Recommendations for standards of physical examination of international competing athletes

• Sports medical examination (morphology climbing: including weight, height, BMI, plicometry [body fat], flexibility, for adolescents: percentile)
• Standard laboratory test
• ECG (12 channels)
• Spiroergometry (bicycle or step test)
• Echocariography (yearly)
• Orthopedical examination (joints, posture, muscular dysbalance)
• Further examinations (X-ray, MRI, etc.) as medically necessary
• Medical examinations should be once per year
• Information about healthy nutrition and psychological support (if necessary)
• Recommendations of necessary vaccinations

STUDIES WITH INJURIES

• Injuries & Medical Incidences During the 2012 Climbing World Cup Series (2012) - Schöffl V; Burtscher E; Coscia F. Conclusion: Low injury risk in World Cup events.
• Accute Injury Risk & Severity in Indoor Climbing - A Prospective Analysis of 515,337 Indoor Climbing Wall Visits in 5 Years (2013) - Volker R. Schöffl, MD, PhD, MHBA; Georg Hoffmann; Thomas Küpper, MD, PhD. Conclusion: Overall low injury risk with low injury severity. The risk of a potential fatal injury always remains.

High level Sport Climbing + Climbing for all

• Correlations Between High Level Sport Climbing and the Development of Adolescents (2011) - Schöffl; Dötsch; Dörr; Jüngert. Conclusion: During certain growth spurts growth plates are at risk. Malnutrition will cause a delayed onset of puberty.
• Climbing for all - impact assessment reports (2010, 2011) - Gigliotti; Coscia; Piratinskij. Studies with a positive impact.

Vulnerable age of epiphyseal injuries in the age group of 13-15

• Injury Trends in Rock Climbers: Evaluation of a Case Series of 911 Injuries Between 2009 and 2012 (2015) - Schöffl et al.

        - High incidence of epiphyseal fractures in the age group 13 to 15.

        - Examined are growth factors, growth spurts and onset of epiphyseal fractures.

        - Precautions need to be instigated, prophylaxis increased. While campus board exercises are known to be one risk factor for epiphyseal fractures in young climbers, others still need to be detected.

Of the 22 injured fingers, 95% concerned the middle finger; in 64.3% the crimp grip led to the injury and was the preferred handhold (71.4%). Half of the injuries occurred during bouldering competitions. They were in average 14.1 years of age and all within the year of their peak velocity growth.

The climbing community started reporting epiphyseal stress fractures in the fingers in 1997. As a consequence of repetitive loading of the fingers the fractures observed were always in the proximal interphalangeal joint. Most often they were fractures of the Salter Harris III type with a fracture through the epiphysis of the middle phalanx. Within the short period of time (24 years) a total of 65 epiphyseal fractures of the fingers have been reported in climbers representing the highest rate of this injury so far in any sport.

All subjects were within a year of the first signs of puberty and within their pubertal growth spurt, a time when the growth plate is especially vulnerable for injuries.

Recommendations for trainers & COACHES referring adolescent climbers with incidence of epiphyseal fractures

• Inform and educate the personnel around athletes

         - Especially those aged 13-15 (around category Youth B), which is a vulnerable age for epiphyseal fractures.

• Be aware of signs

         - Finger pain during and particularly after climbing, almost always at the dorsal aspect of the finger middle joint

         - Finger joint swellings

         - Growth spurt

• Signs consequences

         - Stop training and get a medical evaluation (8-12weeks); inform athlete (personal doctor, parents, National Federation)

         - As appropriate, arrange MRT, X-ray

         - If epiphyseal fracture: break in training and appropriate treatment, otherwise the fracture will not heal and a permanent disability of the finger will result

• Adaption

         - No campus board exercise (especially no crimps)

         - Change the training to technical skills

         - Consider the overall time and number of competitions and exercises (consider regeneration time)

• Notice

         - Growth spurt exerts a high stress on the body with reduced ability of regeneration

         - Without regeneration no trainings effect

BLOOD ON THE FIELD OF PLAY

During Bouldering competitions,  especially in the finals of the youth events, you often find open skin injuries. Questions have therefore arisen as to whether there is a possible transfer risk of contagious diseases (e.g. HIV, Hep. B and C, etc.).

• Risk of Transmission of Blood Borne Infections in Climbing (2011) - Schöffl; Morrison; Küpper. Conclusion: The risk of blood to blood transmission is rather low but existing. Athletes can NOT compete with bleeding wounds. Blood on the holds must be removed. A recommendation has been made for judges regarding blood on the filed of play. 

Gravitational sports, Body fat, Relative Energy Deficiency in sports (RED-S)

• Athletes with extremely low percentage of body fat, insufficient bone mineral density and other medical signs are becoming common issues in many sports - especially in weight sensitive sports. Climbing refers to the group of gravitational sports.
• Athletes may use methods to reduce mass in order to gain a competitive advantage. Body fat may act as ballast, but adipose tissue is a vital endocrine organ in terms of general health. Excessive dieting can lead to serious medical problems and eating disorders (anorexia) with a poor prognosis.
• The syndrome of “Relative energy deficiency” (RED-S) refers to the deficiency of food intake (the daily supply of energy) to the energy needed in sports. The consequences are impaired physiological functions including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency.

The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) (2014) - Margo Mountjoy; Jorunn Sundgot-Borgen; Louise Burke; Susan Carter; Naama Constantini; Constance Lebrun; Nanna Meyer; Roberta Sherman; Kathrin Steffen; Richard Budgett; Arne Ljungqvist.

Climbing - gravitational sport - underweight- bmi: Development & Controlling

Although competition climbing is barely recorded in weight-sensitive sports, body composition becomes important in high level Sport Climbing.

Concerning this subject, the goal of the IFSC Medical Commission is:

• to maintain Sport Climbing on a physical and psychological health level
• to protect Sport Climbing from deliberately induced underweight climbers - associated with eating disorders it may lead to severe health problems
• to inform the athlete and the National Federation in advance, if the BMI (MI) screening shows a critical level
• to draw attention to a possible eating disorder and to help initiate a supporting group around the affected athlete (National Federation, trainer, doctor, nutrition counselling, psychologist)
• to prevent athletes from ending up in sports anorexia with a poor prognosis

From Disordered Eating (DE) to Eating Disorder (ED)

• Disordered eating (DE) continuum starts with an appropriate eating and exercise behaviours, including healthy dieting and the occasional use of more extreme weight loss methods such as short-term restrictive diets.
• The continuum ends with clinical Eating Disorders (ED´s), abnormal eating behaviours, distorted body image, weight fluctuations, medical complications and variable athletic performance.
• These EDs have many features in common, and athletes frequently move among them.
• The pathogenesis of EDs is multifactorial with cultural, familial, individual and genetic/biochemical factors playing roles.
• Factors specific to sport are dieting to enhance performance, personality factors, pressure to lose weight, frequent weight cycling, early start of sport-specific training, overtraining, recurrent and non-healing injuries, inappropriate coaching behaviour and regulations in some sports have been suggested.
• The prevalence differs significantly among sports (13 - 20% female and 3 - 8% male).

IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update (2018) - Margo Mountjoy; Jorunn Kaiander Sundgot-Borgen; Louise M Burke; Kathryn E Ackerman; Cheri Blauwet; Naama Constantini; Constance Lebrun; Bronwen Lundy; Anna Katarina Melin; Nanna L Meyer; Roberta T Sherman; Adam S Tenforde; Monica Klungland Torstveit; Richard Budgett.

BODY mass index (bmi) & Mass index (mi)

The BMI is an easy manageable screening tool to detect a group of underweight athletes. It is calculated by dividing the body weight by the square of the height (BMI = m/h²)

The first international BMI screening in Sport Climbing was carried out during the IFSC Lead World Cup Kranj 2006 by Prof. Wolfram Müller, Institute of Biophysics, Medical University of Graz. He reffered to the percentile according to Kromeyer-Hausschildt from Germany. Figures below the 3 percentile for male (18,5) and female (17,5) are known as critical.

Regular BMI screening (in WC's or WCH's) have been implemented since 2012. The main goal is to prevent eating disorders with severe health consequences in connection with Sport Climbing at an elite level. A letter is sent to athletes and National Federations if the BMI is critical. The IFSC can show up, inform and educate, but National Federations have the responsibility to support the affected athletes with medical, psychological and nutritional help.

The MI considers the continental differences of the body composition.

The sitting height (as an indirect measure for leg length) can be used to extend of the BMI formula to consider the leg length.

In the general MI formula, the hs (sitting height), and m determine the value of this index for the relative body mass.

MI = 0,53 x (m/hs)  

• MI larger than the BMI means long legs and the BMI is low
• MI lower than the BMI means long trunk and the BMI is higher

Current Status of Body Composition Assessment in Sport: Review and Position Statement on Behalf of the Ad Hoc Research Working Group on Body Composition Health and Performance, Under the Auspices of the IOC Medical Commission (2012) - Timothy R. Ackland; Timothy G. Lohman; Jorunn Sundgot-Borgen; Ronald J. Maughan; Nanna L. Meyer; Arthur D. Stewart and Wolfram Müller.

BMI margins, results & consequences

Critical margin - until 2019 (below the 3 percentile)

• MALE 18.5
• FEMALE 17.5

BMI'S 3 PERCENTILE FROM 2012-2018 (MONITORING SEMIFINALISTS)

• 2012 Chamonix (L) - 5 [3f, 2m]
• 2013 Imst (L), Arco (S), Munich (B) - 8 [3f, 5m]
• 2014 Gijon (L&S), Munich (B) - 9 [7f, 2m]
• 2015 Imst (L), Munich (B) - 8 [4f, 4m]
• 2016 Paris (L&B) - 2 [0f, 2m]
• 2017 Arco (L), Munich (B) - 2 [1f, 1m]
• 2018 Briançon (L), Meiringen (B) - 0

As the BMI margins used between 2012-2019 did not reflect the whole critical group of athletes, a slight adjustment of the BMI for 2020 became necessary.

MEDICAL REQUIREMENTS IN SPORT CLIMBING EVENTS

Field of Play (FoP) Medical Team

• During competition
• During training

Minimum facilities and services available

• Room in the vicinity of the FoP
• At the venue

Equipment and typical situation for Sport Climbing

• Overall
• Bouldering

Beating the heat during the Olympic Games Tokyo 2020

• Tips for heat acclimatisation, hydration plan, cooling strategies, etc.
• For further information, click here.

Accident analysis on the boulder mat

Chalk bags, clothes and other personal athlete belongings below the boulders, which may cause injuries by athletes falling onto them and twisting knees and ankles.

Reccommendation: At the technical meeting this should be brought to the attention of the coaches, who should then transmit the information to the athletes.

 Powdered magnesia

There are currently no existing studies on medical concerns regarding chalk. As magnesium carbonate is in general a nutrient the substance itself is harmless, though nevertheless theoretically a risk through fine dust exposition may be possible. Overall, good ventilation for gyms and airflow are recommended. Further studies are still necessary, but pending.