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Abstract

Introduction

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers.

Methods

Climbers (ages 8–18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as “lifetime” injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y^-1, prior to age 12 y (late specialization if after age 12 y).

Results

Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1–2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1–2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups.

Conclusions

Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

Keywords

adolescent youth sports athletes mountaineering

Introduction

In recent years, there has been an increase in the number of youth participating in adventure and extreme sports.¹ The popularity of adventure sports is expected to rise after the inclusion of rock climbing in the 2018 Youth Olympic games² and the debut of 3 new adventure sports in the 2020 Olympic games: rock climbing, skateboarding, and surfing.^3,4 The mean age of adventure sport athletes in the highest levels of competitions has decreased in recent decades.⁵ While participation in adventure sports, including rock climbing, is associated with numerous benefits,⁵^-9 more youth may be specializing at earlier ages, potentially leading to higher injury rates and burnout. Sport specialization has been defined as intensive training and/or competing at a young age in a single sport for more than 8 mo of the year to the exclusion of other sports.¹⁰ Athletes who specialize in their sport prior to puberty (often functionally defined as prior to age 12 y) are classified as early sport specializers.¹¹

While eventual sport specialization may be necessary to achieve elite levels of performance,¹²^-16 current recommendations encourage delaying single sport specialization until mid to late adolescence.^{10,11,15,17,18} Compared to athletes who participate in multiple sports, early sport specialization has been associated with a higher incidence of injury, decreased psychological well-being, and premature withdrawal from sport.¹⁸^-20 However, early specialization in highly technical sports, such as rhythmic gymnastics, may be important for achieving elite levels.²¹ Similar to gymnasts, rock climbers may reach peak performance prior to full skeletal maturation, since lower body fat and high strength-to-mass ratio are beneficial.²²^-25 While there are multiple publications on injury patterns and risk factors in youth climbers,²²^-24,26,27 to the best of our knowledge, no studies to date have examined sport specialization within youth rock climbing.

Reasons to suspect high rates of specialization within climbing include a year-round youth climbing competition season and the ability to climb indoors throughout the year. Rock climbing places unique physical demands on young athletes, such as a particular emphasis on leanness,²³ as well as a high incidence of physeal overuse injuries.^22,23,28,29 However, the effects of specialization on injuries in youth climbing are currently unknown.

The purpose of our study was to examine the proportion of non-, early, and late specializers and the impact of this specialization on injuries among youth rock climbers. Secondary aims were to explore injury characteristics and factors associated with past injuries among elite youth climbers. We hypothesized that those who specialized early (prior to age 12 y)¹¹ were more likely to have had injury compared to their peers.

Methods

This cross-sectional survey study was deemed exempt by the institutional review board of record due to the inclusion of only deidentified data. Prior to completion of the survey, participants were presented a letter that informed them of the purpose of the study, procedures, potential risks, and contact information for the principal investigator and the institutional review board. Participants, and their legally authorized representative if younger than 18 y, indicated their agreement to participate in the study and proceeded to the survey questions. All research procedures conformed to the guidelines set forth by the Declaration of Helsinki.

The 1-time survey (see online Supplemental Material) was administered using an online survey link and was completely anonymous. The survey was developed and data were managed using REDCap electronic data capture tools. REDCap (research electronic data capture)^30,31 is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources.

The survey contained 40 items and included the following sections: demographics, climbing experience, training characteristics, and injury history. Demographic items included age, gender, height, and weight, along with state of residence. Climbing level and experience included questions regarding years climbing, bouldering and sport climbing grade, and competition level (eg, local, regional, national). Training characteristics included questions regarding sport specialization derived from extant literature,^10,11 training methods (eg, hangboarding, campus boarding, systems wall), and injury prevention methods (eg, core strengthening, scapular strengthening, cardiorespiratory training). Injury history items assessed the total number of climbing-related injuries, along with a self-reported description of the most recent injury and time loss from climbing (see online Supplemental Material for climbing and training terminology definitions).

The survey was designed by the study team and face-validated for readability and appropriate climbing terminology by youth climbers and coaches. The target reading level of the survey was aimed at capturing the youngest climbers (8–12 y). The survey was also piloted on a group of 10 climbers in this age range, with favorable descriptive feedback. The average time to complete the survey was 10 min.

Currently, no universal definition of sport specialization exists in the literature.³² Thus, the early-specialized group was defined based on the American Orthopaedic Society for Sports Medicine consensus statement as exclusive participation in climbing at the time of survey response, with training for greater than 8 mo out of the year, at the age of 12 y or under.¹⁰ Those who specialized after age 12 y were defined as late-specialized. Those who reported participation in more than 1 sport, including climbing, were defined as nonspecialized. Participants were categorized as having “high training load” if they reported >16 h‧wk^-1 of training, or h‧wk^-1 > age.¹⁰ An injury was defined as “any pain or injury that impacted your ability to climb or train or caused you to stop climbing for any period of time.”

Injuries were characterized as “acute” or “overuse” based on reported injury mechanism. Reported mechanisms of “falling,” “hard move while climbing,” or “equipment broke” were considered acute. Injuries with a reported mechanism of “I don’t remember a specific event that caused me to be injured” and “training for climbing” were considered overuse. Injuries with a reported mechanism of “other” were categorized based on the written description of the injury.

The online survey link was distributed via email to youth climbing team coaches, including contacts of the study team and coaches identified by an online search for youth climbing teams in the United States. Coaches were asked to distribute the survey to team members for voluntary participation. No incentive was offered to coaches or survey participants. The survey link was also posted on competitive youth climbing-related social media pages. This approach was used to target climbers regularly involved in training and competition, rather than recreational climbers. Inclusion criteria for the study included participation in rock climbing, being ages 8 to 18 y, and the ability to read, write, or speak in English. The only exclusion criterion for this study was not meeting inclusion criteria.

SAS statistical software (version 9.4; SAS Institute, Cary, NC) was used to perform statistical analyses. The main outcome of proportion of climbers suffering an injury was assessed both within the last 12 mo and within their entire climbing experience (defined as “lifetime” injury). Chi-squared tests and risk ratio (RR) calculations were used to compare differences in the primary outcome between specialization groups. T-tests and Fisher’s exact tests were used to compare differences in survey responses before and after March 2020. Participant demographics and climbing characteristics were presented with descriptive statistics mean±SD (range). The overall injury incidence was estimated by dividing total injuries reported by total climbing hours reported. Total climbing hours was estimated based on reported hours per week and months per year of climbing. A P value of ≤0.05 was used as the threshold for statistically significant difference.

Results

One hundred forty-seven survey responses were collected during the data collection period (11/2019–9/2020). Thirty-six survey entries were not included in the final analysis due to either no survey data entered (n=23), no climbing or training data entered (n=3), inappropriate age (n=9), or duplicate survey response (n=1). One hundred eleven youth climbers from around the United States completed the required sections on training and climbing experience (demographics through training section; see online Supplemental Material for full) and were included in the final analysis. Any missing data values were excluded from the corresponding statistical analysis. Due to the open nature of recruitment, researchers were unable to calculate a response rate. However, 111 surveys were ultimately included out of 136 age-appropriate survey respondents who opened the survey (81%).

Sixty-three percent of participants were female. The age was 14±3 (8–18) y (Table 1). Overall, participants were high-level climbers, with 36% having competed at the national or international level. The majority of time climbing was focused indoors, with more time focused on bouldering than sport climbing (Table 2).

Table 1

Demographics and select characteristics of youth rock climbers

Characteristics	Total	Male (n=41)	Female (n=69)
Demographic characteristics
Age (y)	14±3 (8–18)	14±3 (8–18)	14±3 (8–18)
Height (cm)	158±23 (122–188)	165±15 (122–188)	155±23 (127–178)
Weight (kg)	50±13 (23–82)	53±14 (23–77)	49±13 (27–82)
BMI (kg‧m^-2)	19±3 (13–32)	19±3 (14–32)	20±4 (13–32)
Climbing characteristics
Hours per week	10±4 (2–25)	10±4 (4–21)	10±4 (2–25)
Months per year	12±1 (9–12)	12±1 (9–12)	12±1 (9–12)
V6 or higher (%)	68	73	64
5.12 or higher (%)	68	73	65
National or international competition (%)	36	27	41

Data presented as mean±SD (range).

Table 2

Number of months per year focused on climbing type

Please state the number of months of the year that you focus (spend most of your time) on each of the following types of climbing:	Mo‧y^-1
Indoor: Bouldering	7.5±2.9 (0–12)
Indoor: Sport	5.7±2.8 (0–12)
Indoor: Speed	2.2±3.2 (0–12)
Outdoor: Bouldering	1.1±1.8 (0–10)
Outdoor: Sport	0.8±1.6 (0–9)

Data presented as mean±SD (range).

Sport specialization was common, with 55% of all participants specializing in rock climbing and 38% of all climbers specializing early (≤12 y). The age of specialization was 11±2 (7–16) y. Participants climbed 10±4 (2–25) h‧wk^-1 for 12±1 (9–12) mo‧y^-1. No participant climbed for less than 9 mo‧y^-1. Twenty-one percent of participants were categorized as having “high training load.”¹⁰ Many climbers regularly used climbing-specific training methods, with hangboarding and systems wall training being most common (Table 3). Participants reported starting campus board training at an age of 12±2 (8–16) y. Thirteen percent of climbers engaged in weighted hangboarding, beginning at an age of 14±3 (11–18) y. All climbers used at least 1 injury prevention technique consistently (at least once per week), with core and other strength exercises being the most common (Table 3).

Table 3

Number of climbers using training or injury prevention method at least once per week

Do you participate in any of the following consistently (at least once every week): (check all that apply)	Number selected	% selected
Hangboarding	55	50
Systems wall training	50	45
Campus board training	20	18
Hangboarding with weights	14	13

What injury prevention strategies do you do consistently (at least once every week)? (Please select all that apply)
Core strengthening	85	77
Other strengthening (eg, push-ups, squats)	85	77
Complete rest day	80	72
Static stretching	79	71
Dynamic stretching	71	64
Cardio	51	46
Scapular strengthening	46	41

Fifty-three percent of participants sustained at least 1 lifetime injury (during their climbing experience), with 40% having an injury within the last 12 mo. The estimated overall injury incidence in this study was 1.3 injuries per 1000 h of climbing or training.

Injuries to the hand and fingers were most common, followed by ankle injuries (Table 4). Most injuries occurred during bouldering (see online Supplemental Table 1). The most common mechanism of injury was falling. Thirty-nine percent of injuries resulted in <7 d of time lost from climbing (see online Supplemental Figure 1). Twelve growth plate injuries were reported, 4 of which involved the fingers. Other growth plate injuries involved the ankle (n=5), wrist (n=2), and knee (n=1). Three out of the 4 climbers who reported epiphyseal finger fractures in our study also reported consistent (at least once a week) use of campus board training. Three pulley injuries were reported: 1 to the A2, 1 to the A3, and 1 unspecified. Most ankle injuries were reported as sprains (9/15), although 1 peroneal subluxation and 3 fractures were described, including 1 injury resulting in a comminuted talus and medial malleolus fracture.

Table 4

Distribution of injuries

Location of injury	Number
Hand/Finger	16
Ankle	15
Shoulder	7
Back	7
Knee	5
Wrist	4
Arm	4
Foot	2
Skin	2
Elbow	2
Hip/Groin	2
Neck	1
Total	67

Late-specialized climbers were more likely to have suffered an injury within the last 12 mo compared to those who specialized early or not at all (Table 5). Late-specialized climbers were also 1.6 times (95% CI: 1.1–2.3) more likely to have had a lifetime injury than early-specialized climbers. There was no significant difference in proportion of injured climbers when comparing all specialized climbers vs nonspecialized climbers. Similarly, there was no significant difference in the proportion of injured climbers who were categorized as high training load and those who were not.

Table 5

Analysis of specialization and injury in youth climbers

Group	Lifetime injury (%)	Injury last 12 mo (%)
Early-specialized (n=42)	50	41
Late-specialized (n=18)	78	72
Nonspecialized (n=41)	59	37
Risk ratio (95% CI): Late vs early	1.6 (1.1–2.3)	1.8 (1.1–2.8)
	P= 0.045 a	P=0.024 a
Risk ratio (95% CI): Late vs Non	1.3 (0.9–1.9)	2.0 (1.2–3.2)
	P=0.155 a	P=0.012 a

Chi-squared test.

Twenty-nine percent of injuries with reported mechanisms (16/56) were categorized as overuse injuries. There was no difference in the proportion of overuse injuries between early and late specialized climbers (RR 0.7, 95% CI 0.2–2.2) or between early and nonspecialized groups (RR 0.6, 95% CI 0.2–1.6). There was also no difference between late and nonspecialized groups (RR 0.9, 95% CI 0.3–2.4).

Twenty-five percent of survey responses were collected after March 1, 2020, the month when many states in the United States began stay-at-home orders due to the COVID-19 pandemic that may have affected access to climbing gyms. There were no statistically significant differences in reported training patterns, injuries, or sports specialization between responses received prior to March 2020 (“pre-COVID”) and those after (Table 6).

Table 6

Responses before and after March 2020, data presented as mean±SD (range)

	Pre-COVID (n=83)	Post-COVID (n=28)	P-value
Climbing (h‧wk^-1)	9.8±4.1 (4–21)	9.9±4.7 (2–25)	0.96 a
Climbing (mo‧y^-1)	11.7±0.7 (9–12)	11.4±1.0 (9–12)	0.12 a
Total injuries	1.4±1.6 (0–10)	1.8±1.9 (0–6)	0.3 a
Injuries last 12 mo	1.1±1.1 (0–6)	1.5±0.8 (0–3)	0.26 a
High training load (%)	77	86	0.33 b
Overuse injury (%)	29	24	0.32 c
Specialization			0.29 b
Early (%)	42	44
Late (%)	18	20
Nonspecialized (%)	41	36

t-test.

Fisher’s exact test.

Chi-squared test.

Discussion

Sport specialization, including early sport specialization, was common in our study, which follows with recent trends in youth sports in the United States.^33,34 A high proportion of participants were high-level climbers, with 36% having competed at the national or international level. Based on USA Climbing rules, only 12% (6/52) of climbers at the regional competition (first level of competition after general qualifying) advance to nationals (the highest level of competition).³⁵

Fifty-five percent of our participants were single sport specialized in rock climbing, a higher percentage than previously reported in tennis (47%), gymnastics (30%), and dance (26%).³⁶ The age of specialization in surveyed climbers (11±2 y) was older than that reported in gymnastics and men’s golf and younger than seen in men’s basketball or football.^34,36

In this study, late specialization was associated with an almost 2 times greater likelihood of having suffered an injury in the last 12 mo, compared to early or nonspecialized athletes. Late specialization was also associated with an increased likelihood of having had a lifetime injury, compared to early specializers. However, no difference was seen in the proportion of overuse injuries between specialization groups.

This finding differs from previous literature regarding early specialization in other sports.^20,34,36^-39 A 2016 systematic review of 3 studies on sport specialization and overuse injuries (none of which included rock climbers) found an increase in overuse injuries in specialized athletes (OR range: 1.3–4.0).³⁸ However, these studies did not specifically look for differences between those who specialized at early vs later ages.

The discrepancy between our findings and those discussed above may be due to differing patterns of injury seen in rock climbing compared to other sports. Many studies regarding early sport specialization focus on overuse injuries.^20,34,36^-38 However, the most common injuries in this study were of an acute nature. The smaller number of overuse injuries reported in this study makes it difficult to assess for differences between specialization groups. Further research is needed to examine whether climbers who specialized early may have better landing or climbing techniques that are protective against acute injuries, compared to those who specialize at a later age.

The overall injury incidence for our study was 1.3 injuries per 1000 h of climbing and training. This is less than that previously found in a review of 8 studies, which estimated an injury incidence of 2.71±4.49‧1000 h^-1.⁴⁰ Eighty percent of injuries in our study occurred during bouldering, a higher rate than previously described in another study on pediatric climbers (58%).²⁶ Nearly half of reported injuries were to the ankle, a higher proportion than previously described; previous studies have reported lower extremity injuries to make up 13 to 28% of all injuries.⁴¹^-45

Ankle injuries in this study were primarily from falling during bouldering, suggesting that development of injury prevention strategies targeted at reducing ankle sprains may be warranted. High-level climbers typically wear climbing shoes that are very tight and force the ankle into supination and interphalangeal joints into mild flexion.^44,46 The tight fit of these shoes also makes it difficult to fit a traditional ankle brace inside. Incorporation of ankle proprioceptive and strength training may be strategies to reduce these injuries. Further research is needed to evaluate the potential effects of ankle taping and bracing, as well as any influence of the type of landing surface on injury.

Four climbers in our study reported epiphyseal finger fractures, previously described as the most common injury among youth rock climbers.^22,23,27^-29 These injuries most commonly affect the long finger, followed by the ring finger.²⁸ There has been a 600% increase in reported epiphyseal finger fractures among youth rock climbers in the past decade, with the vast majority due to overuse.²⁹ However, despite being described for many years, many youth climbers are unaware of these specific injuries⁴⁷ and allow these injuries to go untreated.²³ One previously described risk factor to these injuries is campus board training.^22,48 Thus, it has been suggested that campus board training, along with weighted hangboarding, should be limited in youth climbers.^23,27,49 Despite this, many of our participants used these training methods at least once a week, with several starting at a young age. Three out of the 4 climbers who reported epiphyseal finger fractures in our study also reported consistent use of campus board training. These findings further emphasize the need for proper education in youth climbers and coaches regarding these injuries and potential risk factors.

Twenty-one percent of participants were categorized as having high training load.¹⁰ However, a high training load was not found to be associated with an increase in injuries as has been reported in previous studies involving youth tennis players.⁵⁰

Limitations

This study was a cross-sectional survey and therefore had limitations consistent with its design, including an inability to assess temporal relationships or causation between observed associations. Additionally, potential long-term effects of sport specialization could not be assessed in this study. Description of injuries was based on self-report, without the ability to verify based on medical records, owing to the anonymous nature of the study. Recall bias may have resulted in more significant injuries or more recent injuries being reported over minor or remote injuries. Survey fatigue may have led to skipped questions and missing data.

In this study, specialization was not categorized into low, moderate, high categories, as has been used previously in the literature.^11,34,37 Additionally, part of the data collection period (11/2019–9/2020) was affected by the COVID-19 pandemic, which may have influenced the ability of athletes to climb and train at a normal volume. Survey questions were written pre-pandemic and remained the same throughout the recruitment period, which may have led to challenges in reporting “average” training behaviors that may have changed during the pandemic. However, no significant differences were noted in data collected before and after March 2020.

Conclusions

In this study investigating sport specialization within youth climbing, early sport specialization was found to be common, although it was not associated with an increase in injuries. Specialization at a later age was associated with a higher likelihood of injury.

The overall injury incidence in our study was lower than in previous climbing studies.^26,51 Ankle, hand, and finger injuries were the most common. Potential areas to target for injury prevention in youth climbing include ankle injuries from falls during bouldering, and overuse hand and finger injuries. Young climbers should be educated further regarding safe training methods, as campus boarding at a young age persists despite its links to growth plate fractures of the fingers.

Footnotes

Acknowledgements

Acknowledgments: The authors thank Dr. Chan-Hee Jo for assisting with the statistical analysis described in this paper, as well as all the climbers, parents, and coaches who facilitated this project.

Author Contributions: Study concept and design (DC, RM, AP, AZ, SS, SM); data acquisition (DC, RM, AP, AZ, JW, SS, SM); data analysis (DC, RM, AZ); drafting of the manuscript (DC, RM, AZ); critical revision of the manuscript (DC, RM, AP, AZ, JW, SS, DH, SM); approval of the final manuscript (all authors).

Financial/Material Support: None.

Disclosures: None.

Supplemental Material(s)

Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j.wem.2022.03.002.

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Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers

Abstract

Introduction

Methods

Results

Conclusions

Keywords

Introduction

Methods

Results

Discussion

Limitations

Conclusions

Footnotes

Acknowledgements

Supplemental Material(s)

References