Training composition and finger injuries in sport climbing: a 6-year multicenter registry analysis of 488 climbers

Introduction Finger injuries are the most frequent diagnoses in sport climbing and are predominantly overuse-related, yet evidence linking specific training-composition patterns to the spectrum of finger injuries is sparse. We analyzed associations between training composition and the five most frequent climbing-specific finger injuries over a six-year period. Methods In this multicenter, registry-based cross-sectional study at two German climbing-orthopedic referral centers (Bamberg and Rostock) we included 488 climbers (372 male, 115 female, 1 not specified; mean age 31.4 ± 9.3 years) presenting between 2017 and 2022 with one of five finger injuries: A1–A5 pulley injury, capsulitis, tenosynovitis, finger epiphyseal stress fracture or lumbrical muscle injury. Climbing experience, climbing level, training composition (climbing volume, campus-board, strength, antagonist, core, warm-up, coach, training plan) and injury characteristics were captured by a validated questionnaire. Cross-tabulations were analyzed by chi-square with column-wise post-hoc tests; continuous training-volume data by ANOVA or Kruskal–Wallis with Bonferroni correction. Results Pulley injuries (34.2%) were most frequent, followed by capsulitis (28.1%), tenosynovitis (26.2%), lumbrical tears (8.0%) and epiphyseal fractures (3.5%). Two-thirds of injuries (68%) were attributable to chronic overload; bouldering was reported 1.6 times more often than rope climbing as the activity at which the injury occurred. Campusboard training was associated with more lumbrical tears but fewer cases of capsulitis; additional strength training was associated with fewer capsulitis cases; warming-up was associated with fewer epiphyseal fractures; training under coach supervision was associated with more epiphyseal and lumbrical injuries. The relative number of epiphyseal fractures did not increase compared with an earlier 2017–2018 evaluation of the same registry. Discussion Training composition is differentially associated with the spectrum of climbing-specific finger injuries, supporting injury-entity–tailored prevention. In adolescents, deferral of campus board and additional-weight training until growth-plate closure and systematic warm-up appear particularly relevant. In adults, supplementary strength training may represent a protective association against capsulitis. Prospective intervention studies are needed to confirm these associations and quantify prevention effects.