Background Climbing is an increasingly popular sport worldwide. However relatively little is known about the mechanisms of injury sustained by climbers.

Objective To investigate mechanisms of injury in a representative sample of British climbers.

Design Retrospective cross-sectional study.

Setting Online survey of active climbers.

Patients (or Participants) 369 active climbers (men n=307, mean±SD, age=37.66 ±14.38 years; Women n=62, mean ±SD, age=34.63 ±12.19 years).

Interventions (or Assessment of Risk Factors) Epidemiological incidence proportion (IP) and mechanism of injury.

Main Outcome Measurements Injuries that resulted in medical intervention and/or withdrawal from participation for ≥1 day.

Results Of 369 climbers surveyed, 299 sustained at least 1 injury in the last 12 months resulting from climbing. The IP was 0.810 (95% CI: 0.770–0.850). Thus the average probability of sustaining at least one injury was 81% (95% CI: 77–85). The total number of injuries sustained was 1088 providing a clinical incidence of 2.95 injuries per climber. 94 climbers sustained an acute injury as a result of impact with the climbing surface and/or ground, 212 climbers sustained an injury resulting from chronic overuse and 166 climbers sustained injuries resulting from a non-impact acute trauma. The average probabilities of sustaining injury per mechanism were: impact injury 25.5% (95% CI: 23.2–27.8); acute non-impact injury 45.1% (95% CI: 42.5–47.7) and chronic overuse injury 57.5% (95% CI: 54.9–60.1). Injury from chronic overuse was positively associated with indoor lead operating standard (P=0.007), bouldering operating standard (P< 0.001) and bouldering frequency (P< 0.001). The most common injury site was the fingers with 180 participants (60%) sustaining at least one finger injury. 85 participants sustained at least 1 chronic overuse reinjury.

Conclusions The most commonly reported injury mechanism was chronic overuse. The most common site was the fingers. Chronic overuse injuries due to repetitive loading may have been historically preceded by a non-impact acute trauma.