Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes

Knee injuries are very common in rock climbing and bouldering in noncompetitive and competitive athletes.  (Asakawa D, 2019) (Buzzacott P, 2019) 

German scientists performed a clinical study to examine the traumatic mechanisms of knee injury in affected athletes. In this study traumatic mechanisms were inquired and severity levels, therapies, and outcomes (Lutter Ch, 2020). This is the first study to describe traumatic injury patterns, and outcome measurements of acute knee injuries in noncompetitive and competitive rock climbers. Four types of injuries were detected: the high step position, the drop knee position, the heel hook technique, and uncontrolled landing during a fall.

The date from this study revealed, that bouldering seems to be causing knee injuries more often than climbing with a rope. The reason for this might be that bouldering routes normally consist of few but very hard moves, which require strong body tension, difficult body positioning, and strength, especially placing the meniscus under enormous stress. Furthermore, falls to the ground are common in bouldering. Climbing routes, however, are generally much longer and require other skills, such as endurance, while a rope protects the athlete from a fall to the ground.


The scientists found several climbing techniques to predominantly cause typical injuries. Iliotibial band sprains at the lateral condyle were caused exclusively by heel hook positions, which seems reasonable as the heel hook position is the only body position among the described mechanisms in which the iliotibial band is fully tightened and eventually glides over the lateral condyle of the femur under tension (Schooeffl V, 2016). All anterior cruciate ligament tears in this study (Lutter Ch, 2020) happened in cases of uncontrolled falls onto the ground. The mean bouldering level in athletes of the fall group was lower than that in the group of noncompetitive climbers. This interesting fact shows increase of more severe injuries in beginners. Medial meniscal tears were predominantly caused by the high step, the drop knee, and the heel hook positions.


That athletes experiencing knee injuries while performing a heel hook had a high climbing or bouldering level as well as a high weekly training workload might strengthen the theory that stronger climbers use this technique more aggressively than others and thereby injure the knee (Schooeffl V, 2016).


The scientists performing the study (Lutter Ch, 2020) suspect injury-causing events for the drop knee and high step positions to be different. In both body positions,   the injury seems to happen within the moment when the athlete releases one hand to reach the next hold, leading to an extra load on the lower extremities. A slipping foot from the contralateral foothold causing eccentric stress onto the other side could cause peak loads to the knee.

It is also discussed, that insufficient technical skills and fatigue might cause harmful rotational motion of the knee in experienced athletes.


Between-group comparison of competitive and noncompetitive athletes revealed 2 interesting findings.

First, noncompetitive athletes had significantly more medial meniscal tears and a slightly higher UIAA injury score. Hypothetically, this could be due to a lower level of body awareness and control in the noncompetitive group.

Second, the noncompetitive group underwent more surgical procedures than the competitive group. The reasons remain unclear but might be influenced by the significantly lower age and body weight of the competitive group; as medial meniscal tears increase in prevalence with age asymptomatic preexisting meniscal lesions should also be considered.

The scientists advise, that for preventing reinjury of the affected knee during the return-to-sport process, rope climbing should be preferred to bouldering to avoid falls and direct impact on the knee. In case of bouldering activities with a previously injured knee, ‘‘down climb’’ (cautious descent) or ‘‘top out’’ (alternative easy descent) should be preferred to jumping down on the mat after the successful ascent.

Rope climbing on an overhanging wall has been described as having a lower injury risk for the lower extremities and should therefore be preferred to rope climbing on vertical walls. Falls on overhangs are stopped exclusively by the rope, whereas falls during rope climbing on a vertical wall can cause a swing into the wall (Schoeffl V, 2013).

Most climbers neglect the leg muscles completely in their training routine. Active training of the knee stabilizers for improved joint control and stretching techniques (eg, iliotibial band) may be advisable. As an effect of this addition, excessive load on the knee during the described climbing techniques might be reduced.  Improved psychomotor skills and body control might better manage and reduce the risk of injury during falls (Lutter Ch, 2020).