Medical professionals united under a common interest in climbing at the BMC Climbing Injury Symposium 2016. In a year when climbing enters the Olympics, growth and development were the key themes; specialist physio Paul Welford reports.

These are exciting times across the country for Britain's climbers, as our motivated and talented youngsters see their dream of Olympic glory come one step closer. And at the BMC Climbing Injury Symposium 2016, we were reminded that, as our sport prepares for a growth spurt, so do many of these young hopefuls.

With an audience of parents and climbers, as well as coaches, physios and medics, it seemed fitting then that growth and development were the key themes at #BMCcis2016.

Climbing: bringing people together

As a physiotherapist and medical student, I regularly attend conferences and they're usually something of a mixed bag. But, for me, there was something different at the BMCcis, as everyone there shared something.

"It was the people that made it special."

On Saturday morning, I arrived early at the well-chosen venue and passed the time chatting to Professor Waqar Bhatti, who said: "I love coming to this event, as the climbers are all so friendly and welcoming. Just wait – you’ll see.” Over the first day I quickly realised what he meant. Despite their differing backgrounds and experience levels, delegates and presenters were united by a common interest in climbing.

Tom Davison of Crux Physiotherapy said: "I'd been very excited ahead of the weekend and was not disappointed. It's great to link my passion for climbing with my passion for physiotherapy and meet experts in the field to learn from their experience."

Incidences of climbing injuries

One of the most inspiring characters of the weekend was Volker Schöffl, whose pioneering work has combined his interests as a high-level climber and academic orthopaedic surgeon. He opened BMCcis with an update on climbing injury epidemiology – the study of how often incidences occur.

"Most climbing injuries are non-traumatic in nature, with 50% involving the finger."

Speaking to me after the session, student physiotherapist Samuel Radcliffe said that this lecture “really highlighted the variety and prevalence of injuries faced by climbers”. My personal view was that the overall safety profile for climbing looks very good, especially when compared with other sports. Indoor sport climbing, for example, results around 0.02 injuries per 1000 climbing hours. International rugby is at the other end of the scale, with up to 262.5 injuries per 1000 hours. 

Avoiding injury with young climbers

Paediatrician Isa Schöffl epitomises the ethos of climbing; she encourages young climbers to push the sport while also advocating for their health. She explained that adolescence is a crucial period for skeletal development, especially of the fingers.

The epiphyseal plates, which are responsible for growth, are of particular concern in climbers at puberty. In fact, fracture of the growth plate or surrounding bone accounts for up to 90% of finger injuries in adolescent climbers. Her message was clear: climbing with undiagnosed finger pain is not acceptable, especially if you are under 18. Delegates were reminded of the BMC guidance on staying safe when campus boarding.

"Pulley ruptures account for around 60% of finger injuries."

Continuing the paediatric theme, professor of musculoskeletal radiology Waqar Bhatti navigated the imaging process used in growth plate injuries and highlighted the range of conditions that afflict the fingers. In addition to pulley ruptures, which comprise around 60% of finger injuries, there are some 30 alternative diagnoses to consider. Ultrasound is generally the most helpful modality. This was music to the ears of eager delegates, who descended en masse with a plethora of hand injuries for the live imaging session.

With a huge range of climbing and rehab experience in the audience, the Q&A sessions at BMCcis were uniquely insightful. I caught up with Sheffield-based climber Philip Guyther after a practical session on the rotator cuff by musculoskeletal physiotherapist Stewart Watson. Philip said that he now realised his shoulder warm-up routine to be ineffective and felt that: “The preventative exercises that Stewart instructed were the highlight of my weekend.”

#BMCcis2016: more than just injuries

It wasn't just about injuries at #BMCcis 2016 but also about how to become the best climber you can possibly be, all while combating the occurence of injuries. Sports scientist Michail Michailov spoke about training and performance, and the difficulty of measuring training intensity. 

Michail observed that, while training volume is relatively easy to monitor, most athletes continue to find it challenging to monitor training intensity. To overcome this, he demonstrated an engineering-based solution involving a fingerboard with mechanical sensors. This allows climbers to develop a preset percentage of their maximum voluntary contraction. He uses a 23mm deep edge on his fingerboard, as he has found that this maximises finger flexor activity while minimising the risk of injury.

Paul's best bits

My educational highlight at BMCcis was hearing Dr Volker Schöffl discuss his ever-expanding mass of climbing-specific surgical data. Volker’s results suggest that a return to near pre-injury climbing levels is possible even after serious injuries. His words offered encouragement to several injured delegates who had taken time out from rehabilitation to learn more about their conditions.

In terms of enjoyment, Dave Macleod’s talk was hard to beat. One theme that spanned the weekend was the limitations of current research literature. Climbing medicine is very much in its infancy and Dave’s stories of self-experimentation reflected this. Injuries have not dictated his success, but he certainly had to work for it. Dave has consulted many specialists during his professional climbing career but always looks beyond the next treatment. Recently, Dave’s ruminations have led him down a nutritional path. 

Towards the end of his talk, he spoke of Font 8c success while experimenting with a periodic diet. Dave’s timing was spot-on, as he shared this anecdote just as delegates finished gorging themselves on the complimentary profiteroles.

Paul is a specialist musculoskeletal physiotherapist at Pure Sports Medicine in London and a final year medical student at St. George’s University of London. 

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