Medial elbow pain isn't always tendinitis; it can be a compressed ulnar nerve. Numbness, or pain after keeping the elbow bent for a while, points to the nerve. In a German case series of climbers' wrist injuries, pinky-side injuries were the most common, and about a third of patients still had discomfort after treatment. For diffuse wrist pain you can't pin down, the researchers recommend an X-ray, then CT or MRI if needed. A working guide for adjusting training: no more than 2/10 pain during an activity and for 24 hours afterwards (a physical therapist's rule of thumb).
Flexibility affects climbing performance, but less than strength and endurance: in a 2000 study it explained only 1.8% of the variance in performance, and the authors of the IRCRA test battery suggest it may be a 'threshold' quality where enough is enough. General tests such as the sit-and-reach barely relate to climbing ability; climbing-specific hip tests do. A 2023 systematic review found no association between stretching and overuse injury, so train mobility to put your feet where you want them, not to prevent injury.
Where climbers get hurt depends on where the data comes from: in a sports-medicine clinic more than half of injuries are fingers; in US emergency-department data half are lower-limb injuries, mostly fractures from falls. A head strike in a fall, new numbness or weakness, a deformed limb or a crack at the moment of injury means call 119 or go to the ED. A finger that pops and then swells, or finger pain in anyone under 18, needs a doctor soon. In Taiwan a physiotherapist treating an injury must work from a doctor's diagnosis or referral, so see the doctor first.
Elite climbers are lean on average, but in Lattice's data BMI showed no significant correlation with grade, and they observed that climbers who stay in a long-term calorie deficit struggle to gain finger strength. Several studies find climbers under-eat: in one study of 25 advanced to elite climbers, 28% had low energy availability. Watch three groups of RED-S warning signs: menstrual changes, repeated injury or illness, and training that stops paying off. For recovery, Eva López recommends 48–72 hours between hangboard sessions. If you suspect RED-S, get assessed by a doctor or registered dietitian.
In specialist clinic data, the shoulder is the second most common injury site after the fingers. Impingement is common in climbing but needs to be told apart from a rotator cuff tear: pain when raising the arm with strength intact looks more like impingement; clear weakness in external rotation, or an arm you can't lift after an injury, means seeing a doctor. In 50 elite climbers with no shoulder pain, 80% had intra-articular findings on MRI, so a finding on a scan isn't the same as an injury. A randomised trial of 84 student climbers found that closed-chain plus eccentric strength training reduced shoulder injuries.