Question for Physiotherapists

ANSWER |

Bouldering is like rock climbing but done without safety ropes: just you, your shoes and a crash mat. The ‘routes’ up the wall are short but require significant skill and power to complete. As the level of skill in the climbers improves, the height to which they climb increases as well. Heights of 4 or 5 metres can be attained and it is common to fall from this height when attempting more advanced manoeuvres.

It is rare to hurt yourself during a fall while rock climbing as the rope and harness are designed to provide safety to the climber. This is not the case when bouldering and hitting the ground from a height means that your legs and knees usually take the impact.

Traditionally climbing has been associated with upper limb injuries such as shoulder dislocations because the safety rope limits the distance you can fall off the wall. Unfortunately, the falls from bouldering are leading to high-energy ground impacts, particularly with the lower limbs. The resulting injuries can range from mild sprains to severe ligament tears, often from awkward landings, twisting movements, or high-impact falls.

The injury patterns that result from these high-energy axial and rotational loading are often multi-ligament knee injuries with dislocations and complex meniscus tears (including posterior root tears and injuries to both medial and lateral menisci). I have even seen a patella tendon rupture.

Most multi-ligament knee injuries in the past have been from sports like rugby which are very male dominated. Since bouldering has a high number of female participants we are now seeing these severe injuries in the female population as well.

Some common scenarios that cause trouble:

• Jumping off the top instead of downclimbing (even controlled jumps can go wrong)
• Landing on one leg or with your knee twisted
• Rotating the knee under load during heel hooks or drop knees
• Misjudged high steps or awkward shifts in body weight

Mechanisms and Common Causes

An awkward landing is the most common cause of serious injury causing hyperextension or forceful rotation of the knee but the knee can be injured dynamically doing heel hooks, drop knees (ER and loaded) or high stepping. These are usually less serious injuries. Once they have completed the climb many participants choose to jump off the wall rather than climbing back down the way they came. While this can be a controlled landing things can still go wrong jumping from a significant height. Falling off unexpectedly is where the most serious injuries occur.

Types of Knee Injuries

Injuries vary from ACL rupture to a complete posterolateral corner disruption. Meniscal tears are common and it is possible to get chondral injuries as well. I have seen patella tendon ruptures, patella dislocations and MCL strains and disruptions. The most serious knee injuries in bouldering often involve ligament damage.

High-energy axial loading that occurs during bouldering falls can lead to meniscus root tears. Given the biomechanical importance of the meniscus root tears (untreated injuries can result in early-onset osteoarthritis), increased vigilance is warranted, particularly when treating female patients with bouldering-related knee injuries because there can be significant articular surface trauma beyond ligamentous and meniscal damage.

This is in contrast to Rock climbing injuries in general.

Spine injuries account for about 5% of all climbing-related injuries and up to 20% of fractures. The majority of these are compression type injuries in the thoracolumbar region sustained by falling from height.

Shoulder injuries are the second most common type in the upper extremity (after the hand). Acute injuries include fractures, acromioclavicular separation, glenohumeral dislocation, and rotator cuff tears. Chronic overuse injuries include rotator cuff tears, impingement, biceps tendonitis, and SLAP tears.

Even first time dislocators are offered surgery as they have a high risk of re-dislocating. Typically an arthroscopic stabilisation and Remplissage procedure will allow them to keep their movement but also remain stable (both of which are essential for climbing).

SLAP tears are also common but often get better with physio. In those that fail non-operative treatment, biceps tenodesis has an almost 100% return to sport rate within 6 months (for high-level competitive rock climbers).

If for some reason the rope does not save you while rock climbing then you are likely to suffer a calcaneal injury or spine fracture.

Conclusion

Bouldering is fun, challenging, and incredibly rewarding — but it also comes with real physical risks, especially to your knees. As climbers push harder and climb higher, injuries from falls are becoming more common, and many of them are serious.

The good news is that most knee injuries in bouldering are preventable. Smart training, proper landing technique, better crash pad use, and education around movement mechanics can all make a huge difference. Jumping off the wall instead of downclimbing, poor landing form, or letting fatigue take over can all lead to avoidable injuries.

As the sport grows, so should our understanding of how to stay safe. Protecting your knees means thinking ahead, respecting your limits, and giving your body the support it needs — whether that’s strength training, recovery time, or just learning to fall well. Protecting their knees should remain a top priority for every boulderer.