers with atotal mean
age of 27.5 (± 10.6) years. Injuries happened in 6 cases
while bouldering, in 16 cases while lead climbing, in 7
cases while top roping and in one case as athird per-
son (not climbing or belaying) while watching another
climber. Fifteen injuries were UIAA MedCom grade
2, 13 grade 3 and 2 grade 4 injuries. The overall injury
rate was 0.02 injuries per 1000 h of climbing activities.
In summary, these indoor climbing studies demon-
strated avery minor injury risk and severity in com-
parison to traditional climbing and various other sports
[2,3,6]. Overuse injuries were commonly reported in
upper limbs, with the finger most affected [2,3].
Only one study analysed competition climbing, but
only at one single event. Schöffl and Küpper recorded in-
juries and injury rates at the 2005 World Championships
[7]. They found an injury rate of 3.1/1000 h. Eighteen
acute medical problems were treated (including 13 cases
of skin bruising). They did not yet grade these injuries
yet according to the UIAA MedCom score, as this study
was prior to the scores publication. In analysing their
injury at this point of time all the 13 cases of skin bruises
are only UIAA grade 1 injuries. Grade 1 injuries are very
minor injuries, which are self treatable and are normally
not included in the evaluation of the significant injuries
[2-4,8,10]. Neglecting these there were only 4 injuries (all
UIAA grade 2b) and one medical incident (grade 2b).
These numbers are similar to the present evaluation of
the 2012 Climbing World Cup. Only one study reported
afatality rate, which was zero in 515.337 indoor climb-
ing wall visits in 5 years [6]. The present evaluation also
showed azero fatality rate, which is similar to the previous
years of World Cup Climbing Competitions (retrospec-
tive data, IFSC, www.ifsc.org). Nevertheless this study
is the first that evaluates awhole season of World Cup
competition climbing completely. Competition climbing
(World Cup) showed avery minor injury risk, with the
injury severity being also minor. Nevertheless the po-
tential risk of afatal injury always remains. These results
may not necessarily represent all competition climbing,
as safety standards may be lower in local or regional level
competitions. Further prospective analysis is necessary
and the monitoring of all Climbing World Cup events
through the IFSC Medical Commission will continue.
Declaration of interest
The authors report no conflicts of interest.
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Accepted: November 28, 2013
Published: December 20, 2013
Address for correspondence:
Volker Schöffl
Klinikum Bamberg, Bugerstr. 80,
96049 Bamberg, Germany
Volker.schoeffl@me.com
Tel. 004995150312241, fax 004995150312249
Eugen Burtscher: eugen.burtscher@vol.at
Francesco Coscia: f.coscia@email.it
... 13 These data differ greatly from other reports on injury statistics of (inter-)national climbing competitions that stated incidences of 0.7 and 3.1 per 1000 hours sports performance. 12 14 Steffen et al compared all new Olympic sports to traditional Olympic sports during the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina. With only one injury among 42 competitors during the entire climbing competition, the authors identified climbing among the sports with the lowest injury/ illness risk during the games. ...
... 17 20-23 In three available studies (performed during 2005-2012), in which injuries during competitive events were listed separately according to discipline, bouldering represented the leading cause of injuries. [12][13][14] With evidence lacking and data currently based on observations rather than on scientific evidence, injury rates in general seem slightly increasing due to the worldwide 'boom' of the sub-discipline bouldering, which also is associated with a wider range of injury types and locations. 22 24 Reasons for higher injury rates in bouldering compared with other sub-disciplines are likely due to more aggressive movements in shorter routes and acrobatic elements (figure 1). ...
... Also, repetitive high load on musculoskeletal structures while repeatedly trying routes within a given time limit, and limited protection when falling from higher heights (usually in the range of 3-5 m), may contribute to higher injury risk. 14 18 22 24 ...
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Chapter
Der Kaderuntersuchung und der Wettkampfbetreuung kommt bei der sportmedizinischen Kaderbetreuung zentrale Stellung zu. Die Kaderuntersuchungen erfolgen auf nationalem und Landesniveau auf der Basis der Empfehlungen des Deutschen Olympischen Sportbunds (DOSB) und beinhalten neben der allgemeinmedizinischen und orthopädischen Untersuchung die Spiroergometrie mit Belastungs-EKG, ein Ruhe-EKG, eine kardiale Echokardiographie sowie eine Labor- und Körperfettuntersuchung. Zusätzlich erfolgt immer eine sonographische Untersuchung der Hände und Finger. Im Rahmen der aktiven Betreuung von Kletterwettkämpfen werden vor allem akute Traumata versorgt, aber auch internistische Probleme gesehen. Zentrale Inhalte einer effektiven Wettkampfbetreuung sind immer Teamarbeit, Planung, Koordination der Einsatzkräfte und fachliches Know-how.
Chapter
In der Analyse von Unfallverletzungen im Klettersport und deren Epidemiologie muss genau zwischen den einzelnen Subdisziplinen der Sportart differenziert werden. So stellt sich das Risiko im alpinen Klettersport mit objektiven Gefahren anders dar als beim Indoorbouldern oder Wettkampfklettern. Beim Fels- und Outdoorklettern betreffen die häufigsten Verletzungen vor allem die untere Extremität und sind Folge von Stürzen. Beim Sport-, Indoor-, Wettkampfklettern und Indoorbouldern stehen Überlastungsschäden im Vordergrund und betreffen vor allem die obere Extremität. Zur Verletzungsgraduierung hat sich mittlerweile der UIAA-MedCom-Score etabliert. Während die meisten Verletzungen niederen Grades sind, häufen sich aktuell Berichte über eine Zunahme schwererer Verletzung, insbesondere in modernen Indoorboulderanlagen.
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Climbing and mountaineering sports are gaining more and more public interest. This chapter reviews scientific studies on injuries and accidents in climbing and mountaineering sports to evaluate the danger of these sports and their specific injuries and preventive measures. An initial PubMed query was performed using the key words 'rock climbing', 'sport climbing', 'mountaineering', 'alpine injuries' and 'climbing injuries'. More than 500 extracted papers were analyzed which gave information on injury, mortality/fatality, prevention and risk factors. Cross-references were also scanned according to the above given criteria. Also the data sources of the UIAA and IFSC Medical Commissions were analyzed. Overall, alpine (traditional) climbing has a higher injury risk than sport climbing, especially indoor climbing. Alpine and ice climbing have more objective dangers which can affect climber safety. Overall injury rates are low, nevertheless fatalities do occur in all climbing disciplines. Altitude-related illnesses/injuries also occur in mountaineering. Most injuries in sport climbing are overstrain injuries of the upper extremity. In alpine climbing, injuries mostly occur through falls which affect the lower extremity. Objective reporting of the injury site and severity varied in most studies according to the injury definition and methodology used. This creates differences in the injury and fatality results and conclusions, which in turn makes inter-study comparisons difficult. In future studies, the UIAA MedCom score for mountain injuries should be used to guarantee inter-study comparability. Evidence in preventive measures is low and further studies must be performed in this field.
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Introduction: Ice-climbing is widely considered to be a hazardous sport with a high risk of injury. To date, there has been no scientific analysis to characterize and reveal the prevalence of injury in this sport. The purpose of this study was to quantify and rate ice-climbing injuries. Methods: Eighty-eight ice-climbers (water ice) (13 female, 75 male, mean age 34.6 years) from nine countries completed a comprehensive questionnaire on ice-climbing accidents and injuries, climbing frequency and risk taking behaviour. Iceclimbing hours were quantified and injuries rated according to the NACA (National Advisory Committee for Aeronautics) score. To enable comparison to other sports, the injury risk was calculated per 1000 hours of participation in a given sport. Results: Seventeen athletes (19%) reported a total of 35 overuse syndromes resulting from ice-climbing. Ninety-five injuries were retrospectively reported for a consecutive 3-year period. The incidence and respective grading of the acute injuries were: 67 for NACA 1, 24 for NACA 2, and 4 for NACA 3. Most acute injuries were open wounds (55.2%) and haematomas (21.9%). These injuries occurred 61.3% of the time while lead climbing, 23.8% while following and the rest during belaying, approach or return. The incidence of overuse injury syndromes was 0.77/1000 hours of sports participation. The injury incidence was 4.07/1000hr for NACA 1-3 with 2.87/1000hr in NACA 1, and none in NACA 4-7. Body mass index (BMI) correlated significantly (P<0.05) with an increased risk of injury. Overuse syndromes correlated significantly with training hours (P<0.01), ice-climbing level (P<0.01) and the risk willingness while lead climbing on ice (P<0.01). Conclusion: Contrary to the popular perception, our study demonstrated that ice-climbing is not a sport with a high risk of injury. All NACA I injuries are of minor medical relevance and would normally not need special treatment or a doctor’s attendance. The results of injury risk per 1000 hours of participation in ice-climbing was comparable to that of indoor competition climbing and to other outdoor sports (hiking, mountain biking, kayaking). The injury risk was also much less than a standard sport such as soccer.
Article
Rock climbing's popularity continues to rise, with people of all ages regularly participating in the sport. Climbing literature suggests climbers get injured mostly in their upper extremities. Most studies on climbing injury analysis are conducted retrospectively, with all the inherent problems of a retrospective setup (no exact time collection, biased injury perception, etc). Prospective data are still missing. We prospectively evaluated all attendees of a major German indoor climbing gym in Stuttgart, Germany, with bouldering and lead climbing facilities. Attendee's age, sex, and time spent climbing were electronically recorded on each visit. All acute injuries were graded using the Medical Commission of the Union Internationale des Associations d'Alpinisme Score. Injury cause, belayers' and climbers' experience, and outcome were additionally analyzed. During a 5-year period (2007-2011), 515,337 visits to the climbing wall were registered, of which 63.6% were by male visitors, 36.4% female, within an age of 8-80 years (median, 34 years). The average time of climbing was 2 hours 47 minutes. Thirty climbing injuries were recorded, 22 were in male and 8 in female climbers with a total mean age of 27.5 ± 10.6 years. Acute injuries happened in 6 cases while bouldering, in 16 cases while lead climbing, in 7 cases while top roping, and in 1 case as a third person (not climbing or belaying) while watching another climber. Bouldering injuries were mostly the result of falls onto the mat, whereas in lead and top rope climbing various scenarios happened. Fifteen (50%) injuries were Medical Commission of the Union Internationale des Associations d'Alpinisme grade 2, 13 (43%) were grade 3, and 2 (7%) were grade 4, with no fatalities. The overall injury rate was 0.02 injuries per 1000 hours of climbing activities. This was the first study to accurately record time spent indoor climbing digitally and evaluate the acute injuries prospectively in a large cohort. There were few injuries sustained, suggesting indoor climbing has a low risk of acute injury per 1000 hours of participation. The injuries were of minor to moderate injury severity, and no fatalities occurred. Several injuries could have been avoided, and further injury-prevention concepts should be developed.
Article
During a period of 6 month the risk of significant injuries on indoor climbing walls was survived. A total of 25,163 visitors were registrated at the 10 walls. Overall only 4 significant injuries were found, the injury-risk per visit was 0.016%.
Article
Variations in definitions, scores, and methodologies have created differences in the results and conclusions obtained from studies on mountaineering and climbing sports injuries and illnesses; this has made interstudy comparisons difficult or impossible. To develop a common, simple, and sport-specific scoring system to classify injuries and illnesses in mountaineering and climbing studies; such retrospective scoring would facilitate the analysis and surveillance of their frequencies, severity and fatalities, and outcomes of any treatment. The UIAA (The International Mountaineering and Climbing Federation) makes recommendations, sets policy, and advocates on behalf of the climbing and mountaineering community internationally through its various commissions. Using a nominal group consensus model approach, a working group was formed during the UIAA Medical Commission's meeting in Adršpach - Zdoňov, in the Czech Republic, 2008. This group critically examined climbing and other relevant literature for various methodological approaches in measuring injury incident rates and severity, including data sources, and produced a working document that was later edited and ratified by all members of the UIAA Medical Commission. Definitions of injury location, injury classification, and fatality risk are proposed. Case fatality, time-related injury risk, and a standardized metric climbing difficulty scale are also defined. The medical commission of the UIAA recommends the use of the described criteria and scores for future research in mountaineering and climbing sports in order to enable robust and comprehensive interstudy comparisons and epidemiological analysis.
Article
From 1981 through 1986, 43631 climbers registered for climbs in the Grand Teton National Park, USA. There were 108 climbing accidents. The accident incidence was 2.5 accidents per 1000 climbers per year, or 5.6 accidents per 10000 climber-hours. There were 23 fatal accidents and 25 fatalities. Mountaineering appears to be a more hazardous activity than rock climbing; travel over snow or ice-covered terrain accounted for high numbers of accidents, climber errors, and fatalities. Effective use of proper equipment (ice axes and helmets), climber experience, self-reliance in difficult situations, and appreciation for the dangers involved in mixed (rock and snow) climbing are all preventive factors that can decrease accidents and injuries among climbers.