By: John Crawley, PT, DPT, OCS
Does it matter if you hurt your labrum? Does it matter if you have worn out your biceps tendon? The answer might surprise you. Often people think that identifiable injury to their body means they need surgery or that they will not be able to climb as hard or as much as they have in the past. Yet, that is not what the evidence is showing us. A growing body of evidence is showing us that injury and function is a complicated matter. What we are finding is that it “depends.” Structure alone is proving to not be a very good indicator of performance or general health. Take for example recent research by Beeler et al.
Why This Study was Conducted
While we know that climbing puts unique, repetitive stress on the upper limbs, the long-term medical consequences of a lifetime of high-level climbing are largely unknown. Previous research typically only looked at climbers who were already injured and not what a climber looks like w/o pain.
The researchers compared 31 elite male climbers (who had climbed at a high level for at least 25 years) against a control group of non-climbers of the same age and sex to identify specific “climber-associated” patterns of shoulder degeneration.
Key Research Findings
The study utilized detailed clinical interviews, physical examinations, and 3-Tesla MRI (highest quality image) scans to compare the two groups.
1. High Prevalence of Shoulder Pain
- 77% of high-level climbers reported experiencing shoulder pain at some point in their lives.
- 55% had experienced pain within the six months prior to the study.
- 26% were experiencing pain on the actual day of their clinical examination.
2. Significant Degenerative Changes (MRI Results)
The MRI scans revealed that climbers had significantly more “wear and tear” compared to non-climbers, particularly in three areas:
- Labrum Abnormalities: Found in 82% of climbers versus 52% of non-climbers.
- Long Biceps Tendon Alterations: Present in 53% of climbers compared to 23% of non-climbers.
- Cartilage Defects: 28% of climbers showed significant cartilage damage, whereas only 3% of the control group did.
3. The “Paradox” of Function vs. Imaging
Perhaps the most interesting finding for us is the disconnect between what an MRI shows and how a climber actually performs:
- Better Function: Despite having more structural “damage” on their scans, climbers actually had better shoulder function scores (Constant scores) than the non-climbers.
- Poor Correlation: There was no relevant correlation between the abnormalities found on the MRI and the results of the physical clinical examinations.
- No Retirement: Remarkably, even with advanced osteoarthritic changes, none of the study participants had to quit climbing due to shoulder pain.
The Takeaway for Climbers
The researchers concluded that while a lifetime of high-level climbing does lead to a high prevalence of pain and degenerative changes in the labrum, biceps tendon, and cartilage, these changes do not necessarily restrict shoulder function. Pain and function are connected but not necessarily determinants of the other.
Structure does not always determine function or the experience you have. If you are struggling with shoulder pain, there are often ways to decrease pain and improve function without surgery. Often this includes modifying the load on the shoulder, restoring lost range of motion and mobility, building back strength, and then building capacity over time.
The physical therapists at Mend are experts at helping you to define your injury. They will help you build an effective treatment plan that will address your impairments so that you can get back to sending hard on the wall.
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Citation:
- Beeler S, Pastor T, Fritz B, Filli L, Schweizer A, Wieser K. Impact of 30 years’ high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers. J Shoulder Elbow Surg. 2021;30(9):2022-2031. doi:10.1016/j.jse.2020.12.017