Falling is a difficult issue in so many ways for climbers. In this fairly academic article Audry Morrison outlines some of the known issues.
Rope tangling injuries – how should a climber fall?
I read with interest the various threads and recent editorials regarding accidents on a climbing forum and wished to contribute some recent medical evidence-based analysis of rope tangling injuries that led to new recommendations on how to fall. These recooendations may seem obvious to most climbers, but they are still not universally accepted. Fellow UIAA Medical Commission colleagues -Volker Schöffl and Thomas Küpper - were responsible for this work. Both are well qualified to comment on such matters as they are climbers and doctors/surgeons specialising in the treatment of climbing injuries at sea level and at altitude for almost two decades. They have also authored some 50 scientific papers on the identification, treatment and prevalence of climbing injuries.
Climbing injuries and accidents are regularly and scientifically analysed to help promote best practice and sport-specific medical treatments. Although such studies can be a pretty dry read for most climbers, and often inaccessible unless you’re at university and have free access such research, hopefully summaries of climbing studies can be disseminated to a wider readership like this.
Such research into injuries and accidents also indirectly drives the innovation for safer climbing equipment, and presumably figures into European directives on safety (ie another dry read… 89/686/EEC for PPE regarding falling from a height, including recreational climbing). For example, a karabiner I bought recently had a novel key locking system, the year of manufacture, production date, unique identification number, and other CE information actually laser etched onto the metal. The strength of slings was tested by a couple of manufacturers not long ago following an accident, and their strength was subsequently improved.
Is a full body harness safer than a sit harness?
It’s known that any major fall can cause a life-threatening throaco-lumbar hyperextension trauma or have the climber in a ‘head down position’ while suspended from their rope (ie hanging upside down, back arched, attached only by rope knotted into harness) – an accident described in many standard Alpine textbooks. Hohlrieder et al. (2007) investigated this by comparing serious injuries to 113 climbers sustained while wearing a sit harness or a body harness. Hohlreider found that the type of harness used did not influence the pattern or severity of injury/s sustained from a major fall, and that the forces transferred from the harness did not result in a specific harness-induced pathology.
Hohlreider’s landmark study served to disprove the often quoted and postulated injury theory of Magdefrau (1991) whereby the sit harness, rather than a body harness, was thought to contribute more to injuries sustained during a fall. To put these studies in some historical context, in Europe around the 1980’s, the ‘older’ traditional alpinists using body harnesses were very suspicious of the first sit harnesses that came onto the market that were worn by a younger generation of climbers pursuing the new sport of sport climbing.
This, at least in Europe, aroused much discussion (often heated!) within the climbing community, comparable to discussions for and against bolts. These discussions often reflected generational differences between the climbers and their views about the type of climbs they pursued, and were seldom based on technical or scientific proof. Today, body harnesses are rarely worn when sport climbing, except by young children.
What is known about falling from a rope
So now let’s examine the scant data on falling while on a rope. Magdefrau and other European researchers like Deweze (1987) and Jakubietz et al. (2006) proposed a common recommendation that during a long fall, a climber should quickly grab the rope as close as possible to the knot on their harness on the premise and that this would probably help to maintain an upright position that avoided the climber being flipped over, head down and in a lumbar hyperextension. The official teaching guide for sport climbing instruction from the German Alpine Club (DAV) suggests flexing the legs up and forward and, if necessary, grabbing the rope.
Let’s consider these recommendations once more from a historial and current perspective. A leader fall from the last point of protection can be potentially result in an injury regardless of the fall factor. The ‘old school’ mentality of free or trad climbers had a simple solution to this risk, and can be summarised by the motto - ‘Don’t Fall...ever’. These climbers tended to climb within their abilities, as reliable protection (if any, and sometimes homemade) was not yet available. For better or worse, technological advances in climbing equipment and safety helped push sport climbing to bolder and more technically difficult climbs. This ‘younger school’ of climbing on a rope, best exemplified by sport climbing, promoted the mentality that ‘If you’re not falling, you are not progressing… or maybe not even trying hard enough’.
It is now not uncommon for a sport climber to fall off a route many times during a single climbing session when they are trying to push their grades or abilities, or sometimes just out of habit. Falling is a normal consequence of sport climbing – you can’t make every hold on these bolted routes. So while there is probably a happy medium to be struck between both schools of thought regarding falling while on a rope, it is not unreasonable to assume a dedicated sport climber may fall fives times during each climbing session. If we tally this fall number by their regular visits to the climbing gym and crag, it would not be unusual for such a dedicated climber to experience almost 500-1000 rope falls per year.
So how should one fall? To answer this question, studies on rope tangling injuries should also be considered. Volker Schöffl and Thomas Küpper have treated the injuries and operated on hundreds of climbers over the years, and have written extensively about them.
Injuries associated with rope climbing
Rope tangling injuries are a well-known pathology in climbing accidents. They encompass a wide spectrum of injuries from rope burns to a life-threatening throaco-lumbar hyperextension trauma when the climber flipped over and head down. Causation for these injuries can be summarised into four separate groups based on reported climbing injury studies:
1. Minor fall just above the point of protection: While falling, the climber may instinctively grab the ascending rope. This grabbing is often a reflex borne out by fear, panic or not trusting your belayer. This grabbing action is completely unnecessary as ‘catching a fall’ is the responsibility of the trained belayer. However, by instinctively grabbing the rope close to the protection point, the following injuries have been reported: 1) the climber may catch the fall by himself and suffer severe skin and soft tissue injuries to the palm/s of his hand or elsewhere; 2) he might get tangled with the belay point and even impale a karabiner stuck in his palm (it happens!); 3) he may unwillingly unclip the belay device or the karabiner at the last point of protection, and this may potentially lead onto more serious injuries or; 4) he may simply tangle the rope around his hand or fingers causing contusions/bruising.
2. Long fall with lots of slack in rope: If the climber follows the recommendation to immediately grab the rope above the knot on his harness to stabilise his fall in an upright position, this longer rope may tangle or loop around the climber’s hand or fingers before he is able to grab this rope with both hands; and at the moment of impact when this rope tightens, it may cause avulsion amputations or severe contusions/bruising ie finger cut off by tightening of looped rope around it.
3. Fall from steep or overhanging route: The climber will be left dangling from the rope beneath the last point of protection. The standard technique in sport climbing to get back onto the wall and up is to perform one or two pull-ups on the rope and then let go. With each pull-up, the belayer takes in the excess rope or runs backward to re-establish rope tension. The climber can then eventually make his way up the rope to the last protection point.
Schöffl reported a case study of a high ability veteran climber who unintentionally managed to entangled and wrap his hand with the rope while performing this standard technique. It’s likely he pulled to bounce to get some slack so he could work his way up the rope, but in pulling so hard a lot of slack was became freed and wrapped around his fingers and hands. This resulted in severe bruising, soft tissue damage and metacarpal fractures.
4. Foot caught by rope during fall: Being flipped over or falling completely ‘head down’ can result from having your foot caught under the rope of the clipped rope section of the route during a fall. As the foot is temporarily caught here, the weight of the body can fall past and below this trapped foot making it impossible to brace onself in a flexed upright position with bent knees and hip. Alternatively, by falling with the ascending rope positioned behind your leg, it is also possible to be flipped over. If the climber is not wearing a helmet during these accidents, the outcome can be very serious from head injuries in addition to a life-threatening throaco-lumbar hyperextension trauma.
While it could be argued that the urge to grab for the ascending rope in a short fall is mostly, though not exclusively, reserved for beginners as outlined in 1), all the severe injuries described in 2) and 3) occurred in very experienced rock climbers. Injuries from 4) have been known to occur in both experienced and inexperienced climbers. You can even spot these injuries happening in DVDs of professional climbers.
Is there a better way of falling to avoid such injuries and maintain an upright position? Yes.
Schoffl and Kupper (2008) propose the following recommendations for a rope fall
The historical advice to immediately grab the rope by the knotted section of the harness was based on very little data. Such advice can result in rope tangling injuries, an established climbing pathology. Instead, the hands should be kept away from rope during the fall, and extended forward to help stabilise the body in an upright position. The hips and knees should also be flexed. (see pictures).
• Then, at the end of the fall when no slack remains in the rope and the body is pulled or swinging towards the wall, the climber should use his feet first, and hands if necessary, to minimise the impact. If there is anything to be protected as a reflex action, it should be the hands/arms protecting the head and chest to reduce any trauma to these areas, especially when no helmet is worn.
• It is only at this final stage of the fall that the ascending rope should be grabbed if required to maintain an upright position, just above the knot in the harness.
• Never climb with your foot under any clipped in section the rope while climbing, and always be vigilant to understand where the rope is while climbing to avoid the body being flipped over this way in the event of a fall.
• Ensure you have competent belayer who knows and understands what to do to help minimise any potential impact during a fall!
Many climbers may follow these recommendations already, but they are not the standard text yet in many climbing instruction books. With the historic technique of “hands to the rope” in the event of a fall, tangling is likely, and may even result in more serious injuries or fatalities. It’s time to update these evidence-based falling recommendations.
Bibliography
1. Hochholzer T, Schöffl V. One move to many ed.; Lochner Verlag: Ebenhausen, 2003;'Vol.'
2. Jakubietz R G, Jakubietz M G, Gruenert J G. Digital Amputation Caused by Climbing-Rope Entanglement. Wilderness Environ Med 2006;17:178-9.
3. DAV Bergunfallstatistik 2004-2005; München, 2006; p^pp.
4. Schoffl V R, Schoffl I. Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness 2007;47(1):70-8.
5. Locker T, Chan D, Cross S. Factors predicting serious injury in rock-climbing and non-rock-climbing falls. J Trauma 2004;57:1321-23.
6. DAV, Sturztraining. In Lehrplan Trainer C, ed.; Alpenverein, D., 'Ed.'^'Eds.' München, 2006; 'Vol.' p^pp 11.
7. Deweze S, LeMenestrel M. Escalade Libre. ed.; Laffont: Paris, France, 1987;'Vol.'
8. Güllich W, Kubin A. Sportklettern heute. ed.; Bruckmann: München, 1986;'Vol.'
9. Hohlrieder M, Lutz M, Schubert H, Eschertzhuber S, Mair P. Pattern of injury after rock-climbing falls is not determined by harness type. Wilderness Environ Med 2007;18(1):30-5.
10. Mägdefrau H. Die Belastung des menschlichen Körpers beim Sturz ins Seil und deren Folgen. Anthrop Anz 1991;49(1/2):85-95.
11. Pesterfield H. Traditional Lead Climbing Surviving the Learning Years. Wilderness Press, Berkeley CA.2002.
12. Schoffl V, Kupper K. Rope Tangling Injuries—How Should a Climber Fall? Wilderness & Environmental Medicine 19(2):146-149. 2008. Online version
Summit article on falling
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