Hamstring Injuries in Rock Climbers

Hamstring strains are one of the more common lower body injuries we see in the climbers we treat in our office. Climbing puts a unique type of stress on the hamstring that is not encountered in most other activities. The obvious time this occurs is in heel hooks, and this is the most common mechanism of injury we see. However, other movements, including high steps and overhung climbing involving high levels of toeing in, also put a lot of stress on the hamstring.  Because of these types of recurrent stresses experienced while climbing, without appropriate treatment and management, these injuries can sometimes linger for a long time.

The author performing a heel hook

Hamstring strains occur in varying levels of severity, typically graded on a scale from 1-3. 

• Grade 1: Mild, just a few fibers of the muscle have been damaged. Typically no notable swelling or bruising.

• Grade 2: Moderate, increased amount of muscle fiber damage. Typically visible swelling and bruising, and there are likely disturbances to normal walking gait. There will be notable pain with hamstring activation.

• Grade 3: Severe, greater than half of the muscle fibers have been damaged or there has been a full rupture. There is a lot of swelling and pain, and weakness is noted with hamstring activation. 

There are 3 muscles that make up the hamstring: the biceps femoris, semitendinosis, and semimembranosis. The biceps femoris (which is the most lateral muscle) is the most commonly injured, although injury to any, or a combination, of the muscles may be possible. 

Hamstring anatomy, showing the 3 muscles that make up the hamstring

The most common symptoms are:

• Pain, typically below the sit bone, can also be behind back of the knee

• Tightness along the hamstring

• Pain with prolonged sitting

• Pain with deep squatting/high stepping

• Pain with overhung climbing

• Pain with heel hooking

• Can cause numbness/tingling into lower hamstring and calf, more common in chronic cases

Initially, it is best to avoid the positions that put strain on the hamstring, including stretching the hamstring. During the initial injury phase, keeping light movement is encouraged - walking is great, but running, especially uphill and with speed, can put more stress on the muscle. Upper body strengthening and hang boarding/finger training are appropriate to continue, but depending on the severity of the injury, a break from climbing may be indicated. 

Example hamstring loading using a foam roller

Initial rehab exercises may include gentle dynamic stretching, isometric loading of the hamstring, and strengthening around the hamstring by targeting muscle groups such as the glutes and calves.

As symptoms improve, progressing to heavier loading of the hamstring is recommended. Finding the appropriate dosage and intensity of loading can be tricky, so this is where having a physical therapist familiar with your current symptoms can be very helpful to create the best exercise program for you. 

Example of a climbing specific exercise that replicates toeing in on the wall

The biggest mistake in rehabbing hamstring strains is ending the rehab process too early. Ideally, your rehab will include a return to heavy loading and explosive / plyometric movements. This will help prepare the hamstring to handle things like hard, rock over heel hooks, as well as surprise falls. Once the hamstring tissue has been damaged, it is at an increased risk of recurrent injury, so sticking with some focused strengthening even as symptoms resolve is important. 

For those looking for injury mitigation, even if you have not previously experienced an injury to the hamstring, warming up the hamstrings before climbing can go a long way, especially if you are about to try a route with a demanding heel hook. Doing mobility and off the wall loading prior to getting on the climb can be a good place to start!

If you think you have suffered a strain of the hamstring, we definitely recommend getting it checked out by a professional! You can schedule a free, 15-minute phone consultation with us at The Climb Clinic, or book an appointment to come in for an evaluation on our website!