Gudmund Grønhaug

Objective: The objective of this study was to investigate whether low energy availability (LEA) symptom burden is associated with current self-reported climbing-related injury status. Methods: A cross-sectional, web-based survey was conducted to assess current self-reported climbing-related injury status, LEA symptoms, eating pathology, and psychological distress using validated and previously published instruments. Multivariable logistic regression models were applied to estimate odds ratios (ORs) for reporting a current injury, adjusting for age, sex, level of performance, training frequency, and climbing frequency. Sensitivity and interaction analyses were performed to evaluate psychosocial and climbing-context moderators. Results: A total of 417 climbers participated (mean age 33.1 ± 9.9 years; 56.2% female). Higher-ability climbers showed greater odds of reporting a current climbing-related injury than lower-ability climbers (OR 2.10, 95% CI 1.33–3.30). LEA symptom burden was independently associated with current self-reported injury status (OR 1.38, 95% CI 1.08–1.76). The association remained significant after adjusting for anxiety and climbing discipline but was attenuated after adjusting for eating pathology and depressive symptoms. Eating pathology, depression, and anxiety were not independently associated with injury. Exploratory interaction analyses suggested that the association between LEA symptom burden and current self-reported injury status may be stronger among climbers scoring higher on eating pathology and higher climbing ability; however, these interactions were not statistically significant and should therefore be interpreted cautiously. Gastrointestinal symptoms were the LEA domain most consistently associated with self-reported current injury status. Conclusion: Greater LEA symptom burden was independently associated with current self-reported climbing-related injury status after adjusting for demographic characteristics and climbing exposure. Gastrointestinal symptoms demonstrated the most consistent association with current self-reported injury status. Higher climbing ability and LEA symptom burden were also associated with greater odds of reporting a current injury. However, there is a need for prospective longitudinal studies to clarify the temporal and potentially causal relationships among energy availability, psychological health, training load, and injury outcomes.

EditorialInjuries, injury prevention and training in climbingVolume 2Climbing as a sport has matured. Today, we see a rise in evidence based on systematic training, elevated level of performance, and science is closing scientific gaps regarding injury prevention and treatment. Appearance in two Olympics has shaped the future athlete’s perspective of what is achievable in climbing. Still, for the vast majority, climbing is a recreational unorganized activity making it impossible to quantify the total number of people attending climbing on a regular basis. For the research on climbing the maturity is shown in the introduction of the research papers; it is no longer a need to explain what climbing is, how it is organised and how it has grown in the past decade. The different disciplines of climbing demands different morphology, different training regimes, and risk factors of different potential injuries. As climbing as a sport becomes more specialised, the research must follow along. It is about time to present the research on climbing with clear distinction on what discipline the respondents or subjects are attending and training for. Furthermore, the results of the research needs to be presented with analyses based on gender and levels of performance. This way of presenting results and discussion will make the research easier to apply to the relevant groups. Randomized controlled trials is rarely included study design in the climbing literature, until now. It is therefore great to see Saeterbakken et al presenting one of few randomized controlled trials examining climbing training in this research topic. We hope to see more of these in the future.The quality of the research on climbing have been improving during the last decade with new areas, new perspective, and with new methodology. The research is also increasingly globalised. In this research topic we are presenting eight papers from a total of 32 researchers representing most of the continents. This research topic covers a thematic span from how to optimize training, what to focus on while training, how to treat injuries, and potential barriers to seeking treatment as well as an insight on optimal body composition for bouldering.A topic that has been following in the footsteps of climbing since early morning is what it takes to become a top-level climber. A never-ending debate in the world of climbing is the importance of height. Is it favourable to be tall or not? These questions and more are answered in a study of the morphology of the World Cup elite boulderers and comparing them with national level climbers and a group of students (Draga et al). Some might find the results surprising while others will have their view confirmed.Another topic that seems to make headlines is the relative high level of eating disorders and potential Low Energy Availability (LEA) or Relative Energy Deficit (RED-S) among climbers. An interesting study is examining the possible interactions between social media use and food tracking behaviours (Slagel, Kage and Wichern). The authors recommended campaigns in social media to help climbers keep a healthy body image to avoid potential health issues and injuries. Importantly, the study included recreational climbers meaning these findings is not only related to high performance athletes but everyday men/women you meet in the climbing gym or at the crag. By presenting new research in a research topic, we can see several papers together. In this topic we can see the broader picture when combining the new research on what is the most important feature for predicting performance (Draga), how to perform the training (Saeterbakken et al), and how to optimize recovery (Kruoková, Tufano, Balás). All these three papers are advances in their own respect, but gives a deeper insight read together as a total. Injuries in climbing are sadly rather common and well documented in previous research. These injuries are well documented in previous research. However, the novelty of the growing body of evidence is how to treat the injuries. In this topis we can present treatment algorithms for two common finger injuries in climbing. Schöffl et al examined a One treatment algorithm for capsulitis (Schöffl et al) and synovial chondromatosis (Becker et al ).Sadly, climbers do not seek or use professional health care as often as they should. The lack of trust in health care seems to be a phenomenon that repeats itself across the globe. In this research topic one of the studies are examining the barriers for health seeking behaviour in Manilla (Cruz, Cabrera). This paper is also one of few that are studying only those who focus on indoor climbing.To summon up, we are proud to present the second edition of the research topic Injuries, injury prevention and training in climbing. This research topic aimed to gain new insight in topics relevant for injury, injury prevention and training methodology in the different disciplines of climbing. On behalf of the editorial team and with the help from the researchers who chose to publish their research in this topic I am proud to say that we achieved our goal.We are aiming to open up for a third volume of this topic in early 2026. In the next volume we hope to see new research to gain more insight on climbing injuries, injury prevention and training. The research has the potential to help the sport of climbing to reach new heights and fulfil its potential, without injuries!Gudmund Grønhaug Pt, Msc, PhDGuest editor

Introduction Climbing has evolved from an obscure outdoor sport to a predominantly indoor sport with the rise of mainstream climbing on artificial walls. Reported climbing-related injuries were predominantly chronic and may be avoided with proper planning of training. All climbers, regardless of age and gender, are training on the same routes and perform similar movements; however, few studies have investigated gender-specific injuries in climbing. Objectives Assess the distribution of chronic climbing injuries in an international population with gender-specific analyses and assess the impact of the person’s training focus or aim of training on those injuries. Methods A cross-sectional survey using a web-based item-driven questionnaire was created and promoted using social media and several climbing media stakeholders. All climbers engaged in either sport climbing, bouldering or traditional climbing were included. Results The survey received 1513 responses (877 men, 427 women and 9 not reporting gender), of which 50.3% (n=665; 51.4% men and 48.0% women) had experienced an injury in the past 12 months. There were significant differences in injuries in feet/ankle (p=0.014), neck (p=0.03), head (p=0.0001), shoulder (p=0.001), elbow (p=0.021) and fingers (p=0.003). Conclusion Over 50% of the climbers experienced an injury in the past 12 months. The most common injuries were to the shoulders (women) and fingers (men). There were significant differences between the genders regarding injury site and prevalence. The gender differences may be affected by the aim for training and the style of climbing.

Objectives: Competitive sport climbing has made its way to the Olympic stage. This prestige has brought about route setting and training alterations which presumably affect injury epidemiology. Most of the climbing injury literature contains male climbers and lacks high performing athletes. Studies with both female and male climbers, rarely included separate analyses for performance level or sex. Therefore, injury concerns for elite female competitive climbers are impossible to discern. A former study examined the prevalence of amenorrhea in elite international female climbers (n = 114) and reported that 53.5% had at least one injury in the past 12 months, but injury details were excluded. This study's aim was to report these injury details and their associations with BMI, menstrual status and eating disorders of the cohort.Methods: Online survey was emailed to competitive female climbers recruited through the IFSC database between June and August 2021. Data was analyzed using Mann–Whitney U, χ² and logistic regression.Results: 229 registered IFSC climbers opened the questionnaire and 114 (49.7%) provided valid responses. Respondents (mean ± SD; age = 22.9 ± 5 year) represented 30 different countries and more than half (53.5%, n = 61) reported an injury in the prior 12 months with the majority in shoulders (37.7%, n = 23) and fingers (34.4%, n = 21). Injury prevalence in climbers with amenorrhea was 55.6% (n = 10). BMI was not a significant predictor of injury risk (OR = 1.082, 95% CI: 0.89, 1.3; p = 0.440) while accounting for current ED over the past 12 months. However, the odds ratio for having an injury was doubled for those with an ED (OR = 2.129, 95% CI: 0.905, 5.010; p = 0.08).Conclusion: With over half reporting recent injuries (<12 months) mostly to shoulders and fingers, development of new strategies for injury prevention in competitive female climbers are warranted. In addition, climbers with disordered eating behaviors and/or menstrual disturbances might be more prone to injury. More research in this population is required. Suitable screening to prevent these health issues and proper monitoring of these athletes are paramount to long-term athlete success.

Objectives To assess the use of healthcare, and reasons not to seek healthcare, by climbers with a chronic injury. Method Retrospective survey. Setting Web-based questionnaire. Participants 667 active climbers (385 with chronic injuries). Outcome measure Use of healthcare (including reasons not to seek healthcare if the patient was not attended by health professionals), performance level in sport climbing, onset of a climbing-related injury, site of injury, preferred style of climbing and gender differences. Result Of the 667 respondents, 385 had experienced a chronic injury in the past 6 months. Climbers with a chronic injury are reluctant to seek healthcare, and male climbers are less likely to seek healthcare than female climbers. The two most frequent reasons not to seek healthcare were: (1) an assumption that the injury was not serious enough (70%) and (2) a belief that a health professional could not help (60%). Only one in five of the climbers with a finger injury sought healthcare. The more experienced climbers were less likely to seek healthcare than recreational climbers. Conclusion Use of healthcare among climbers with a chronic injury is limited and injured climbers self-assess the injury before seeking medical aid. Experience is a strong predictor for not seeking healthcare after an injury. These findings open up the possibility that some of those who do not seek healthcare after self-assessing the injury are underestimating the seriousness of the injury due to lack of confidence in the health professionals’ abilities to help treating chronic climbing related injuries.

Objective: To assess the perceived quality of care received by people with osteoarthritis (OA) in Norway and explore factors associated with the quality of care. Methods: A national survey in which members of the Norwegian Rheumatism Association with OA registered as their main diagnosis completed a questionnaire. The perceived quality of care was reported on a 17-item OsteoArthritis Quality Indicator questionnaire, covering both pharmacological and non-pharmacological aspects of OA care. In addition, the four-page questionnaire covered areas related to demographic characteristics, the location and impact of the OA, and utilization and satisfaction with health care services. The quality of care is calculated as pass rates, where the numerator represents the number of indicators passed and the denominator represents the number of eligible persons. Results: In total, 1,247 participants (response rate 57%) completed the questionnaire. Mean age was 68 years (standard deviation 32) and 1,142 (92%) were women. Respondents reported OA in hand only (12.4%), hip only (7.3%), knee only (10.4%), in two locations (42%) or all three locations (27%). The overall OsteoArthritis Quality Indicator pass rate was 47% (95% confidence interval [CI] 46%–48%), and it was higher for pharmacological aspects (53% [51%–54%]) than for non-pharmacological aspects of care (44% [43%–46%]). The pass rate for the individual quality indicators ranged from 8% for “referral for weight reduction” to 81% for “receiving advice about exercises”. Satisfaction with care was strongly associated with perceived quality. The pass rate for those who were “very satisfied” was 33% (25%–40%) higher than those who were “very unsatisfied” with care. Conclusion: While the OA patient seems to be rather satisfied with the perceived OA care, there is still room for improvement in the quality of care. Although the quality of care in the present study is somewhat higher than in other studies, less than 50% of the recommended care has been provided.

Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care. A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables. A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate. Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.