Portal de Periódicos da CAPES

The “Newbie” Syndrome

2017; Elsevier BV; Volume: 28; Issue: 4 Linguagem: Inglês

10.1016/j.wem.2017.07.008

1545-1534

Volker Schöffl, Christoph Lutter,

Traumatic Ocular and Foreign Body Injuries

"Unfitness may lead to injury." Might this be a new mandatory sign for "new age" bouldering gyms? Or, to put it into a more scientific context, are the data on indoor bouldering injuries still up to date, or do we need to reevaluate the injury rate and severity and add the "newbie" syndrome? Many studies have been conducted during the last decade on climbing injuries—their grading, incidence, and variation in between certain disciplines.1Schöffl V. Morrison A. Schöffl I. Küpper T. Epidemiology of injury in mountainering, rock and iceclimbing.in: Caine D. Heggie T. Medicine and Sport Science–Epidemiology of Injury in Adventure and Extreme Sports.58. S. Karger AG, Basel, Switzerland2012: 17-43Google Scholar, 2Schöffl V. Morrison A.B. Schwarz U. Schöffl I. Küpper T. Evaluation of injury and fatality risk in rock and ice climbing.Sport Med. 2010; 40: 657-679Crossref PubMed Scopus (90) Google Scholar, 3Woollings K.Y. McKay C.D. Emery C.A. Risk factors for injury in sport climbing and bouldering: a systematic review of the literature.Br J Sports Med. 2015; 49: 1094-1099Crossref PubMed Scopus (50) Google Scholar, 4Backe S. Ericson L. Janson S. Timpka T. Rock climbing injury rates and associated risk factors in a general climbing population.Scand J Med Sci Sports. 2009; 19: 850-856Crossref PubMed Scopus (73) Google Scholar, 5Nelson N.G. McKenzie L.B. Rock climbing injuries treated in emergency departments in the US, 1990-2007.Am J Prev Med. 2009; 37: 195-200Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Most of the newer studies were consistent with the fact that overall climbing injury incidence was minor, with most injuries being of minor grade, but fatalities still happen in all disciplines.1Schöffl V. Morrison A. Schöffl I. Küpper T. Epidemiology of injury in mountainering, rock and iceclimbing.in: Caine D. Heggie T. Medicine and Sport Science–Epidemiology of Injury in Adventure and Extreme Sports.58. S. Karger AG, Basel, Switzerland2012: 17-43Google Scholar, 2Schöffl V. Morrison A.B. Schwarz U. Schöffl I. Küpper T. Evaluation of injury and fatality risk in rock and ice climbing.Sport Med. 2010; 40: 657-679Crossref PubMed Scopus (90) Google Scholar, 3Woollings K.Y. McKay C.D. Emery C.A. Risk factors for injury in sport climbing and bouldering: a systematic review of the literature.Br J Sports Med. 2015; 49: 1094-1099Crossref PubMed Scopus (50) Google Scholar, 6Jones G. Asghar A. Llewellyn D.J. The epidemiology of rock climbing injuries.Br J Sports Med. 2008; 42: 773-778Crossref PubMed Scopus (97) Google Scholar Of the different climbing disciplines, indoor climbing (lead and bouldering) had the lowest incidence of injury (0.02–0.08 injuries per 1000 hours of sports performance) with most being of minor severity.1Schöffl V. Morrison A. Schöffl I. Küpper T. Epidemiology of injury in mountainering, rock and iceclimbing.in: Caine D. Heggie T. Medicine and Sport Science–Epidemiology of Injury in Adventure and Extreme Sports.58. S. Karger AG, Basel, Switzerland2012: 17-43Google Scholar, 2Schöffl V. Morrison A.B. Schwarz U. Schöffl I. Küpper T. Evaluation of injury and fatality risk in rock and ice climbing.Sport Med. 2010; 40: 657-679Crossref PubMed Scopus (90) Google Scholar, 7Schöffl V.R. Hoffmann G. Kupper T. Acute injury risk and severity in indoor climbing-a prospective analysis of 515,337 indoor climbing wall visits in 5 years.Wilderness Environ Med. 2013; 24: 187-194Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 8Schöffl V. Burtscher E. Coscia F. Injuries and medical incidences during the IFSC 2012 Climbing World Cup Series.Med Sport. 2013; 17: 168-170Google Scholar In a prospective analysis of more than half a million entries to a large indoor climbing and bouldering gym, we found an injury rate of 0.02 per 1000 hours with 15 being International Climbing and Mountaineering Federation (UIAA) injury severity grade 2, 13 UIAA 3, and 2 UIAA 4.7Schöffl V.R. Hoffmann G. Kupper T. Acute injury risk and severity in indoor climbing-a prospective analysis of 515,337 indoor climbing wall visits in 5 years.Wilderness Environ Med. 2013; 24: 187-194Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar Acute injuries happened in 6 cases while bouldering, in 16 cases while lead climbing, in 7 cases while top roping, and in 1 case as a third person (not climbing or belaying) while watching another climber.7Schöffl V.R. Hoffmann G. Kupper T. Acute injury risk and severity in indoor climbing-a prospective analysis of 515,337 indoor climbing wall visits in 5 years.Wilderness Environ Med. 2013; 24: 187-194Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar No injuries of a higher UIAA grade were reported, and no fatalities occurred in this study. Furthermore, in analyzing our patients with climbing injuries between 2009 and 2012, we found out of 911 injuries, only 13 were grade 3 injuries, and there were no higher grade injuries.9Schöffl V. Popp D. Küpper T. Schöffl I. Injury distribution in rock climbers–A prospective evaluation of 911 injuries between 2009-2012.Wilderness Environ Med. 2015; 26: 62-67Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar These findings of mostly minor grade injuries in indoor climbing are consistent with the literature.1Schöffl V. Morrison A. Schöffl I. Küpper T. Epidemiology of injury in mountainering, rock and iceclimbing.in: Caine D. Heggie T. Medicine and Sport Science–Epidemiology of Injury in Adventure and Extreme Sports.58. S. Karger AG, Basel, Switzerland2012: 17-43Google Scholar, 2Schöffl V. Morrison A.B. Schwarz U. Schöffl I. Küpper T. Evaluation of injury and fatality risk in rock and ice climbing.Sport Med. 2010; 40: 657-679Crossref PubMed Scopus (90) Google Scholar, 5Nelson N.G. McKenzie L.B. Rock climbing injuries treated in emergency departments in the US, 1990-2007.Am J Prev Med. 2009; 37: 195-200Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar, 7Schöffl V.R. Hoffmann G. Kupper T. Acute injury risk and severity in indoor climbing-a prospective analysis of 515,337 indoor climbing wall visits in 5 years.Wilderness Environ Med. 2013; 24: 187-194Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 8Schöffl V. Burtscher E. Coscia F. Injuries and medical incidences during the IFSC 2012 Climbing World Cup Series.Med Sport. 2013; 17: 168-170Google Scholar, 10Josephsen G. Shinneman S. Tamayo-Sarver J. et al.Injuries in bouldering: a prospective study.Wilderness Environ Med. 2007; 18: 271-280Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar In contradiction, over the last 5 years we have seen a clear shift toward more serious injuries caused by indoor bouldering. This is interesting because Josephsen et al10Josephsen G. Shinneman S. Tamayo-Sarver J. et al.Injuries in bouldering: a prospective study.Wilderness Environ Med. 2007; 18: 271-280Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar reported no major differences between indoor and outdoor bouldering. To further analyze this shift, one needs to investigate the change in modern bouldering and the current development of indoor boulder gyms. With the advent of boulder competitions, the route setting recently changed to include more spectacular movements and acrobatics. The new boulder problems are a combination of classical climbing and bouldering with "Parkour" and acrobatics. This, of course, demands different skills compared with competition climbers in the 1990s. Most climbing moves are dynamic and 3-dimensional, and heelhooks are frequently essential.11Schöffl V. Lutter C. Popp D. The "heel hook"—a climbing-specific technique to injure the leg.Wilderness Environ Med. 2016; 27: 294-301Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar These heelhooks have already reportedly led to an increase in knee and hip injuries in climbers.11Schöffl V. Lutter C. Popp D. The "heel hook"—a climbing-specific technique to injure the leg.Wilderness Environ Med. 2016; 27: 294-301Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The increase in dynamic and spectacular moves, many of them at a greater height, are subsequently increasing the rate and severity of injury because falls are more unpredictable and more difficult to control. As competition boulder style and sport-specific requirements have changed, there has been a parallel development: a major change in the landscape of bouldering gyms. Until about 5 years ago, most indoor gyms were classical rope climbing gyms or traditional bouldering gyms. As these traditional bouldering walls are already referred to as "old style," we will reluctantly use this term. "Old style" bouldering gyms have a large number of holds in a grid style on wooden panels. Although this high number of holds allows great variety for training in limited space, it also demands that climbers find and define routes for training by themselves. Even if this is still considered a very effective way for training, it has little interest for recreational climbers and beginners. Within the last 5 to 7 years, a vast number of "new style" bouldering gyms have evolved with a completely different setup. Boulder problems are preset in various colors that reflect the grade. These grading colors vary among gyms. This style is rewarding even to the newest boulderers ("newbies") because it provides an immediate sense of accomplishment. When these "new style" gyms first evolved in Europe, they soon attracted boulderers from all over the area, but also motivated nonclimbers to give it a try. In the meantime, almost every large city in Germany has a new modern-style boulder gym. These gyms are meeting venues for competition boulderers to train, and many fun competitions are taking place. However, they also attract leisure climbers and beginners because they immediately feel successful at climbing. Thus, it is common for staff outings, manager meetings, and children's birthday parties to be held in boulder gyms. This causes a new injury mechanism, which we called the "newbie" syndrome. These beginner climbers are often completely untrained. They lack the basic trained muscular system needed to stabilize the body, especially the skeletal system. Thus, a comparably minor fall can lead to major injuries. Also, the beginner's equilibrium, body perception, and control is less developed, resulting in weaker body position control during falls and while landing. Within the first 4 months of this year, we treated 4 patients with UIAA grade 4 injuries, which represents a massive increase in severe injuries in our area, just from indoor bouldering. (Figure 1, Figure 2) All athletes were new to the sport, and none had climbed regularly for more than 1 year.Figure 2Compound fracture of L1 after a 1 m fall causing significant narrowing of the spinal canal (A, B).View Large Image Figure ViewerDownload Hi-res image Download (PPT) A 23-year-old female climber (body mass index 21.3 kg/m2) was seen in the emergency room for severe pain in her lower back without neurological failure after an indoor bouldering fall. She had started climbing as a recreational activity just 4 months earlier and overall was not an athletic person. The fall itself was also not spectacular or uncontrolled, as she fell from 1 m height straight down on her feet and onto high-quality floor matting—a fall that in a trained athlete would very likely not lead to any consequences. Clinical investigation demonstrated pain in the lumbar vertebra, and radiographs showed a fracture of the first lumbar vertebra. A computed tomography scan then revealed an incomplete burst fracture of the first lumbar vertebra, and the patient underwent an immediate surgical procedure with repositioning of the fracture site, dorsal instrumentation (internal fixation from thoracic vertebra 12 to lumbar vertebra 2), and laminectomy. Secondary, a ventral fusion was performed (Figure 1, Figure 2). This example demonstrates how a relatively minor impact (straight downward fall onto the feet from 1 m height onto high-quality matting) involving a not-well-trained body can lead to serious injury. In consequence of the aforementioned increasing number of higher grade injuries in indoor climbing, the following question arises: Do we need to retract the statement that indoor climbing is a safe sport and can be done by almost everyone? Not completely, but general fitness training should accompany the idea to start climbing. Route setters and gyms need to understand the limited physical capacity of people who may never have participated in any sports. Yes, people may be able to climb up that boulder problem, but they may not be fit enough to jump down safely afterward.