When it comes to climbing injuries, the spotlight stays fixed on the upper body: fingers, elbows, and shoulders. It makes sense. Those three areas undergo significant wear and tear. But it's just as important to consider the risk of injury in our lower half, where our knees are the most taxed from climbing movement. From heel hooks to drop knees to the impact from thousands of falls, the knees take a beating. Still, you don’t hear much about knee injuries until they happen, and when they do—as was the case with Alex Puccio’s torn ACL at the 2015 Vail World Cup—they can be brutal, often involving surgery and several months out of climbing commission.
The knee is a hinge joint that connects large muscles between the calf and quad. It's supported by cable-like ligaments. Of these, the MCL and LCL provide side to side stability (think twisting or rotating knee movements), and the PCL and ACL provide front to back stability (think stopping suddenly while sprinting). For climbers, falling injuries usually impact the PCL and ACL. Heel hooks and drop knees are the two main culprits of injuries that are not the result of a fall. They usually impact the MCL and LCL.
To gain some insight into biomechanics and prevention strategies, I sat down with Revo Physiotherapy and Sports Performance co-founder Matthew Smith. Here are a few of his recommended strategies for maintaining healthy knees.
1. Butt Back, Knees Wide
According to Smith, the best strategy to prevent fall injuries when bouldering is to land with proper form. Try to keep your butt back behind your heels and feet slightly wider than your hips. This keeps the knees in a healthy position, preventing them from buckling when your feet hit the pads. The trick is to train your body to adopt this form unconsciously, because falls are frequently unexpected. In order to practice good form and train the glutes to activate when landing, Smith recommends exercises that both mimic this stance and isolate the glutes, like squats. The goal isn’t to use a lot of weight, but to condition muscle memory in this stance under force. Try incorporating simple body weight squats or back squats at low weight into your regimen. For more challenge and stability, upgrade to one-legged squats, or one-legged squats on a Bosu ball.
2. Look up the Chain
No movement that involves the knee can be considered in isolation. Smith advises looking up the chain to the hip when assessing knee health. “The knee is a manifestation of what is happening in the hip,” says Smith. He adds that a drop knee injury could result from a lack of hip mobility or stability, causing the climber to compensate by twisting the knee too much. This applies to heel hooks too; if the hip is too tight or weak to support the heel hook, the extra strain is picked up by the knee. To assess hip stability, Smith points to one-legged squats. Perform a one-legged squat in front of a mirror with the back leg free hanging or supported by a chair. Bend into the squat and watch your hips. Do they stay level or does one drop? Does the base knee bow in or out? Proper form requires the hips to stay level and the supporting knee to stay in line with the hip.
3. Add Resistance
Resistance bands offer a convenient way to perform preventative exercises at the gym, at home, or on the road. To strengthen the hamstring and the glute, prone (on your stomach) hamstring curls with a resistance band are a good option. Anchor the band at the base of a weight bench or around a leg of furniture. Attach the other end to your ankle. Then curl the heel toward the glute.
For a knee targeted exercise, loop a resistance band around both legs so that it sits around the ankles. In a squat position, take side steps to increase the resistance of the band. Take several steps in either direction. Focus on keeping the knees in line with the hips and feet parallel.
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4. Motion is Lotion
The importance of warming up cannot be stressed enough; easy movement before hard exercise delivers blood flow to the muscles, creating local heat which decreases the chance of muscle tears or pulls. Whether you are taking a long break between pitches belaying a partner, or big rests between boulder problems, (re)warming up, especially the lower body, can help prevent tweaks or tears. Jog in place for a minute or bust out some jumping jacks to get the blood flowing after long rests.
5. Get Exposure
Several years ago Dave Macleod, the Scottish climbing writer and multi-discipline aficionado, suffered a tear to his MCL and a minor hamstring injury while executing a drop knee. In a blog post discussing the factors involved, he writes “I always take great care to concentrate and ‘feel’ the feedback from the knee to see if I’m properly and safely set before making the hand movement,” and suggests that perhaps he was too tired and not warmed up properly at the time of injury. In over 20 years of climbing, with only two minor knee injures, Macleod advocates practicing risky movements in low pressure situations, while staying on guard for red flags, “Do drop knees, they are a killer climbing technique. But be careful. Concentrate, keep warm and do them year round to keep your knees strong.” The take away: routinely practice easy drop knees and heel hooks in the gym if these are techniques you plan to use.