Injuries: Chronic Exertional Compartment Syndrome (CECS) in Rock Climbers

There are a handful of questions I am asked repeatedly as a climber specializing in wide crack climbing in particular inverts. These questions include: why do climb upside-down, how do you get upside-down, how do you get right-side up and why do you climb nothing but offwidths?

Why do I climb only offwidths?

Well, I don’t climb only offwidths. How many times have you walked up to a crag and seen 100’ much less 1000’ of pure offwidth? There are inevitably long sections of finger cracks, hand cracks and even moments of crimping between sections of wide cracks. Of course I am overjoyed when cleaning a new route and a pillar with a splitter finger crack collapses leaving a dirty squeeze chimney in its place. I’d been climbing for over ten years, avoiding wide cracks like everyone else until 4 years ago when I made the transition to the sordid world of wide cracks. And it wasn’t exactly by choice.

Chronic Exertional Compartment Syndrome (CECS)

Over a particularly obsessive winter of mixed climbing and bouldering I developed chronic exertional compartment syndrome (CECS) in my forearms. I thought I was getting pumped and needed to train more but the more I trained the more painful my forearms became. Finally, it got to a point where I needed help prying my hands off my ice-tools and I started having difficulty with fine motor skills. And the pain was excruciating. I decided it was time to see a doctor and ultimately consulted four surgeons.

CECS is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. My diagnosis was confirmed by measuring the pressure in the compartments of my forearm using a needle attached to a pressure meter which was inserted into the compartments. My compartment pressures exceeded 35 mg Hg. After conservative approaches to treat the CECS failed (anti-inflammatories, physical therapy, sports massage) my surgeons agreed that because my case was so severe I had two options: quit climbing or have a fasciotomy.

The fasciotomy involves making incisions in the skin to expose the fascial covering over the muscle compartments. The fascia is released, and the skin is closed outside of the muscle compartments. This procedure gives the muscles room to swell, alleviating pressure on the nerves and blood vessels. I only personally know of one climber who had the fasciotomy years ago and was not happy with the results but the surgery had been performed successfully on many athletes.

CECS Forearm Fasciotomy: Volar Incision Method

I opted to quit climbing due to the considerable risks and scarring involved in the surgery as well as questionable long-term prognosis. I was especially concerned about scar tissue causing more damage. My climbing “retirement” lasted for approximately two months when I discovered that wide crack climbing — due to it’s full body nature — is less forearm intensive for me than sport-climbing, ice-climbing and/or bouldering. And so I was able to continue climbing in this style. I am able to boulder, sport-climb and climb finger cracks to a very limited extent as well. I still have problems with the CECS and avoid training my forearms as much as possible.

Pamela Shanti Pack, not crimping on Lucille 13a, Vedauwoo, WY Photo: Jim Beissel

More information on CECS:

I will continue updating these links and including additional information in the future. I have a friend who is planning of having the procedure on both arms to prevent the forearm pump he experiences as a motocross racer.



      1. I’ve never heard for sure, of a climber that has had that procedure, but with as many as there it seems likely. Maybe in Europe?
        Lydia P in Reno has had carpal tunnel and rotator cuff surgeries. She has had others as well, and was out of climbing a few years because of them. I wonder if she, had that? I know she got back into it, and was crushing hard @ Rifle.

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