Bouldering and osteopathy: Understanding, preventing and treating injuries

Bouldering is a fascinating discipline that intensely engages the whole body and mind. Unlike classic climbing on walls or cliffs, bouldering is practiced on low walls (generally less than 4.5 meters) without belaying, but with landing mats in case of a fall. This activity requires strength, flexibility, coordination and mental strategy. However, because of its physical demands, it also entails a not inconsiderable number of injuries. Osteopathy is therefore an invaluable aid in the prevention and treatment of climbing injuries.

Bouldering places intense demands on muscles, tendons and joints. Explosive movements, prolonged suspensions and jump landings can lead to a variety of injuries, including :

The fingers are the first to be affected en bloc. The stresses exerted on the tendons and digital pulleys (small fibrous rings guiding the tendons of the finger flexors) can cause :

• Pulley ruptures (A2, A3, A4): typical when using curved grips. Pulleys are fibrous structures located along the fingers and acting as guides for the flexor tendons. When subjected to excessive load, they can rupture, causing intense pain and collapse of the tendon under the skin.
• Flexor tendonitis: caused by repetitive movements and overuse. Tendonitis is an inflammation of the tendons caused by overuse and lack of recovery. It causes pain when flexing the fingers, and can develop into a chronic condition if left untreated. If tendinitis persists over time, it can develop into tendinopathy, i.e. a pathology of the tendon without inflammation.

• Lesions of the synovial sheaths: inflammation of the tissues surrounding the tendons, often due to poor heating or excessive tension. These sheaths enable the tendons to glide easily during movement. Excessive irritation causes swelling and pain, limiting the fluidity of finger movements.

Lateral epicondylitis is an inflammation of the tendons of the extensor muscles of the forearm, which attach to the lateral epicondyle of the humerus (the bony relief on the outside of the elbow). This pathology is often linked to repeated movements involving these muscles, such as pulling, gripping or certain technical sports movements (tennis, climbing, weight training, golf).

 Symptoms :

• Pain on the outside of the elbow, which may radiate to the forearm.
• Increased sensitivity to palpation of the lateral epicondyle.
• Pain when extending the wrist or grasping objects (e.g. shaking hands, lifting a load).

 Support :

• Relative rest by reducing painful activities.
• Stretching and progressive muscle strengthening under professional supervision.
• Osteopathy and physiotherapy to improve mobility, release tension and correct any postural imbalances.
• Wear an anti-epicondylitis brace, such as the condylex bracelet, to limit stress on the tendon.
• Kinesiotaping

Subacromial impingement is a shoulder condition caused by excessive rubbing of the rotator cuff tendons under the acromion (the part of the scapula above the joint). This friction leads to inflammation of the tendons and sometimes to bursitis (inflammation of the bursa protecting the tendons).

Shoulder dislocation is the displacement of the head of the humerus from the glenoid cavity of the scapula, often as a result of trauma (fall, direct impact, sudden movement). Subluxation is a partial form of this displacement, where the joint spontaneously springs back into place.

 Symptoms :

• Intense pain and sensation of dislocation.
• Visible deformity in the case of complete dislocation.
• Inability to move shoulder normally.
• Chronic instability if the joint has already suffered several episodes of dislocation.

 Support :

• Reduction of the dislocation (repositioning of the joint) by a medical professional.
• Temporary immobilization in a sling to avoid further displacement.
• Early rehabilitation with a physiotherapist to strengthen the shoulder's stabilizing muscles and prevent recurrence.
• Prevention: avoid risky movements, strengthen shoulder stabilizers, improve proprioception.

⚠️ In the event of recurrent dislocation, surgical treatment may be considered to stabilize the joint.

The wrist is a highly stressed joint in climbing, whether it's during arched holds, locks, or dynamic movements that impose torsional and compressive stresses. These repeated movements can lead to injuries such as carpal tunnel syndrome and wrist instability.

 What is carpal tunnel syndrome?
Carpal tunnel syndrome is a compression of the median nerve at the wrist, in a narrow tunnel formed by the carpal bones and a thick ligament (the anterior annular carpal ligament). In rock climbing, prolonged flexion of the wrist and forceful gripping of small rulers can encourage this compression.

 Symptoms :

• Tingling and numbness in thumb, index finger, middle finger and half of ring finger.
• Sensation of electric shock, especially at night or after a climbing session.
• Loss of grip strength, difficulty holding a fine grip for long.

 Care and prevention :

• Relative rest: reduce the intensity of training and avoid holds requiring strong wrist flexion.
• Stretching and mobilization of the median nerve to limit compression.
• Strengthening forearm muscles and wrist stabilizers to prevent tendon overload and limit inflammation.
• Use of straps to limit wrist hyperflexion on certain holds.
• If it persists: a medical consultation is necessary, which may include infiltrations or surgery as a last resort if the compression becomes too disabling.

 What is wrist instability?
Wrist instability occurs when the ligaments that stabilize the carpal bones are weakened or distended. In climbing, this can be caused by abrupt movements, poorly controlled landings after a throw, or repeated twisting on demanding holds (e.g. rulers, inverted holds).

 Symptoms :

• Weakness or looseness of the wrist on certain holds.
• Diffuse pain on the top or side of the wrist, especially after prolonged exertion.
• Cracking or popping when rotating the wrist.

 Care and prevention :

• Rest and adapt movements: avoid traumatic gestures and opt for holds that place less strain on the ligaments when twisted.
• Targeted muscle strengthening: exercises with elastic bands to strengthen the stabilizing muscles of the wrist.
• Strapping or wearing an orthosis during climbing to limit excessive movements and relieve the ligaments.
• Proprioception training to improve wrist control and avoid repetitive strain injury.
• Osteopathy and physiotherapy to restore mobility and prevent recurrence.

Bouldering puts intense stress on the lower limbs, particularly when landing jumps and performing technical movements such as the drop knee (where the knee is twisted to gain height and optimize support). These movements, combined with repeated falls onto mats of varying hardness, can lead to knee and ankle injuries.

What is patellar syndrome?
Patellar syndrome is an inflammation of the cartilage behind the kneecap. In climbing, it is favored by movements where the knee is in prolonged flexion under load (drop-knee, deep squats on a low grip) or by repeated impacts during abrupt landings.

 Symptoms :

• Diffuse pain in the front of the knee, often accentuated on descent or after a long bouldering session.
• Sensation of discomfort or cracking under the patella.
• Stiffness of the knee after a session.

 Care and prevention :

• Adapt movements: avoid extreme drop-knees or prolonged positions in deep flexion.
• Muscular strengthening: work the quadriceps and hip stabilizer muscles to distribute loads more evenly.
• Stretching and self-massage: release tension in the quadriceps and fascia lata (lateral thigh muscle).
• In case of persistent pain: rehabilitation with a physiotherapist to improve knee alignment and stability.

 What are sprains?
Sprains occur when ligaments are overstretched or partially or totally ruptured. In bouldering, they are generally caused by poorly controlled landings after a missed throw, or a shift in the center of gravity following a poorly anticipated fall.

 Symptoms :

• Acute pain at the moment of trauma, often followed by swelling.
• Joint instability, sometimes with a "loose" sensation.
• Hematoma if a ligament is affected.

 Care and prevention :

Apply the PEACE and LOVE method developed by the runner's clinic:

• Muscle strengthening and proprioception to stabilize the joint and prevent recurrence.
• Work on falling techniques: absorb the impact with your legs and avoid putting your foot down suddenly (risk of external ankle sprain).
• Ankle braces or strapping may be worn if there is a history of frequent sprains.

What are menisci?
The menisci are small pads of cartilage located between the femur and the tibia, acting as shock absorbers and stabilizers for the knee. When climbing, they can be subjected to excessive stress during extreme twisting (forced drop-knee, violent rotation on a low handhold). Meniscus injuries can occur suddenly after a traumatic movement, or progressively with repeated microtrauma.

 Symptoms :

• Internal or external knee pain, often accentuated by flexion or rotation.
• Sensation of locking or catching in the joint.
• Swelling of the knee after an intense session.

 Care and prevention :

• Limit extreme twisting: adapt the angle of drop knees and avoid forcing on unstable holds.
• Muscle strengthening and proprioception: improve neuromuscular control to protect menisci.
• If symptoms persist (blockages, recurrent swelling), imaging (MRI) may be required to assess meniscus damage and adapt treatment (rehabilitation or surgery if necessary).

Bouldering places intense demands on the back, particularly during dynamic movements, sheathing locks and landing jumps. Incorrect movements or lack of strengthening can lead to lumbar pain, or even more serious pathologies such as herniated discs.

What is lower back pain?
Low back pain is pain in the lower back, often caused by muscular overload, poor posture or repetitive strain injury. They generally occur as a result of :

• A lack of sheathing during dynamic movements, forcing the back to compensate.
• A poorly absorbed landing where the impact is felt in the lumbar region.
• Muscular tension accumulated by prolonged locking or excessive twisting.

 Symptoms :

• Diffuse or occasional pain in the lower back, often after an intense session.
• Stiffness in the morning or after prolonged sitting.
• Pain exacerbated by certain movements (e.g. flexion of the torso, rotation of the trunk).

 Care and prevention :

• Strengthening deep abdominal muscles: work the deep abdominals (transverse) and back stabilizing muscles (multifidi) to better absorb stress.
• Avoid hyperextending the back on certain arched holds.
• Careful landings: bend the knees and absorb the impact with the legs rather than the lower back.
• Osteopathy and physiotherapy for blockages or persistent tension.
• Stretching and mobility: focus on lumbar, psoas and hamstring muscles to avoid excessive tension.

What are intervertebral discs?
Intervertebral discs act as shock absorbers between vertebrae. A herniated disc occurs when a disc becomes deformed and compresses a nerve root. This can be caused by :

• A lack of sheathing leading to excessive pressure on the discs.
• Rough landings where the impact reverberates down the spine.
• Poorly controlled flexion combined with torsion, which weakens the discs.

 Symptoms :

• Acute lumbar pain, often radiating down one leg to the front or back of the leg
• Sensation of electrical discharge or numbness in the lower limbs.
• Reduced muscle strength in one leg if nerve compression is severe.

 Care and prevention :

• Don't neglect core training: regular strengthening of the core to protect the spine.
• Take the time to learn how to fall correctly: bend your legs to absorb the shock.
• Mobility and active stretching to limit the tensions that increase pressure on the discs.
• Progressive rehabilitation in cases of confirmed hernia: osteopathy, physiotherapy and adaptation of practice.
• In the event of persistent pain: medical consultation and imaging (MRI) may be required to assess severity and adapt treatment.

Osteopathy is a holistic approach that aims to restore balance to the body by identifying and treating mobility restrictions. For climbers, osteopathy can intervene at several levels:

An osteopath can help detect areas of tension before they become problematic. By mobilizing joints and releasing myofascial tension, he can prevent the onset of tendonitis, muscle contractures and harmful postural compensations.

In the event of injury, the osteopath can relieve pain by releasing joint and muscle tension, optimizing blood and lymph circulation and promoting better tissue recovery.

A body that is well aligned and free of mobility restrictions is more efficient during exercise. Osteopathy helps climbers improve their joint amplitude, proprioception and flexibility.

During an osteopathic consultation, your osteopath will give you specific advice on how to optimize your climbing and your body. Here are some fairly general examples of exercises:

A good warm-up increases body temperature and prepares muscles and tendons for exertion. It should include :

• Light cardiovascular exercise (skipping rope, jogging on the spot).

• Dynamic stretching to mobilize fingers, wrists, shoulders and hips.

• Progressive increases in intensity on easy holds.

Good posture prevents back pain and optimizes the transmission of forces between the upper and lower limbs.

• Strengthen deep core muscles with exercises such as the plank or hollow body.

• Improve hip and shoulder flexibility for greater amplitude and less joint stress. Be careful, however, not to stretch just before or just after training.

Recovery is essential to avoid overwork and chronic injury:

• Post-workout stretching and self-massage: to prevent stiffness and improve recovery, focus on active and passive stretching, with particular emphasis on forearms, shoulders, back and legs. The use of a massage roller or ball can also help release deep-seated tension.
• Proper hydration and nutrition: well-hydrated tissues are more resistant to microtrauma. Make sure you drink enough fluids and eat a balanced diet to promote muscle recovery.
• Listen to your body and recover: don't ignore signs of fatigue or pain. If discomfort persists, give yourself a rest and consult an osteopath before the problem worsens.

• Get enough sleep to promote muscle regeneration.

Climbing, and bouldering in particular, places heavy demands on the body: repetitive movements, asymmetrical muscular tension, impact during landings... Even in the absence of pain, these microtraumas can accumulate and impair mobility or fluidity of movement. Regular consultation with an osteopath can help prevent injuries before they become limiting, optimize recovery and maintain optimal joint alignment. A well-balanced body freed from mobility restrictions will perform better, be more resistant to fatigue and less prone to compensations that can lead to chronic pain. Regular osteopathic care is therefore a real investment in the climber's longevity and efficiency.

By incorporating these best practices into your routine, you'll maximize your comfort, reduce the risk of injury and make more serene progress in your bouldering practice.

Bouldering is a demanding sport that places intense demands on the whole body. Between muscular tension, repeated impacts and extreme movements, climbers are particularly prone to injury. Good physical preparation, a proper warm-up, sheathing work and optimized recovery are key to preserving the body and avoiding chronic pain.

Osteopathy is a real ally for climbers, whether to prevent injury, relieve pain or optimize performance. By rebalancing the structures involved, improving joint mobility and providing advice tailored to your climbing needs, osteopathy helps you climb more serenely and effectively.

Whether you're an occasional climber or a passionate enthusiast, listening to your body and regular check-ups with an osteopath will help you prolong your pleasure on the wall, while ensuring that your climbing lasts longer. Climb hard, but climb smart! ‍♂️