Knee injuries in Rock climbing and Bouldering - An Update

Abstract

Introduction: Rock climbing and bouldering is undergoing a worldwide “boom” and has recently been selected for the next Olympic summer games. An injury mechanism in this sport is the socalled heel hook position, which is used more frequently today due to changing training and competition modes. With rising numbers of knee injuries in climbing and bouldering, we now aimed to analyze this specific injury mechanism and its underlying pathologies. Methods: Among 50 climbing athletes with unspecific knee pain, we identified 9 patients with injuries of the lower extremities after performing a heel hook. The outcome was evaluated at a minimum of 6 months after the injury and classified in a sport-specific score. After clinical examination and exclusion of the minor injuries, we performed ultrasound and/or magnetic resonance imaging. Patients were treated conservatively with initial partial immobilization and early functional therapy with physiotherapy. Only one patient with a partial meniscus tear needed a surgical procedure. Results: All patients reported sudden dorsal-sided pain in the knee while performing the hook. Seven patients also reported hearing a snapping sound, similar to those reported in Achilles tendon tears. Walking was difficult and all were limping. Five patients were diagnosed a strain of the lateral collateral ligament and two patients a lateral meniscus tear. The other patients had either a partial tear of the PCL, or a strain of the distal hamstring tendons. In 8 of 9 cases, we received “good” to “excellent” outcomes with a conservative approach. The popping sound at the time of injury may correspond to a change of the pivot of the tractus iliotibialis that then “jumps” over the condyle. While the hook is performed, there is frequently an active knee flexion involved, which thus changes the pivot of the tractus. Conclusion: In climbing and bouldering, injuries of the knee will further increase due to the use of heel hooks. MRI shows that the proper diagnosis and therapeutic approach is the conservative treatment. The outcome after heel hook injuries is good to excellent in most of the cases. Warm-up routine, avoidance of muscular imbalances, and flexibility training can help to avoid injuries.