Eight tips for reducing the risk of growth plate fractures in the fingers of youth climbers.

Rock climbing is a wonderful sport for young minds and bodies, and I’m a strong advocate for youngsters giving the sport a try. Recreating in the vertical world develops a wide range of important mental skills, and it’s a wonderful physical workout that builds strength, power, endurance, and flexibility.

What’s more, climbing is a character-shaping activity that teaches youths goal setting, perseverance,  challenging fear,  and the power of will. Finally, as I’m most fond of promoting, rock climbing is a “life sport”! Whereas involvement in many youth sports terminates at the end of junior high or high school, climbing is a rich, diverse activity that can be enjoyed throughout your adult life. You can trust coach Hörst on this one—I began climbing at age 13 and I’m still loving the sport at age 53!

As with any rigorous sport, however, rock climbing presents some physical risks. While the indoor climbing activities that most youths participate in are extraordinarily safe (given proper instruction and adult supervision), there is a growing incidence of epiphyseal fractures (injury to the growth plate in the finger) among adolescents. The increasing focus on hard bouldering, competition climbing, and year-round training have contributed to an alarming increase in growth plate fractures both in the United States and Europe. My colleague, Dr. Volker Schöffl, has been studying climbing injuries for 20 years and he’s documented a 600 percent increase in epiphyseal fractures over the past decade.

Early identification of this often insidious injury and a relatively short layoff from climbing (a few months) usually leads to a rapid resolution and return to climbing. Left to their own devices, however, many youths will continue to climb despite ongoing finger pain. Consequently, it’s essential that a coach (or parent) direct a reduction in—or complete withdraw from—climbing until the pain subsides. Consulting an Orthopedist is prudent, and a simple hand X-Ray will reveal the extent of the injury. Sadly, some parents and coaches remain ignorant and, incredibly, there are a few coaches who deny that this injury is even “real”…perhaps to allow their continued use of inappropriate (advanced) training tactics in the quest of developing the next champion climber.

How Does This Injury Present? What Action Should Be Taken?

Epiphyseal fractures typically occur during the adolescent growth spurt—between the ages of 10 – 14 for girls and 12 – 16 for boys—and they are most common during the year (or two) of highest growth velocity. Common growth plate injuries in other sports include Sever’s Heel and Osgood-Schlatter’s (knee) among running athletes and Little Leaguer’s Elbow with throwing athletes.

Among climbers, the injury is most common at the middle joint of the long (middle) finger. While a low-grade injury will present as slight knuckle pain only while climbing, a worsening condition will yield more acute pain while climbing as well as discomfort/aching during everyday activities. Since epiphyseal finger injury usually develops gradually, early identification and reduction of climbing time (or complete withdraw) will often bring about a rapid resolution (in a few months or less). Attempting to “climb through the injury” may result in a Salter-Harris fracture that can take many months to resolve and, in severe or untreated cases, lead to permanent disfigurement/dysfunction. A surprising number of the world’s top youth climbers—many who have stood on podiums and pushed the boundaries of outdoor climbing—have suffered a Salter-Harris fracture. Sadly, a few individuals have experienced repeated fractures, thus forcing a multi-year withdrawal from climbing.

How Should Youth Climbers Be Monitored To Reduce Risk of Growth Plate Fractures?

Proactive coaching is essential for enthusiastic youth climbers entering their growth spurt years. Since every child hits their growth spurt at a somewhat different time (some “bloom” early, while others have a delayed growth spurt), I recommend taking a quarterly measurement of height and weight from the age of 9 to 16. Plotting this data quarter-after-quarter will often reveal the onset of increasing growth velocity—this marks the beginning of the 12 to 24 months of highest risk of epiphyseal fracture…and it should prompt a coach to more closely monitor the youth’s fingers (frequently asking “do you have any finger pain/discomfort”) as well as ponder a possible reduction of time spent on “limit” climbing and specific training.

An annual hand ultrasound is a powerful monitoring tool, even with asymptomatic youths, and an X-Ray is appropriate in the case of acute finger pain (to determine if there’s a Salter-Harris fracture) and to confirm complete fusion of a mature youth (~age 16). This is an approach I’ve used to monitor the hands of my sons, and the recent X-Ray of my older son, Cameron’s (age 16), has revealed that his growth plates are now fused (photo below). Consequently, he’s now matured beyond the age of concern for this injury, and so I’ve finally been able to give him the “all clear” to ramp up his training intensity and volume to elite levels (after several year’s of holding him back from certain advanced/risky training practices).

Conversely, recent imagery of my younger son, Jonathan (age 14), reveals wide-open growth plates that, along with his recent growth of 5cm+ in the past year, places him in the period of highest risk of growth plate injury. By moderating Jonathan’s training, limiting his time doing extreme bouldering, and ensuring he gets plenty of sleep and high-quality nutrition, I trust that he can navigate Jonathan’s growth spurt years without injury (as his older brother did), while still enabling him to climb at an elite level at the crags. (You can read more about the Horst brothers and how they achieved the 5.14a/8b+ grade by the age of 11, while being multi-sport athletes and non-year-round climbers.)

8 Coaching Tips for Reducing Risk of Growth Plate Fractures

• Track a climber’s height and weight from age 9 to 16 to identify the period of highest growth velocity (when the injury is most common). Consider annual hand ultrasound (or X-Ray in the case of acute pain) to screen for injury and to identify when the growth plates fuse (the end of GP injury concern). Coach each youth climber as a unique individual—a “slow grower” may be less at risk of growth plate injury than a fast-growing climber of similar ability and exposure.
• Coach a comprehensive approach to improving climbing performance, with a strong emphasis on technique and mental skill development, rather than placing excessive focus on physical training.
• Avoid specialization (such as a singular focus on extreme bouldering) and foster the development of diverse climbing skills by exposing youths to many different styles of climbing. Place a strong focus (and value) on onsight, flash, and “second go” climbing over projecting of extreme boulders and routes.
• Favor generalized training with young climbers, including the development of antagonist and stabilizer muscle, aerobic capacity, flexibility, and tumbling ability. Keep training fun and varied, rather than regimented and highly targeted. Utilize a wide range of body-weight exercises (pull-ups, push-ups, core exercises, etc.) prior to the growth spurt, and introduce a limited number of free weight exercises and a modest amount of climbing-specific training during the growth spurt years.
• While highly fit and advanced youth climbers may be able to do a small amount of hangboard training and “laddering” up a campus board, they should not engage in any “double dyno” campus training nor weighted hangboard training during their growth spurt years. The most prudent coaches will allow no campus board training during the growth spurt years.
• During the period of highest growth velocity, time spent “limit bouldering” should be reduced to just 30 to 60 minutes once or twice per week. Climbing frequency should be limited to 2 to 4 days per week during the growth spurt years, with an immediate reduction in climbing time at the first sign of pain in the knuckles.
• Coaches should instruct on minimal use of the crimp grip, which is highly stressful on the middle (PIP) joint of the long fingers. Route setters should avoid setting excessively crimpy problems for youth climbers (and at comps).
• All youth climbers should have an “off-season” during which they do little or no climbing for one to four months. Playing a second sport is strongly recommended through age 16, in order to develop a high physical IQ and diverse motor skills that will last a lifetime.

Note: This article was originally posted in May 2017. Since then, Jonathan (now 17) has reached his adult height (fused growth plates) without injury. Thus, the guidelines detailed in this article enabled both Hörst boys to climb hard (and train appropriately) throughout their growth-spurt years without incurring a growth plate fracture and forced withdrawal from climbing.

Further Reading and Related Articles:

• Training For Climbing – The most complete and up-to-date guide on physical, technical, and mental training for climbers of all ages.
• One Move Too Many – The definitive guide to climbing injuries, treatment, and avoidance, by Dr. Volker Schöffl.
• Overview of youth training for climbing.
• Age-appropriate physical training for adolescent climbers.
• Learn the tendon and bone health benefits of daily collagen consumption. Here’s a product designed specifically for climbers >>

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