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How to Deal With the Dreaded Climber’s Hunchback

As our chest becomes tighter, the shoulders and back become more rounded, and a forward head posture can develop. While not inherently harmful, these traits can put climbers at higher risk of shoulder or neck injuries.

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Overhead arm mobility is hugely important to a climber’s wingspan, their comfort while climbing, and avoiding injury. Often, when thinking about upper-body mobility, our shoulders are first to come to mind; but it is important to consider our spine too, especially the thoracic region. The thoracic spine is the portion below our neck but above our lower back. As our shoulders move overhead or to the side, our thoracic spine should flex, extend, bend, or rotate.

In more difficult terrain, climbers often end up in positions that lend themselves to bending forwards into a hunched posture; think bunched high feet or steep terrain. Add to these climbing positions our back musculature and we begin to look like our chimpanzee ancestors. Our chest becomes tighter, the shoulders and back become more rounded, and a forward head posture can develop. This phenomenon is often labelled “climber’s back.” Although not inherently harmful, these traits can put climbers at higher risk of shoulder or neck injuries if we try to compensate for it while climbing.

What we know about “climber’s back”

In 2014, a study found climbers to have much more thoracic kyphosis, that is, mid-back spine curvature, than those who did not climb. They also had increased lumbar lordosis, that is, low-back curvature.1 Interestingly, those who were at a higher climbing level had more kyphosis, theorized due to shortened pectoral muscles.

A 2009 study showed the same findings, but also mentioned that no difference in thoracic movement was apparent between climbers and non-climbers.2 Regardless, it has been suggested that individuals with kyphosis and rounded shoulders have an increased incidence of pain between the shoulder blades (interscapular pain), and those with a forward-head posture have an increased incidence of cervical, interscapular, and headache pain.3 This information is important for climbers to be aware of. As overhead athletes we are particularly susceptible to the flow-on effects of poor posture and thoracic mobility deficits.

Signs and symptoms

When problems arise due to thoracic posture or mobility, they present in either the upper back, shoulders, or neck. Symptoms can include a reduced range of motion, a feeling of tightness or dull ache.

If thoracic mobility is limited, rotating to the side while seated or arching the spine backwards can feel difficult. This may be apparent when looking over a shoulder or reaching the arms above or behind the head. When climbing and reaching far for the next hold a restriction in the shoulder may be felt.

A feeling of tightness or pain in the upper back will often accompany reduced mobility of the thoracic spine which can worsen after climbing sessions. This tight feeling may even refer up further into the neck. Pain due to mobility restriction tends to be a dull ache that can be felt between or behind the shoulder blades.

Assessment

Occiput-wall distance and overhead mobility

Identifying posture can give an indication of whether there is rounding of the shoulders, thoracic kyphosis (hunching) or lumbar lordosis (arching); characteristics of “climber’s back.” A quick measure of thoracic kyphosis is the occiput-wall distance test.

Start standing with a straight posture against a wall with heels, buttocks, and shoulders touching. Looking forward, attempt to have the back of the head touch the wall. If the back of the head does not touch the wall, the distance between can be measured.4,5

Scoring:

  • Touching wall – 2cm = normal
  • >2cm = abnormal

From the same position, it’s possible to then screen overhead mobility. With the head still touching the wall, raise arms above the head, aiming to reach backs of hands to the wall. Reaching the wall is an indication of good thoracic extension and shoulder mobility. The lower back or head should not come off the wall in this exercise.

Scoring:

  • Pass if can reach the wall with backs of hands with arms straight
  • Fail if unable to reach the wall
  • Fail if lower back or head comes off wall when reaching (compensating)

Thoracic rotation test6

This assessment tests thoracic rotation, and for climbers is relevant when side reaching and twisting. Seated on a chair or bench, place a ball and squeeze between the legs and place a piece of dowel (broomstick) across the chest with arms crossed. These aids are used to help prevent movement compensating from other body parts when measuring. Using a smartphone app with protractor/compass placed on the upper spine (T1-T2), begin looking forward – this is the starting point. Rotate to one side, making a note of the degrees of movement. Rotate to the other side and compare.

Scoring:

  • <50degrees = poor
  • 50-60 degrees = good
  • >60 degrees = excellent
  • Take note if one side is more restricted than the other

 

Improving thoracic mobility and strength for climbing

Movement is medicine when it comes to the body, and the thoracic spine is no different. The aim with these exercises is to improve thoracic extension, rotation, and overall posture. Thoracic extension should be improved before working through rotation. Later, strength components can be considered to build upon the range gained. Lastly, climbing movements can be incorporated to bring it all together.

Chest/pec stretch in doorway

Aim: Stretch the chest/pectorals and improve thoracic spine extension
Equipment: Doorway
Set up: Split stance in a doorway, raise the arms to approximately 130 degrees and press through into the doorway until a slight stretch is felt in the chest. Hold for 3 x 30 seconds.

Pec doorway strecth

(Photo: David Cook)

Cat-cow pose

Aim: Full spine movement into flexion and extension
Equipment: None
Set up: Start in a quadrupled position, bend the back downwards while the neck extends upwards, hold for a few seconds, then move into an arched back and neck downwards, again holding for a few

Cat-cow stretch pose
(Photo: David Cook)

Foam roller thoracic extension

Aim: Improve thoracic extension
Equipment: Foam roller
Set up: Start lying on the floor, place a foam roller under the upper back. Putting arms behind the head, arch the back over the foam roller as far as comfortable. Try to keep a neutral lower back position throughout the movement. Repeat this 5 times, then move the foam roller up or down the upper back to a different level.

Foam roller back extension
(Photo: David Cook)

Kneeling thoracic extension

Aim: Improve thoracic extension
Equipment: Bench/chair
Set up: Start kneeling with elbows positioned on a chair or bench in front. Lean down into the chair/bench until a stretch is felt, hold this, then return to the starting position. A variation is to use arms instead of elbows on the chair/bench. Repeat 10 times.

Thread the needle

Aim: Improve thoracic rotation
Equipment: None
Set up: Start in a quadrupled position. With a straight arm, reach up behind and rotate towards the sky as far as possible. With the same arm, bring it back and reach down, through and across the body under the body towards opposite side. Do the same with the other arm and then repeat 5 times.

Half-kneel thoracic spine rotation

Aim: Improve thoracic rotation
Equipment: Wall
Set up: Start in a half-kneel position against a wall. Start with both arms straight in front of the body. Hold whichever arm is next to the wall parallel with it. With the opposite arm straight out in front, rotate it away from the wall around the body as far as possible. Come back to the start position and repeat 5 times. Do the same on the other side.

Strength exercises

Swiss ball Ys

Aim: Increase shoulder and upper back strength
Equipment: Swiss ball
Set up: Kneeling with stomach resting on a swiss ball, maintain a straight spine and extend the arms overhead as far as possible. Repeat 10 times. If too difficult, change the angle to be more upright, or if too easy, try holding dumbbell weights.

(Photo: David Cook)

(Photo: David Cook)

Superhero isometric holds

Aim: Improve trunk strength in extension
Equipment: None
Set up: Face down on floor, extend hands above head and lift head, chest, knees and legs off the ground and hold. Aim to hold for 60 seconds and repeat 3-5 times.

Superhero isometric holds
(Photo: David Cook)

Banded seated rows

Aim: Increase mid back strength and scapular control
Equipment: Band and post
Set up: Sitting upright with legs out in front facing a post with a band wrapped around, retract the band while maintaining control and a straight back. Repeat 10 times.

(Photo: David Cook)
(Photo: David Cook)

Climbing movement exercises

Crossovers on the wall

Aim: Improve thoracic rotation and control while climbing
Equipment: Climbing, bouldering or system wall
Set up: Ideal to be used during a warmup, choose a section of wall with relatively large holds. Purposefully cross over between the holds, concentrating of the rotation element of the movement. To increase the difficulty, increase the distance between holds or use opposite facing side-pulling holds. Repeat until feeling warmed up.

La Rose

Aim: Improve thoracic rotation and control while climbing
Equipment: Climbing, bouldering or system wall
Set up: Choose a section of wall with good foot holds, take a handhold with either hand, then cross all the way through underneath one side as far as you can reach then match the hold or pull through further. Repeat with the opposite side, then attempt to increase the distance reached.

Seek professional advice

The shoulder and spine are complex regions of the body, so it is important to seek professional advice if experiencing an injury. Physiotherapists/physical therapists can diagnose and treat climbing injuries, and it is recommended to see those who are familiar with climbing or are those who are climbers themselves for the best possible outcomes.


David Cook climbs in Australia.

About the Author

David Cook is a fourth year Physiotherapy Student at the University of Canberra.

David has been climbing for nine years and is currently living in Canberra (Ngunnawal country), Australia. He’s passionate about climbing, the outdoors and improving through movement and strength.

Find him on Instagram to see his latest adventures: @davidcook_

Or follow me on thecrag.com here.


About the Contributors

Profile of climber-physiotherapist Jared Vagy.

Dr. Jared Vagy “The Climbing Doctor,” is a doctor of physical therapy and an experienced climber, has devoted his career and studies to climbing-related injury prevention, orthopedics, and movement science. He authored the Amazon best-selling book Climb Injury-Free, and is a frequent contributor to Climbing Magazine. He is also a professor at the University of Southern California, an internationally recognized lecturer, and a board-certified orthopedic clinical specialist.

To learn more about Dr. Vagy you can visit theclimbingdoctor.com or visit him on Instagram @theclimbingdoctor

 

Profile of Jennifer Demyanek racking up cams for a rock climb.

Jennifer Demyanek is a physical therapist, college professor, and rock climber in Las Vegas, Nevada. She is a graduate of the University of Maryland School of Medicine with a Doctorate degree in Physical Therapy. Jennifer is the owner of Onsight Movement, a private physical therapy practice located in Las Vegas, specializing in treating rock climbing injuries and improving climbing performance. She also currently serves as Adjunct Faculty at the College of Southern Nevada teaching Anatomy & Physiology.

Jennifer is an officer of the virtual Rock Climbing Special Interest Group as well as a member of the American Physical Therapy Association’s Orthopedic Section. She also holds a certification in Dry Needling from the American Academy of Manipulative Therapy. When not practicing physical therapy, Jennifer can be found outside rock climbing around the southwest or spending time with her husband, Dylan. You can contact Jennifer via email at jennifer@onsightmovement.com or by visiting www.onsightmovement.com.

Portrait of climber Kevin Cowell.

Kevin Cowell is a physical therapist, clinical instructor, and rock climber based out of Broomfield, CO. Kevin owns and operates The Climb Clinic (located at G1 Climbing + Fitness) where he specializes in rehab and strength training for climbers and mountain athletes. He found his passion for climbing in Colorado while attending Regis University for his Doctorate of Physical Therapy and has since become a Certified Strength & Conditioning Coach (CSCS), Board-Certified Orthopaedic Clinical Specialist (OCS), and a Fellow of the American Academy of Orthopaedic Manual Physical Therapy (FAAOMPT).

You can contact Kevin via email at kevin@theclimbclinic.com or by visiting www.theclimbclinic.com. Also, be sure to follow Kevin at @theclimbclinic on Instagram for free rehab and strength training resources.


References

  1. Kiełt, M., Król, A., Szczygieł, A., & Bilski, J. (2014). The characteristic body posture of people practicing rock climbing. Medicina Sportiva, 18, 72-77. https://doi.org/10.5604/17342260.1110314
  2. Förster, R., Penka, G., Bösl, T., & Schöffl, V. R. (2009). Climber’s back–form and mobility of the thoracolumbar spine leading to postural adaptations in male high ability rock climbers. International journal of sports medicine30(1), 53–59. https://doi.org/10.1055/s-2008-1038762
  3. Griegel-Morris, P., Larson, K., Mueller-Klaus, K., & Oatis, C. A. (1992). Incidence of Common Postural Abnormalities in the Cervical, Shoulder, and Thoracic Regions and Their Association with Pain in Two Age Groups of Healthy Subjects. Physical Therapy, 72(6), 425-431. https://doi.org/10.1093/ptj/72.6.425
  4. Centers for Disease Control and Prevention. (2011). National Health and Nutrition Examination Survey 2009-2010. Retrieved from https://wwwn.cdc.gov/Nchs/Nhanes/2009-2010/ARX_F.htm#Protocol_and_Procedure
  5. Johnson, K. D., & Grindstaff, T. L. (2010). Thoracic rotation measurement techniques: clinical commentary. North American journal of sports physical therapy : NAJSPT, 5(4), 252-256.
  6. Wiyanad, A., Chokphukiao, P., Suwannarat, P., Thaweewannakij, T., Wattanapan, P., Gaogasigam, C., . . . Amatachaya, S. (2018). Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis? Musculoskeletal Science and Practice, 38, 63-68. https://doi.org/https://doi.org/10.1016/j.msksp.2018.09.010