Your Climbing Injury Is Not From Climbing

March 29, 2023

If you’ve been doing your Theraband exercises and your I’s, Y’s & T’s religiously without any change in your shoulder strength or pain, I’d like you to stop.
If you’ve converted to yogi-ism for your chronically tight hips and hamstrings that prevent you from high steps or heel hooks, & have devoted yourself to pigeon pose, figure 4 stretch, and forward fold to no avail; stop. 

In this article, I’m going to help you understand the true SOURCE of your “climbing injuries.” I’ll also tell you what one exercise can abolish this pain and/or weakness of yours, and share recent studies to support why climbing is likely not what is causing your pain. 

It makes logical sense to assume that your forearm pain is coming from your forearm; after all, we stress those tendons more than any other sport. However, if this pain comes on at rest or while working on your strenuous laptop, it’s probably not coming from your forearm. If your symptoms seem to move locations and have an insidious onset, it’s likely not coming from an overuse of your forearm. If your shoulder blade pain or weakness was because you needed stronger rotator cuff muscles and to stretch your pecs, that would have resolved within 6-8 weeks. Let’s dive into the research.

The Data

In 2019, a study by Rosedal et. al exploring the prevalence of extremity pain being of a spinal source found that over 40% of participants with pain in their arms or legs, who believed their pain was coming from the location of the pain (not the spine), responded to spinal intervention. Interestingly enough, these patients had significantly better outcomes and prognoses than those whose extremity pain was not of a spinal source, and instead was managed with local (the extremity in pain) intervention. 

I see it DAILY in my clinic; a climber comes into Converge PT with climber’s elbow. They have been a good & faithful student of the Therabar, and have returned to their regular practice of working antagonist muscles, but it always comes back. As I dig deeper with my questions, I discover that they often feel like that whole arm is always a problem – that shoulder often feels unstable or pinchy, they’ve dealt with biceps tendinopathy, that forearm betrays them by getting pumped quicker, and that hand gets more finger injuries than the other hand. “Has my right arm been cursed?!”

No. Well, maybe — but that’s not my area of expertise. As I examine the climber,  I often find that their neck mobility is significantly limited, and often on the same side of their “cursed” arm. After gathering the typical data and other baselines, we rule out the spine being the source of their pain or not.

The climber performs a baseline test that reliably reproduces their familiar symptoms; oftentimes they do a pull up on my hangboard and report a 5/10 pain at the inner elbow. Then I have them perform repeated movements of the neck, and immediately re-check that baseline test of a pull up. If the pain is not coming from the spine, they report no change in their pain. If the pain is coming from the spine, they often look at me as if I have just performed witchcraft on them.

How can elbow pain change from doing ten repeated neck movements and you didn’t even have neck pain? Our nerves travel from our brain, through our spine, and down our extremities. Your nerves are responsible for everything that happens – muscle activation and inhibition, the awareness that something cold or hot is touching you, and so much more. If there is an obstruction in the neck, it can be as if someone botched a game of telephone. But instead of the original message of “I love Rock n Roll” being warped into “The Headsetter’s Mom is a Troll” because Sally needs to get her hearing checked … In your body, it’s more like the message from your brain to your shoulder stabilizers and forearm flexors to activate at 100% as you throw for a dyno, the message gets warped at the spine and comes out as “stabilize & activate at 20%. We are fatigued (or whatever your symptoms are, if not fatigue).” 

Additionally,  your nerves exit from the back of your spine, which is the area that gets the most “stretched out” (for layman’s terms) because everything we do is in front of us, requiring us to hunch forward. How you eat, when you socialize, driving, working, texting, scrolling through this post RIGHT NOW – you are hunched over and you know it. 

Now that you have straightened up your posture, you are already onto the first habit that will help your pain, so let’s talk about how to know if your spine is the source of your pain / weakness, and what to do about it. 

Below is a list of the strongest predictors that your extremity pain could be coming from your spine: 

  1. Correcting your posture changes your symptoms
  2. There is NOT range of motion loss in the involved extremity
  3. There IS range of motion loss in the spine
  4. Symptoms are worse with sitting, bending the head down (while reading this article or working at a desk), turning your head, and when you are still.

If you fit any of the above descriptors, then your POSTURE should be adjusted while working, driving, and ESPECIALLY between climbs!


  1. Ergonomic Work Set up!
sit posture

2. Posture between climbs can be the difference between muscles working at 100% vs. 20%! Boulderers, sit upright! Rope climbers, use belay specs to help avoid slouched postures that can hinder your next climb.

3. Perform Cervical retraction Exercise:

Who doesn’t love making a double chin in public? By moving your head from a neutral spine position to back as far as you can as if the back of your head is trying to hit a wall behind you, you are mobilizing your spine opposite of how we live our lives. Try complete 10-15 of these before, during and after climbing.

(Left) neutral spine with upright posture. (Right) Retract back of head as far back as able

Be sure to Include spinal mobility as part of your warm up, especially moving your spine opposite of how you typically move it through the day. [this is the most common reductive movement for people’s pain but may NOT be the movement for everyone]

In conclusion, if you find yourself dealing with injuries that just don’t seem to improve or don’t make any sense, see if adjusting your posture and increasing the ways that you move your body helps. And contact a Physical Therapist!

[Disclaimer: This is not meant to be taken as medical advice. Consult your local Physical Therapist / Medical Provider, specifically if you can find one that is MDT certified . ]

Dr. Amy Frugé has been climbing for over 16 years, and as the clinic owner of Converge PT in Salt Lake City, UT she has worked with Olympic medalists and professional mountain athletes of many different disciplines. Dr. Amy has also been fortunate to work with USA Climbing at Nationals in 2021, and has been asked to be the Physio for the German Climbing Team during the World Cup in 2022 & 2023. For more climbing PT tips, check out Dr. Amy Fruge, PT, DPT @convergept Instagram account, or her website for more details about her services.

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