Shoulder Pain in Climbers: Impingement, Rotator Cuff, SLAP, Dislocation, and Why an MRI Finding Isn't an Injury

🌏 中文版

You've been climbing on the overhang lately, with more and more cross-throughs and big spans. One day, reaching overhead for a hold, you feel a sharp pain on the outside of your shoulder; at night, lying on that side wakes you up. A friend says: "You've pinched your shoulder. Train your scapulae."

That might be right, or it might be underplaying something that needs a doctor. This post covers four things: common causes of shoulder pain in climbers, how to read "abnormal" findings on an MRI report, which prevention training has research behind it, and a self-check. The self-check is there to tell you when to see a doctor. It doesn't replace a diagnosis.

The previous post, Elbow and Wrist, noted that elbow problems often lead back to the shoulder; the full antagonist routine is in Antagonist and Core Training.

Where the shoulder ranks

It depends on where the data come from, but the shoulder usually ranks high:

• Schöffl et al. (2015) prospectively recorded 911 injuries at a German climbing clinic: fingers first, shoulder second. The authors also noted shoulder injuries were becoming more common.
• Grønhaug's 2018 survey of 667 climbers about chronic injuries in the past six months also put the shoulder second.

The same German group, in a 2019 review, expects shoulder injuries to keep rising as bouldering and new competition formats put more stress on the body.

Something you can do tonight: think back over the past month and count how many sessions were on overhangs, dynamic moves or big spans. That's your shoulder's "workload", and the sections below come back to it.

Common kinds of shoulder pain

On evidence first: there isn't much dedicated research on climbers' shoulders, and much of what's said comes from other overhead sports or physical therapists' experience. Each item below is labelled by source type.

Impingement: the one you hear about most

The UIAA Medical Commission's sport climbing factsheet says shoulder impingement is "quite common" in climbing, possibly from tendons, the rotator cuff or other structures getting "pinched" by constantly reaching and pulling on overhead holds. It recommends physiotherapy and strengthening the shoulder muscles (expert opinion).

Physical therapist Jason Hooper, in Hooper's Beta's impingement episode, splits impingement into two types (physical therapist experience):

• Primary: caused by bone shape, for example a curved or hooked acromion.
• Secondary: shoulder instability or scapular dyskinesis lets the humeral head ride up as the arm is raised.

The typical symptoms he lists: pain in the deltoid or outer upper arm when reaching overhead, pain reaching behind you, and pain lying on that shoulder. Taiwanese physical therapist Li Bin (in Chinese) likewise links climbers' impingement to weak scapular stabilisers (serratus anterior, lower trapezius) and a tight pectoralis minor.

Rotator cuff injury: tell it apart from impingement

Hooper says the most important thing is to distinguish impingement from a rotator cuff tear. His split:

• Impingement: external rotation hurts, but strength is largely intact; it usually develops gradually.
• Rotator cuff tear: pain plus clear weakness, especially in external rotation; the arm drops when you try to lower it from overhead; often linked to a single traumatic event.

His conclusion: "Best advice: see a professional." Whether the problem is mobility, stability or bone shape is hard to work out yourself.

SLAP and labrum: little climbing research

A SLAP lesion is a tear of the labrum at the top of the socket. In the Schöffl group's 2019 review, SLAP lesions were the fifth most common diagnosis in their patient population. The same paper names rotator cuff injuries, long biceps tendon ruptures, impingement and dislocation injuries as increasingly important in climbers.

There are few dedicated case studies of SLAP lesions in climbers, so all we can say is that it isn't rare in specialist clinics, not who is more prone to it or how to prevent it.

One small study is worth mentioning. A 2024 Brazilian study of 35 indoor boulderers (Mena et al.) found that those who preferred a dynamic style more often had anterior shoulder apprehension, the feeling that the shoulder is about to slip out. A cross-sectional study of 35 people is only a warning sign. For doing dynamic moves safely, see Dynamic Moves.

Dislocation: acute, see a doctor

Simon et al. (2023) say traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, and are rising. They followed 27 climbers who had a first-time dislocation repaired arthroscopically. After a little over four years on average, about nine in ten were climbing again, and most were near their previous grade (case series, surgical patients only).

A deformed shoulder, or an arm that's numb or tingling, is on the NHS list for going straight to A&E.

Something you can do tonight: write down whether your shoulder pain came on "gradually" or "after one particular move", and whether it's "pain when raising the arm" or "can't raise the arm". The second pair together (after one move + can't raise it) is the signal to see a doctor.

A finding on MRI isn't the same as an injury

Many people panic when an MRI report says "tendinopathy" or "labral tear". Read these two first:

• Cooper et al. (2022) scanned both shoulders of 50 elite climbers with no shoulder pain at all: 80% had intra-articular findings, and more than half had a discrete labral tear.
• Beeler et al. (2021) compared 31 high-level climbers with at least 25 years of climbing to age-matched non-climbers. The climbers had more changes in the labrum, long biceps tendon and cartilage, yet their shoulder function scores were no worse than the non-climbers'.

MRI is still useful; it's just that imaging has to be read together with symptoms and a clinical exam. Leave that to the doctor; your job is to describe your symptoms clearly.

Something you can do tonight: if you already have a shoulder MRI report, write "which movement hurts, for how long" next to it and bring both to your follow-up. Ask the doctor: "Which of these findings match my symptoms?"

Prevention: what has research, what is experience

Backed by a randomised trial: strength training

Kozin et al.'s 2021 randomised controlled trial split 84 male student climbers aged 18–19 into two groups: one added closed-chain, eccentric and strength exercises, the other didn't. The training group had markedly fewer shoulder injuries (research).

Quarmby et al.'s 2023 systematic review concludes that strength training prevents shoulder and elbow injuries, and that conclusion comes from this group's research on these student climbers. The limits are clear: one research group, only young male students. It's a good starting point, not a settled answer.

Another study, Grohnert et al. (2022), had 20 climbers who already had shoulder overstrain symptoms do a 4-week, 6-exercise shoulder compensation programme; pain and function improved. But it had no control group, and the authors say outright that whether it can prevent shoulder injuries remains unknown.

Coach and physical therapist consensus: scapulae and external rotation

• The BMC's summary of its 2016 Climbing Injury Symposium says shoulder muscle imbalances are common in climbers, and direction-specific exercises can go into warm-ups or accessory work.
• Wong and Ng (2009) measured that climbers' external rotators were relatively weaker than their internal rotators, a different ratio from non-climbers. The authors note that the clinical meaning of this difference hasn't been studied.
• Hooper thinks many overhead athletes lack external rotation strength, and addressing it may be an easy fix. Esther Smith, writing for Black Diamond, recommends prone I's, Y's and T's and quadruped serratus push-ups to strengthen the shoulder stabilisers.

All of these are expert opinion. For an actual routine, see Antagonist and Core Training, which lays out Hooper's once-a-week, three-circuit version (external rotation with scapular retraction, W's, face pulls). For upper-body strength beyond the fingers, see Strength, Shoulders and the Campus Board.

Something you can do tonight: lie face down on your bed, arms reaching forward in a Y with thumbs up, and lift your arms off the bed 10 times. Keep your shoulders away from your ears. Note which side is harder to lift or tires first.

Shoulder self-check: when to see a doctor

The self-check isn't a diagnosis; it's for deciding whether to see a doctor and how to describe the problem. In front of a mirror:

1. Compare sides: slowly raise both arms out to the sides and overhead. Do both shoulder blades move the same way? Does one shrug noticeably higher?
2. Where and when it hurts: at what height does the pain start? Does it ease once your arm is past that point? Does reaching behind you, or lying on that side, hurt?
3. Strength: elbow tucked at your side and bent to 90 degrees, rotate your forearm outwards. Are both sides about equal, or does one clearly give way?

See a doctor if any of these apply:

• Clear weakness in external rotation or raising the arm, or an arm that drops when you try to lower it (signs Hooper lists for a rotator cuff tear).
• Pain that started after a particular fall or move, especially with a sound, a visible deformity, or a numb arm.
• A feeling that the shoulder slips out, or a previous dislocation.
• Pain that won't go away and doesn't improve after you cut back. The UIAA factsheet notes that shoulder pain has many possible causes and needs a proper medical diagnosis.

In Taiwan, the shoulder can be seen in orthopaedics, a sports medicine clinic, or rehabilitation medicine (PM&R). The Taiwan Society for Surgery of the Hand (in Chinese) also describes hand surgery's scope as "the upper limb, from the shoulder to the fingertips". For differences between departments and NHI referrals, see the series overview.

Something you can do tonight: do the three steps above once, and film step 1 from the front and from behind on your phone. You can compare against it at your next appointment or self-check.

Practice: four scenarios

Answers are below each question. Think first, then look.

1. You catch a hold on a dyno and your arm gets yanked straight, with a sharp pain at the front of the shoulder. You can still raise your arm, but at certain angles it feels like it's "about to slip out".

2. Your shoulder MRI report says "labral tear", but you only feel occasional soreness and it doesn't affect your climbing. You're worried and want to ask about surgery.

3. Your outer shoulder hurts when you reach overhead and when you sleep on that side, but strength is about equal on both sides. A friend says "just train your scapulae".

4. After reading this, you want to share Kozin's study with your whole climbing club as proof that "shoulder training means you won't get injured".

Next

From fingers to shoulder, the upper body is mostly about overuse. Switch to emergency department data and the picture changes: Lin et al.'s analysis of US ED data from 2014–2023 found lower-extremity injuries made up about half; fractures were the most common injury type, and falls the most common cause. The next post, Bouldering Falls and Ankles, covers how to land, gaps between pads, and ankle sprains and fractures.

References

• Schöffl V et al. Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009 and 2012. Wilderness Environ Med 2015
• Grønhaug G. Self-reported chronic injuries in climbing: who gets injured when? BMJ Open Sport Exerc Med 2018
• Schöffl V, Simon M, Lutter C. Finger and shoulder injuries in rock climbing (in German). Orthopäde 2019
• Mena L et al. Prevalence and Risk Factors of Upper Extremity Injuries in Indoor Bouldering: A Cross-Sectional Study. Cureus 2024
• Simon M et al. Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers. Wilderness Environ Med 2023
• Cooper JD et al. Shoulder Pathology on Magnetic Resonance Imaging in Asymptomatic Elite-Level Rock Climbers. Orthop J Sports Med 2022
• Beeler S et al. Impact of 30 years' high-level rock climbing on the shoulder: an MRI study of 31 climbers. J Shoulder Elbow Surg 2021
• Kozin S et al. Application of closed kinematic chain exercises with eccentric and strength exercises for the shoulder injuries prevention in student rock climbers: a randomized controlled trial. Acta Bioeng Biomech 2021
• Quarmby A et al. Risk factors and injury prevention strategies for overuse injuries in adult climbers: a systematic review. Front Sports Act Living 2023
• Grohnert LS, Bonato M, Schöffl V. Evaluation of a four-week Adjunct Compensatory Training for climbing-specific overstrain syndromes of the shoulder. Sportverletz Sportschaden 2022
• Wong EK, Ng GY. Strength profiles of shoulder rotators in healthy sport climbers and nonclimbers. J Athl Train 2009
• Sprains and strains (NHS)
• Lin JQ et al. National Trends in Rock Climbing Injuries: A 10-Year Epidemiological Analysis of US Emergency Department Data (2014–2023). JB JS Open Access 2026
• UIAA Medical Commission: Factsheet on Sport Climbing (PDF)
• Shoulder Impingement Syndrome in Rock Climbers (Jason Hooper, Hooper's Beta, 2020)
• 5 points learned at the BMC Climbing Injury Symposium 2016 (BMC)
• Hang Right Part 2: Elbow Pain in Climbers (Esther Smith, Black Diamond)
• Injury prevention for climbers' fingers, elbows and shoulders (Li Bin, PT, Anjian Weikang Physical Therapy) (in Chinese)
• Taiwan Society for Surgery of the Hand: About (in Chinese)