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Overuse Injuries

July 1, 2026

Climbing injuries are most often the result of repetitive stress rather than a single traumatic event. Research suggests that more than 80% of climbing injuries are related to overuse, making them the most common type of injury seen in both recreational and elite climbers. Since climbing's inclusion in the Olympic Games in 2020, injury research has expanded substantially and consistently shows that the upper extremity bears the greatest injury burden. Approximately 77% of climbing injuries involve the upper extremity, compared to about 18% in the lower extremity (Lutter 2020). The fingers account for over 40% of all injuries, followed by the shoulder, elbow, and hand. Although acute injuries such as falls, ankle sprains, or traumatic shoulder injuries certainly occur, particularly during outdoor climbing and bouldering where falls, landing surfaces, weather, and rock conditions increase risk, many "acute" injuries are actually the culmination of repetitive loading that has exceeded the body's ability to recover.

In surfing overuse injuries are the minority compared to acute injuries such as sprains and fractures and injuries to the skin such as cuts, abrasions, and contusions from board or ocean floor contact. Overuse issues like tendinopathy, muscle strain, and low back pain range roughly from about 20 to 40 percent of injuries (Remnant 2020). The most common body region of these overuse injuries from surfing being the shoulder, low back, and neck, and are often associated with prolonged paddling (McArthur 2020 and Hanchard 2021).

Mechanisms of overuse injury in climbing/surfing

Repetitive movements
- ex. finger flexion in climbing and shoulder flexion/internal rotation in surfing
Rapid increase in training volume or intensity
- ex. High-volume paddling sessions or boulder sessions without adequate tissue adaptation
Movement dysfunction at adjacent body region
- ex. Lumbar spine compensation and pain especially when hip mobility or thoracic extension is limited
Poor technique
- ex. chicken wing in climbing or lack of trunk control during paddling

Tendinopathy vs Tenosynovitis vs Capsulitis

Similar, sometimes overlapping pathologies often seen with finger overuse injuries in rock climbers.

Tendinopathy: The tendon itself has lost its ability to handle load. The solution is better loading, not prolonged rest.

Tenosynovitis: The sheath around the tendon is irritated. The priority is reducing friction and swelling, then gradually restoring tendon movement.

Capsulitis: The joint capsule is irritated and stiff. The focus is improving mobility while reducing compressive stress.

See more info on the differences in the table below:

More on Tendinopathy

Tendinopathy is a common source of pain and distress in the shoulders and elbows of both climbers and rock climbers, but is often confused. Tendinopathy is the modern term used to describe a painful tendon under load, and it reflects an important shift in how these conditions are understood. It was originally labeled “tendinitis,” based on the assumption that inflammation was the primary driver, but research consistently failed to show meaningful inflammatory cell presence in most chronic cases. The term “tendinosis” was then introduced to describe a degenerative process within the tendon, yet imaging and histology findings complicated this model because degeneration can exist with or without pain and pain can occur in the absence of visible structural change. As a result, the umbrella term “tendinopathy” is now used to describe the clinical picture of load-related tendon pain rather than a purely structural diagnosis.

Modern management has also shifted away from trying to “fix” or normalize tendon structure and toward improving load tolerance of the entire tendon system, often described as “treating the donut, not the hole.” In this model, the goal is not to eliminate every area of tendon change seen on imaging, which is potentially not possible, but to strengthen the surrounding healthy tendon tissue so the system as a whole can tolerate higher mechanical demand. This is supported by the observation that pain and function are often highly reversible, with many individuals returning to full sport participation despite persistent imaging findings such as tendon thickening or disorganization. In other words, a tendon can become stronger and more resilient without necessarily returning to a perfectly “normal” appearance on ultrasound or MRI.

From a load perspective, most tendinopathies are understood as a mismatch between tissue capacity and mechanical demand, where intensity, frequency, or volume of loading exceeds the tendon’s ability to recover and adapt. In many cases, this reflects doing too much too soon or progressing load faster than the tissue can remodel. At the same time, tendon health is not purely mechanical. Chronic low-grade systemic factors such as poor sleep, high stress, nutrition quality, alcohol use, smoking, and overall activity levels can influence tendon sensitivity and recovery, affecting both onset and persistence of symptoms. Similar to other load-related musculoskeletal conditions like osteoarthritis, mechanical overload remains the primary driver, but it is often mediated by broader physiological and lifestyle factors that modulate tissue response and healing capacity (E3 Rehab Podcast).

References

Lutter C, Tischer T, Hotfiel T, et al. Current Trends in Sport Climbing Injuries after the Inclusion into the Olympic Program. Analysis of 633 Injuries within the years 2017/18. Muscles, Ligaments & Tendons Journal (MLTJ). 2020;10(2):201-210. doi:10.32098/mltj.02.2020.06

Remnant D, Moran RW, Furness J, Climstein M, Hing WA, Bacon CJ. Gradual-onset surfing-related injuries in New Zealand: A cross-sectional study. J Sci Med Sport. 2020;23(11):1049-1054. doi:10.1016/j.jsams.2020.05.010

McArthur K, Jorgensen D, Climstein M, Furness J. Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A Systematic Review. Sports (Basel). 2020;8(2):25. Published 2020 Feb 20. doi:10.3390/sports8020025

Hanchard S, Duncan A, Furness J, Simas V, Climstein M, Kemp-Smith K. Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review. Sports (Basel). 2021;9(2):23. Published 2021 Jan 29. doi:10.3390/sports9020023

Hughen C and Surdyka M. The E3 Rehab Podcast. A Deep Dive Into Tendon Rehab w/ Marc Surdyka. 2025 Feb 25. Accessed July 1, 2026. https://open.spotify.com/episode/4SUrZTJvevWovFEnsfRIBX?si=6PMcHCKbTYCtaLW1EXcUaw

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