Epidemiology of Rock and Ice Climbing Injuries Boulder V. Schöffl

Epidemiology of Rock and Ice Climbing Injuries Boulder 2014 V. Schöffl

Definitions: 5 major types of climbing mountaineering traditional (alpine) rock climbing sport climbing (incl. bouldering) indoor climbing (including competition climbing) vertical ice climbing (including frozen waterfalls) All have different risks in accordance to objective danger, environmental hazards, safety margins etc. 2

Mountaineering 3

Traditional Rock Climbing 4

Sport Climbing and Bouldering 5

Indoor and Competition Climbing 6

Solo and Free Solo Climbing 7

Ice Climbing 8

Climbers are an inhomogenous group: No age limitation Fred Beckey 88y, 2013 90th birthday 9 Luc and Keo 1y9m

Gender Alpine, sport and indoor climbing: inhomogeneous gender distribution (Schöffl, Neuhof, Jones, Josephsen, Backe, Bowie, Schussmann and more) Ice climbing: female climbers were injured more often (76.9%) than males (58.7%) (Schwarz, Schöffl) Mountaineering: Inhomogeneous distribution Schussmann, Stephens). (McIntosh, In fatal accidents significantly more men are involved than women (Küpper). 10

Anatomical location Sport and Indoor climbing: Mostly upper extremity, mostly overstrain injury Alpine Climbing: Mostly lower extremity due to fall Ice Climbing: Head and the upper extremity Mountaineering: 36% head or vertebral column, 14.3% trunk, 25.5% legs, and 14.1% arms (Küpper et al.) 13

Distribution of Sport Climbing Injuries (no overuse injuries) n = 1943 Body region Percent (n) Body Part n Upper extremity 42.6 (356) Finger Arm Hand 200 98 58 Lower extremity 41.3 (345) Feet Legs Perineal 204 113 28 Trunk 12.6 (105) Back Lower Body Breast Abdomen 64 21 19 1 Other 3.6 (30) Head 30 Total 100% (836 in 699 incidences) Neuhof, Schöffl IJSM 2011 836

Lower Extremity Injury Cause 17

Lower Extremity Injury Cause 18

Lower Extremity Injury Cause 19

Lower Extremity Injury Cause 20

Injury Type Alpine, sport and indoor climbing: fractures, strains and sprains are predominant, hand and finger injuries are the most common (see review: Schöffl et al. 2012). Ice Climbing: Mostly open wounds and haematoma (Schwarz, Schöffl) Mountaineering: associated with higher graded trauma, multiple fractures, severe wounds and polytraumatic patients (Küpper) 21

Head Injuries Rock fall Rock hit Face Injuries Only with helmet? 22

Sportclimbing: Injury distribution according to body area (2009-2012: n=911, and 1998-2001: n=604) 2009 Body area - 2012 1998 2001 n % n % Finger 474 52 247 41 Shoulder 157 17.2 30 5 Hand 119 13.1 47 7.8 Forearm and elbow 83 9.1 81 13.4 Lower leg/foot 35 3.8 55 9.1 Knee 19 2.1 22 3.6 Trunk and spine 17 1.9 43 7.1 Pelvis 4 0.4 0 0 Other 3 0.3 79 13 (Schöffl, Hochholzer, Winkelmann, Strecker, Dt.Z.f.Sportmed.2/2003 and Schöffl et al. 2014 in progress) 23 -

High Grade Injuries? High Grade injuries of all 604 injuries (n=604) Polytraumatic 5 Ankle fracture 5 Severe soft tissue injury (hand) 3 Radius fracture 3 Multiple severe contusions 2 Calcaneus fracture 2 Navicular fractur 2 Pelvic fracture 1 Vertebral fracture 1 Amputations 1 (Schöffl, Hochholzer, Winkelmann, Strecker, Dt.Z.f.Sportmed.2/2003) 24

Sportclimbing: 10 most frequent injuries (20092012: n=911, and 1998-2001: n=604) (Schöffl, Hochholzer, Winkelmann, Strecker, Dt.Z.f.Sportmed.2/2003 and Schöffl et al. 2014 in progress) 25

Risk profile in Ice Climbing 26

Weapon like Equipment... 27

Long Climbs: Mordor Ice-fall Rock-fall no-return 28

Descent 29

Weather To warm To cold To bad... 30

Objektive Dangers: Ice Fall 31

Drytooling Injuries Ice Climbing Frost bite 9,4% Skin leasions and wounds 55,2% Fractures 2,1% Hematoma 21,9% other 17,7% Schwarz et al. Sportortho - Sporttrauma 2008 Schöffl et al. Med Sport 2009 32

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing: 33

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing: Schöffl et al.2010, 2012 34

Climbing: Injury Risk Study Type of climbing (geographical location) Injury rate (per 1000h) Injury severity (Bowie, Hunt et al. 1988) Traditional climbing, bouldering; some rock walls 100m high (Yosemite Valley, CA, USA) 37.5 a Majority of minor severity using ISS score <13; 5% ISS 13-75 (Schussmann, Lutz et al. 1990) Mountaineering and traditional climbing (Grand Tetons, WY, USA) (Schöffl and Winkelmann 1999) Indoor climbing walls (Germany) 0.079 3 NACA 2; 1 NACA 3 (Wright, Royle et al. 2001) Overuse injuries in indoor climbing at World Championship NS NACA 1-2 b (Schöffl and Küpper 2006) Indoor competition climbing, World championships 3.1 16 NACA 1; 1 NACA 2 1 NACA 3 No fatality (Gerdes, Hafner et al. 2006) Rock climbing NS NS 20% no injury; 60% NACA I; 20% >NACA I b (Schöffl, Schöffl et al. 2009) Ice climbing (international) 4.07 for NACA I-III (Nelson and McKenzie 2009) Rock climbing injuries, indoor and outdoor (NS) Measures of participation and frequency of exposure to rock climbing are not specified Mostly NACA I-IIb, 11.3% hospitalization (Backe S 2009) Indoor and outdoor climbing activities 4.2 (overuse syndromes accounting for 93% of injuries) NS Neuhhof / Schöffl (2011) Acute Sport Climbing injuries (Europe) 0.2 Mostly minor severity Schöffl et al. (WMED 2013) Indoor sport climbing (515337 Indoor Climbing Wall Visits in 5 Years) 0.02 15 UIAA 2 13 UIAA 3 2 UIAA 4 No fatality Schöffl, IFSC MedCom IFSC World Cup 2012 0.74 all UIAA 2 No fatality 0.56 for injuries; 013 for fatalities; incidence 5.6 injuries/10000 h of mountaineering 23% of the injuries were fatal (NACA 7) b 2.87/1000h NACA I, 1.2/1000h NACA II & III None > NACA III a Injuries/fatalities per 1000h calculated by Schöffl et al. (Schöffl, Morrison et al. 2010) b NACA score graded by Schöffl et al. according to the information given in the study (Schöffl, Morrison et al. 2010)

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing: Conclusion: Retrospective data on sport-specific injuries and fatalities was not reported in a standardised manner. To improve preventative injury measures for climbing sports, it is recommended that a standardised, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity, and fatality in climbing sports. Schöffl et al.2010, Sports Medicine 36

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing: Injury Location Schöffl et al.2010, UIAA Score 37

Evaluation of Injury and Fatality Risk in Rock and Ice Climbing: UIAA MedCom Score Schöffl et al.2010, UIAA Score 38

Is climbing a high risk sport? Fatalities occurred in all sports, it was not allways clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering, sport and indoor climbing showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports including basketball, sailing or soccer; indoor climbing ranked the lowest of all sports assessed. Nevertheless a fatality risk remains, especially in Alpine and ice climbing. In the absence of a standard definition for a high-risk sport, categorising climbing as a high-risk sport was found to be either subjective or dependent on the definition used. Schöffl et al.2010, Sports Medicine 39

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